You are here

  • Home
  • Archive
  • Volume 15, Issue 2
  • Effectiveness of clinical healthcare interventions for enhancing the work participation of patients with various health conditions: a synthesis of systematic reviews

Article Text

Article menu

Download PDFPDF

Occupational and environmental medicine
Original research
Effectiveness of clinical healthcare interventions for enhancing the work participation of patients with various health conditions: a synthesis of systematic reviews
  1. Lana Kluit1,2,
  2. Jan L Hoving1,2,
  3. Faridi S Jamaludin3,
  4. Coen A M van Bennekom1,4,
  5. Annechien Beumer1,5,
  6. Angela G E M de Boer1,2,6,
  7. Astrid de Wind1,2
  1. 1 Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  2. 2 Societal Participation & Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
  3. 3 Medical Library AMC, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  4. 4 Heliomare Rehabilitation Centre, Wijk aan Zee, The Netherlands
  5. 5 Upper Limb Unit Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
  6. 6 Cancer Treatment and Quality of Life, Cancer Centre Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Mrs Lana Kluit; l.kluit{at}amsterdamumc.nl; Dr Astrid de Wind; a.dewind{at}amsterdamumc.nl

Abstract

Objectives This objectives of this study were to determine the effectiveness of clinical healthcare interventions designed for improving the work participation of patients with various health conditions and identify promising elements within these interventions.

Design A systematic literature search was conducted, and a synthesis of systematic reviews (SRs) was performed.

Data sources MEDLINE, Embase, Cochrane Library and CINAHL were searched for articles published from January 2012 to December 2023.

Eligibility criteria SRs of randomised controlled trials evaluating the effectiveness of interventions that aimed at improving work participation initiated within clinical healthcare in patients being treated for various health conditions were included.

Data extraction and synthesis Two authors independently used standardised methods to search and select SRs, and extract data. Our primary outcome was work participation, which could include return-to-work rate or sick leave duration. We were interested in both short-, medium-, as well as long-term outcomes. Risk of bias was assessed using the AMSTAR-2 tool. We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to evaluate the certainty of the evidence and findings were summarised in GRADE evidence profiles. We used a deductive synthesis to identify promising intervention elements.

Results The health conditions included in the selected SRs were cancer, chronic low back and musculoskeletal pain, coronary heart disease, inflammatory arthritis, complaints of the lumbopelvic region during pregnancy, stroke and traumatic brain injury. Across health conditions, many interventions trended towards small, favourable effects. Moderately certain evidence showed that multidisciplinary and physical interventions enhance work participation at 12 months for people with cancer (risk ratio (RR) 1.23, 95% CI 1.09 to 1.33 and RR 1.23, 95% CI 1.08 to 1.39, respectively), and that multidisciplinary interventions reduce the days of return to work compared with usual care for people with coronary heart disease (40.77 days lower than control, 95% CI −67.19 to −14.35). Low-certainty evidence suggested that multidisciplinary interventions may enhance work participation at 12 months for people with coronary heart disease (RR 1.56, 95% CI 1.23 to 1.98) and reduce the number of sick leave days at 12 months for people with chronic low back pain (82, IQR 51 to 164 vs 175, IQR 91 to 365; p=0.003). Promising elements included (psycho)education, cognitive-behavioural therapy, psychosocial support, group and vocational counselling and physical training.

Conclusions There is considerable overlap in clinical healthcare interventions that aim to enhance work participation for patients across health conditions. Although their effects on work participation vary, some conditions show favourable response to multidisciplinary interventions. More evidence is needed on developing tailored interventions and evaluating their cost-effectiveness.

PROSPERO registration number CRD42022346552.

  • Systematic Review
  • Occupational Health Services
  • Patient-Centred Care
  • Delivery of Health Care, Integrated
  • Clinical Decision-Making

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All data supporting the findings of this review are available within the paper and its supplementary material.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2024-094201

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    STRENGTHS AND LIMITATIONS OF THIS STUDY

    • This synthesis of systematic reviews (SRs) provides a comprehensive summary of clinical healthcare interventions designed to enhance work participation in people being treated for various health conditions and the effectiveness of these initiatives.

    • To guide the final selection of SRs, we conducted a risk-of-bias assessment using AMSTAR-2.

    • Grading of Recommendations Assessment, Development, and Evaluation was used to evaluate the certainty of evidence.

    • A deductive synthesis allowed us to identify promising elements of work participation interventions across health conditions.

    • SRs that lacked detailed information (such as the setting of individual randomised controlled trials) were excluded, which may have resulted in the omission of relevant interventions.

    Introduction

    Employment is important for many patients dealing with (chronic) health conditions because it provides economic independence, social contact and the possibility to contribute to society.1 Often, chronically ill individuals desire support and guidance to deal with work challenges as an integral part of routine clinical healthcare.2–6 For them, successful treatment ensures the preservation of their ability for social participation, especially in sustaining work participation and income.7–9

    Clinical healthcare is defined as healthcare that takes place in or originates from a hospital setting (also referred to as secondary or tertiary care). Providing attention to work challenges during routine clinical healthcare encounters from the onset of diagnosis promotes better outcomes.10–12 Patients are more empowered in decision-making and more self-reliant when they are provided with support and guidance for their work participation challenges.13 14 In addition, specialists who give attention to patient needs related to work participation experience better patient relationships.15 As such, patients could benefit from work participation being integrated as a treatment goal.16–18 However, it is unknown what interventions medical professionals providing clinical care in a hospital setting could use to enhance work participation.

    There is thus a great need for systematic reviews (SRs) that focus on the effectiveness of work participation interventions that can be integrated into clinical care. The number of SRs investigating interventions that aim to improve work participation for patients is increasing.19–21 However, these reviews do not specifically focus on clinical healthcare interventions to maintain or return to work (RTW). Furthermore, interventions aimed at enhancing work participation often include various elements, which can be broadly categorised under the categories of psycho-educational, vocational, physical and medical. Although previous research has identified common elements within interventions,22 23 these reviews did not identify which aspects of the interventions showed greatest promise. We define promising elements as those that are frequently included in effective interventions. Detecting these promising elements across health conditions could aid in decision-making when it comes to incorporating work participation support into treatment clinical healthcare.

    This review aims to provide an overview of SRs that assess the effectiveness of interventions aimed at improving work participation for patients treated in clinical healthcare settings. Evidence from this review can inform and support the development of future clinical guidelines by providing recommendations to improve work participation.

    Our research aims are as follows:

    1. To evaluate the effectiveness of interventions that aimed at improving work participation initiated within clinical healthcare, compared with usual care, in people being treated for various health conditions.

    2. To identify promising elements within the most effective interventions across health conditions.

    Methods

    Protocol registration

    We registered our review protocol with PROSPERO (reference number: CRD42022346552). The review is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.24 25

    Patient and public involvement

    This review was conducted to support the development of a generic module for work participation in medical specialist guidelines in the Netherlands.26 The module was created at the request of patient organisations to structurally embed the topic of work into clinical care. The guideline panel developing this module (consisting of representatives from various scientific associations of medical specialists as well as patient representatives) provided feedback on our review protocol. The results of the first research aim were used by the guideline panel. Later, our research group added a second research objective to the review.

