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Table 1

Return to:   Factors Affecting Return To Work After Injury Or Illness

Characteristics of accepted systematic reviews

First author, yearSearch date, databases, language, limitersPopulationPrognostic factorsOutcomesStudy authors’ main conclusions
Musculoskeletal Conditions

Brox 2008Up to 2006; MEDLINE; English; RCTsNon-specific chronic LBP (>12 weeks)Back schools (5 RCTs), brief education in the clinical setting (4 RCTs), fear-avoidance training (3 RCTs)RTW/sick leaveBased on 12 RCTs.
Brief education vs. usual care in the clinical setting: strong evidence.
Back schools: moderate evidence that they are not more effective than no intervention, waiting list, usual care, or a cognitive-behavioural-based back school; conflicting evidence for back schools vs. no intervention.
Fear-avoidance training: moderate evidence for effectiveness compared to usual care.
Sick leave:
Fear-avoidance training incorporated in rehabilitation programs consisting of cognitive intervention and exercises is not different form spinal fusion.

Campbell 2013Up to November 2011; MEDLINE, EMBASE, PsycINFO, CINAHL, IBSS, AMED, BNI; English; prospective, case-controlNonspecific LBPEmployment social support type (e.g., co-worker, supervisor, general support)RTWBased on 32 articles. Weak effects of employment support; greater levels of co-worker support and general work support were associated with less time to RTW.

Carroll 20101990-2010; MEDLINE, Allied and Complementary Medicine, Applied social Sciences Index and Abstracts, British Nursing Index, Business Source Premier, the Cochrane Library, Cinahl, Current Contents, International Bibliography of the Social Sciences, PsycINFO, Sociological Abstracts, Science and the Social science Citation Index, Health Economics Evaluation Database, NHS Economics Evaluation Database, EconLit, Web of Science; English RCTs, controlled intervention studiesBack painInterventions involving the workplaceRTWBased on 8 RCTs and 1 non-randomized controlled trial. Moderate evidence that stakeholder participation (i.e., the employee, the workplace, occupational health professionals) and work modification are more effective than other workplace-linked interventions, including exercise. Early intervention was effective.

Clay 2010 [49]1985-May 2009; MEDLINE, EMBASE, PsycINFO, CINAHL, AMED; English; prospective and retrospective cohort studiesAcute orthopaedic traumaSociodemographic factors, injury and treatment related factors, psychosocial factors, work-related factorsRTW, duration of work disabilityBased on 15 studies.
RTW: limited evidence for any factor.
Duration of work disability: strong evidence for level of education and blue collar work; moderate evidence for self-efficacy, injury severity and compensation

Dick 2011Up to 2008; MEDLINE, EMBASE, CINAHL, AMED, PEDro, Cochrane Library; English; RCTs, cohort studies, systematic reviewsUpper limb disorders (carpal tunnel syndrome, non-specific arm pain, extensor tenosynovitis, lateral epicondylitis)Workplace interventionEmployment outcomesBased on 4 studies (3 RCTs, 1 cohort study).
Non-specific arm pain: limited evidence that multidisciplinary rehabilitation for was beneficial for workers absent at least 4 weeks.

Franche 2005 [26]January 1990-December 2003; MEDLINE, EMBASE, CINAHL, PsycINFO, Sociological Abstracts, ASSIA (Applied Social Sciences Index and Abstracts), ABI (American Business Index); English, French; quantitative studiesMSK and other pain-related conditionsWorkplace-based RTW intervention components: early contact with the worker by the workplace, work accommodation offer, contact between healthcare provider and the workplace, ergonomic work site visits, supernumerary replacements, RTW coordinationWork disability durationBased on 10 studies (4 RCTs, 1 non-RCT, 3 cohort, 1 pre-post, 1 cross-sectional). Overall moderate-strong evidence that workplace-based RTW interventions can reduce work disability duration. Intervention components: strong evidence for work accommodation, and contact between healthcare provider and workplace; moderate evidence for early contact with worker by workplace (within first 3 months of onset of work disability), ergonomic work site visits, and presence of a RTW coordinator. Insufficient evidence to support the effect of supernumerary replacements and the sustainability of effects beyond 1 year.

