Study characteristics of included RCTs (N=37)
| Author (country, year) | Disease | Employment status and baseline risk for adverse work outcome | Intervention (setting)((components)) (feature) | Comparator | Randomised, N | Outcome measure | Time point measurement (months) | Reported effect (intervention vs comparator*†) |
| Inflammatory RMD | ||||||||
| De Buck et al50 (The Netherlands, 2005) | RA, AS, PsA, reactive arthritis, SLE or scleroderma | Working full time or part time or on sick leave, either with or without a partial disability pension | Multidisciplinary job-retention vocational rehabilitation programme (CLI) ((multiple)) (VWS, ORG) | Usual care | I: 74 C: 66 | Work status: job loss (work disability or unemployment); n/ total (%) | 24 | 14/59 (24%) vs 12/53 (23%) p=0.89 |
| Van Vilsteren et al92 (The Netherlands, 2017) | RA | Employed, not on sick leave or on sick leave for maximum 3 months | Workplace integrated care intervention and participatory workplace intervention, with clinical occupational physician, patients' rheumatologist and occupational therapist (combined) ((multiple)) (VWS, ORG) | Usual care | I: 75 C: 75 | Presenteeism: work instability (range 0–23, a high score indicated more instability); mean score (SD) | 12 | 9.3 (5.2) vs 7.7 (6.0) |
| Baldwin et al38 (USA, 2012) | RA/OA | Full-time or part-time employment; not on sick leave | Ergonomic intervention and assessment, work plan and follow-up (WPLACE) ((multiple)) (VWS) | Brochures/educational material | I: 48 C: 41 | Presenteeism: degree of work impairment (range 0–5); mean score (SD) | 24 | 1.49 (1.35) vs 2.16 (1.93) p=0.03 |
| Hammond et al54 (UK, 2017) | IA, RA, PsA | Employed, not on extended (>3 months) sick leave | Job retention vocational rehabilitation: work assessment, activity diaries, action planning, broad individualised programme and self-help information (OTHER) ((multiple)) (VWS) | Usual care (self-help work information) | I: 29 C: 26 | Sick leave (arthritis): mean % of working days lost (SD) Work status: stopped working; n (%) Presenteeism: workplace limitations (range −100 to 0); mean change from baseline (SD) | 9 | Sick leave: 8.0% (13.8) vs 15.0% (25.0) Work status: 0 (0%) vs 2 (9%) Presenteeism: −12.4 (SD 13.2) vs −2.5 (SD 15.9) |
| Macedo et al74 (UK, 2009) | RA | Employed, medium or high risk of work disability | Occupational therapy: medical assessment, work assessment, education, discussion with employer on work accommodations, stress management (OTHER) ((multiple)) (VWS) | Usual care | I: 16 C: 16 | Sick leave: days missed from work due to illness per month; mean change from baseline (SD) Presenteeism: impact of RA on work performance (range n.d.); mean change from baseline (SD) | 6 | Sick leave: −2.80 (6.18) vs 0.63 (4.86) p=0.10 Presenteeism: −43.20 (35.01) vs −4.69 (43.91) p=0.01 |
| Allaire et al34 (USA, 2005) | RA, knee OA, SLE, AS, PsA | Employed, at risk of job loss | Work barrier identification, counselling and education (OTHER) ((multiple)) (VWS) | Pamphlets with information on how to sustain work | I: 122 C: 120 | Work status: remaining employed; n/total (%) | 12 | 118/122 (97%) vs 108/120 (90%) |
| Van Tubergen et al91 (The Netherlands, 2002) | AS | n.d. | Combined spa–exercise therapy (OTHER) ((multiple)) (PHY) at two locations: (1) Austria (including Heilstollen), (2) the Netherlands | Usual care | 1: 38 2: 36 C: 37 | Sick leave: workday lost because of illness; mean (SD) | 9 | 1: 2.5 (6.5) vs 6.1 (15.8) 2: 6.4 (26.4) vs 6.1 (15.8) |