    Eligibility criteria

    Population, Intervention, Comparator, Outcome, and Setting (PICOS) were specified to identify eligible SRs of randomised controlled trials (RCTs) or cluster RCTs on the effectiveness of interventions aiming at enhancing work participation (table 1). We restricted our review to RCTs because this research design is more likely to provide unbiased information about the effectiveness of interventions than non-randomised studies of interventions.27 Work participation was defined as paid employment, which includes full- or part-time work and excludes voluntary work and unpaid domestic labour. For inclusion, the aim of the intervention had to be for patients to maintain or RTW. The intervention could be aimed at an individual patient or a group of patients and could be undertaken by any qualified (para)medical professional (eg, medical specialist or specialised nurse) embedded within a clinical secondary or tertiary healthcare setting. We were interested in both short-term (ie, less than 6 months), medium-term (ie, between 6 months and 1 year), as well as long-term outcomes (ie, more than 1 year). We excluded SRs that lacked an explicit review objective, search strategy, inclusion criteria, quality assessment methods and data synthesis plan. We only included SRs that were published in English or Dutch.

    View this table:
    Table 1

    Population, Intervention, Comparator, Outcome, and Setting eligibility criteria

    Information sources and search strategy

    An exhaustive search was conducted by an information specialist (FSJ) in four databases: MEDLINE (Ovid), Embase (Ovid), Cochrane Database of Systematic Reviews (Wiley) and CINAHL (EBSCOhost), covering the period from January 2012 to December 2023. The search strategy was designed with three main components: ‘work participation’, ‘setting’ and a ‘systematic review filter’. It was limited to SRs published in the last decade, though included RCTs could extend further back in time. The reason for this limitation is that the focus on work participation in clinical practice was considerably more limited before that period. As such, it does justice to how contemporary care is organised. Studies about geriatrics, paediatrics and animals were also excluded. Ongoing or recently completed (unpublished) SRs were not included in the search. The detailed search queries for all four databases are presented in online supplemental appendix A.

    Supplemental material

    Screening and selecting

    Two reviewers (LK and AdW/AB) independently screened the titles and abstracts using a machine learning algorithm with the open-source software ASreview.28 This algorithm presented the most relevant articles first and continuously calculated which articles were most relevant based on the decisions the reviewers made as the process went on. This made it unnecessary to screen all titles and abstracts. Each reviewer stopped after screening 200 irrelevant articles in a row, but we ensured that each reviewer screened at least 20% of all titles. Afterwards, the data sets of the two reviewers were compared, and any disagreements were resolved until consensus was reached. We used the standard settings of the software, which have been proven to provide the best results28 (online supplemental appendix B). Full-text screening was done by a pair of two reviewers (LK and AdW/AB) independently using the online SR tool Rayyan Systems Inc (rayyan.ai). Disagreements were resolved through discussion, with the review team consulted as necessary. All SRs were checked for recent updates. When multiple SRs addressed the same health condition (eg, two or more SRs considering cancer), we selected the highest-quality SR based on the AMSTAR-2 risk-of-bias (RoB) assessment29 (see below) or—in case of equal quality—the most recent SR to avoid double inclusion of primary studies.

    Evaluation of methodological quality of included SRs

    One reviewer (LK) assessed the methodological quality of the included SRs using the AMSTAR-2 tool,29 which was then cross-checked by another reviewer (AdW). Disagreements were resolved through discussion. We determined the overall confidence in each of the SRs’ quality relative to our review question by critically evaluating all items of the AMSTAR-2 tool. We selected six critical items for this assessment: Q1 (Were PICO components included?), Q4 (Was there a comprehensive literature search?), Q8 (Were included studies described in adequate detail?), Q9 (Was a satisfactory technique for assessing the RoB used?), Q11 (Were appropriate methods for statistical combination of results of RCTs used?) and Q12 (Was the potential impact of RoB in individual studies assessed on the results?). These items were chosen to ensure our confidence in the SRs’ quality, given that we did not intend to search for or select primary studies, extract data, reanalyse data or reassess the RoB ourselves. The confidence levels were determined as follows: no critical flaws and zero or one non-critical flaw resulted in high confidence, no critical flaws and more than one non-critical flaw resulted in moderate confidence, one critical flaw with or without non-critical flaws resulted in low confidence and more than one critical flaw with or without non-critical flaws resulted in critically low confidence.

    Data extraction

    Data were extracted by LK and cross-checked by AdW. Disagreements between the reviewers were resolved through discussion, and, if necessary, a third reviewer was involved. We used a data extraction form designed and piloted by the review team to extract data on SR methodology and characteristics, characteristics of the primary studies and SR findings. Since the scope of the included SRs had the potential to be broader than our research aim, we also reviewed the eligibility of individual RCTs within each SR and only extracted data from individual RCTs that met our eligibility criteria. When individual RCTs that did not meet our eligibility criteria were included in a meta-analysis within the SR, we made a note of this and discussed with the review team as to whether this would influence the certainty of the evidence (see below).

    Reporting and synthesis of findings

    We reported findings from the SRs descriptively, detailing the characteristics of all included SRs. This included the range of SR topics (ie, types of populations, types of interventions and their contexts and setting), the range of outcomes reported and the quality of the SRs. We synthesised information on common issues related to reporting quality, methodological quality and quality of evidence. We did not reanalyse data from the primary studies; however, we did determine the risk ratio (RR) when the assumed risk of comparator and intervention was provided and the SR authors had not reported the RR themselves.

    To facilitate the interpretation of the results regarding the effectiveness of interventions to enhance work participation, we first organised all outcomes by type of health condition (eg, cancer, coronary heart disease) and then by type of intervention (ie, psycho-educational, vocational, physical, medical or multidisciplinary). For each outcome, we rated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.30 We used the certainty of the evidence ratings provided in the included SRs when available; otherwise, we assessed it ourselves using the GRADE criteria. We adopted the SR authors’ assessment of the RoB in the primary studies. Details of the GRADE are available in online supplemental appendix C.

    To analyse the promising elements of effective interventions across different health conditions, we used a deductive synthesis. We developed a framework based on the elements of the four types of interventions described in our protocol. If an element did not fit in the framework, this element was added to the framework. The elements of individual RCTs as reported in the SRs were scored and then added up to determine the frequency for each type of intervention by health condition. Finally, we identified the intervention types most likely to be effective for a given health condition, as determined by our GRADE-based assessment to understand which elements could be considered promising. We considered an element promising if it appeared more than once across two or more of the effective intervention types for various health conditions.

    Results

    Results of the search

    The search strategies identified 4615 titles, which were reduced to 3934 titles after deduplication and uploaded to ASreview. Following this, 97 articles were retrieved and screened for full text, resulting in 13 SRs being selected for methodological quality assessment (figure 1). Reasons for exclusion of SRs based on full-text screening can be found in online supplemental appendix D. The methodological quality assessment allowed us to filter out lower-quality SRs on the same interventions and patient populations, ensuring that only higher-quality SRs were retained.

    Figure 1
    Figure 1

    Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. RCTs, randomised controlled trials; SRs, systematic reviews.