Hansson 2004Up to October 2002; Medline, PsycINFO, SSCI; English, Danish, Norwegian, Swedish; longitudinal studiesBack and neck disordersDemographic, medical, physical workplace, psychosocial workplace, socioeconomic, work organization, factorsSickness absence, RTWBased on 48 studies. Factors with consistent, but limited, support: (a) heavy physical workload, bent or twisted working position, and low work satisfaction increases the risk for short- and long-term sick leave; (b) specific back diagnoses and previous sick leave due to back disorders increases the risk for short-and long-term sick leave; (c) female gender, smoking, exposure to vibration, and deficient social support were not found to increase the risk for short- and long-term sick leave; (d) self-reported pain and functional impairments were associated with a high risk for long-term sick leave; (e) longer employment periods reduced the risk for short-term sick leave; (f) perceived demands at work did not influence short-term sick leave; (g) female gender and higher age increases the risk for disability pension.

Heymans 2005Up to November 2004; MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials; English, Dutch, French, German; RCTsNon-specific LBPBack schoolsRTWBased on 4 RCTs. Moderate evidence that back schools in an occupational setting improve RTW in the short- and intermediate-term, compared with exercises, manipulation, myofascial therapy, advice, placebo, or waiting list controls, for patients with chronic and recurrent LBP.

Hlobil 2005Up to February 2004; MEDLINE, PsycINFO, EMBASE, Cochrane Controlled Trials Register; English; RCTsSubacute, nonspecific LBP (with or without referral to the leg)Out-patient interventions aimed at RTW (e.g., physical exercise or advice about it and education, behavioral treatment, ergonomic measures, case management).RTW rate, days of work absenteeismBased on 9 RCTs. Strong evidence for RTW interventions on the RTW rate after 6 months, and on the reduction of days of absence from work after ≥ 12 months. Conflicting evidence for the RTW rate after ≥ 12 months and on days of work absenteeism at 6 months.

Hoffman 2007Up to October 2004; MEDLINE, PsycINFO, EMBASE, CENTRAL, CINAHL; English; RCTsNoncancerous chronic LBP (≤3 months)Psychological interventionsEmployment/ disability compensation statusBased on 5 RCTs. Moderate evidence that multidisciplinary approaches that included a psychological component, when compared with active control conditions, have positive long-term effects on RTW (effect size 0.53, p<.05).

Iles 2008 [31]Up to April 2006; MEDLINE, EMBASE, PsycINFO, CINAHL, PEDro; English; retrospective studies were excludedNon-specific LBP (≤3 months)Psychosocial variablesRTWBased on 24 studies. Strong evidence that recovery expectation predicts work outcome and that depression, job satisfaction and stress/psychological strain do not predict work outcome. Moderate evidence that fear avoidance beliefs predict work outcome, and that anxiety does not predict work outcome. Insufficient evidence to determine whether compensation or locus of control predict work outcome.

Kent 2008Up to 2007; MEDLINE, CINAHL, EMBASE, PsycINFO, AMED; English; prospective cohort studiesNon-specific LBP (<12 weeks)Varying prognostic factors and interventions (psychosocial, history, pain, physical impairment, activity limitation, participation restriction, clinician factors)Duration of compensation, time-off-work, return-to-full-work duties, RTW duties, time-off work.Based on 50 studies. Conflicting and incomplete findings.

Kuijer 2006 [30]Up to October 2004; MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, Cochrane; Dutch, English, German; cohort studies, RCTsNon-specific chronic LBPFactors: sociodemographic, lifestyle, medical history, pain, observed disability, self-reported disability, health beliefs, physical work demands, psychological work demands, emotions, expectations.Decision to report sickness absence or RTWBased on 4 cohort studies and 13 RCTs. Consistent (strong) evidence for own expectations of recovery predicted decision to RTW. Patients with higher expectations had less sickness absence. No core set of predictors exists for sickness absence in general.

Kuijpers 2004Up to February 2003; MEDLINE, EMBASE, CINAHL, PsycINFO, Sportdiscus; English; cohort studiesShoulder complaintsFactors: worker group (blue vs. white collar), previous sick leave, duration of symptoms, continuous high intensity pain, pain with head rotation, pain with arm abductionSick leaveBased on 6 studies. Inconclusive.

