Elements of Return-to-Work Interventions for Workers on Long-Term Sick Leave: A Systematic Literature Review.

PURPOSE: The aim of this systematic review is to identify vocational rehabilitation (VR) interventions that are effective to enhance return-to-work (RTW) for people on long-term sick leave (> 90 days) and to identify main elements of these interventions. METHODS: Six electronic databases were searched for peer-reviewed studies published up to February 2022. Each article was screened independently by two different reviewers. Thereafter, one author performed the data-extraction which was checked by another author. The EPHPP quality assessment tool was used to appraise the methodological quality of the studies. RESULTS: 11.837 articles were identified. 21 articles were included in the review, which described 25 interventions. Results showed that ten interventions were more effective than usual care on RTW. Two interventions had mixed results. The effective interventions varied widely in content, but were often more extensive than usual care. Common elements of the effective interventions were: coaching, counseling and motivational interviewing, planning return to work, placing the worker in work or teaching practical skills and advising at the workplace. However, these elements were also common in interventions that were not effective on RTW compared to usual care and can therefore not explain why certain interventions are effective and others are not. CONCLUSION: The effective interventions included in this study were often quite extensive and aimed at multiple phases of the RTW-process of the worker. In the future, researchers need to describe the population and the content of the investigated interventions more elaborate to be able to better compare VR interventions and determine what elements make interventions effective.

Tailored vocational rehabilitation for people with a work disability pension in The Netherlands; an in-depth data analysis of the content and outcomes of vocational rehabilitation trajectories of the Social Security Institute.

PURPOSE: People with a work disability pension receive vocational rehabilitation (VR) services from the Dutch Social Security Institute (SSI) in order to facilitate return-to-work (RTW). The SSI offers tailored VR existing of two trajectories (aimed at getting fit for work or aimed at returning to work). The purpose of this study is to describe the current practice of VR. This includes a description of client characteristics, RTW barriers and the intensity, duration, content and the outcomes of the offered trajectories. MATERIALS AND METHODS: We analyzed data from 197 clients that were randomly selected from clients who attended a VR trajectory between 1 January t 2017 and 31 December 2018. Data were obtained from the SSI registration databases and client files. RESULTS: Both VR trajectories at the SSI have a different aim, but in practice the content of the VR interventions often overlaps. Around half of both trajectories reached their goal. Reasons for unsuccessful trajectories were that the client did not find work or barriers were more complex than initially assessed. CONCLUSIONS: The SSI delivers tailored VR to the specific needs of the client, however substantiations for why a certain VR intervention is offered are limited. Guidelines are needed to support professionals.

This study shows the usual practice of vocational rehabilitation by the Dutch Social Security Institute for all clients with a work disability pension who attended between January 2017 and January 2019.The rationale why a certain vocational rehabilitation intervention is offered by vocational rehabilitation professionals is often unclear or missing.This missing rationale may lead to unwanted practice variation, which is a barrier for evidence-based vocational rehabilitation.Tools and guidelines are needed to support professional decision making and evidence-based vocational rehabilitation and improve return to work.

A roadmap for sustainable implementation of vocational rehabilitation for people with mental disorders and its outcomes: a qualitative evaluation.

BACKGROUND: People suffering from mental health disorders have lower work participation compared to people without mental challenges. To increase work participation within this group vocational rehabilitation interventions are often offered. Collaboration between the mental health care and social security sectors is needed to enable professionals to perform optimally when carrying out these interventions. Yet, regulatory and financial barriers often hinder sustainable implementation. To overcome these barriers an experimental roadmap for sustainable funding based on a shared savings strategy was piloted in four regions. The aim of the present qualitative study was to gain understanding of the uses of this roadmap and the factors that were important in the experiment's process. METHOD: The roadmap consisted of five steps based upon insights from shared savings strategies and implementation science knowledge, and was initiated by a national steering board. The roadmap aimed to make sustainable funding agreements (based on shared savings) for the implementation of a vocational rehabilitation intervention. In four regions, stakeholders from the mental health care and social security services sector followed the roadmap. We conducted interviews (n = 16) with involved participants and project leaders of the experiment and collected 54 sets of field notes and documents to evaluate the roadmap process. A thematic analysis was used to analyse the data. RESULTS: Regions perceived improved stakeholder collaboration around vocational rehabilitation after they were guided by the roadmap. Three regions made, or intended to make, agreements on collaboration and funding, yet not based on shared savings. Moreover, going through the roadmap took more time than anticipated. Stakeholder collaboration depended on factors like personal and organizational interests and collaboration conditions and values. Financial legislation and politics were regarded as barriers and personal motives were mentioned as a facilitator in this process. CONCLUSIONS: Our study showed that the roadmap supported stakeholders to establish a more sustainable collaboration, even though no sustainable financial agreements were made yet. Although participants acknowledged the function of financial insights and the need for financial resources, the driver for collaboration was found to be more on improving clients' perspectives than on solving unfair financial distribution issues. This suggests modifying the focus of the roadmap from financial benefits to improving clients' perspectives.