    Of the 13 selected SRs (table 2, online supplemental table S1, online supplemental appendix E), we excluded 5 lower-quality SRs that reported on similar patient populations (ie, three regarding people with cancer,31–33 one regarding people with coronary heart disease,34 one regarding people with chronic low back pain35 and one with a more recent update by a different author group available regarding patients with inflammatory arthritis).36 Of the seven remaining SRs, the overall confidence in the quality was high in two SRs,37 38 moderate in two SRs39 40 and low to critically low in the remaining SRs.41–43 Common problems that downgraded quality confidence included limitations in the description of the search strategy, lack of complete description of one or more PICO components and lack of assessment of potential RoB in individual studies on the results of the meta-analyses.

    Supplemental material

    View this table:
    Table 2

    Risk of bias of the included systematic reviews using AMSTAR-2 (critical items only)

    Description of included SRs

    A summary of the characteristics of the seven included SRs is presented in table 3. These SRs covered diverse populations, including people with cancer,37 people with chronic low back pain and chronic musculoskeletal pain,40 people with coronary heart disease,38 people with inflammatory arthritis,43 pregnant women with complaints of the lumbopelvic region,41 poststroke individuals42 and people with traumatic brain injuries.39 Three SRs were Cochrane reviews.37–39 The number of RCTs that were included in the SRs ranged from 5 to 50, with a median of 13. Many individual RCTs within these SRs lacked adequate descriptions of the setting or clarity on the work participation outcomes used, leading to their exclusion from our review. The majority of the SRs focused on interventions to enhance work participation, including psycho-educational, vocational, physical or multidisciplinary approaches, but none addressed medical interventions. The most reported work participation outcome was the proportion of participants returning to work within 12 months. Several SRs did not perform meta-analyses due to heterogeneity of interventions and/or outcomes, or low numbers of RCTs.

    View this table:
    Table 3

    Characteristics and PICOS elements of included reviews

    Effectiveness of interventions for specific health conditions

    A summary of the main findings is presented in online supplemental table S2. Although the interventions varied slightly in name and were applied across different health conditions, many of these interventions targeting work participation showed a trend towards small, favourable effects. Statistically significant results were observed only in some of the more frequently studied health conditions.

    Supplemental material

    Cancer

    In total, data from 14 RCTs included in the SR of work interventions for people with cancer37 were eligible for our review, analysing the results from a total of 1477 patients. Most studies evaluated breast cancer, but other types of cancer (eg, prostate cancer, cancer of head and neck, cervical cancer or colorectal cancer) were also present in the study sample. Four studies investigated psycho-educational interventions that aimed to ameliorate the psychological consequences of the diagnosis and treatment of cancer on ability to work. These interventions often started when active treatment was still being provided, had a duration of anywhere between 4 weeks and 6 months, and were provided by multidisciplinary teams. Four studies examined physical interventions designed to improve the physical consequences of the diagnosis and treatment of cancer on the ability to work. The duration of these interventions ranged from 12 weeks to 6 months, and timing was either synchronised with chemotherapy treatment or took place several weeks after surgery. The involved professionals were physiotherapists, exercise instructors, health educators and nurses. Finally, six studies investigated multidisciplinary interventions that aimed to amend the psychological, vocational and/or physical consequences of the diagnosis and treatment of cancer on the ability to work. Most interventions started after active treatment, lasted from 4 weeks to 14 months and involved multidisciplinary teams.

    Overall, the RoB was low for eight RCTs and high for six RCTs (according to the SRs’ authors).

    • Physical interventions likely increase RTW at 12 months compared with usual care (RR 1.23, 95% CI 1.08 to 1.39; moderate certainty evidence) in people with cancer.

    • Multidisciplinary interventions likely increase RTW at 12 months compared with usual care (RR 1.23, 95% CI 1.09 to 1.33; moderate certainty evidence) in people with cancer.

    • Psycho-educational interventions likely result in little to no difference in RTW at 12 months compared with usual care (RR 1.09, 95% CI 0.96 to 1.24; moderate certainty evidence) in people with cancer.

    Chronic low back pain and chronic musculoskeletal pain

    From the SR considering people with chronic low back pain and chronic musculoskeletal pain,40 data from five RCTs focusing on low back pain and from five RCTs focusing on musculoskeletal pain were eligible for our review. The sample consisted of 1548 people with chronic low back pain and 1825 with chronic musculoskeletal pain. Chronic pain was defined as pain which persisted for more than 3 months by the SR authors. Three RCTs investigated psycho-educational interventions, one RCT reported on a vocational intervention, three RCTs evaluated physical training and six RCTs investigated multidisciplinary interventions. The aims and characteristics were similar for all interventions. All interventions aimed to improve the employees’ psychological and/or physical capacity, enabling them to successfully RTW. The interventions took place during the chronic phase of the condition and lasted from 3 days to 3 months led by a physiotherapist or a multidisciplinary team.

    According to the SR authors, the RoB was low for two RCTs, unclear for two RCTs and high for six RCTs. The SR authors did not perform any meta-analysis due to heterogeneity of the outcome measures.

    • Multidisciplinary interventions may reduce the number of sick leave days at 12 months compared with usual care (82, IQR 51 to 164 vs 175, IQR 91 to 365; p=0.003; low certainty evidence) in people with low back pain.

    • Psycho-educational interventions may result in little to no difference in RTW at 23 months compared with usual care (RR 1.42, 95% CI 0.87 to 2.33; low certainty evidence) in people with chronic musculoskeletal pain.

    • The evidence is very uncertain about the effects of psycho-educational, vocational, physical and multidisciplinary interventions on work participation at any point in time other than in the points mentioned above compared with usual care or other interventions (very low certainty evidence) in people with chronic low back pain and chronic musculoskeletal pain alike.

    Coronary heart disease

    In total, data from 34 RCTs from the SR that focused on interventions to support work participation for people with coronary heart disease38 were selected for our analysis, covering a total of 4438 patients. Most studies included patients who had experienced (acute) myocardial infarction. 11 studies evaluated psycho-educational interventions that aimed to facilitate RTW by changing peoples’ perceptions of their illness such that they could consider themselves to be capable workers again and not merely recovering patients. These interventions often started immediately after the coronary heart event occurred and lasted anywhere from the duration of the patient’s hospital stay to 5.5 months. They were provided by nurses, psychologists and cardiologists and/or attending physicians. Four studies investigated vocational interventions that aimed to facilitate RTW by reducing perceived or actual barriers through measures such as implementing workplace design changes, scheduling pauses and similar adjustments. These interventions started immediately after the coronary heart event occurred and lasted between a single session and 3 weeks, and they were provided by the same professionals as psycho-educational interventions. Nine studies evaluated physical interventions that aimed to facilitate RTW by equipping patients with the level of functional capacity necessary to perform work tasks safely and successfully. These interventions started anywhere from 1 to 3 days to 8 weeks after discharge from the hospital (with one exceptional case starting after 7 months), had a duration that ranged from 2 to 12 months and were conducted by physical therapists. Finally, 13 studies investigated multidisciplinary interventions that combined components of the abovementioned intervention types. These interventions started either during hospital admission (immediately after the coronary heart event) or between 3 weeks and 6 months after discharge from the hospital. They lasted between 2 months and 5 years and were carried out by multidisciplinary teams.

    As evaluated by the original review authors, the RoB was high in 12 RCTs, low in 6 RCTs and unclear in 16 RCTs.

