Patient reported outcomes.

<p>Individual trials’ outcomes expressed on a 0 to 100 scale. RTW coord. = return to work coordination. MID = minimal important difference.</p

Study selection.

<p>Last update of electronic search to April 2, 2012.</p

Characteristics of interventions and comparisons.

<p>RTW = return to work, n.r. = not reported, OP = occupational physician, PT = physical therapist, GP = general practitioner, rehab. = rehabilitation.</p>1<p>The trial compared three intervention arms with usual practice. We considered only the arm “combined intervention” because the other arms were restricted to either workplace or health care interventions.</p>2<p>In the Dutch system, each company is obliged to have company insurance for sick leave and to offer their employees access to occupational health care. Occupational physicians provide social-medical guidance for sick listed employees with the aim to return to work (RTW) as quickly as possible. Usually, occupational physicians are organised as third party service providers.</p>3<p>From personal correspondence.</p

Return to Work Coordination Programmes for Work Disability: A Meta-Analysis of Randomised Controlled Trials

<div><h3>Background</h3><p>The dramatic rise in chronically ill patients on permanent disability benefits threatens the sustainability of social security in high-income countries. Social insurance organizations have started to invest in promising, but costly return to work (RTW) coordination programmes. The benefit, however, remains uncertain. We conducted a systematic review to determine the long-term effectiveness of RTW coordination compared to usual practice in patients at risk for long-term disability.</p> <h3>Methods and Findings</h3><p>Eligible trials enrolled employees on work absence for at least 4 weeks and randomly assigned them to RTW coordination or to usual practice. We searched 5 databases (to April 2, 2012). Two investigators performed standardised eligibility assessment, study appraisal and data extraction independently and in duplicate. The GRADE framework guided our assessment of confidence in the meta-analytic estimates. We identified 9 trials from 7 countries, 8 focusing on musculoskeletal, and 1 on mental complaints. Most trials followed participants for 12 months or less. No trial assessed permanent disability. Moderate quality evidence suggests a benefit of RTW coordination on proportion at work at end of follow-up (risk ratio = 1.08, 95% CI = 1.03 to 1.13; absolute effect = 5 in 100 additional individuals returning to work, 95% CI = 2 to 8), overall function (mean difference [MD] on a 0 to 100 scale = 5.2, 95% CI = 2.4 to 8.0; minimal important difference [MID] = 10), physical function (MD = 5.3, 95% CI = 1.4 to 9.1; MID = 8.4), mental function (MD = 3.1, 95% CI = 0.7 to 5.6; MID = 7.3) and pain (MD = 6.1, 95% CI = 3.1 to 9.2; MID = 10).</p> <h3>Conclusions</h3><p>Moderate quality evidence suggests that RTW coordination results in small relative, but likely important absolute benefits in the likelihood of disabled or sick-listed patients returning to work, and associated small improvements in function and pain. Future research should explore whether the limited effects persist, and whether the programmes are cost effective in the long term.</p> </div

Evidence Profile, relevant outcomes.

1<p>Risk of attrition bias.</p>2<p>Risk of reporting bias.</p>3<p>Total population size less than 400.</p>4<p>Use of unvalidated instruments.</p>5<p>Confidence interval encloses no effect and meaningful difference.</p

Methodological components.

<p>RTW = return to work, PRO = patient reported outcomes, Y = yes, (Y) = probably Yes, N = No, (N) = probably no, ? = unclear, n.a. = not applicable.</p>1<p>Participants analysed in the group to which they were initially assigned.</p>2<p>“No” if protocol published and all outcomes correctly reported; “?” if no protocol published and selective reporting not obvious.</p>3<p>From personal correspondence.</p>4<p>Participants were probably not aware of the intervention.</p>5<p>RTW-outcomes not published, incomplete outcome information (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0049760#pone-0049760-t003" target="_blank">table 3</a>).</p>6<p>Results presented in subgroups, incomplete outcome information (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0049760#pone-0049760-t003" target="_blank">table 3</a>).</p>7<p>Primary outcome not mentioned in protocol.</p>8<p>Incomplete outcome information (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0049760#pone-0049760-t003" target="_blank">table 3</a>).</p>9<p>Cluster randomised trials: No risk of recruitment bias. Baseline information of individual clusters not reported. Effects of RTW-outcomes not corrected for possible design effects (risk of inflated precision).</p

Characteristics of studies and populations (at time of randomisation).

<p>RTW = return to work, n.r. = not reported.</p>1<p>As inferred from a subsample of 131 participants.</p>2<p>From personal correspondence.</p

A clinically integrated curriculum in Evidence-based Medicine for just-in-time learning through on-the-job training: The EU-EBM project-1

<p><b>Copyright information:</b></p><p>Taken from "A clinically integrated curriculum in Evidence-based Medicine for just-in-time learning through on-the-job training: The EU-EBM project"</p><p>http://www.biomedcentral.com/1472-6920/7/46</p><p>BMC Medical Education 2007;7():46-46.</p><p>Published online 27 Nov 2007</p><p>PMCID:PMC2228282.</p><p></p>ing: a) a person is talking to the learner; b) the learner can follow the presentation by reading the notes; c) the slide summarizes the core content of the presentation; it may contain hyperlinks to other topics in the same module; d) the sidebar provides orientation to the learner about the content of the lecture; e) the bottom bar allows the learner to pause, or quickly navigate forth and back

A clinically integrated curriculum in Evidence-based Medicine for just-in-time learning through on-the-job training: The EU-EBM project-2

<p><b>Copyright information:</b></p><p>Taken from "A clinically integrated curriculum in Evidence-based Medicine for just-in-time learning through on-the-job training: The EU-EBM project"</p><p>http://www.biomedcentral.com/1472-6920/7/46</p><p>BMC Medical Education 2007;7():46-46.</p><p>Published online 27 Nov 2007</p><p>PMCID:PMC2228282.</p><p></p>cational programs to student orientated, problem based learning programs. The size of the arrows in this figure indicates the magnitude of change between a traditional and the EU-EBM course

A clinically integrated curriculum in Evidence-based Medicine for just-in-time learning through on-the-job training: The EU-EBM project-0

<p><b>Copyright information:</b></p><p>Taken from "A clinically integrated curriculum in Evidence-based Medicine for just-in-time learning through on-the-job training: The EU-EBM project"</p><p>http://www.biomedcentral.com/1472-6920/7/46</p><p>BMC Medical Education 2007;7():46-46.</p><p>Published online 27 Nov 2007</p><p>PMCID:PMC2228282.</p><p></p>helps in formulating targeted questions. Hereafter, the learner attends the e-learning modules and consequently completes small activities and an assignment. All five modules are collected in a portfolio. After successful completion of the course, the student will receive a course certificate