A Decision Aid to Support Vocational Rehabilitation Professionals Offering Tailored Care to Benefit Recipients with a Long-Term Work Disability: A Feasibility Study.

PURPOSE: This feasibility study focusses on the implementation and use of a decision aid, which supports vocational rehabilitation (VR) professionals in helping clients with a disability pension return to work in practice. The decision aid shows an overview of the clients' return to work barriers and suggests suitable VR interventions based on these barriers. METHODS: The study population consisted of VR professionals working at the Dutch Social Security Institute and their clients receiving a (partial) work disability pension. The feasibility was measured with concepts of the Linnan and Steckler framework and the attitude, social norm and self-efficacy model. Data were collected using questionnaires, checklists and qualitative interviews. RESULTS: Ten professionals participated in this study. Fifty-four clients were asked to fill in the questionnaire of the decision aid and 32 clients received VR care based on the decision aid. In general, VR professionals and clients were satisfied with the decision aid and perceived a few barriers for using the decision aid. CONCLUSIONS: This study showed that it is feasible to implement and use the decision aid. To improve the implementation of this decision aid, it should be implemented in digital systems used by professionals to improve efficiency of working with the decision aid.

Experiences and needs of welfare benefit recipients regarding their welfare-to-work services and case workers.

BACKGROUND: This study aimed to explore the experiences and needs of (ex-)welfare benefit recipients from a large urban municipality in the Netherlands regarding their welfare-to-work services and their case workers. METHODS: Quantitative data from a client satisfaction survey that was filled out by 213 people (response rate 11%) who received welfare-to-work services was combined with results from four group interviews with a total of 15 people receiving welfare-to-work services. Verbatim transcripts from the interviews were analysed using inductive thematic analysis. RESULTS: The survey results showed that most clients were reasonably satisfied with the welfare-to-work services they received. Four main themes emerged from the interviews: (1) experiences and needs related to the interactions between case workers and benefit recipients; (2) the need for tailored services; (3) the complicating role of the system the case workers operate within; and (4) the existence of differences between case workers regarding how strict they followed the rules and to what extent they connected with their clients on a personal level. CONCLUSIONS: Our findings show that clients were reasonably satisfied with the welfare-to-work services provided by their municipality but that there is still room for improvement. Case workers should have good social skills to build a trusting relationship with the client, welfare-to-work services should be tailored to the individual, and clear concise information should be given to welfare benefit recipients, especially with regard to what benefit recipients can expect of the municipality and the case workers, given their dual role in supporting (re-)integration to work and monitoring benefit eligibility.

Needs, expectations, facilitators, and barriers among insurance physicians related to the use of eHealth in their work: results of a survey.

PURPOSE: To determine needs, expectations, facilitators, and barriers of insurance physicians (IPs) for using eHealth in their work. Also, we investigated differences between age groups. MATERIALS AND METHODS: All insurance physicians employed at the Dutch Social Security Institute (SSI) received an online anonymous survey in July 2020. RESULTS: Three hundred and fifteen IPs (31%) responded. According to these IPs, the most important need for using eHealth was to collect medical information more effectively and efficiently (71%).Main facilitators were that eHealth could make IPs' work more effectively and efficiently (61%) and more future-proof (60%). Main barriers were losing human interaction (54%) and security issues (51%). Younger IPs saw more options for using eHealth, compared to older IPs. CONCLUSIONS: The majority of IPs (in particular younger IPs) had a positive view towards using eHealth in their daily work. Nevertheless, differences in needs, expectations, facilitators and barriers between the age groups should be taken into account for the successful development and implementation of interventions using eHealth in insurance medicine.

For the successful development and implementation of eHealth interventions in insurance medicine and rehabilitation, the needs, expectations, facilitators, and barriers that physicians indicate should be taken into account.Insurance physicians support the use of eHealth interventions to collect medical information more effectively and efficiently, to contribute to and maintain the quality of care, in the perspective of managing expected shortages in insurance physicians.When concretizing eHealth interventions for rehabilitation professionals, one should take the importance of face to face interaction with patients into account.Extra education and training for older insurance physicians may improve the implementation of eHealth interventions, because they are less inclined to see its value and feel less competent to use it.

Work and health during the COVID-19 crisis among Dutch workers and jobseekers with (partial) work disabilities: a mixed methods study.