    • Multidisciplinary interventions are likely to reduce the days of RTW compared with usual care (40.77 days lower than control, 95% CI −67.19 to −14.35; moderate certainty evidence), and they may increase RTW at 6 months compared with usual care (RR 1.56, 95% CI 1.23 to 1.98; low certainty evidence) in patients with coronary heart disease, but they may result in little to no difference compared with usual care in RTW at 6−12 months (RR 1.06, 95% CI 1.00 to 1.13; low certainty evidence) in patients with coronary heart disease.

    • Physical intervention may increase RTW at more than 5 years compared with usual care (RR 1.83, 95% CI 1.26 to 2.66; low certainty evidence) in patients with coronary heart disease, but they may result in little to no difference in RTW at 6−12 months (RR 1.09, 95% CI 0.99 to 1.20; low certainty evidence), 1−5 years (RR 1.04, 95% CI 0.82 to 1.30; low certainty evidence) and may not reduce or increase days until RTW (7.86 days lower than control, 95% CI −29.46 to 13.74; low certainty evidence) compared with usual care in patients with coronary heart disease.

    • Vocational interventions may result in little to no difference compared with usual care in RTW at 6 months (RR 1.06, 95% CI 0.87 to 1.28; low certainty evidence), 6−12 months (from two RCTs,respectively, RR 1.07, 95% CI 0.97 to 1.17, and RR 0.91, 95% CI 0.83 to 1.0; low certainty evidence), 1−5 years (RR 1.00, 95% CI 0.89 to 1.12; low certainty evidence) and may not reduce or increase days until RTW (7.52 days lower than control, 95% CI −20.07 to 5.03; low certainty evidence) compared with usual care in patients with coronary heart disease.

    • Psycho-educational interventions may result in little to no difference in RTW at 1−5 years (RR 1.09, 95% CI 0.88 to 1.34; low certainty evidence) compared with usual care.

    • The evidence is very uncertain about the effect of psycho-educational, physical and multidisciplinary interventions on work participation at any point in time other than in the points mentioned above compared with usual care (very low certainty evidence) in patients with coronary heart disease.

    Inflammatory arthritis

    In total, data from three RCTs that were included in the SR that focused on job loss prevention interventions for people with inflammatory arthritis (including rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis)43 met our eligibility criteria, analysing a total of 224 patients. The job loss prevention interventions aimed to improve work ability or decrease absenteeism and job loss. The interventions contained educational and vocational elements and occurred during the chronic phase of the disease, lasting between 1 and 6 months and involving a multidisciplinary team or a single occupational therapist.

    The RoB was low for all three RCTs according to the SR authors. The SR authors did not perform any meta-analysis due to heterogeneity of the outcome measures.

    • Job loss prevention interventions may result in little to no difference in job loss at 6 months (RR 0.97, 95% CI 0.90 to 1.03; low certainty) and 9 months (RR 0.93, 95% CI 0.84 to 1.023; low certainty) compared with usual care in patients with inflammatory arthritis.

    • The evidence is very uncertain about the effect of job loss prevention interventions on absenteeism at any point in time compared with usual care (very low certainty) in patients with inflammatory arthritis.

    Pregnant women with complaints of the lumbopelvic region

    From the SR describing pregnant women with complaints of the lumbopelvic region41 we included two RCTs with a total sample of 1156 women. The interventions aimed to reduce sick leave due to lumbopelvic pain during pregnancy. Both RCTs described a 12-week physical training (with both aerobic and strength training components) which started between gestation weeks 20–24 and was led by a physiotherapist.

    The RoB of these RCTs was low according to the SR authors. The SR authors did not perform a meta-analysis.

    • The evidence is very uncertain about the effect of physical training on reducing sick leave due to lumbopelvic pain compared with usual care (for each RCT, respectively, RR 0.84, 95% CI 0.56 to 1.28; and RR 0.73, 95% CI 0.58 to 0.94; very low certainty) in pregnant women at 32–36 weeks of gestation.

    Stroke

    Findings from one RCT with a moderate RoB from the SR describing poststroke individuals42 were extracted from this SR. The sample of this study consisted of 80 patients who were post-stroke and investigated a tailored workplace rehabilitation intervention aiming to improve RTW rates for these adults.

    • The evidence is very uncertain about the effect of tailored workplace rehabilitation on RTW at 6 months compared with usual care (very low certainty) in poststroke patients.

    Traumatic brain injury

    The SR concerning people with traumatic brain injury39 focused specifically on cognitive rehabilitation interventions that aimed to improve the overall performance of people with traumatic brain injuries by enhancing specific cognitive aspects such as memory, visuospatial abilities, apraxia and aphasia. In total, data from four RCTs included in this SR were eligible for our analysis. These RCTs analysed 604 people with mild-to-severe traumatic brain injuries. All but one of the RCTs reported on war veterans. The interventions started during medical recovery from the brain injury and lasted between 20 days and 16 weeks, involving an interdisciplinary team, a psychiatric nurse or an employment specialist.

    The RoB was assessed as low in three RCTs and high in one by the SR authors. The SR authors could not perform a meta-analysis due to the heterogeneity of the outcome measures.

    • Cognitive rehabilitation likely results in little to no difference in RTW at 12 months compared with another cognitive strategy (RR 1.10, 95% CI 0.83 to 1.46; moderate certainty); hospital-based cognitive rehabilitation likely results in little to no difference in RTW at 2 years compared with a home programme (RR 0.95, 95% CI 0.85 to 1.05; moderate certainty) in people with traumatic brain injury.

    • Cognitive rehabilitation may result in little to no difference in RTW at 6 months compared with usual care (RR 0.95, 95% CI 0.85 to 1.05; low certainty); the evidence is very uncertain about the effect of cognitive rehabilitation on RTW at 14 weeks compared with no treatment (RR 1.43, 95% CI 0.87 to 2.33; very low certainty) in people with traumatic brain injury.

    Promising elements of the interventions

    Figure 2 provides an overview of the elements that were included in the interventions. Multidisciplinary interventions for people with cancer, coronary heart disease and low back pain37 38 40 and physical interventions for people with cancer37 were likely or possibly effective. Therefore, elements were considered promising primarily when they were used in multidisciplinary interventions. Physical elements were also deemed promising in physical interventions for people with cancer. Combinations of elements within focused psycho-educational, vocational or physical interventions did not lead to effective outcomes. Overall, a few interventions included tailored programmes that offered elements based on patients’ specific needs. However, there is no distinction whether these tailored approaches were applied in effective interventions or in those with a low certainty of evidence.

    Figure 2
    Figure 2

    Elements of the interventions aiming to enhance work participation.

    Among the implemented psycho-educational elements, promising elements included psychoeducation about coping skills related to stress, fatigue or fear; education about disease and treatment or prevention and lifestyle; cognitive-behavioural therapy, psychosocial support; and group counselling or therapy. Within the vocational interventions, vocational counselling was found to be promising. Finally, within the psychical interventions, strength training, aerobics training and low-intensity exercises or exercise therapy were all promising elements.