| Degenerative RMD | ||||||||
| Chopp-Hurley et al48 (USA, 2017) | Hip and/or knee OA | Employed, not on sick leave | Exercise programme: supervised exercise classes, at workplace sport facility (WPLACE) ((single)) (PHY) | Usual care (no exercise programme) | I: 12 C: 12 | Presenteeism: work ability score (range 7–49); mean (SD) | 3 | 20 (6) vs 40 (5) p=0.049 |
| Eichler et al51 (Germany, 2019) | Hip or knee OA | Mixed (not) employed, n.d. | Rehabilitation with interactive telerehabilitation aftercare (OTHER) ((multiple)) (PHY) | Usual care | I: 56 C: 55 | Work status: gainfully employed; n (%) | 3 | 31 (64.6%) vs 18 (46.2%) p=0.01 |
| Eshøj et al53 (Denmark, 2001) | Non-inflammatory disorder of locomotor system | Mixed (not) employed, at risk of sick leave | Early vocational intervention: sociomedical examination, multidisciplinary assessment and sociomedical rehabilitation plan (OTHER) ((multiple)) (VWS, ORG) | Usual care | I: 108 C: 93 | Work status: employed; n (%), RR (95% CI) | 12 | 65 (60.2%) vs 52 (55.9%); RR 1.1 (0.8 to 1.4) |
| Mixed or not specified RMD | ||||||||
| Skagseth et al86 (Norway, 2020) | Musculoskeletal, psychological or general and unspecified diseases | Employed, on (partial) sick leave | Workplace intervention added to an inpatient multimodal occupational rehabilitation programme (I-MORE) (CLI) ((multiple))(VWS, PHY, PSYCH) | Usual care | I: 88 C: 87 | Sick leave: cumulated sickness absence days; n (IQR) | 12 | 130 (81–212) vs 115 days (53–183) p=0.084 |
| Briest and Bethge43 (Germany, 2016)/Knapp et al29 (Germany, 2015) | MSD | Employed, on sick leave, previous sick leave or poor return to work prognosis | Intensive work-related rehabilitation aftercare: work-related training, job-specific psychosocial training, social support, relaxation training (CLI)((multiple)) (VWS, PHY, PSYCH) | Usual care | I: 157 C: 150 | Sick leave: length of sick leave in weeks during last 3 months; mean (SD) Presenteeism: work ability index (range 7–49); mean score (SD) | 12 | Sick leave: 1.6 (3.7) vs 1.7 (4.1) p=0.786 Presenteeism: 31.3 (9.1) vs 30.8 (10.9) |
| Streibelt and Bethge89 (Germany, 2014) | Chronic musculoskeletal disorders | Mixed (not) employed, mixed (not) on sick leave | Functional capacity evaluation on work demands and abilities (CLI) ((multiple)) (VWS, PHY, PSYCH) | Multidisciplinary rehabilitation (a less intense programme) | I: 109 C: 113 | Sick leave: duration of sick leave (in weeks); mean differences, estimated marginal means (range) | 12 | 5.2 vs 13.2; –8.0 (–17.4 to 1.4) p=0.095 |
| Carlsson et al46 (Sweden, 2013) | Psychiatric disease or MSD | Mixed (not) employed, currently sick-listed with maximum period of 28 days | Early multidisciplinary assessment at primary healthcare centre (CLI) ((single)) (ORG) | Usual care | I: 18 C: 15 | Sick leave; mean net days during last 9 months (SD) | 12 | 77 (109) vs 37 (62) p=0.580 |
| Bethge et al40 (Germany, 2011) | MSD | Mixed (not) employed; at least 12 weeks of sick leave in the year before | Multimodal work hardening: motivation, counselling, coping behaviour, exercises, functional capacity training and relaxation techniques (CLI) ((multiple)) (VWS, PHY) | Conventional musculoskeletal rehabilitation | I: 118 C: 118 | Sick leave: working and ≤6 weeks of sick leave; %; OR (95% CI) | 12 | Intervention (pre/post): 39.2%–59.5%; Comparator (pre/post): 48.6%–51.4%; OR: 2.363 (1.266 to 4.410) p=0.007) |