BACKGROUND: The consequences of restrictive measures during the COVID-19 outbreak have potentially been enormous, especially for those in a vulnerable position in the labour market. This study aims to describe the impact of the COVID-19 crisis on work status, working conditions and health among people with (partial) work disabilities-with and in search of work-during the COVID-19 pandemic in the Netherlands. METHODS: A mixed methods design was used, combining a cross-sectional online survey and ten semi-structured interviews with people with a (partial) work disability. The quantitative data included responses to job-related questions, self-reported health, and demographics. The qualitative data consisted of participants' perceptions about work, vocational rehabilitation, and health. We used descriptive statistics to summarize the responses, conducted logistic and linear regression and integrated our qualitative findings with the quantitative findings, aiming at complementarity. RESULTS: Five hundred and eighty-four participants (response rate 30.2%) completed the online survey. The majority of participants experienced no change in work status: 39 percent remained employed, 45 percent remained unemployed, six percent of respondents lost their job, and ten percent became employed during the COVID-19 crisis. In general, the results showed a deterioration in self-rated health during the COVID-19 outbreak, both for participants at work and in search of work. Participants who lost their job during the COVID-19 crisis reported the highest deterioration in self-rated health. Interview findings revealed that loneliness and social isolation were persistent during the COVID-19 crisis, especially among those in search of work. Additionally, employed participants identified a safe work environment and the possibility to work at the office as important factors for overall health. CONCLUSIONS: The vast majority of study participants (84.2%) experienced no change in work status during the COVID-19 crisis. Nonetheless, people at work and in search of work encountered barriers to maintaining or (re)gaining employment. People with a (partial) work disability who lost their job during the crisis appeared to be most affected in terms of health. Employment and health protections could be strengthened for persons with (partial) work disabilities in order to build resilience in times of crisis.

Mixed-methods process evaluation of the Dynamic Work study: A multicomponent intervention for office workers to reduce sitting time.

Previously, we observed no significant reductions in sitting time of the multicomponent Dynamic Work (DW) intervention among office workers. In this study we used mixed-method data to understand context, implementation (i.e. recruitment and delivery) and mechanism of impact (i.e. experiences) of the DW intervention and to explore whether an higher implementation index score led to larger changes in participants' outcomes. We found considerable variation across departments regarding context (i.e. different size and work tasks) and implementation (i.e. delivery varied). Satisfaction with the DW intervention was high. An higher implementation index score was associated with lower overall sitting time, lower occupational sitting time, higher number of steps/day and steps/day at work at 4-months, which was maintained at 8-month for occupational sitting time. These findings provide an understanding that implementation was affected by a lack of availability of intervention components, department policy, work tasks, positioning and work location. TRIAL REGISTRATION: Clinicaltrials.gov, registration number:NCT03115645. Registered February 17, 2017 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03115645.

Barriers and facilitators influencing the implementation of the occupational health intervention 'Dynamic Work': a qualitative study.

BACKGROUND: Sedentary behavior is associated with an increased risk of morbidity and mortality. To reduce occupational sitting time of office workers, the multi-component intervention 'Dynamic Work' was implemented in a Dutch insurance company. Although the results showed no significant reductions in sitting time, associations were found between higher levels of implementation and reductions in sitting time. Building upon these findings, this qualitative study aimed to identify barriers and facilitators from an organizational perspective for the implementation of Dynamic Work. In addition, we explored differences in barriers and facilitators between departments with a low, middle and high level of implementation. METHODS: In total, eighteen semi-structured interviews were conducted with two Dynamic Work coordinators, three occupational physiotherapists who delivered the intervention, and thirteen department managers. All participants were purposively sampled. The data was coded in Atlas.ti and a thematic analysis was performed guided by The Integrated Checklist of Determinants (TICD). RESULTS: Implementation factors were related to the organization; working culture and financial support facilitated implementation. Factors related to the implementing department mainly hindered implementation, i.e. lack of information at start of the project, late delivery of Dynamic Work equipment, large group sizes, employee's workload and work tasks, and an ongoing reorganization. The facilitating role of managers was experienced as both enabling and hindering. The pre-existing familiarity of the occupational physiotherapists with the departments and alignment amongst the three implementers facilitated implementation. Yet, the non-obligatory nature of the intervention as well as limited availability and technical problems of equipment did not support implementation. CONCLUSIONS: Various barriers and facilitators influenced the implementation of the Dynamic Work intervention, where the key role of the department manager, late delivery of dynamic work equipment and groups sizes varied between low and high implementing departments. These results can contribute to developing and improving implementation strategies in order to increase the effectiveness of future occupational health interventions. TRIAL REGISTRATION: The study protocol was registered on April 14, 2017 in the ClinicalTrials.gov Protocol Registration and Results System under registration number NCT03115645 .

Return to work factors and vocational rehabilitation interventions for long-term, partially disabled workers: a modified Delphi study among vocational rehabilitation professionals.

