Interventions regarding physicians’ sickness certification practice – a systematic literature review with meta-analyses

Figures & data

Table 1. The outcomes measures regarding sickness absence (SA) and return to work (RTW) used in the nine included intervention studies regarding physicians’ sickness certification.

Time to RTW
First RTW, from the first day of SA to the first day of RTW, measured as number of workers [36]^a
Time to first RTW, in days from randomization to RTW [41]^a
Days to partial RTW, in the same job as before the onset of the SA or a job with equal earnings [32,33]^a
Number of days on SA between inclusion to the intervention and RTW to previous job without reduction of duties [37]^a
Work resumption rate as dependent/non-dependent of SA benefits [39]^a
Mean of total hours of SA before RTW [36]^a
Mean days for patients’ SA episodes [35]
Median number of SA days from first day of SA until lasting (at least four weeks) full RTW [30]
Number of workers with full RTW, from the first day of SA to the first day of full RTW [36]^a
Mean days to full RTW, from the first day of SA to the first day of full RTW [36]^a
Median of days to full RTW, from the first day of SA to the first day of full RTW [36]^a
Mean days to first RTW, from the first day of SA to the first day of full RTW [36]^a
Median of days to first RTW, from the first day of SA to the first day of full RTW [36]^a
Time in days to full lasting RTW from onset of SA to RTW at 3 months follow-up [38]
Time in days to full lasting RTW from onset of SA to RTW at 6 months follow-up [38]
Number of calendar days to full RTW, contracted working hours/week from the first day of SA to the first day of full RTW [40]^a
Days to full RTW, in the same job as before the onset of the SA or a job with equal earnings [32,33]^a
Time to full RTW, in days from randomization to RTW [41]^a
Estimates for probability of SA or RTW measures
HR for first day of full RTW [36]^a
HR for first day of RTW [36,41]^a
HR for partial RTW [32,33,40]^a
OR for part-time SA [35]^a
HR for full RTW [32,33,40,41]^a
HR for lasting full RTW [30]^a
RR for lasting full RTW [38]
HR for RTW to previous job without reduction of duties [37]^a
RR for dependent/non-dependent of SA benefits [39]^a
HR for duration of patient SA episodes [35]^a
HR for decreased prescription of active SA [35]^a
RR for gradual dependent/non-dependent of SA benefits [39]^a

SA: sickness absence; RTW: return to work; HR: hazard ratio; OR: odds ratio; RR: relative risk. ^aRegister data.

Figure 1. Flow chart showing selection of included studies.  

Table 2. Summarized relative risk estimates from meta-analyses using random effects model and 95% confidence intervals for interventions on physicians’ sickness certification practice measured as any return to work (RTW) (first-, partial- or full RTW) or as full RTW, stratified by type of intervention, type of physician, and geographical area.

	Studies (n = 9)	RR any RTW (95% CI)	p value for heterogeneity	I^2 statistic (%)	RR full RTW (95% CI)	p value for heterogeneity	I^2 statistic (%)
Type of intervention
“Simple interventions”	7	1.03 (0.90–1.18)	0.019	60.4	0.96 (0.87–1.05)	0.075	47.6
“Complex interventions”	2	1.12 (0.73–1.74)	0.073	68.8	0.86 (0.37–1.98)	0.007	86.4
Design
RCT	7	1.09 (0.99–1.19)	0.197	30.3	0.96 (0.86–1.07)	0.129	39.4
CT	2	1.74 (0.32–1.71)	0.083	66.7	0.76 (0.39–1.48)	0.004	87.9
Physicians
OPs targeted (n = 297)	6	1.07 (0.98–1.16)	0.352	10.0	0.99 (0.88–1.11)	0.151	38.2
GPs targeted (n = 159)	3	1.95 (0.64–1.42)	0.001	84.7	0.86 (0.66–1.11)	0.016	75.7
Geographical area
Netherlands	7	1.01 (0.88–1.15)	0.021	59.7	0.92 (0.78–1.10)	0.017	61.2
Rest of Europe	2	1.32 (1.06–1.65)	0.879	0.0	0.96 (0.83–1.11)	0.068	70.0

RR: relative risk; RCT: randomised controlled trial; CT: controlled trial; OP: occupational physician; GP: general practitioner.

Figure 2. (a) Any return to work. (b) Full return to work.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Data from 12 scientific publications have been used.