| Heinrich et al60 (The Netherlands, 2009), first arm | Non-specific MSD | Self-employed with new work disability claim (duration 1 day–8 weeks) | 1. Physical training (CLI) ((multiple)) (PHY) | Usual care | I: 53 C: 50 | Sick leave: gross claim duration; median days (IQR) | 12 | 228 (122–365) vs 165 (48–365) p=0.18 |
| Heinrich et al60 (The Netherlands, 2009), second arm | Non-specific MSD | Self-employed with new work disability claim (duration 1 day–8 weeks) | 2. Physical training with cognitive–behavioural component and workplace-specific exercises (CLI)((multiple)) (PHY, PSYCH) | Usual care | I: 76 C: 75 | Sick leave: gross claim duration; median days (IQR) | 12 | 148 (75–343) vs 137 (48–365) p=0.95 |
| Meijer et al77 (The Netherlands, 2006) | Non-specific upper extremity musculoskeletal disorders | Employed, on sick leave | Psychological and physical sessions aiming to reconditioning, ‘de-medicalising’, unrestrained moving and return to work (CLI) ((multiple)) (VWS, PHY, PSYCH) | Usual care: supervision by occupational health services | I: 23 C: 15 | Sick leave: return to work; % of original number of hours (95% CI) | 12 | 86.0% (68.5% to 103.4%) vs 72.8% (52.5% to 93.2%) p=0.840 |
| Abasolo et al27 (Spain, 2005) | MSD | Employed, temporary work disability | Education, protocol-based clinical management and administrative duties (CLI) ((multiple)) (ORG) at three locations | Usual care | I1: 1845 C1: 3045 I2: 1474 C2: 1557 I3: 1953 C3: 3203 | Sick leave: return to work; relative rate (95% CI) | 12 | 1: 1.26 (1.19 to 1.33) 2: 1.27 (1.20 to 1.35) 3: 1.31 (1.24 to 1.36) |
| Shiri et al84 (Finland, 2011)/Martimo et al31 (Sweden, 2010) | Upper extremity symptoms | Employed, not on sick leave | Early ergonomic intervention: contact with employer, work visit on work accommodations (combined) ((multiple)) (VWS) | Usual care | I: 89 C: 84 | Sick leave: sick leave days: mean (SD) Presenteeism: productivity loss; % (proportion of patients with any loss) and magnitude (SD) | 12 | Sick leave: 4.07 (11.2) vs 5.12 (13.2) Presenteeism: 25%, 6.8 (17.4) vs 51.3%, 18.4 (25.7) |
| Bultmann et al44 (Denmark, 2009) | LBP and MSD | Employed, on sick leave | Coordinated and tailored work rehabilitation, including a work disability screening and work rehabilitation plan by an interdisciplinary team (OTHER) ((multiple)) (VWS, ORG) | Conventional case management | I: 68 C: 51 | Sick leave: cumulative sickness absence hours; mean (SD) | 12 | 656.6 (565.2) vs 997.3 (668.8) p=0.006 |
| Fleten and Johnsen56 (Norway, 2006) | LBP, rheumatic disorder/arthritis, other MSK | Employed, newly sick-listed, longer than 14 days | Postal package to participants with information on work-related measures (OTHER) ((single)) (other) | Usual care (no postal package) | I: 495 C: 495 | Sick leave: mean difference (95% CI) in number of sick leave days | 12 | Per disease group: LBP: 17.2 (−12.5 to 46.9) RMD: −68.3 (−123.3 to −13.3) Other MSK: 0.5 (−18.1 to 19.1) |