Liddle 20071985-September 2004; MEDLINE, AMED, CINAHL, PsycINFO, Cochrane-Dare and Central Register of Controlled Trials, PubMed; RCTsLBPUse of advice in the management of LBP (e.g., to promote an understanding of LBP, and the importance of the patient playing an active role in their recovery).Work disabilityBased on 14 RCTs. Strong-medium support that advice as an adjunct to exercise is most effective for improving work disability in chronic LBP but, for acute LBP, is no more effective for improving work disability than simple advice to stay active.

Macedo 2010Up to February 2009; MEDLINE, CINAHL, PsychINFO, PEDro, EMBASE; no language restriction; RCTs or quasi-randomized controlled trialsNon-specific LBP(persistent >6 weeks or recurrent)Graded activity or graded exposureRTWBased on 3 RCTs. Conflicting evidence that graded activity vs. a minimal intervention provides faster RTW.

Meijer 2005January 1990-December 2004; MEDLINE, EMBASE, PsycINFO, CINAHL; English; RCTs, clinical controlled trials, systematic reviewsNon-specific MSK complaints (mostly LBP)RTW treatment programs: (1) knowledge conditioning (e.g., education, information); (2) physical conditioning (e.g., fitness exercises, graded activity exercise training); (3) psychological conditioning (e.g., cognitive behavioral techniques, coping skills); (4) social conditioning (training of social skills); (5) work conditioning (e.g., vocational training, workplace- based interventions)RTWBased on 18 studies (22 treatment programs). Inconsistent evidence. Seven experimental treatments resulted in faster RTW compared to control. Effective components: knowledge, psychological, physical and work conditioning, possibly supplemented with relaxation exercises. No negative findings .

Norlund 2009April 1998-December 2006; PubMed; English; RCTs, controlled clinical trialsLBP: subacute (5-11 weeks) or chronic (≥12 weeks)Multidisciplinary interventionsRTWBased on 5 studies. Strong evidence that multidisciplinary interventions have a significant effect on RTW (RR 1.21, 95% CI 1.13-1.31).

Oesch 2010Up to August 2008; MEDLINE, EMBASE, PEDro, Cochrane Library databases, NIOSHTIC-2, PsycINFO; language restrictions not specified; RCTsNon-acute non-specific LBP (≥4 weeks)Exercise (alone or as a part of multidisciplinary treatment)Work disabilityBased on 23 RCTs. Strong evidence in favour of exercise on work disability in the long term (OR 0.66, 95% CI 0.48-0.92) but not in the short and intermediate term. No conclusions regarding exercise types.

Palmer 20121990- April 2010; MEDLINE, EMBASE; RCTs, cohort studiesMSK disordersCommunity- and workplace-based interventions: exercise therapy, behavioural change techniques, workplace adaptations, provision of additional servicesRTW (27 studies), sickness absence (21), job loss (5)Based on 42 studies (34 RCTs). Limited evidence that most interventions were beneficial (benefits are small): median RR for RTW was 1.21 (IQR 1.00-1.60), median RR for avoiding job loss was 1.25 (IQR 1.06-1.71), median RR for reduction in sickness absence was 1.11 (IQR 0.32-3.20) days/month. No intervention was clearly superior; effort-intensive interventions were less effective than simple ones.

Ravenek 2010July 1998-July 2009; PubMed, EMBASE, SCOPUS, CINAHL, PsycINFO, Cochrane Library; English; RCTs, controlled clinical trialsChronic LBP (≥12 weeks)Multidisciplinary programsEmployment outcomesBased on 12 trials. Conflicting evidence. Occupational therapists were underutilized.

Schaafsma 2013Up to April 2012; CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, PEDro; CBRG Trials Register, ClilnicalTrials.gov, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP); no language restrictions; RCTsBack pain: acute (<6 weeks), subacute (6-12 weeks), or chronic (>12 weeks)Physical conditioning as part of a RTW strategyWork status outcomesBased on 41 articles reporting on 25 RCTs. Low-moderate evidence: Light physical conditioning has no effect on sickness absence duration for workers with subacute or chronic back pain. Conflicting results for intense physical conditioning for workers with subacute back pain. Intense physical conditioning probably had a small effect on reducing sick leave at 12 months follow-up compared to usual care for workers with chronic back pain.
Involving the workplace, or physical conditioning being part of integrated care management may have had a positive effect on reducing sick leave.

