Effectiveness of work-related interventions for return to work in people on sick leave: a systematic review and meta-analysis of randomized controlled trials

Background: Long-term sick leave is a serious concern in developed countries and the cost of sickness absence and disability benefits cause major challenges for both the individual and society as a whole. Despite an increasing body of research reported by existing systematic reviews, there is uncertainty regarding the effect on return to work of workrelated interventions for workers with different diagnoses. The objective of this systematic review was to assess and summarize available research about the effects of work-related interventions for people on long-term sick leave and those at risk of long-term sick leave. Methods: We conducted a systematic review in accordance with international guidelines. Campbell Collabora‑ tion (Area: Social Welfare), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Embase, Epistemonikos, MEDLINE, PsycINFO, Scopus, and Sociological Abstracts were systematically searched in March 2021. Two authors independently screened the studies. We conducted risk of bias assessments and meta-anal‑ yses of the available evidence in randomized controlled trials (RCTs). The remaining comparisons were synthesized narratively. The certainty of evidence for each outcome was assessed. Results: We included 20 RCTs comprising 5753 participants at baseline from 4 different countries. The studies had generally low risk of bias. Our certainty in the effect estimates ranged from very low to moderate. Eight different interventions were identified. Meta-analysis revealed no statistically signifcant difference between multidisciplinary rehabilitation (MR) and usual care (US) (Risk Ratio [RR] 1.01; Confidence Interval [CI] 95% 0.70-1.48 at 12 months fol‑ low-up) and between MR and other active intervention (Risk Ratio [RR] 1.04; Confidence Interval [CI] 95% 0.86-1.25 at 12 months follow-up). Remaining intervention groups revealed marginal, or no effect compared to the control group. The results for the secondary outcomes (self-efficacy, symptom reduction, function, cost-effectiveness) showed varied and small effects in the intervention groups. Conclusion: Overall, the present data showed no conclusive evidence of which work-related intervention is most effective for return to work. However, a handful of potential interventions exist, that may contribute to a foundation for future research. Our findings support the need for adequately powered and methodologically strong studies

Quality care in residential childcare institutions: a systematic scoping review

Source at https://www.fhi.no/publ/2020/gode-barnevernsinstitusjoner/Vi undersøkte hva forskning fra 2010-2019 sier om tiltak, metoder og strategier som skal legge til rette for god omsorg for barn og unge i barnevernsinstitusjoner

Cost–utility analysis of antibiotic treatment in patients with chronic low back pain and Modic changes: results from a randomised, placebo-controlled trial in Norway (the AIM study)

Objective To evaluate the cost–utility of 100 days of antibiotics in patients with chronic low back pain (LBP) and type I or II Modic changes included in the Antibiotic treatment In patients with chronic low back pain and Modic changes (AIM) study. Design A cost–utility analysis from a societal and healthcare perspective alongside a double-blinded, parallel group, placebo, multicentre trial. Setting Hospital outpatient clinics at six hospitals in Norway. The main results from the AIM study showed a small effect in back-related disability in favour of the antibiotics group, and slightly larger in those with type I Modic changes, but this effect was below the pre-defined threshold for clinically relevant effect. Participants 180 patients with chronic LBP, previous disc herniation and Modic changes type I (n=118) or type II (n=62) were randomised to antibiotic treatment (n=89) or placebo-control (n=91). Interventions Oral treatment with either 750 mg amoxicillin or placebo three times daily for 100 days. Main outcome measures Quality-adjusted life years (QALYs) by EuroQoL-5D over 12 months and costs for healthcare and productivity loss measured in Euro (€1=NOK 10), in the intention-to-treat population. Cost–utility was expressed in incremental cost-effectiveness ratio (ICER). Results Mean (SD) total cost was €21 046 (20 105) in the amoxicillin group and €19 076 (19 356) in the placebo group, mean difference €1970 (95% CI; −3835 to 7774). Cost per QALY gained was €24 625. In those with type I Modic changes, the amoxicillin group had higher healthcare consumption than the placebo group, resulting in €39 425 per QALY gained. Given these ICERs and a willingness-to-pay threshold of €27 500 (NOK 275 000), the probability of amoxicillin being cost-effective was 51%. Even when the willingness-to-pay threshold increased to €55 000, the probability of amoxicillin being cost-effective was never higher than 53%. Conclusions Amoxicillin treatment showed no evidence of being cost-effective for people with chronic LBP and Modic changes during 1-year follow-up.publishedVersio

Protocol for Work-related interventions for people on long-term sick leave

Source at https://www.fhi.no/.The Norwegian Institute of Public Health (NIPH) was commissioned by the Norwegian Labour and Welfare Administration (NAV) to conduct a systematic review on the effect of work-related interventions for people on long-term sick leave and people at risk for long-term sick leave

Prosjektplan for Arbeidsrettede rehabiliteringstiltak ved langtidssykmelding

Source at https://www.fhi.no/.Fagmiljø for velferdstjenesteforskning i Folkehelseinstituttet (FHI) fikk våren 2019 i oppdrag av Arbeids- og velferdsdirektoratet (NAV) å utføre en systematisk kunnskapsoppsummering (oversikt) om effekten av arbeidsrettede rehabiliteringstiltak for langtidssykmeldte og de som står i fare for å bli langtidssykmeldte

