Reincorporación al trabajo después de un epidodio de incapacidad temporal por contingencia común de larga duración. Análisis de los factores pronóstico.

La incapacidad temporal por contingencia común (ITcc) representa un elevado coste social. Cualquier esfuerzo para desarrollar políticas orientadas a mejorar la gestión de los episodios de ITcc y facilitar el retorno al trabajo (RAT) debe pasar por conocer cuáles son los factores que impactan en la duración de la ITcc. El objetivo de esta tesis es examinar qué factores del entorno laboral intervienen en la duración de la ITcc y analizar el valor pronóstico de la percepción del trabajador sobre el episodio de ITcc y sus expectativas de retornar al trabajo respecto a la duración de los episodios. A partir de una cohorte prospectiva de trabajadores en situación de ITcc de más de 15 días de duración y mediante modelos de regresión de Cox se observó que la exposición a un nivel alto de actividad física en el trabajo y trabajar con la espalda torcida, inclinada o doblada se asociaron a una mayor duración de la ITcc hasta el RAT. Los trabajadores que percibían un mayor apoyo al RAT por parte de sus empresas se reincorporaron antes al trabajo, mientras que aquellos que declaraban necesitar más tiempo para llegar a realizar el mismo trabajo y tenían escasas expectativas de reincorporarse a la vida laboral presentaron episodios de ITcc más largos. Las conclusiones de esta tesis apoyan la necesidad de incorporar a la empresa en la investigación de la ITcc y en el proceso de reincorporación al trabajo tras un episodio de ITcc.Temporary sickness absence (SA) benefits for non-work-related illness carry a high social cost. Any effort to develop policies aimed at improving the management of an SA episode by facilitating return to work (RTW) should start by determining which factors influence its duration. The objective of this thesis is to examine which work environment factors affect SA duration and to analyze the prognostic value of worker perceptions regarding their SA episode and RTW expectations on the duration of the SA episode. In the context of a prospective cohort of workers with a SA episode of greater than 15 days, and using Cox regression models, we observed that high physical demands at work and working with the back twisted or bent were associated with a longer time to RTW. Workers who perceived a greater level of employer support for RTW returned to work earlier, whereas workers who felt they were not ready to return and/or had little expectations of doing so had longer episodes of SA. The conclusions of this thesis support the need to engage employers in SA research and in the RTW process following a non-work-related sick leave episode

Effectiveness of very early workplace interventions to reduce sickness absence: a systematic review of the literature and meta-analysis.

OBJECTIVE: The aim of this review was to investigate the effectiveness of workplace return-to-work (RTW) interventions delivered at very early stages (<15 days) of sickness absence (SA). METHODS: A systematic literature search was conducted in PubMed, Health Management Information Consortium (HMIC), Cochrane library database, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychInfo and Embase. Using pre-established criteria, independent pairs of researchers carried out the study selection, quality appraisal and data extraction. Workplace interventions before day 15 of SA, were included. Primary outcome measures included rates of and time until RTW, productivity loss, and recurrences of SA. RESULTS: We found limited available evidence on the benefits of "very early" workplace interventions in terms of RTW after a SA episode compared to usual care. Only three randomized controlled trials classed as high or intermediate quality were identified. Early part-time sick leave together with appropriate job modifications led to a reduction in the duration and recurrence of SA. There is evidence of benefit of intervening during the first two weeks of SA for musculoskeletal disorders. CONCLUSION: Our review has identified a lack of evidence from the literature at this time point to support "very early" intervention compared to usual care. The methodological design of the studies, notably the extent and timing of usual care provided and variable compliance/crossover between groups could however explain the lack of demonstrated benefit. Consensus is required on the definition of "early" and "very early" interventions, and further research is recommended to improve understanding of the factors influencing when and how best to intervene for maximum gain.E Demou was supported by the MRC Strategic Award MC_PC_13027

Effectiveness of very early workplace interventions to reduce sickness absence: a systematic review of the literature and meta-analysis.

OBJECTIVE: The aim of this review was to investigate the effectiveness of workplace return-to-work (RTW) interventions delivered at very early stages (<15 days) of sickness absence (SA). METHODS: A systematic literature search was conducted in PubMed, Health Management Information Consortium (HMIC), Cochrane library database, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychInfo and Embase. Using pre-established criteria, independent pairs of researchers carried out the study selection, quality appraisal and data extraction. Workplace interventions before day 15 of SA, were included. Primary outcome measures included rates of and time until RTW, productivity loss, and recurrences of SA. RESULTS: We found limited available evidence on the benefits of "very early" workplace interventions in terms of RTW after a SA episode compared to usual care. Only three randomized controlled trials classed as high or intermediate quality were identified. Early part-time sick leave together with appropriate job modifications led to a reduction in the duration and recurrence of SA. There is evidence of benefit of intervening during the first two weeks of SA for musculoskeletal disorders. CONCLUSION: Our review has identified a lack of evidence from the literature at this time point to support "very early" intervention compared to usual care. The methodological design of the studies, notably the extent and timing of usual care provided and variable compliance/crossover between groups could however explain the lack of demonstrated benefit. Consensus is required on the definition of "early" and "very early" interventions, and further research is recommended to improve understanding of the factors influencing when and how best to intervene for maximum gain.E Demou was supported by the MRC Strategic Award MC_PC_13027