Steenstra 2005 [47]1966 – December 2003; MEDLINE; no language restrictions specified; inception cohort studiesAcute LBPFactors related to: pain, worker and workers’ health, psychosocial in worker and work, work organization, policyDuration of sick leaveBased on 18 publications (14 cohorts). Moderate-strong evidence: specific LBP, higher disability levels, older age, female gender, more social dysfunction and more social isolation, heavier work, and receiving higher compensation predicted a longer duration of sick leave. A history of LBP, job satisfaction, educational level, marital status, number of dependants, smoking, working more than 8 hour shifts, occupation, and size of industry or company did not influence duration of sick leave due to LBP.

Tveito 2004 [25]1980-November 2002; MEDLINE Advanced, PsycINFO, ISI base, Cochrane Controlled Trials Register; English; controlled trialsEmployees (no further description)LBP interventions at the workplace: preventive (educational, exercise, back belts, multidisciplinary, pamphlet), treatmentSick leaveBased on 31 publications from 28 interventions (24 preventive, 4 treatment). Limited evidence: exercise interventions effect sick leave; multidisciplinary interventions have no effect.
Moderate evidence:comprehensive treatment interventions
No evidence for effect on sick leave: educational interventions, back belts, pamphlet.

van der Giessen 2012Up to July 2011; PubMed, EMBASE, CINAHL, the Cochrane Library; no language restrictions; RCTsNon-specific LBPGraded activityRTWBased on 5 RCTs. Conflicting evidence that graded activity results in better RTW.

van Geen 2007 [23]Up to April 2003; MEDLINE, Embase, Cochrane Controlled Trial register, PubMed, Psychlit; language restrictions not specificied; RCTsChronic non-specific LBP (≥12 weeks)Multidisciplinary back training (including one physical and at least one other component: psychological, behavioral, educational or social)Work participation (ability to work, number of days of sick leave, RTW)Based on 5 studies. Strong evidence for positive long-term effect. Moderate evidence that the intensity of the intervention does not influence its effectiveness.

van Middelkoop 2011Up to December 2008; MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro; English, Dutch, German; RCTsChronic non-specific LBP (≥12 weeks)Physical and rehabilitation interventionsRTW, sick leaveBased on 3 studies. Low to moderate quality evidence that behavioural therapy and multidisciplinary treatment reduces sick leave.

Verkerk 2012Up to March 2010; PubMed, CINAHL, EMBASE; RCTs, randomized cohort designsChronic non-specific LBP (≥12 weeks)Factors: personal, health, pain, social, work, physical, psychologicalRTWBased on 8 studies. At baseline, there was limited evidence of a positive influence of lower pain intensity and physical job demands on RTW. At long-term follow-up, there is conflicting evidence for the association between RTW and age, sex, and activities of daily living.

Williams 20071982-April 2005; MEDLINE, CINAHL, EMBASE, AMED; English; prospective or cross-sectional designsMSK LBP injuriesWorkplace rehabilitation interventions involving secondary preventionRTWBased on 15 articles (10 studies). Limited evidence: clinical interventions with occupational interventions, and early RTW/modified work interventions were effective. These studies included early contact with the worker by the workplace and a health care provider intervention at the workplace. Ergonomic interventions (participatory ergonomics, workplace adaptation, adaptation of job tasks , adaptation of working hours) are effective.

Musculoskeletal and Other Conditions

Corbière 20061985-2005; Cochrance Central Register of Controlled Trials, Cochrance Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO; English, FrenchMental health problems and/or physical injuries (mostly MSK)Psychological RTW interventions (e.g., cognitive behavioural therapy, communication skills)Work outcomesBased on 14 studies (4 RCTs, 2 controlled trials, 5 trials without randomization or control group, 1 evaluation only, 1 case study). Moderate-strong evidence of significant improvement in RTW.