| Keysor et al68 (USA, 2018) | Rheumatic/MSK disorder | Employed, at risk of unemployment according to patient | Modified vocational rehabilitation approach: assessment, written materials, action plan, follow-up (OTHER) ((single)) (VWS) | Written materials only | I: 143 C: 144 | Sick leave: sick leave due to health complaints; mean days in last 3 months Work status: permanent job loss due to retirement/laid off/work disability; occurrence; n (%), HR (95% CI) Presenteeism: work limitations; mean change from baseline (SD) | 24 | Sick leave: 1.4 vs 3.6 p<0.001 Work status: 11 (8%) vs 25 (17%); 0.47 (0.23 to 0.95) p=0.03 Presenteeism: −8.60 (1.92) vs −8.33 (2.22) p=0.93 |
| MSKP | ||||||||
| Sennehed et al83 (Sweden, 2018)/Forsbrand et al33 (Sweden, 2020) | Acute/subacute neck and back pain | Mixed (not) employed, at risk of sick leave | Structured physiotherapy and convergence dialogue meeting to support work ability and return to work (CLI) ((multiple)) (VWS, PHY) | Structured physiotherapy | I: 146 C: 206 | Sick leave: no sick leave or disability pension for 4 consecutive weeks; n/total (%) Presenteeism: work ability score; mean difference (95% CI) | 12 | Sick leave: 108/127 (85%) vs 127/171 (75%) p=0.002 Presenteeism: −0.05 (−0.63 to 0.53) |
| Wynne-Jones et al94 (UK, 2018) | Musculoskeletal pain | Employed, on sick leave | Vocational advice service on psychological beliefs, work perceptions and contextual factors (CLI) ((multiple)) (VWS, PSYCH) | Education to general and nurse practitioners | I: 158 C: 180 | Sick leave: days off work; mean (SD) Presenteeism: presenteeism score (range 6–30); mean (SD) | 12 | Sick leave: 20.3 (40.6) vs 24.3 (50.7) p=0.198 Presenteeism: 22.0 (5.6) vs 20.1 (5.7) p=0.082 |
| Åsenlöf et al37 (Sweden, 2009)/Emilson et al32 (Sweden, 2017) | Musculoskeletal pain | Mixed (not) employed; n.d. | Tailored behavioural medicine treatment in a physiotherapy context (CLI) ((single)) (PSYCH) | Exercise-based physiotherapy | I: 57 C: 65 | Sick leave: on sick leave; n/total (%) | 24 | 2/28 (7%) vs 10/37 (27%) p=0.06 |
| Brendbekken et al42 (Norway, 2017) | MSKP | Employed, on sick leave in last 12 months for 50%–100% | Multidisciplinary intervention by social worker, physician, physiotherapist: visual educational tool, self-management and focus on working conditions (CLI)((multiple)) (VWS) | Brief intervention of 2 sessions with only a physician or physiotherapist | I: 141 C: 143 | Sick leave: full return to work; n/total | 24 | 60/141 vs 52/142 |
| Andersen et al35 (Denmark, 2015), first arm | Back or neck pain | Employed, maximum 9 weeks sick-listed | Tailored physical activity programme+health guidance in dialogue meeting (CLI) ((multiple)) (PHY) | Health guidance in dialogue meeting | I: 47 C: 47 | Sick leave: return to work; n/total (%) Presenteeism: work ability (range 0–10); mean score (SD) | 11 | Sick leave: 23/46 (50%) vs 17/47 (36%) Presenteeism (pre vs post): I: 3.1 (2.7) vs 5.0 (3.1) C: 2.9 (2.8) vs 4.8 (2.9) |
| Myhre et al80 (Norway, 2014) | Neck and back pain | Employed, on sick leave between 4 weeks and 12 months | Work-focused rehabilitation: clinical examination, education, physical therapy, enhance coping, return to work planning (CLI) ((multiple)) (VWS) at two locations | Usual care | I1: 109 C1: 107 I2: 100 C2: 97 | Sick leave: returned to work (5-week period without benefits); n (%) | 12 | 1: 69 (65%) vs 80 (75%) 2: 73 (75%) vs 72 (75%) |
