Workplace Disability Management Programs Promoting Return to Work: A Systematic Review

This Campbell systematic review assesses the effectiveness of workplace disability management programs (‘WPDM’) in promoting return to work. The review summarises findings from 13 studies, eight conducted in the USA and five in Canada. Participants were employees on sick leave, from the private and public sectors, with an inability to work due to physical injury, illness or mental disorders. WPDM programmes typically comprise multiple components, such as early and considerate contact, modified/tailored work schedule or duties, a revision of workplace roles, education of workplace staff, and rehabilitation activities. Programmes typically involved an inter-disciplinary team of competences from several corporate located key parties such as: occupational physicians and physiotherapists, occupational therapist/ergonomists, case managers/return-to work (‘RTW’) coordinators, union representatives, supervisors, and managerial HR staff. A RTW policy was used to describe procedures, and stakeholder engagement with roles and responsibilities written into the policy. A joint labour-management committee may serve as a vehicle for developing consensus among key decision makers in the design, implementation and evaluation of each component, and inclusion of senior management may drive corporate support and commitment. The available evidence was not suitable for quantitative synthesis, so no overall conclusion on the effectiveness of WPDM programmes can be made. It cannot be determined if specific program components or specific sets of components are driving effectiveness. The majority of studies programs focused on musculoskeletal disorders during the off work/pre-return phase of the RTW process. There is little evidence regarding programmes targeting mental health conditions. EXECUTIVE SUMMARY This report presents a Campbell systematic review on the effectiveness of workplace disability management programs (WPDM programs) promoting return to work (RTW), as implemented and practised by employers. The objectives of this review were to assess the effects of WPDM programs, to examine components or combination of components, which appear more highly related to positive RTW outcomes, and get an understanding of the research area to assess needed research. Twelve databases were searched for peer-reviewed studies published between 1948 to July 2010 on WPDM programs provided by the employer to re-entering employees with injuries or illnesses (occupational or non-occupational). Screening of articles, risk of bias assessment and data extraction were conducted in pairs of reviewers. A total of 16,932 records were identified by the initial search. Of these 599 papers were assessed for relevance. Thirteen studies (two non-randomized studies (NRS) and eleven single group ‘before and after’ studies (B&A), including eleven different WPDM programs, met the inclusion criteria. There were insufficient data on the characteristics of the sample and the effect sizes were uncertain. However, narrative descriptions of the included program characteristics were rich, and provide valuable insights into program scope, components, procedures and human resources involved. There is a lack of evidence to draw unambiguous conclusions on the effectiveness of employer provided WPDM programs promoting RTW. Thus we could not determine if specific program components or specific sets of components are driving effectiveness. The review adds to the exiting knowledge base on WPDM program development, characteristics and evaluation. As an organizational level intervention employer provided WPDM programs are multi-component offering a suite of policies and practices for injured or ill employees. The review identified 15 constituent program components, covering individual, organizational, and system level policies and practices, depicting key human resources involved in workplace program procedures and administration. The majority of WPDM programs were targeted musculoskeletal disorders, during the off-work and pre-return phase of the RTW process, with only little evidence on WPDM programs targeting mental health conditions and post return/stay at work. Future program evaluations ought to broaden their focus beyond the first phases of the RTW process and incorporate sustainable outcomes (e.g. job retention, satisfactory and productive job performance, work role functioning, and maintenance of job function). Given the lack of WPDM programs evaluated in peer-reviewed publications, more attention needs to be given to locate and evaluate efforts from company studies that may still exist outside the peer reviewed published literature. Thus, researchers following this track need to consider if these studies, when located have adequate study designs. While many employers recognize the importance of WPDM and are adopting policies and practices to promote RTW, judging from this review, the existing evidence leaves room for more rigorous methodological studies to develop the present WPDM knowledge base. Prospectively WPDM evaluation research also needs to enlarge its perspective and analytic tools to examine information that is meaningful and cost effective to those who will benefit from it to further advance the field. The review findings might help explicate WPDM programs and its potential impact on RTW outcomes, and provide a more complete understanding of the research in the field of WPDM. This may inspire researchers, employers, and policy makers, who are interested not only in questions regarding the impact of programs, but also their nature, to promote future design and evaluation of DM in organizations.

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