Désiron 20111980-September 2010; CINAHL, Cochrane Library, EBSCO, MEDLINE (PubMed), PsycINFO; English; RCTs, cohort studiesPatients of working age that had participated in a rehabilitation programRTW multidisciplinary rehabilitation programs that included occupational therapy (i.e., the therapeutic efforts had to be part of a defined program whose specific goal was to help patients re-enter or remain in the work force)Work-related outcomes, e.g., RTW, sick leave, or employment statusBased on 3 RCTs and 3 cohort studies. Sufficient evidence that intervention contributes to RTW. Not clear what the effective components of the intervention are, except for workplace interventions.

Gensby 2012Up to July 2010; MEDLINE, EMBASE, CINAHL, The Cochrane Library, SocINDEX, Social Services Abstracts, Sociological Abstracts, PsycINFO, EconLit, Business Source Elite, Safety Science and Risk, Dissertation Abstracts International (DAI); no language restrictions; RCTs, quasi experimental designs, single group designsEmployees on sick leave with injuries or illnesses (occupational or non-occupational)Workplace disability management programsRTWBased on 13 studies (2 non-randomized studies, 11 single group ‘before and after’ studies). MSK disorders: 10, mental health conditions: 2. Lack of evidence on the effectiveness of programs.

Hoefsmit 20121994-2019; PubMed, CINAHL, Cochrane Library, Google Scholar; English; empirical studies or systematic literature reviewsMultiple groups, e.g., physical complaints, psychological complaintsRTW interventionsRTWBased on 18 quantitative studies and 5 systematic reviews. Early interventions (initiated in first 6 weeks of sickness absence) are effective in multiple groups. Multidisciplinary interventions: effective in physical and psychological complaints. Time-contingent interventions: effective in physical complaints; inconsistent evidence for psychological complaints. Activating interventions: effective in physical complaints (not studied for other complaints). Inconsistent evidence: targeting at employees with specific diagnoses, interventions of varying intensity and interventions covering employee and/or employer decision latitude. No positive effect: generic interventions targeted at all employees on sick leave.

Schandelmaier 2012 [46]Up to April 2012; MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials; limiters not described; RCTsEmployees on work absence for at least 4 weeks.RTW coordination programsRTWBased on 9 RCTs (8 MSK complaints, 1 mental health complaint). Moderate evidence: improves proportion at work at end of follow-up (risk ratio = 1.08, 95% CI = 1.03-1.13; absolute effect = 5 in 100 additional individuals returning to work, 95% CI = 2-8).

van Oostrom 2009Up to November 2007; Cochrane Occupational Health Field Trials Register, CENTRAL, MEDLINE, EMBASE, PsycINFO; RCTs; no restrictions by date, language or publication statusMSK disorders, mental health problems, and other health conditionsWorkplace interventions focusing on changes in the workplace or equipment, work design and organization, working conditions or environment, and occupational (case) management with active stakeholder involvement of the worker and the employer.Sickness absenceBased on 6 RCTs: MSK disorders (5), mental health problems (1). Moderate evidence supports the use of workplace interventions to reduce sickness absence among workers with MSK disorders when compared to usual care. Not possible to investigate the effectiveness of workplace interventions among workers with mental health problems and other health conditions due to a lack of studies.

Mental Health Conditions

Arends 2012Cochrane Depression, Anxiety and Neurosis Review Group’s Specialised Register (CCDANCTR), up to October 2011. Cochrane Central Register of Controlled Trials (CENTRAL) up to Issue 4, 2011; MEDLINE, EMBASE, PsycINFO and ISI Web of Science, up to February 2011; WHO trials portal (ICTRP) and ClinicalTrials.gov in March 2011; RCTsAcute or chronic adjustment disordersPharmacological interventions, psychological interventions, relaxation techniques, exercise programs, employee assistance programs or combinations of these interventions.RTW (partial and full)Based on 9 studies reporting on 10 psychological interventions and 1 combined intervention. Moderate evidence: cognitive behavioural therapy (CBT) did not significantly reduce time until partial RTW. Low evidence: CBT did not significantly reduce time to full RTW compared with no treatment.
Moderate evidence: problem solving therapy significantly enhanced partial RTW at 1-year follow-up compared to non-guideline based care (MD -17.00, 95% CI -26.48 to -7.52) but did not significantly enhance time to full RTW at 1-year follow-up.