| Lindell et al71 (Sweden, 2008) | Non-specific back and neck pain | Mixed (not) employed, sick-listed | Cognitive–behavioural rehabilitation: graded activity, manual therapy, applied relaxation, ognitive–behavioural therapy (CLI) ((multiple)) (VWS, PHY, PSYCH) | Usual care | I: 63 C: 62 | Sick leave: mean net days of sick leave (95% CI) | 18 | 397 (354 to 440) vs 391 (345 to 436) |
| Zaproudina et al95 (Finland, 2007), first arm | Chronic non-specific neck pain | Employed, not on sick leave | Traditional bone setting (CLI) ((single)) (PHY) | Conventional physiotherapy | I: 35 C: 34 | Sick leave: days sick-listed; number per person | 12 | 0.61 vs 2.6 |
| Zaproudina et al95 (Finland, 2007), second arm | Chronic non-specific neck pain | Employed, not on sick leave | Traditional bone setting (CLI) ((single)) (PHY) | Massage therapy | I: 35 C: 33 | Sick leave: days sick-listed; number per person | 12 | 0.61 vs 3.9 |
| Chiu et al47 (China, 2005) | Neck pain | Mixed (not) employed, n.d. | Exercise programme: activation and dynamic strengthening of neck muscles+infrared irradiation (CLI) ((single)) (PHY) | Usual care (infrared irradiation) | I: 67 C: 78 | Sick leave: n (%) of cases with sick leave during last 3 weeks | 6 | 2 (3.0%) vs 7 (9.0%) p=0.22 |
| Linton et al72 (Sweden, 2005), first arm | Non-specific neck or back pain | Employed, maximum of 4 months’ sick leave in last year | Minimal treatment+cognitive–behavioural treatment (CLI) ((multiple)) (PSYCH) | Minimal treatment (information, check for red flags) | I: 69 C: 47 | Sick leave: occurrence of long-term sick leave (≥15 days); n (%) | 12 | 4 (7.4%) vs 4 (16.4%) (extracted from figure) |
| Linton et al72 (Sweden, 2005), second arm | Non-specific neck or back pain | Employed, maximum of 4 months’ sick leave in last year | Minimal treatment+cognitive–behavioural treatment+preventive physical therapy (CLI)((multiple)) (PHY, PSYCH) | Minimal treatment (information, check for red flags) | I: 69 C: 47 | Sick leave: occurrence of long-term sick leave (≥15 days); n (%) | 12 | 4 (6.6%) vs 4 (16.4%) (extracted from figure) |
| Jensen et al64 (Sweden, 2001)/Bergström et al30 (Sweden, 2012), first arm | Non-specific back or neck pain | Mixed (not) employed, on sick leave | 1. Behavioural medicine rehabilitation (CLI)((multiple)) (PHY, PSYCH) | Usual care | I: 63 C: 48 | Sick leave: sick leave (any) during last month; % Work status: full-time early retirement; OR (95% CI) | 18 | Sick leave: Males: 52% vs 70% Females: 50% vs 54% Work status: Males: 0.4 (0.1 to 1.9); Females: 0.4 (0.1 to 1.4) |
| Jensen et al64 (Sweden, 2001)/Bergström et al30 (Sweden, 2012), second arm | Non-specific back or neck pain | Mixed (not) employed, on sick leave | 2. Behaviour-oriented physical therapy (CLI)((multiple)) (PHY) | Usual care | I: 54 C: 48 | Sick leave: sick leave (any) during last month; % Work status: full-time early retirement; OR (95% CI) | 18 | Sick leave: Males: 65% vs 70% Females: 54% vs 54% Work status: Males: 0.6 (0.1 to 2.9); Females: 0.1 (0.0 to 0.6) |
| Jensen et al64 (Sweden, 2001)/Bergström et al30 (Sweden, 2012), third arm | Non-specific back or neck pain | Mixed (not) employed, on sick leave | 3. Cognitive–behavioural therapy (CLI) ((multiple)) (PSYCH) | Usual care | I: 49 C: 48 | Sick leave: sick leave (any) during last month; % Work status: full-time early retirement; OR (95% CI) | 18 | Sick leave: Males: 59% vs 70% Females: 54% vs 54% Work status: Males: 0.5 (0.1 to 2.3); Females: 0.1 (0.0 to 0.8) |
