TY - JOUR
T1 - Non-pharmacological interventions to promote work participation in people with rheumatic and musculoskeletal diseases: a systematic review and meta-analysis from the EULAR taskforce on healthy and sustainable work participation
AU - Butink, M.H.P.
AU - Webers, C.
AU - Verstappen, S.M.M.
AU - Falzon, L.
AU - Betteridge, N.
AU - Wiek, D.
AU - Woolf, A.D.
AU - Stamm, T.A.
AU - Burmester, G.R.
AU - Bijlsma, J.W.J.
AU - Christensen, R.
AU - Boonen, A.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - ObjectiveTo summarise the evidence on effectiveness of non-pharmacological (ie, non-drug, non-surgical) interventions on work participation (sick leave, work status and presenteeism) in people with rheumatic and musculoskeletal diseases (RMDs).MethodsA systematic review of randomised controlled trials (RCTs) and longitudinal observational studies (LOS) was performed. Qualitative (RCTs/LOS) and quantitative (RCTs) evidence syntheses were conducted. Mixed-effects restricted maximum likelihood models were used to combine effect estimates, using standardised mean differences (SMDs) as the summary measure for each outcome domain separately, with a negative SMD favouring the intervention over comparator. Subgroup analyses were performed for type of RMD, risk status at baseline regarding adverse work outcomes and intervention characteristics.ResultsOf 10 153 records, 64 studies (37 RCTs and 27 LOS; corresponding to k=71 treatment comparisons) were included. Interventions were mostly conducted in clinical settings (44 of 71, 62%). Qualitative synthesis suggested clear beneficial effects of 7 of 64 (11%) interventions for sick leave, 1 of 18 (6%) for work status and 1 of 17 (6%) for presenteeism. Quantitative synthesis (37 RCTs; k=43 treatment comparisons) suggested statistically significant but only small clinical effects on each outcome (SMDsick leave (95% CI)=-0.23 (-0.33 to -0.13; k=42); SMDwork status=-0.38 (-0.63 to -0.12; k=9); SMDpresenteeism=-0.25 (-0.39 to -0.12; k=13)).ConclusionIn people with RMDs, empirical evidence shows that non-pharmacological interventions have small effects on work participation. Effectiveness depends on contextual factors such as disease, population risk status, intervention characteristics and outcome of interest, highlighting the importance of tailoring interventions.
AB - ObjectiveTo summarise the evidence on effectiveness of non-pharmacological (ie, non-drug, non-surgical) interventions on work participation (sick leave, work status and presenteeism) in people with rheumatic and musculoskeletal diseases (RMDs).MethodsA systematic review of randomised controlled trials (RCTs) and longitudinal observational studies (LOS) was performed. Qualitative (RCTs/LOS) and quantitative (RCTs) evidence syntheses were conducted. Mixed-effects restricted maximum likelihood models were used to combine effect estimates, using standardised mean differences (SMDs) as the summary measure for each outcome domain separately, with a negative SMD favouring the intervention over comparator. Subgroup analyses were performed for type of RMD, risk status at baseline regarding adverse work outcomes and intervention characteristics.ResultsOf 10 153 records, 64 studies (37 RCTs and 27 LOS; corresponding to k=71 treatment comparisons) were included. Interventions were mostly conducted in clinical settings (44 of 71, 62%). Qualitative synthesis suggested clear beneficial effects of 7 of 64 (11%) interventions for sick leave, 1 of 18 (6%) for work status and 1 of 17 (6%) for presenteeism. Quantitative synthesis (37 RCTs; k=43 treatment comparisons) suggested statistically significant but only small clinical effects on each outcome (SMDsick leave (95% CI)=-0.23 (-0.33 to -0.13; k=42); SMDwork status=-0.38 (-0.63 to -0.12; k=9); SMDpresenteeism=-0.25 (-0.39 to -0.12; k=13)).ConclusionIn people with RMDs, empirical evidence shows that non-pharmacological interventions have small effects on work participation. Effectiveness depends on contextual factors such as disease, population risk status, intervention characteristics and outcome of interest, highlighting the importance of tailoring interventions.
KW - Occupational therapy
KW - Rehabilitation
KW - Psychology
KW - RANDOMIZED-CONTROLLED-TRIAL
KW - MULTIDISCIPLINARY REHABILITATION PROGRAM
KW - ORIENTED MEDICAL REHABILITATION
KW - TAILORED BEHAVIORAL TREATMENT
KW - REDUCING SICKNESS ABSENCE
KW - 2-YEAR FOLLOW-UP
KW - QUALITY-OF-LIFE
KW - VOCATIONAL-REHABILITATION
KW - CHRONIC NECK
KW - BACK-PAIN
U2 - 10.1136/rmdopen-2022-002903
DO - 10.1136/rmdopen-2022-002903
M3 - (Systematic) Review article
C2 - 36596655
SN - 2056-5933
VL - 9
JO - RMD Open
JF - RMD Open
IS - 1
M1 - e002903
ER -