| dc.description.abstract | What did we want to know?
In the UK, tens of millions of working days are lost due to work-related ill health every year, costing billions of pounds. Prior to the COVID-19 pandemic, around 8 million working-age people were registered disabled and about half of these were in employment.
The role of Occupational Health (OH) services is vital in helping workers to maintain employment when they encounter injury or illness. Part of this role is to advise on prevention of illness and injury at work, but a large part of it is to manage the recovery, rehabilitation and return to work (RTW) of sick-listed employees. The combination of an ageing population, increasing levels of chronic illness, mental health difficulties and disability, and the removal of the default retirement age, means that the demand for occupational health (OH) services is ever increasing.
OH providers traditionally rely on a clinical workforce to deliver these services, particularly doctors and nurses with OH qualifications. However, the increasing demand for OH services is unlikely to be met in future using this traditional model, as the number of OH-trained doctors and nurses in the UK is declining. Experts suggest multi-disciplinary models of OH delivery, including a more varied range of healthcare and non-healthcare professionals, can be highly effective. Moving to a more multidisciplinary workforce could also enable OH market capacity to significantly increase to meet new demand with less reliance on OH-trained doctors and nurses.
There is a therefore a pressing need to identify effective collaborative models of occupational health service delivery that involve a variety of healthcare and non-healthcare professionals. At this stage, it is necessary to review existing evidence regarding the effectiveness of multi-disciplinary OH-delivered interventions on return-to work outcomes.
There is an existing pool of systematic review evidence evaluating OH interventions, but it is difficult to identify which aspects of the delivery of these interventions may be associated with success. The array of interventions and conditions studied across the systematic review evidence base makes it difficult to distil a broader sense of what might be effective. By seeking to evaluate any workplace based multidisciplinary OH intervention that involved the workplace and looking across any health condition leading to sickness absence, we sought to determine which combination of multi-disciplinary professionals are effective for different populations.
Aim
To review the effectiveness and cost-effectiveness systematic review evidence that evaluates multi-disciplinary OH interventions aiming to improve work outcomes including return to work and reduced sickness absence.
Research questions
1. What multi-disciplinary delivery models for OH services are effective, and for whom?
2. What are the characteristics of effective multi-disciplinary delivery models for OH?
3. Which multi-disciplinary models of OH service delivery are cost-effective?
Specific research objectives:
To identify, critically appraise, and narratively summarise systematic review evidence regarding:
1. The effectiveness of multi-disciplinary interventions intended to improve work outcomes following illness or injury, such as return to work and reduced sickness absence;
2. The cost-effectiveness of multi-disciplinary interventions intended to improve work outcomes following illness or injury.
To meet these research objectives, we aimed to:
1. Identify, critically appraise, and map relevant systematic review evidence;
2. Narratively summarise the key findings;
3. Develop a taxonomy of successful interventions.
What did we find?
Systematic review evidence
We identified 89 systematic reviews that contained relevant interventions which involved a variety of professionals and the workplace, and which measured effectiveness in terms of RTW. Of these, we focused on the 24 where the population and intervention characteristics within the systematic reviews were the most relevant to our research questions. The 24 reviews were of varying quality, split evenly between High/Moderate quality and Low/Critically Low-quality ratings.
We mapped these 24 reviews in an evidence and gap map (https://eppi.ioe.ac.uk/cms/Portals/35/Maps/MN_Exeter_Feb22.html), providing a visual representation of the evidence. Due to the heterogeneity of the interventions included within the systematic reviews, we were unable to structure the map according to the different types of intervention being evaluated. Instead, using the evidence and gap map, it is possible to view i) the quality and quantity of systematic review evidence for a given health condition, ii) how the review authors rated the effectiveness or cost-effectiveness of the interventions included. Furthermore, by navigating the evidence and gap map, one can see the relevant primary studies within each review.
Our umbrella review provides the first point of reference for interventions under the broad remit of multidisciplinary OH services involving the workplace, across any health condition leading to sick leave. However, the body of systematic review evidence about multidisciplinary models of OH services is highly heterogeneous in terms of intervention, health condition, size and quality and we were unable to draw conclusions about the relative effectiveness of different interventions across health conditions from this body of evidence.