    Discussion

    To the best of our knowledge, this is the first overview of SRs that examines the effectiveness of interventions to enhance work participation for patients in a clinical healthcare setting and identify promising elements within these effective interventions across various health conditions. We identified SRs that considered people with cancer,37 people with chronic low back pain and chronic musculoskeletal pain,40 people with coronary heart disease,38 people with inflammatory arthritis,43 pregnant women with complaints of the lumbopelvic region,41 poststroke individuals42 and people with traumatic brain injuries.39 For people with cancer, we found moderately certain evidence that multidisciplinary and physical interventions are likely to increase the RTW rate at 1 year. For people with coronary heart disease, we found moderate certainty evidence that multidisciplinary interventions are likely to reduce the days of RTW compared with usual care, and low-certainty evidence that multidisciplinary interventions may increase RTW at 6 months and probably also reduce the time away from work. Finally, for people with chronic low back pain, we found low-certainty evidence that multidisciplinary interventions may reduce the number of sick leave days during the first 12 months. (Psycho)education, cognitive-behavioural therapy, psychosocial support, group counselling or therapy, vocational counselling, strength training, aerobics training and low-intensity exercises or exercise therapy could be promising elements across health conditions for interventions aiming to enhance work participation.

    Overall, multidisciplinary interventions seemed to be the most favourable for improving work participation (compared with usual care). We are uncertain about the effectiveness of many other interventions due to limitations such as small sample sizes, single studies reporting on a particular outcome and limitations in the quality of reporting of the SRs or individual studies themselves. However, when reviewing the interventions with low or very low GRADE scores in detail, many outcomes indicated a positive trend in favour of those interventions aimed at improving work participation. This trend is also found in other reviews examining vocational interventions.19 44–46 Although overall the effects are uncertain because we did not combine the data due to heterogeneity in the interventions, the outcome measures and the patient populations, this does not negate the potential effectiveness of these less investigated interventions. Therefore, despite the low certainty of the evidence, it is possible that additional interventions or elements of interventions could be shown to positively impact work participation.23 47 48

    Considerable variation in dose and other intervention characteristics was noted. This heterogeneity could be another reason for the limited effects reported and often led to the original review authors refraining from performing a meta-analysis.39–41 43 For example, it is reasonable to expect different results among physical interventions when participants receive supervised training from a physical therapist twice a week compared with participants performing exercises at home unsupervised.49 This heterogeneity makes it difficult to compare the different interventions.

    Multidisciplinary interventions were shown to be favourable across health conditions compared with psycho-educational, vocational or physical interventions alone. This might be a result of the synergy of multiple elements or the fact that individuals are exposed to a mix of the right elements within multidisciplinary interventions.40 44 50 Yet, providing the same elements and doses in multidisciplinary interventions to all patients could also result in providing unnecessary care, since individual patients have different needs. Tailored interventions may be suggested as a more targeted alternative. Tailored interventions could provide substantial effects for enhancing work participation and might be more cost-efficient than non-tailored interventions.46 51–54

    To make informed decisions about which elements to provide in a tailored intervention, it is important to understand the working mechanisms of the various promising elements that were detected in this overview of SRs. Promising elements were defined as those elements that were frequently included in effective interventions. The elements that were identified as promising could be integrated into a tailored intervention aiming to enhance work participation in hospital-based clinical care setting. Psychoeducation including coping with fatigue, stress or fear by developing relaxation and self-acceptance skills55 and education about disease pathology and lifestyle both address people’s perceptions of their illnesses and their own roles in their rehabilitation process. Addressing people’s perceptions of illness and responsibility in rehabilitation can indirectly influence work ability.37 38 56 57 Cognitive-behavioural therapy can likewise enhance this; it is an effective aid for people in returning to work in that it focuses on improving cognition and underlying thought processes that may cause people to take sick leave.58 59 Psychosocial support often includes involving family members or significant others, especially for people with coronary heart disease.38 Involving spouses may further enhance people’s likelihood to adhere to lifestyle rules or training programmes and be a motivating factor for RTW.21 60 The social support resulting from involving others in treatment was also incorporated in some group-based interventions.38 39 41 Providing RTW advice during vocational counselling could potentially influence an individual’s own prediction about RTW, which has a significant impact on actual RTW outcomes.61–63 Finally, physical training, regardless of its exact form, can be a promising element for ensuring an individual has the necessary functional capacity to perform work.37 38 64 65 By understanding these different mechanisms and knowing the specific needs of a certain patient population, an informed decision can be made to design an effective tailored intervention that is more likely also cost-effective.

    Methodological considerations

    This overview of SRs provides a comprehensive summary of interventions and their effectiveness to enhance work participation within clinical healthcare. Rather than repeating study eligibility, assessing RoB or performing a meta-analysis of the included studies, we integrated the available evidence from seven SRs that focused on specific health conditions to present a comprehensive picture.66 This picture was created with a deductive synthesis and allowed us to detect promising elements across a variety of interventions aimed at improving work participation for different health conditions, which are often described by other authors as heterogeneous.20 23 44 46 55 Furthermore, GRADE was used to evaluate the certainty of evidence.30

    To ensure that we presented the highest available quality of evidence and avoided redundancy, we conducted a comprehensive RoB assessment of the available SRs by employing AMSTAR-229 which we used to make our final selection of SRs. A downside of our strict eligibility criteria is that we excluded SRs that lacked detailed information (such as the setting of the individual RCTs). Several SRs that we excluded based on missing information about the setting covered vocational interventions.44 67 68 This probably caused the notable lack of vocational intervention elements in the subgroup of vocational interventions compared with multidisciplinary interventions (figure 2), whereas these elements might be delivered within clinical healthcare.

    Implications for practice and research

    To further inform guideline developers and policymakers about work participation as a treatment goal, future research should focus on generating meta-analyses for those patient populations we did not detect with this overview of SRs. When a lack of evidence is found, new RCTs can be designed and implemented. Furthermore, more harmonised usage of work participation outcomes is recommended because most of the SRs we included were unable to perform a meta-analysis due to the heterogeneity of the outcome measures. A solution to reduce future heterogeneity could be for experts to agree on a core set of minimum outcomes which should be measured in all trials in a specific health area.69 Applying a recently proposed framework to select work participation outcomes70 could aid in including the most appropriate work participation outcomes for that specific health area.

    Conclusion

    There is considerable overlap in interventions that aim to enhance work participation for patients treated within a clinical healthcare setting across health conditions. Although their effects on work participation vary, some diseases like cancer show favourable results from multidisciplinary interventions. Across interventions and diseases included in this overview, promising elements were (psycho)education, cognitive-behavioural therapy, psychosocial support, group counselling or therapy, vocational counselling, strength training, aerobics training and low-intensity exercises or exercise therapy. However, in our comprehensive search, SRs were found for only seven health conditions. To support evidence-based policy and practice, there is a need for more research on the health conditions that could not be included in this review. For the evidence we did find, further research is recommended to develop tailored interventions and evaluate their cost-effectiveness.

    Supplemental material

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. All data supporting the findings of this review are available within the paper and its supplementary material.

    Ethics statements

    Patient consent for publication

    Ethics approval

    Not applicable.

