Is there really a “golden hour” for work disability interventions? A narrative review

Figures & data

Table 1. Characteristics of included studies.

Study	Diagnosis for sick leave	RTW-outcomes^a	Intervention content	Comparison	Employment at inclusion^b
Musculoskeletal complaints
Lindstrom et al. [2]	Low back pain	Time to RTW and number of sickness absence days during 12 months of follow-up	A graded activity program: measurements of functional capacity, a work-place visit, back school education and progressive exercise program	Usual care	Employed
Sweden
Indahl et al. [3]	Low back pain	Time to RTW	Brief intervention^c	Usual care	N/R
Norway
Loisel et al. [5]	Back pain	Time to RTW during 12 months of follow-up	Three interventions: (1) Clinical intervention: visit to a back pain specialist and back care school (2) Occupational intervention: a worksite evaluation to determine need for job modifications (3) Full intervention: combination of 1 and 2	Usual care	Employed
Canada
Haldorsen et al. [17]	Musculoskeletal pain	Percentage of RTW in the two groups during 12 months of follow-up	Multimodal treatment: structured examination, physical treatment, cognitive behavioral modification, education, examination of work situation	Usual care	Employed
Norway
Hagen et al. [11]	Low back pain	Relative risk for RTW at 3, 6 and 12 months	Brief intervention^c	Usual care	No employment criteria. Mostly employed (>90%)
Norway
Anema et al. [12]	Low back pain	Time to RTW (4 weeks without relapse) during 12 months of follow-up	Two interventions^d: 1) Work place intervention: workplace assessment and modifications. Case management involving all stakeholders. 2) A clinical intervention with graded activity (gradually increasing exercise)	Usual care according to the Dutch occupational guideline for low back pain	Employed
The Netherlands
Bültmann et al. [14]	Musculoskeletal disorders	Cumulative sickness absence hours at different intervals up to 12 months of follow-up	Coordinated and tailored work rehabilitation: work disability screening, formulation and implementation of a coordinated, tailored and action-oriented work rehabilitation plan developed by an interdisciplinary team	Conventional case management	Employed
Denmark
Lambeek et al. [18]	Low back pain	Time to RTW (4 weeks without relapse) during 12 months of follow-up	Integrated care: workplace intervention (identifying obstacles for RTW, finding solutions), graded activity program (exercise, encouraging activity despite pain) and coordination of communication and care.	Usual care	Employed
The Netherlands
Vermeulen et al. [13]	Musculoskeletal disorders	Time to RTW (28 days without relapse) during 12 months of follow-up	Participatory return-to-work program: a stepwise procedure aiming for a consensus-based RTW-plan, with the possibility of a temporary (therapeutic) workplace	Usual care for workers without employment: vocational rehabilitation guidance	Unemployed and temporary agency workers
The Netherlands
Jensen et al. [16]	Low back pain	Time to RTW (4 weeks without relapse) during 12 months of follow-up	Brief intervention^c + hospital-based multidisciplinary intervention: identifying obstacles for RTW, developing an RTW plan, contact with work place and job centre to discuss/coordinate relevant initiatives.	Brief Intervention^c	Employed
Denmark
Myhre et al. [21]Norway	Neck or back pain	Time to RTW (5 weeks without relapse) during 12 months of follow-up	Thorough clinical examination, information about findings and reassurance about physical activity being safe +	Same thorough clinical examination as the intervention group +	Employed
			Work-focused rehabilitation (multicenter): discussing obstacles for RTW, telephone contact with employer, creating an RTW plan	Existing treatments at the two included hospitals: comprehensive multidisciplinary rehabilitation (neck and back school) or brief intervention^c
Brendbekken et al. [20]	Musculoskeletal pain	Partial or full RTW at 12 and 24 months of follow-up	Multidisciplinary intervention: assessment of barriers for work participation and maintaining factors for pain, creating a rehabilitation plan	Brief intervention^c	At least 50% employment contract
Norway
Reme et al. [22]	Low back pain	Proportions with increased work participation at 12 months of follow-up	Three different interventions, all combined with brief intervention^c: (1) Tailored CBT (2) soy oil (3) seal oil	Brief intervention^c	No employment criteria. Percentage employed N/R
Norway
Gross et al. [23]	Musculoskeletal conditions	Number of days receiving wage replacement benefits and recurrence rates during 12 months of follow-up	Motivational interviewing added to standard rehabilitation (graded activity, therapeutic exercise, RTW planning and work accommodations)	Standard rehabilitation	No employment criteria. 70% employed
Canada
Moll et al. [15]	Neck or shoulder pain	Time to RTW (4 weeks without relapse) during 12 months of follow-up	Brief intervention^c plus multidisciplinary intervention: case manager coordinating communication between stakeholders, RTW plan, optional workplace involvement.	Brief intervention^c	Employed
Denmark
Mental health disorders
Van der Klink et al. [24]	Adjustment disorder	Reports among others: time to partial and full RTW, duration of sick leave and recurrence during 12 months of follow-up	Activating intervention: graded activity approach (identifying stressors and solving strategies, putting them into action and gradually increase activities). Contact with the company’s management.	Usual care by occupational physicians	Employed
The Netherlands
Blonk et al. [25]	Work-related psychological complaints (anxiety, depression, burnout)	Time to partial and full RTW among outcomes	Two interventions: (1) CBT (2) Brief CBT combined with a workplace and an individual focused intervention. Both included graded activity	Two brief sessions with a general practitioner	Self-employed
The Netherlands
Van Oostrom et al. [26]	Distress	Time to RTW (4 weeks without relapse) during 12 months of follow-up	Workplace intervention: involving the employee and their supervisor, identify obstacles for RTW and creating an RTW plan	Usual care according to the Dutch guideline for occupational physicians	Employed
The Netherlands
Vlasveld et al. [27]	Major depressive disorder	Time to RTW (4 weeks without relapse) during 12 months of follow-up	Collaborative care: a care manager coordinating care, problem solving treatment (a brief structured psychological intervention aimed at learning problem solving skills), a workplace intervention (workplace assessment, work adjustments and making an RTW plan)	Usual care	Employed
The Netherlands
Reme et al. [32]	Common mental disorders^e	Increased or maintained work participation at 12 months of follow-up	Integrated individual work-focused CBT with job support (facilitate workplace adaptions or identification of appropriate employment)	Usual care	No employment criteria. 8% unemployed
Norway
Lammerts et al. [28]	Common mental disorders	Time to RTW in competitive employment (28 days without relapse) during 12 months of follow-up	Participatory supportive RTW-program: identifying obstacles for RTW and making an RTW plan with help of an RTW coordinator and labor expert. Referral to a vocational rehabilitation agency offering the participant competitive jobs.	Usual care according to the Dutch guideline for occupational physicians	Without employment contract
The Netherlands
Finnes et al. [31]	Depression, anxiety and exhaustion disorder	Number of sickness absence days during 9 months of follow-up	Three interventions: (1) Individual Acceptance and commitment therapy (2) A workplace dialog intervention: facilitating constructive worker- supervisor dialogue, agreeing on a rehabilitations plan (3) A combination of (1) and (2)	Usual care	Employed
Sweden
Dalgaard et al. [29]	Work-related adjustment disorder or mild depression	Time to RTW (4 weeks without relapse) during 10 months of follow-up	Work-focused CBT with an optional workplace intervention (1–2 meetings at the workplace)	Two: (1) clinical assessment, but no treatment (2) no assessment	Employed
Denmark
Salomonsson et al. [30]	Common mental disorders	Number of sickness absence days during 12 months of follow-up	Two interventions: (1) RTW-intervention: early contact with workplace, identifying obstacles for RTW and making an RTW plan (2) A combination of (1) and CBT	CBT	N/R
Sweden
Aasdahl et al. [19]	Musculoskeletal, psychological or general and unspecified	Number of sickness absence days during 6 and 12 months of follow-up	Inpatient occupational rehabilitation: Acceptance and commitment therapy, physical training, mindfulness, psychoeducation, work-related problem solving and creating an RTW plan	Outpatient group-based Acceptance and commitment therapy.	No employment criteria. 13% unemployed
Norway