Cornelius 2011 [29]January 1990-March 2009; PubMed, PsycINFO, EMBASE, CINAHL, Business Source Premier; English, German, French, Dutch; observational studies (i.e., case-control, cohort, longitudinal)Mental disordersFactors: nature and severity of mental disorder focusing on depression, anxiety disorder and substance use disorder; demographics; health service use; adequacy of treatment; coping strategies and social supportRTW, long-term disabilityBased on 7 studies (4 cohorts).
Strong evidence: older age (>50 years) is associated with continuing disability and longer time to RTW.
Limited evidence: for the association of other personal factors (gender, education, history of previous sickness absence, negative recovery expectation, socioeconomic status), health-related (stress-related and shoulder/back pain, depression/anxiety disorder) and external i.e., job-related factors (unemployment, quality and continuity of occupational care, supervisor behavior) with disability and RTW. Long-term disability is mostly related to non-medical conditions.

Hensing 2004Up to October 2002; MEDLINE, PsycINFO, SSCI; English, Danish, Norwegian, Swedish; no restrictions on study designPychiatric disordersFactors: demographic, work-related, family and social network, psychosocial related to childhood and adolescenceSickness absence, disability pensionBased on 28 studies (6 cross-sectional, 20 longitudinal/prospective, 2 register studies). Limited evidence: women have a higher frequency and incidence of sickness absence. Conflicting evidence: effect of gender on the duration of sickness absence; age; work-related factors, factors related to family and social networks, psychosocial factors; whether individuals were at greater risk for sickness absence and disability pension; alcohol problems associated with increased risk of sickness absence and disability pension.

Lagerveld 20101995-2008; PsycINFO, PubMed, Scopus; English; no study design restrictionDepressionDisorder-related factors (most commonly addressed); personal and work-related factors (less frequently addressed)Work participation, work functioningBased on 30 studies (half cross-sectional, half longitudinal).
Work participation: strong evidence for the association between a long duration of the depressive episode and work disability. Moderate evidence for the associations between more severe types of depressive disorder, presence of co-morbid mental or physical disorders, older age, a history of previous sick leave, and work disability. Work functioning: moderate evidence that severe depressive symptoms were associated with work limitations and clinical improvement was related to work productivity.

Nieuwenhuijsen 2008Up to August 2006; Cochrane Library CENTRAL register, MEDLINE, EMBASE, CINAHL, PsycINFO, OSH-ROM, NHS-EED; database of Abstracts of Reviews of Effectiveness; no language restrictions; RCTsDepressionWork-directed (e.g., modified working hours and job tasks) and worker-directed interventions (e.g., pharmacological or psychological) aimed at reducing work disability.Sickness absenceBased on 11 studies (worker-directed interventions). No evidence of an effect of medication alone, enhanced primary care, psychological interventions or the combination of those with medication on sickness absence of depressed workers.

Stergiopoulos 2011 [52]Up to June 2011; MEDLINE, PsycINFO, EMBASE, Web of Science; English, French; no restrictions on study designWork-related post-traumatic stress disorderWork-related interventionsWork outcomesBased on 7 articles (3 RCTs, 3 pre-post, 1 systematic review). Strong evidence that psychotherapy-based workplace interventions may be effective at improving work outcomes.

Brain Injury

Baldwin 2011Up to September 2009. CINAHL, AMED, MEDLINE, PsycINFO, Proquest 5000; EnglishStroke survivorshipVocational rehabilitation programsRTW ratesBased on 6 studies (retrospective single cohort designs). Limited evidence: RTW rates ranged from 12% to 49%.