What are the implications?
This umbrella review has highlighted an array of systematic review evidence that exists in relation to the effectiveness or cost-effectiveness of multi-disciplinary OH interventions in supporting RTW. This evidence may be useful for supporting policy makers and commissioners of services to determine which OH interventions may be most useful for supporting different population groups in different contexts. OH professionals may find the content of the evidence and gap map useful in identifying systematic review evidence to support their practice.
The evidence and gap map also identifies where systematic review evidence in this area is lacking, or where existing evidence is of poor quality. These may represent areas where it may be particularly useful to conduct further systematic reviews. This umbrella review also highlights the primary studies within these reviews which are specifically relevant to our research aims and objectives. A series of smaller, more specific, systematic reviews, including a search focused on identifying primary studies, quality appraisal and full synthesis, could be conducted using these studies as a starting point/basis to determine the confidence which can be placed in the descriptive findings of this review.
How did we get these results?
We followed best practice guidance, and our protocol was registered on the Open Science Framework. Our approach was that of an umbrella review, featuring a rigorous search for systematic review evidence, critical appraisal and mapping of evidence.
Finding the systematic review evidence
The search strategy included search terms that describe returning to work, such as ‘return to work’, ‘re-entering work’ and ‘vocational rehabilitation’, in conjunction with a systematic review study type filter. An historical date limit of 2001 was applied, and the results limited to English language studies. We searched a selection of health and non-health care bibliographic databases and search engines to identify evidence from a variety of sectors of employment. To identify grey literature we searched Google Search, Google Scholar and a selection of topically relevant websites. We also consulted with stakeholders to identify reports already known to them.
We sought systematic reviews about adults (16 or over) in employment who have had absence or are absent from work for any medical reason and were receiving an intervention to get them back to work or help them retain work. Interventions needed to be multi-disciplinary (including professionals from different backgrounds in clinical and non-clinical professions) and designed to support employees and employers to manage health conditions in the workplace and/or to help employees with health conditions retain work and/or return to work following medical absence. Effectiveness needed to be measured in terms of return to work, work retention or measures of absence, or economic evaluation outcomes.
Data extraction and quality appraisal
Summary data for each eligible review was extracted. More detailed data extraction was carried out for the twenty-four reviews rated as being the most relevant to the aims of our umbrella review. Then, details of the primary studies identified within these reviews that met our inclusion criteria, were extracted. This aimed to supplement data which was reported poorly at the level of the review and focused on information about the professionals who delivered the intervention. All data were extracted by one reviewer and checked by a second, with disagreements being settled through discussion.
The quality of the systematic reviews rated as high or medium relevance following full-text screening was appraised using the AMSTAR-2 quality appraisal tool.
Data analysis and presentation
Summary data for all eligible systematic reviews were tabulated and described narratively. The data extracted from reviews of High and Medium relevance was imported into EPPI-Mapper software to create an evidence and gap map (https://eppi.ioe.ac.uk/cms/Portals/35/Maps/MN_Exeter_Feb22.html)
The evidence and gap map was structured according to the health condition that led to sick leave, and the main findings relating to the return to work outcome(s) reported at review level. The size and colour of the circles within each segment of the map represent the number and quality of reviews reporting RTW outcomes for interventions conducted with particular health conditions.
Each segment can be clicked upon to view the abstracts of the systematic reviews included in that segment, and a link to the included primary studies which were relevant to our umbrella review.
Details of the systematic reviews included within the map were tabulated and described narratively.
Primary studies which were relevant to the aims of our umbrella review were tagged in the record of the included systematic review within the map.
Stakeholder involvement
We worked alongside a variety of stakeholders and advisors to ensure our umbrella review reflects the needs of individuals who will use it. Stakeholders included commissioners and policy makers from DHSC and DWP, OH personnel and people with lived experience of accessing OH services themselves and/or supporting employees to access OH services. | en_GB |
