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Systematic review

Effects of interventions for prevention of sick leave and disability for health personnel

The objective of the systematic review was to synthesise research into the effectiveness of interventions designed to prevent sick leave and disability retirement for employees in the health- and caring services.

The objective of the systematic review was to synthesise research into the effectiveness of interventions designed to prevent sick leave and disability retirement for employees in the health- and caring services.


Key message

The health service in Norway employs nine percent of the working population. This means that 286 000 people works in the health- and caring sector of that a total 84 percent are women. In the last three months of 2012, medically prescribed sick leave was 8.6 for women and 5 percent for men.

The objective of the systematic review was to synthesise research into the effectiveness of interventions designed to prevent sick leave and disability retirement for employees in the health- and caring services.

We have included twelve randomised controlled trials with a total of more than 2000 participants where the studies reported sick leave as an outcome. The research evidence shows that:

  • It is uncertain if either physical fitness training or integrated emotion-oriented care is effective in reducing sick leave for employees working in nursing- or caring homes
  • Influenza vaccination may make little or no difference on sick-leave among employees in hospitals

  • It is uncertain if physical fitness training alone, physical fitness in combination with transfer technique, physical fitness and back belts, incremental supportive schemes for sick leave, cognitive behavioural therapy or process consultation are effective in reducing sick leave among employees in hospitals.

None of the studies reported disability retirement as an outcome.

In general, the results from the included studies did not show any statistically significant difference between the differing interventions. One should however, be careful in making the assumption that no documentation of difference equates to documenting that there is no difference. Most of the studies had few participants and large variations.

Summary

Background

The health service in Norway employs nine percent of the working population. This means that 286 000 people works in the health- and caring sector of that a total 84 percent are women. In the last three months of 2012, medically prescribed sick leave was 8.6 for women and 5 percent for men. Medical doctors have a lower sick leave rate compared to the other health personnel.

The objective of the systematic review was to synthesise research into the effectiveness of interventions designed to prevent sick leave and disability retirement for employees in the health- and caring services.

Methods

We searched for systematic reviews in medical databases and ISI Web of Science in September 2013 and for randomised controlled trials in Cochrane Central Register of Controlled Trials (CENTRAL) November 2013. Titles and abstracts were screened, potentially relevant publications ordered in full text and considered for inclusion or exclusion according to predefined criteria. The quality of the evidence for each outcome was checked according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). Two people carried out the screening process and the critical appraisal and if there was disagreement, a third person was consulted. This was a rapid review, which meant that work was time limited.

Results

None of the systematic reviews satisfied the inclusion criteria. We included twelve randomised controlled trials with a total of more than 2000 participants, where the studies reported sick leave as an outcome. Eight studies were conducted in hospitals and four in nursing- or caring homes. 

Primary care

Four randomised controlled trials with participants from nursing or caring homes reported on the outcome sick leave and none reported disability retirement as an outcome.

Two studies were from Norway, one from the United States and one from the Netherlands. Two reported the effect of a physical fitness program combined with stress and ergonomic education, one Tai Chi exercise and one integrated emotion-oriented care.

Two studies assessed physical fitness programs, combined with stress and ergonomic education, compared to usual practice or waiting list. They showed a mean difference between the groups of 4.38 days (95% Ci -5.59 to 14.39) in favour of the control group, but the difference was not statistically significant. A small study with several methodological limitations found a difference in favour of the group receiving Tai Chi exercise, but this result is very uncertain. It is uncertain if physical fitness programs, combined with other interventions, compared to usual practice have an effect on sick leave for health personnel working in nursing or caring homes

One study assessed whether education of nursing assistants in emotion-oriented care for patients with dementia effected sick leave. The study found none or little difference in the number of sick leave days between the groups, but the result is uncertain due to very low quality of the documentation.

The small studies did not detect a difference between the groups when physical fitness training in combination with education was compared with usual practice on sick leave for personnel working in nursing or caring homes. It is uncertain if integrated emotion-oriented care effects sick leave for health personnel working with patients with dementia in nursing homes. 

Hospitals

Eight randomised controlled trials with participants from hospitals reported change in sick leave. One of the studies reported quality of life and none disability.

Three studies were from the United States and the others were from Switzerland, Denmark, Finland, Canada and Sweden. Three studies assessed the effectiveness of different physical fitness programs, with or without education in transfer techniques and back belt, two assessed influenza vaccination whilst the other assessed one of the following; incremental supportive scheme for sick leave, cognitive behavioural therapy or process consultation.

The two studies, which assessed the effect of physical fitness programs with education in transfer techniques, found no difference between the intervention and the control group, but the results are uncertain. One small study reported that a physical fitness program in combination with the use of a back belt in risk situations gave less hours of sick leave due to back problems over a period of six months. The results are uncertain and the documentation is of very low quality.

The two studies assessed the effect of vaccinating hospital staff against influenza and showed little difference between the groups. However, the quality of the documentation is low so the vaccine may make little or no difference on sick leave.

None of the studies reported disability retirement as an outcome.

Discussion

We might not have found all possible studies as we only included randomised controlled trials identified from systematic reviews or studies from CENTRAL. We did not identify studies assessing interventions for medical doctors or interventions such as rotas or work schedules.

The report is a systematic review conducted in a limited time frame, but the report has been subjected to all the usual quality controls and has been peer reviewed externally and internally. The limitations are primarily in the time spent in writing the introduction and the discussion and the restriction in the number of databases searched. Systematic methods and transparency are strengths of the methods applied, and it is possible to check all phases of the research.

We have assessed the effectiveness of interventions for employees in the health sector and no other employees. It may well be that research on sick leave in a general population might have transferability to the health sector, but that is not assessed in this review. 

Conclusion

It is uncertain if the above mentioned interventions, designed to reduce sick leave among health personnel are effective. None of the studies that satisfied the inclusion criteria had disability retirement as an outcome.

    About this publication

  • Year: 2014
  • Authors Larun L, Dalsbø TK, Hafstad E, Reinar LM.
  • ISSN (digital): 1890-1298
  • ISBN (digital): 978-82-8121-848-2