    References

    1. ↵
      2. Vooijs M ,
      3. Leensen MCJ ,
      4. Hoving JL , et al
      . Value of work for employees with a chronic disease. Occup Med 2018;68:26–31. doi:10.1093/occmed/kqx178
      OpenUrl
    2. ↵
      2. Newington L ,
      3. Brooks C ,
      4. Warwick D , et al
      . Return to work after carpal tunnel release surgery: a qualitative interview study. BMC Musculoskelet Disord 2019;20:242. doi:10.1186/s12891-019-2638-5
    3. ↵
      2. Bosma AR ,
      3. Boot CRL ,
      4. Schaafsma FG , et al
      . Facilitators, barriers and support needs for staying at work with a chronic condition: a focus group study. BMC Public Health 2020;20:201. doi:10.1186/s12889-020-8320-x
    4. ↵
      2. Van der Meer M ,
      3. Hoving JL ,
      4. Vermeulen MIM , et al
      . Experiences and needs for work participation in employees with rheumatoid arthritis treated with anti-tumour necrosis factor therapy. Disabil Rehabil 2011;33:2587–95. doi:10.3109/09638288.2011.582923
      OpenUrlCrossRefPubMed
    5. ↵
      2. Hagendijk ME ,
      3. Zipfel N ,
      4. Oomen FJ , et al
      . Work-focused healthcare from the perspective of employees living with cardiovascular disease: a patient experience journey mapping study. BMC Public Health 2023;23:1765. doi:10.1186/s12889-023-16486-x
    6. ↵
      2. Hagendijk ME ,
      3. Zipfel N ,
      4. Melles M , et al
      . Patients’ Needs Regarding Work-Focused Healthcare: A Qualitative Evidence Synthesis. J Occup Rehabil 2024. doi:10.1007/s10926-024-10225-8
    7. ↵
      2. Dugan AG ,
      3. Decker RE ,
      4. Namazi S , et al
      . Perceptions of clinical support for employed breast cancer survivors managing work and health challenges. J Cancer Surviv 2021;15:890–905. doi:10.1007/s11764-020-00982-9
      OpenUrl
    8. ↵
      2. Isaksson J ,
      3. Wilms T ,
      4. Laurell G , et al
      . Meaning of work and the process of returning after head and neck cancer. Support Care Cancer 2016;24:205–13. doi:10.1007/s00520-015-2769-7
      OpenUrl
    9. ↵
      2. Ullah MM ,
      3. Fossey E ,
      4. Stuckey R
      . The meaning of work after spinal cord injury: a scoping review. Spinal Cord 2018;56:92–105. doi:10.1038/s41393-017-0006-6
      OpenUrl
    10. ↵
      2. Waddell G ,
      3. Burton A
      . Is work good for your health and well-being. London: The Stationery Office, 2006.
    11. ↵
      2. Bartys S ,
      3. Edmondson A ,
      4. Burton K , et al
      . Work conversations in healthcare: how, where, when and by whom: a review to understand conversations about work in healthcare and identify opportunities to make work conversations a part of everyday health interactions. London: Public Health England, 2019.
    12. ↵
      2. Holmlund L ,
      3. Guidetti S ,
      4. Eriksson G , et al
      . Return-to-work: Exploring professionals’ experiences of support for persons with spinal cord injury. Scand J Occup Ther 2021;28:571–81. doi:10.1080/11038128.2020.1795245
      OpenUrl
    13. ↵
      2. Paniccia A ,
      3. Colquhoun H ,
      4. Kirsh B , et al
      . Youth and young adults with acquired brain injury transition towards work-related roles: a qualitative study. Disabil Rehabil 2019;41:1331–42. doi:10.1080/09638288.2018.1425743
      OpenUrl
    14. ↵
      2. Nordgren L ,
      3. Söderlund A
      . Associations between socio-demographic factors, encounters with healthcare professionals and perceived ability to return to work in people sick-listed due to heart failure in Sweden: a cross-sectional study. Disabil Rehabil 2016;38:168–73. doi:10.3109/09638288.2015.1031289
      OpenUrl
    15. ↵
      2. Moscrop A ,
      3. Ziebland S ,
      4. Roberts N , et al
      . A systematic review of reasons for and against asking patients about their socioeconomic contexts. Int J Equity Health 2019;18:112. doi:10.1186/s12939-019-1014-2
    16. ↵
      2. Kosny A ,
      3. Lifshen M ,
      4. Yanar B , et al
      . The Role of Healthcare Providers in Return to Work. Int J Disabil Manag 2018;13:e3. doi:10.1017/idm.2018.4
    17. ↵
      2. Szekeres M ,
      3. Macdermid JC ,
      4. Katchky A , et al
      . Physician decision-making in the management of work related upper extremity injuries. Work 2018;60:19–28. doi:10.3233/WOR-182724
      OpenUrl
    18. ↵
      2. Wieczorek M ,
      3. Verstappen SM ,
      4. Putrik P , et al
      . Association of vocational interventions and work-related factors with disease and work outcomes in people with RMDs: A systematic review. Semin Arthritis Rheum 2023;58:152135. doi:10.1016/j.semarthrit.2022.152135
      OpenUrl
    19. ↵
      2. Levack WMM ,
      3. Fadyl JK
      . Vocational interventions to help adults with long-term health conditions or disabilities gain and maintain paid work: an overview of systematic reviews. BMJ Open 2021;11:e049522. doi:10.1136/bmjopen-2021-049522
    20. ↵
      2. Vooijs M ,
      3. Leensen MCJ ,
      4. Hoving JL , et al
      . Interventions to enhance work participation of workers with a chronic disease: a systematic review of reviews. Occup Environ Med 2015;72:820–6. doi:10.1136/oemed-2015-103062
      OpenUrlAbstract/FREE Full Text
    21. ↵
      2. Cocchiara RA ,
      3. Sciarra I ,
      4. D’Egidio V , et al
      . Returning to work after breast cancer: A systematic review of reviews. Work 2018;61:463–76. doi:10.3233/WOR-182810
      OpenUrl
    22. ↵
      2. Tamminga SJ ,
      3. de Boer AGEM ,
      4. Verbeek JHAM , et al
      . Return-to-work interventions integrated into cancer care: a systematic review. Occup Environ Med 2010;67:639–48. doi:10.1136/oem.2009.050070
      OpenUrlAbstract/FREE Full Text
    23. ↵
      2. Xie Y ,
      3. Hutting N ,
      4. Bartys S , et al
      . Interventions to Promote Work-Focused Care by Healthcare Providers for Individuals with Musculoskeletal Conditions a Scoping Review. J Occup Rehabil 2021;31:840–65. doi:10.1007/s10926-021-09971-w
      OpenUrl
    24. ↵
      2. Page MJ ,
      3. McKenzie JE ,
      4. Bossuyt PM , et al
      . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi:10.1136/bmj.n71
    25. ↵
      2. Page MJ ,
      3. Moher D ,
      4. Bossuyt PM , et al
      . PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 2021;372:n160. doi:10.1136/bmj.n160
    26. ↵
      1. Federatie Medisch Specialisten