Fadyl 2009 [55]1990-2007; MEDLINE, PsycINFO, CINAHL, AMED, Health and Psychosocial Instruments, Evidence-Based Medicine databases, Web of Science; English; no limit on study designTraumatic brain injuryVocational rehabilitation: (1) program-based vocational rehabilitation model, (2) supported employment model, (3) case coordination modelEmployment outcomesBased on 20 quantitative studies. (1) Program-based: weak evidence for better vocational outcomes (e.g., employment, wages, remain employed at 1 year following placement); (2) supported employment: weak evidence for gaining employment that lasted at least 90 days; (3) case coordination: moderate evidence for higher employment and productivity outcomes. Weak evidence that people who receive this intervention within the first year following injury are placed into employment more quickly No clear evidence to suggest what should be considered the “best practice” approach to vocational rehabilitation.

Nightingale 2007 [48]Up to June 2006; MEDLINE, PsycINFO, EMBASE, CINAHL; English; cohort studiesTraumatic brain injuryPreinjury, injury, and early postinjury factorsRTWBased on 27 studies. Limited evidence for preinjury employment, injury severity, cognitive factors, neurophysical factors, and multidimensional/participation factors.

Turner-Stokes 2005 [45]Up to April 2008; CENTRAL (The Cochrane Library 2008, Issue 2), MEDLINE, EMBASE, ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISIWeb of Science: Conference Proceedings Citation Index-Science (CPCI-S), Internet-based trials registers: ClinicalTrials.gov, Current Controlled Trials, and RehabTrials.org.; RCTs, quasi-randomized and quasi-experimental designsAcquired brain injuryMultidisciplinary rehabilitationRTWBased on 2 RCTs regarding traumatic brain injury. Moderate-strong evidence for no significant differences between intervention and controls (appropriate information and advice).

van Velzen 20091992-July 2008; PubMed, EMBASE, CINAHL, PsycINFO; English, Dutch, German; no restrictions on study designAcquired brain injuryVarying prognostic factorsRTWBased on 22 studies.
Strong evidence for no association or a negative association with RTW: gender, anatomic location, injury severity, depression, anxiety, inpatient length of stay.
Weak evidence for trainable/treatable factors: ability to perform activities of daily living, residual physical deficits/higher disability level, number of associated injuries.

Willemse-van Son 20071995-April 2005; PubMed, PsycINFO; English, French, German, Dutch; prospective cohort studiesTraumatic brain injuryVarying prognostic factorsActivity limitations, participation restrictionsBased on 25 articles reporting on 14 cohorts. Strong evidence for predicting disability: older age, pre-injury unemployment, pre-injury substance abuse, and more disability at rehabilitation discharge. Strong prognostic factors for being non-productive: pre-injury unemployment, longer post-traumatic amnesia, more disability at rehabilitation admission, and pre-injury substance abuse.


Allebeck 2004Up to October 2002; MEDLINE, PsycINFO, SSCI; English, Danish, Norwegian, Swedish; no restriction on study designAny diagnosis or underlying diseaseVarying prognostic factorsSick leave, disability pensionBased on 96 studies (44 cross-sectional, 32 longitudinal, 7 cohort, 6 time series, 5 quasi-experimental, 2RCT). Family factors: no evidence that marital status or children living at home are associated with sickness absence; limited evidence for an effect of divorce. Work-related factors: limited evidence for an effect of physically stressful work; moderate evidence for low psychological control over the work situation. Limited evidence for a correlation in time between unemployment and sickness absence. Moderate evidence that the amount of sickness absence is influenced by the design of the social insurance system, but insufficient evidence on the magnitude of change required to influence the level of sickness absence. The same results apply to disability pension. Moderate evidence for the effects of socio-economic status.

de Boer 2011 [24]Up to February 2010; Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane Library Issue 2, 2010), MEDLINE, EMBASE, CINAHL, OSH-ROM, PsycINFO, DARE; RCTs, controlled before-after studiesCancerRTW interventions (e.g., psychological, vocational, physical, medical or multidisciplinary)RTWBased on 14 articles reporting 14 RCTs and 4 controlled before-after studies. Low evidence of similar RTW rates for psychological interventions compared to care as usual (OR 2.32, 95% CI 0.94- 5.71). No vocational interventions were retrieved.
Very low evidence: physical training is not more effective than care as usual (OR 1.20, 95% CI 0.32- 4.54).
Low quality evidence: functioning conserving approaches had similar RTW rates as more radical treatments (OR 1.53, 95% CI 0.95- 2.45).
Moderate evidence: multidisciplinary interventions involving physical, psychological and vocational components led to higher RTW rates than care as usual (OR 1.87, 95% CI 1.07-3.27).