Arbeidsrettede rehabiliteringstiltak ved langtidssykmelding: en systematisk oversikt

Folkehelseinstituttet har på oppdrag fra Arbeids- og velferdsdirektoratet (NAV) utført en systematisk oversikt om effekten av arbeidsrettede rehabiliteringstiltak på retur til arbeid for personer som er, eller står i fare for å bli, langtidssykmeldt. Vi utførte i mai 2020 et systematisk søk i samfunnsmedisinske forskningsdatabaser. Vi vurderte treffene, trakk ut data og analyserte studier som møtte inklusjonskriteriene. Vi inkluderte 20 randomiserte kontrollerte studier, samt 13 systematiske oversikter av høy metodisk kvalitet. Primærstudiene omhandlet åtte forskjellige tiltak. Rapportens hovedfunn er: • Det er usikkert om det er noen forskjell mellom arbeidsrettede rehabiliteringstiltak og andre aktive tiltak eller vanlig praksis i retur til arbeid etter 12 måneder. • Det er trolig ingen forskjell mellom tverrfaglig rehabilitering og andre aktive tiltak i retur til arbeid etter 24 måneder. • Det er usikkert om det er noen forskjell mellom arbeidsrettede rehabiliteringstiltak og vanlig praksis i helserelaterte utfall.Det ser ikke ut til å være noen forskjell på arbeidsrettede rehabiliteringstiltak og andre aktive tiltak eller vanlig praksis i effekt på retur til arbeid for personer som er langtidssykmeldt. Vår konklusjon sammenfaller med tidligere systematiske oversikter. Fremtidige studier kan endre konklusjonen

Back beliefs among elderly seeking health care due to back pain; psychometric properties of the Norwegian version of the back beliefs questionnaire

Background: The Back Beliefs Questionnaire (BBQ) is a 14-item patient-reported questionnaire that measures attitudes and beliefs about the consequences of back pain. The BBQ has recently been translated into Norwegian, but its psychometric properties have not yet been tested. The aim of this study is to evaluate the reliability and construct validity of the BBQ when used on elderly patients with back pain. Method: A prospective cohort study with a test-retest design among 116 elderly patients (> 55 years of age) seeking primary care for a new episode of back pain. Test-retest, standard error of measurement (SEM), minimal detectable change (MDC), internal consistency and construct validity by a priori hypotheses (Spearman’s- and Pearson correlation coefficient) were tested. Results: A total of 116 patients, mean age (SD) 67.7 (8.3), were included and 63 patients responded to the testretest assessment. The mean (SD) BBQ sum scores (range 9–45) were 29.8 (7.0) and 29.2 (6.7) for the test and retest respectively. The test-retest was acceptable with an intraclass correlation coefficient of 0.71 (95% CI, 0.54–0.82), SEM was 3.8 and MDC 10.5. Internal consistency with Cronbach’s alpha was good (0.82) and acceptable construct validity was supported by the confirmation of 75% of the a priori hypotheses. Conclusion: The Norwegian version of the BBQ demonstrated acceptable test-retest reliability and good construct validity and can be used to assess pessimistic beliefs in elderly patients with back pain

Lindrende behandling og omsorg i sykehjem og eget hjem: oversikt over systematiske oversikter

Dette oppdraget består av en oversikt over systematiske oversikter som har sett på effekten av lindrende behandling og omsorg i sykehjem og eget hjem. Vi utførte i oktober 2020 et litteratursøk i relevante databaser. Vi vurderte referansene, trakk ut data og analyserte resultatene i oversiktene som møtte inklusjonskriteriene. Vi vurderte tilliten til resultatene ved hjelp av verktøyet GRADE. Fem systematiske oversikter ble inkludert. Populasjonen var i hovedsak voksne pasienter med kreft, mens pårørende ble inkludert i to oversikter. Lindrende behandling og omsorg omfattet oppfølging fra palliativt team, bruk av sansehager, støtte til pårørende og ulike alternative tiltak. Relevante utfall var pasientenes og pårørendes livskvalitet, uønskede hendelser, dødssted, pasienttilfredshet, sykehusinnleggelse, funksjonsnedsettelse, depresjon og angst. Rapportens hovedfunn er: • Det er usikkert hvilken effekt hjemmebasert eller sykehjemsbasert lindrende behandling og omsorg har blant pasienter med ulike diagnoser og deres pårørende sammenliknet med vanlig omsorg. • Det er usikkert hvilken effekt lindrende behandling og omsorg i sansehager eller gjennom alternative tiltak har blant pasienter med ulike diagnoser sammenliknet med vanlig omsorg. • Det mangler informasjon om effekten av lindrende behandling og omsorg blant barn og unge. Vi har svært lav tillit til resultatene for samtlige utfall grunnet metodiske skjevheter, manglende presisjon, samt begrenset overførbarhet til norske forhold