      . Work participation for medical specialist guidelines [arbeidsparticipatie voor medisch specialistische richtlijnen. 2024. Available: https://richtlijnendatabase.nl/richtlijn/arbeidsparticipatie_voor_medisch_specialistische_richtlijnen/startpagina_en_algemene_inleiding_generieke_module_arbeidsparticipatie_voor_medisch_specialistische_richtlijnen_2024.html [Accessed 15 Oct 2024].
    27. ↵
      2. Higgins JPT TJ ,
      3. Chandler J ,
      4. Cumpston M
      , eds. Cochrane handbook for systematic reviews of interventions version 6.4. Cochrane, 2023.
    28. ↵
      2. van de Schoot R ,
      3. de Bruin J ,
      4. Schram R , et al
      . An open source machine learning framework for efficient and transparent systematic reviews. Nat Mach Intell 2021;3:125–33. doi:10.1038/s42256-020-00287-7
      OpenUrl
    29. ↵
      2. Shea BJ ,
      3. Reeves BC ,
      4. Wells G , et al
      . AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 2017;358:j4008. doi:10.1136/bmj.j4008
    30. ↵
      2. Schünemann H ,
      3. Brożek J ,
      4. Guyatt G , et al
      . GRADE handbook for grading quality of evidence and strength of recommendations. The GRADE Working Group, 2013.
    31. ↵
      2. Algeo N ,
      3. Bennett K ,
      4. Connolly D
      . Rehabilitation interventions to support return to work for women with breast cancer: a systematic review and meta-analysis. BMC Cancer 2021;21:895. doi:10.1186/s12885-021-08613-x
    32. ↵
      2. Wilson TN ,
      3. Nambiema A ,
      4. Porro B , et al
      . Effectiveness of Physical Activity Interventions on Return to Work After a Cancer Diagnosis: A Systematic Review and Meta-analysis. J Occup Rehabil 2023;33:4–19. doi:10.1007/s10926-022-10052-9
      OpenUrl
    33. ↵
      2. Lamore K ,
      3. Dubois T ,
      4. Rothe U , et al
      . Return to Work Interventions for Cancer Survivors: A Systematic Review and a Methodological Critique. Int J Environ Res Public Health 2019;16:1343. doi:10.3390/ijerph16081343
    34. ↵
      2. O’Brien L ,
      3. Wallace S ,
      4. Romero L
      . Effect of Psychosocial and Vocational Interventions on Return-to-Work Rates Post–Acute Myocardial Infarction. J Cardiopulm Rehabil Prev 2018;38:215–23. doi:10.1097/HCR.0000000000000261
      OpenUrl
    35. ↵
      2. Ishimaru T ,
      3. Chimed-Ochir O ,
      4. Arphorn S , et al
      . Effectiveness of fitness for work interventions for workers with low back pain: A systematic review. J Occup Health 2021;63:e12261. doi:10.1002/1348-9585.12261
    36. ↵
      2. Hoving JL ,
      3. Lacaille D ,
      4. Urquhart DM , et al
      . Non-pharmacological interventions for preventing job loss in workers with inflammatory arthritis. Cochrane Database Syst Rev 2014;2014:CD010208. doi:10.1002/14651858.CD010208.pub2
    37. ↵
      2. de Boer AG ,
      3. Tamminga SJ ,
      4. Boschman JS , et al
      . Non-medical interventions to enhance return to work for people with cancer. Cochrane Database Syst Rev 2024;2024. doi:10.1002/14651858.CD007569.pub4
    38. ↵
      2. Hegewald J ,
      3. Wegewitz UE ,
      4. Euler U , et al
      . Interventions to support return to work for people with coronary heart disease. Cochrane Database Syst Rev 2019;3:CD010748. doi:10.1002/14651858.CD010748.pub2
    39. ↵
      2. Kumar KS ,
      3. Samuelkamaleshkumar S ,
      4. Viswanathan A , et al
      . Cognitive rehabilitation for adults with traumatic brain injury to improve occupational outcomes. Cochrane Database Syst Rev 2017;6:CD007935. doi:10.1002/14651858.CD007935.pub2
    40. ↵
      2. Wegrzynek PA ,
      3. Wainwright E ,
      4. Ravalier J
      . Return to work interventions for chronic pain: a systematic review. Occup Med 2020;70:268–77. doi:10.1093/occmed/kqaa066
      OpenUrl
    41. ↵
      2. Pedersen P ,
      3. Labriola M ,
      4. Nielsen CV , et al
      . Systematic review of interventions targeting sickness absence among pregnant women in healthcare settings and workplaces. BMJ Open 2018;8:e024032. doi:10.1136/bmjopen-2018-024032
    42. ↵
      2. Proffitt R ,
      3. Boone A ,
      4. Hunter EG , et al
      . Interventions to Improve Social Participation, Work, and Leisure Among Adults Poststroke: A Systematic Review. Am J Occup Ther 2022;76:1–11. doi:10.5014/ajot.2022.049305
      OpenUrl
    43. ↵
      2. Madsen CMT ,
      3. Bisgaard SK ,
      4. Primdahl J , et al
      . A Systematic Review of Job Loss Prevention Interventions for Persons with Inflammatory Arthritis. J Occup Rehabil 2021;31:866–85. doi:10.1007/s10926-021-09972-9
      OpenUrlPubMed
    44. ↵
      2. Verhoef JAC ,
      3. Bal MI ,
      4. Roelofs PDDM , et al
      . Effectiveness and characteristics of interventions to improve work participation in adults with chronic physical conditions: a systematic review. Disabil Rehabil 2022;44:1007–22. doi:10.1080/09638288.2020.1788180
      OpenUrl
    45. ↵
      2. van der Burg LRA ,
      3. Ter Wee MM ,
      4. Boonen A
      . Effect of biological therapy on work participation in patients with ankylosing spondylitis: a systematic review. Ann Rheum Dis 2012;71:1924–33. doi:10.1136/annrheumdis-2012-201914
      OpenUrlAbstract/FREE Full Text
    46. ↵
      2. Butink MHP ,
      3. Webers C ,
      4. Verstappen SMM , et al
      . 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. RMD Open 2023;9:e002903. doi:10.1136/rmdopen-2022-002903
    47. ↵
      2. Noyes S ,
      3. Sokolow H ,
      4. Arbesman M
      . Evidence for Occupational Therapy Intervention With Employment and Education for Adults With Serious Mental Illness: A Systematic Review. Am J Occup Ther 2018;72. doi:10.5014/ajot.2018.033068
    48. ↵
      2. Nieuwenhuijsen K ,
      3. Verbeek JH ,
      4. Neumeyer-Gromen A , et al
      . Interventions to improve return to work in depressed people. Cochrane Database Syst Rev 2020;10:CD006237. doi:10.1002/14651858.CD006237.pub4
    49. ↵
      2. van Waart H ,
      3. Stuiver MM ,
      4. van Harten WH , et al
      . Effect of Low-Intensity Physical Activity and Moderate- to High-Intensity Physical Exercise During Adjuvant Chemotherapy on Physical Fitness, Fatigue, and Chemotherapy Completion Rates: Results of the PACES Randomized Clinical Trial. J Clin Oncol 2015;33:1918–27. doi:10.1200/JCO.2014.59.1081
      OpenUrlAbstract/FREE Full Text
    50. ↵
      2. Steenstra I ,
      3. Cullen K ,
      4. Irvin E , et al
      . A systematic review of interventions to promote work participation in older workers. J Safety Res 2017;60:93–102. doi:10.1016/j.jsr.2016.12.004