Dekkers-Sanchez 2008Up to July 2007; MEDLINE, EMBASE, PsycINFO, Web of Science; no specified language restriction; cohort studiesWorkers on sick leave for at least 6 weeksFactors: predisposing, precipitating, perpetuating, individual or work-relatedLong-term sick leaveBased on 5 cohort studies.
Weak evidence that older age and history of sickness absence are associated with long-term sick leave. Insufficient evidence regarding individual or work-related factors. No evidence regarding perpetuating factors.

Detaille 2009 [22]1990-2008; MEDLINE, EMBASE; EnglishRheumatoid arthritis, chronic obstructive pulmonary disease, asthma, diabetes mellitus, or ischemic heart disease5 groups of prognostic factors based on ICF: disease-related factors, body function or structural impairment factors, activity limitation and participation restriction factors, environmental factors, and personal factorsWork disabilityBased on 43 cohort studies (20 rheumatoid arthritis, 3 asthma, 20 ischemic heart disease).
Moderate-strong evidence that employees are at higher risk of work disability if they have: (i) a more severe chronic disease (disease-related factors), including a high level of perceived health complaints, (ii) disease-specific impaired body functions, such as pain and swollen/deformed joints in rheumatoid arthritis, depression in ischemic heart disease, sickness absence (body function or structural impairment factors) and (iii) more daily physical limitations caused by the disease (activity limitation and participation restriction factors). Other factors contributing to work disability are older workers (personal), women (personal), manual/blue-collar workers (environmental) and low-educated workers (personal).

Khan 2009Cochrane Multiple Sclerosis Group’s Trials Register (February 2011), PEDro (1990-2011), ISI Science Citation Index (1981-2011), Cochrane Rehabilitation and Related Therapies Field trials Register, National Health Service National Research Register; no language restrictions; RCTs, controlled clinical trialsMultiple sclerosisVocational rehabilitation interventionsRTW and employmentBased on 2 trials (1 RCT, 1 clinical controlled). Insufficient evidence to support vocational rehabilitation interventions.

O’Neil 2010 [28]1994-July 2009; PubMed, OVID, MEDLINE, PROQUEST, CINAHL plus, CCOHS, SCOPUS, Web of Knowledge; English; prospective cohort studiesCardiac event (myocardial infarction, acute coronary syndrome, coronary artery disease)DepressionWork resumptionBased on 12 articles (11 prospective cohort studies, 1 RCT). Strong evidence. Depression recorded between admission and up to 2 months post-discharge can significantly predict poorer RTW outcomes 6-12 months after a cardiac event. Other common predictors were age and patient perceptions of their illness and work performance.

Perk 2004Up to October 2002; MEDLINE, PsycINFO, SSCI; English, Danish, Norwegian, Swedish; no restriction on study designStroke, coronary artery diseaseFactors, interventionsSick leaveBased on 33 cohort studies, 10 RCTs, 1 randomized trial, 1 case-control. Limited evidence: stroke: higher rate for younger patients RTW during first year post-stroke. Myocardial infarction: RTW is more rapid with percutaneous coronary intervention vs. coronary artery bypass grafting; no differences in long-term sick leave. People at higher ages or with physically demanding jobs RTW to a lesser degree.

Shepherd 2012January 1999-November 2010; CINAHL, MEDLINE, PsycINFO; English; RCTsCoronary heart diseaseCardiac rehabilitation interventions (publicly funded)RTWBased on 1 RCT. Limited evidence observed for earlier RTW.

Tamminga 2010 [53]Up to October 2008; MEDLINE, PsycINFO, EMBASE, CINAHL; no language or study design restrictionCancerWork-directed interventionsRTW, employment status, work retentionBased on 7 studies (1 RCT, 3 controlled trials, 3 prospective cohort studies). The most frequently reported work-directed components were occupational training, encouragement, work advice, work accommodations, or education. Limited evidence that the intervention increased RTW.
ICF International Classification of Functioning, Disability, and Health
LBP low back pain
MSK musculoskeletal
RTW return to work