Improving Employment Outcomes for People with Psychiatric Disorders and Other Disabilities. F. Reviewed of Employment Interventions Outside the United States


We explored systematic reviews of RTW interventions in Organisation for Economic Co-operation and Development (OECD) countries, such as the United Kingdom, Canada, Finland, Sweden, the Netherlands, and others. Carroll et al. (2010) conducted a systematic review comparing workplace and non-workplace interventions for persons with back pain. He found ten articles reporting nine trials from Europe and Canada, and four articles evaluating the cost-effectiveness of interventions. The majority of the trials were of good or moderate quality. Participants in eight trials had back pain and related musculoskeletal conditions, and consisted of full-time or part-time employees on long-term sick leave at the time of the intervention. The authors reported that interventions involving employees, health practitioners, and employers working together to implement work modifications were more consistently effective than those that do not possess such components. The authors also found EI to be effective. Economic evaluations indicated that interventions with a workplace component are likely to be more cost-effective than those without. The authors concluded that stakeholder participation and work modification were more effective and cost-effective than other workplace-linked interventions, including exercise, at returning adults with musculoskeletal conditions to work.

Schandelmaier et al. (2012) conducted a systematic review of the effectiveness of interventions involving RTW coordination compared to usual practice in patients at risk for long-term disabilities, focusing on private disability insurance or third-party RTW providers. The authors conducted a meta-analysis of nine trials from OECD countries, including one from the United States. Employers provided the interventions and included employees who had been absent from work for at least four weeks. The majority of participants reported musculoskeletal disorders and LBP. Overall, the authors found moderate evidence that RTW coordination interventions resulted in small relative increases in RTW but found no evidence that one type of RTW coordination program was superior to another.

Dibben et al. (2012) conducted a systematic review of RTW studies published between 2005 and 2011. The review focused primarily on evidence from the United Kingdom, but included findings from the United States and other countries. Interventions were designed to help people with common health conditions stay at or return to work, and included workplace-based cognitive behavioral therapy, workplace-based patient education, VR, and encouragement of physical activity. The authors reported a strong body of evidence, with positive effects, for workplace-based interventions for those with musculoskeletal disorders (particularly LBP), including cognitive behavioral therapy, VR, and workplace rehabilitation. Similar to Schandelmaier et al. (2012), the authors reported some evidence of the benefits gained from coordination with rehabilitation professionals. Dibben et al. noted that evidence of effectiveness for other interventions was based on an insufficient number of studies, studies of poor quality, or studies that were inconclusive. The authors suggested there is a need to consider longer-term outcomes to assess sustainability of DM interventions.

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