      OpenUrl
    51. ↵
      2. Zaman ACGNM ,
      3. Tytgat KMAJ ,
      4. Klinkenbijl JHG , et al
      . Effectiveness of a Tailored Work-Related Support Intervention for Patients Diagnosed with Gastrointestinal Cancer: A Multicenter Randomized Controlled Trial. J Occup Rehabil 2021;31:323–38. doi:10.1007/s10926-020-09920-z
      OpenUrl
    52. ↵
      2. Bültmann U ,
      3. Sherson D ,
      4. Olsen J , et al
      . Coordinated and Tailored Work Rehabilitation: A Randomized Controlled Trial with Economic Evaluation Undertaken with Workers on Sick Leave Due to Musculoskeletal Disorders. J Occup Rehabil 2009;19:81–93. doi:10.1007/s10926-009-9162-7
      OpenUrlCrossRefPubMedWeb of Science
    53. ↵
      2. Kangas P ,
      3. Soini S ,
      4. Pamilo K , et al
      . Return to Work Following Hip or Knee Arthroplasty: A One-Year Prospective Cohort Study in Participants with Direct Referral from Hospital to Occupational Health Care Services. J Occup Rehabil 2024. doi:10.1007/s10926-024-10218-7
    54. ↵
      2. Lavikainen P ,
      3. Heiskanen J ,
      4. Jalkanen K , et al
      . Effectiveness of the Coordinated Return to Work model after orthopaedic surgery for lumbar discectomy and hip and knee arthroplasty: a register-based study. Occup Environ Med 2024;81:150–7. doi:10.1136/oemed-2023-109276
      OpenUrlAbstract/FREE Full Text
    55. ↵
      2. Guo Y-J ,
      3. Tang J ,
      4. Li J-M , et al
      . Exploration of interventions to enhance return-to-work for cancer patients: A scoping review. Clin Rehabil 2021;35:1674–93. doi:10.1177/02692155211021706
      OpenUrl
    56. ↵
      2. Lee BO ,
      3. Fan JY ,
      4. Chan PT , et al
      . Illness Perceptions and Return to Work in Patients With Moderate to Severe Injuries. Rehabil Nurs 2018;43:297–304. doi:10.1097/rnj.0000000000000101
      OpenUrl
    57. ↵
      2. Giri P ,
      3. Poole J ,
      4. Nightingale P , et al
      . Perceptions of illness and their impact on sickness absence. Occup Med (Lond) 2009;59:550–5. doi:10.1093/occmed/kqp123
      OpenUrlPubMed
    58. ↵
      2. Xu H ,
      3. Cai J ,
      4. Sawhney R , et al
      . The Effectiveness of Cognitive-Behavioral Therapy in Helping People on Sick Leave to Return to Work: A Systematic Review and Meta-analysis. J Occup Rehabil 2024;34:4–36. doi:10.1007/s10926-023-10116-4
      OpenUrl
    59. ↵
      2. Mervis JE ,
      3. Lysaker PH ,
      4. Fiszdon JM , et al
      . Addressing defeatist beliefs in work rehabilitation. J Ment Health 2016;25:366–71. doi:10.3109/09638237.2016.1139069
      OpenUrl
    60. ↵
      2. Ahlstrom L ,
      3. Hagberg M ,
      4. Dellve L
      . Workplace rehabilitation and supportive conditions at work: a prospective study. J Occup Rehabil 2013;23:248–60. doi:10.1007/s10926-012-9391-z
      OpenUrl
    61. ↵
      2. Vooijs M ,
      3. Leensen MCJ ,
      4. Hoving JL , et al
      . Disease-generic factors of work participation of workers with a chronic disease: a systematic review. Int Arch Occup Environ Health 2015;88:1015–29. doi:10.1007/s00420-015-1025-2
      OpenUrl
    62. ↵
      2. Rymenans I ,
      3. Vanovenberghe C ,
      4. Du Bois M , et al
      . Process Evaluation of a Motivational Interviewing Intervention in a Social Security Setting: A Qualitative Study among Work-Disabled Patients. J Occup Rehabil 2024;34:141–56. doi:10.1007/s10926-023-10108-4
      OpenUrl
    63. ↵
      2. Kvam L ,
      3. Vik K ,
      4. Eide AH
      . Importance of participation in major life areas matters for return to work. J Occup Rehabil 2015;25:368–77. doi:10.1007/s10926-014-9545-2
      OpenUrlCrossRef
    64. ↵
      2. Egan MY ,
      3. McEwen S ,
      4. Sikora L , et al
      . Rehabilitation following cancer treatment. Disabil Rehabil 2013;35:2245–58. doi:10.3109/09638288.2013.774441
      OpenUrlCrossRefPubMed
    65. ↵
      2. Schaafsma FG ,
      3. Whelan K ,
      4. van der Beek AJ , et al
      . Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain. Cochrane Database Syst Rev 2013;2013:CD001822. doi:10.1002/14651858.CD001822.pub3
    66. ↵
      2. Choi GJ ,
      3. Kang H
      . Introduction to Umbrella Reviews as a Useful Evidence-Based Practice. J Lipid Atheroscler 2023;12:3–11. doi:10.12997/jla.2023.12.1.3
      OpenUrl
    67. ↵
      2. Tingulstad A ,
      3. Meneses-Echavez J ,
      4. Evensen LH , et al
      . Effectiveness of work-related interventions for return to work in people on sick leave: a systematic review and meta-analysis of randomized controlled trials. Syst Rev 2022;11:192. doi:10.1186/s13643-022-02055-7
    68. ↵
      2. Pearce G ,
      3. O’Donnell J ,
      4. Pimentel R , et al
      . Interventions to Facilitate Return to Work after Stroke: A Systematic Review. IJERPH 2023;20:6469. doi:10.3390/ijerph20156469
      OpenUrl
    69. ↵
      2. Kirkham JJ ,
      3. Gargon E ,
      4. Clarke M , et al
      . Can a core outcome set improve the quality of systematic reviews? – a survey of the Co-ordinating Editors of Cochrane review groups. Trials 2013;14:21. doi:10.1186/1745-6215-14-21
      OpenUrlCrossRefPubMedWeb of Science
    70. ↵
      2. Ravinskaya M ,
      3. Verbeek JH ,
      4. Langendam MW , et al
      . A general framework for selecting work participation outcomes in intervention studies among persons with health problems: a concept paper. BMC Public Health 2022;22:2189. doi:10.1186/s12889-022-14564-0

    Footnotes

    • Contributors All authors contributed to the study conception and design; read and approved the final manuscript. LK wrote the first draft of the manuscript. JLH, FSJ, CAMVB, AB, AGEMdB and AdW commented on the manuscript. AdW acted as the guarantor. ASreview was used during the title and abstract screening to limit the time investment to execute this phase. A detailed description of our usage of the technology has been included in the 'Methods' section.

    • Funding This work was supported by Stichting Kwaliteitsgelden Medische Specialisten 2, commissioned by the Knowledge Institute—project 'Z69118343 NOV—More human, less patient: Generic module for work participation in medical specialist guidelines.

    • Competing interests AB was chair of the guideline panel that developed a generic module about work participation in medical specialist guidelines.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the 'Methods' section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.