RTW: return to work.

N/R: not reported.

CBT: cognitive behavior therapy.

^a RTW is more precisely described in terms of time off benefits when reported in the article. Follow-up time is reported when described in the article.

^b Most studies do not clearly distinguish between self-employment and employment.

^c Brief intervention: consists of a thorough examination by a physician, explanation of findings and pain using a non-injury model. Reassurance and advice about staying active. A follow-up by a physiotherapist with the same message. Often 1–2 booster sessions.

^d First participants were randomized to the workplace intervention or usual care. Participants still sick listed at 8 weeks were randomized to the clinical intervention or usual care.

^e Diagnosis after a psychological evaluation based on informal self-reports of symptoms. Participants were not necessarily sick listed, could also be at risk of sick leave.

Figure 1. Boxes indicate length of sick leave at inclusion in studies including participants with musculoskeletal disorders. The vertical line through the box indicate the median/mean sick leave duration, when reported. Grey outline on the box means that the study reported an effect on return to work, while black indicates it did not. A plus sign indicate inclusion beyond the time illustrated on the x-axis. The Aasdahl-study included both musculoskeletal complaints and mental health disorders.

Figure 2. Boxes indicate length of sick leave at inclusion in studies including participants with mental health disorders. The vertical line through the box indicate the median/mean sick leave duration, when reported. Grey outline on the box means the study reported an effect on return to work, while black indicates it did not. A dotted box indicate that the inclusion criteria of the study is not clear. A plus sign indicate inclusion beyond the time illustrated on the x-axis.

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