| Johansson et al66 (Sweden, 1998) | Chronic musculoskeletal pain | Mixed (not) employed, n.d. | Cognitive–behavioural multidisciplinary pain management programme: education, goal setting, physical training, relaxation, planning of return to work (CLI) ((multiple)) (VWS, PHY, PSYCH) | Waiting list | I: 21 C: 21 | Sick leave: level of sick leave (range 0–100%); mean % (SD) | 1 | 80.4% (34.8) vs 59.6% (42.5) |
| Viikari-Juntura et al93 (Finland, 2012)/Shiri et al28 (Finland, 2013) | Musculoskeletal pain | Employed, not on sick leave or only short-term sick leave | Part-time sick leave (WPLACE) ((single)) (ORG) | Full-time sick leave | I: 31 C: 30 | Sick leave: time to return to work (≥4 weeks without recurrent sick leave); median days (IQR), HR (95% CI) Presenteeism: productivity loss; mean % (SD) | 12 | Sick leave: 12 (6–33) vs 20 (8–35) HR 1.60 (0.98 to 2.63) p=0.10 Presenteeism: 22.6% (26.7) vs 23.9% (24.2) p=0.52 |
| Andersen et al35 (Denmark, 2015), second arm | Back or neck pain | Employed, maximum 9 weeks sick-listed | Chronic pain self-management programme+health guidance in dialogue meeting (OTHER)((multiple)) (PSYCH) | Health guidance in dialogue meeting | I: 47 C: 47 | Sick leave: return to work; n, total n (%) Presenteeism: work ability (range 0–10); mean score (SD) | 11 | Sick leave: 22/47 (46.8%) vs 17/47 (36.2%) Presenteeism (pre vs post): I: 2.5 (3.4) vs 4.8 (3.4) C: 2.9 (2.8) vs 4.8 (2.9 |
| Linton and Ryberg73 (Sweden, 2001) | Persistent neck and back pain | Mixed (not) employed, maximum of 30 days’ sick leave in last year | Cognitive–behavioural programme, pain management, adaptation to work, skill building (OTHER) ((multiple)) (PSYCH) | Usual care | I: 84 C: 91 | Sick leave: sickness absence ≥14 days; n (%) | 6 | 4 (5%) vs 14 (15%) |
| Other | ||||||||
| Granviken and Vasseljen58 (Norway, 2015) | Subacromial impingement | n.d. | Supervised exercises and home exercises (CLI) ((single)) (PHY) | Home exercises | I: 23 C: 23 | Sick leave: on sick leave; n/total (%) Work status: unemployed or disability pension; n | 6 | Sick leave: 3/21 (14.3%) vs 4/18 (22.2%) Work status: 1 unemployed, 1 disability pension |
Studies sorted based on (1) disease (inflammatory RMD, degenerative RMD, mixed or not specified RMD; MSKP; other), (2) setting (clinical, combined, workplace, other) and (3) publication year (descending).
*At endpoint or for follow-up period unless otherwise indicated in column ‘Outcome measure’.
†Direction of reported effect follows the outcome measure’s description (eg, work limitation: higher score indicates more limitations; work ability: higher score indicates better ability).
AS, arthritis psoriatica; C, control; CLI, clinical setting; combined, clinical and workplace setting; I, intervention; IA, inflammatory arthritis; LBP, low back pain; MSD, musculoskeletal disease; MSK, musculoskeletal; MSKP, musculoskeletal pain; N, number; n.d., not described/reported; OA, osteoarthritis; OR, odds ratio; ORG, organisational or system change feature; PHY, physical training and therapy; PsA, psoriatic arthritis; PSYCH, psychological feature; RA, rheumatoid arthritis; RCTs, randomised controlled trials; RMD, rheumatic and musculoskeletal disease; RR, relative risk; SLE, systemic lupus erythematosus; VWS, vocational or work support; WPLACE, workplace.