BACKGROUND: Long-term disability has a great impact on both society and workers with disabilities. Little is known about the barriers which prohibit workers with long-term disabilities from returning to work and which interventions are best suited to counteract these barriers. The main purpose of this study was to obtain consensus among professionals on important return to work (RTW) factors and effective vocational rehabilitation (VR) interventions for long-term (> 2 years), partially disabled workers. Our three research questions were: (1) which factors are associated with RTW for long-term disabled workers?; (2) which factors associated with RTW can be targeted by VR interventions?; and (3) which VR interventions are the most effective to target these factors? METHODS: A modified Delphi Study was conducted using a panel of 22 labour experts, caseworkers, and insurance physicians. The study consisted of several rounds of questionnaires and one online meeting. RESULTS: The multidisciplinary panel reached consensus that 58 out of 67 factors were important for RTW and that 35 of these factors could be targeted using VR interventions. In five rounds, the expert panel reached consensus that 11 out of 22 VR interventions were effective for at least one of the eight most important RTW factors. CONCLUSIONS: Consensus was reached among the expert panel that many factors that are important for the RTW of short-term disabled workers are also important for the RTW of long-term partially disabled workers and that a substantial number of these factors could effectively be targeted using VR interventions. The results of this study will be used to develop a decision aid that supports vocational rehabilitation professionals in profiling clients and in choosing suitable VR interventions.

Physical activity at work may not be health enhancing. A systematic review with meta-analysis on the association between occupational physical activity and cardiovascular disease mortality covering 23 studies with 655 892 participants.

OBJECTIVES: Emerging evidence suggests contrasting health effects for leisure-time and occupational physical activity. In this systematic review, we synthesized and described the epidemiological evidence regarding the association between occupational physical activity and cardiovascular disease (CVD) mortality. METHODS: A literature search was performed in PubMed, Embase, CINAHL, PsycINFO and Evidence-Based Medicine Reviews, from database inception to 17 April 2020. Articles were included if they described original observational prospective research, assessing the association between occupational physical activity and CVD mortality among adult workers. Reviews were included if they controlled for age and gender and at least one other relevant variable. We performed meta-analyses on the associations between occupational physical activity and CVD mortality. RESULTS: We screened 3345 unique articles, and 31 articles (from 23 studies) were described in this review. In the meta-analysis, occupational physical activity showed no significant association with overall CVD mortality for both males [hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.87-1.15] and females (HR 0.95, 95% CI 0.82-1.09). Additional analysis showed that higher levels of occupational physical activity were non-significantly associated with a 15% increase in studies reporting on the outcome ischemic heart disease mortality (HR 1.15, 95% CI 0.88-1.49). CONCLUSIONS: While the beneficial association between leisure-time physical activity and CVD mortality has been widely documented, occupational physical activity was not found to have a beneficial association with CVD mortality. This observation may have implications for our appreciation of the association between physical activity and health for workers in physically demanding jobs, as occupational physical activity may not be health enhancing.

Preferences regarding the way of use and design of a work ability prognosis support tool: a focus group study among professionals.

PURPOSE: To explore the preferable way of use and design of a work ability prognosis support tool for insurance physicians (IPs) and labour experts (LEs), based on a prediction model for future changes in work ability among individuals applying for a work disability benefit. METHODS: We conducted three focus groups with professionals of the Dutch Social Security Institute (17 IPs and 7 LEs). Data were audio recorded and qualitatively analysed according to the main principles of thematic analysis. RESULTS: Clarity and ease of use were mentioned as important features of the tool. Most professionals preferred to make their own judgement during the work disability assessment interview with the claimant and afterwards verify their evaluation with the tool. Concerning preferences on the design of the tool, dividing work disability claimants into categories based on the outcome of the prediction model was experienced as the most straightforward and clear way of presenting the results. Professionals expected that this encourages them to use the tool and act accordingly. CONCLUSIONS: The tool should be easy to access and interpret, to increase the chance that professionals will use it. This way it can optimally help professionals making accurate prognoses of future changes in work ability.Implications for rehabilitationA work ability prognosis support tool based on a prediction model for changes in work ability at one-year follow-up can help occupational health professionals in making accurate prognosis of individuals applying for a work disability benefit.To be used in occupational health practice, these tools should have a simple and easy-to-use design.Graphical risk presentation can be used to provide intuitive meaning to numerical information and support users' understanding.Taking professionals' preferences into account when developing these tools encourages professionals to use the tools and act accordingly.

How does occupational physical activity influence health? An umbrella review of 23 health outcomes across 158 observational studies.

OBJECTIVE: Physical activity (PA) has substantial benefits across a range of health outcomes. There is uncertainty about the PA-specific health effects, and in particular, the occupational domain. In this umbrella review, we synthesised available evidence on the associations between occupational PA (OPA) and health-related outcomes (including cancer, all-cause mortality and cardiovascular disease). This work informed the development of WHO's guidelines on PA and sedentary behaviour (2020). DESIGN: Umbrella review of systematic reviews. DATA SOURCE: We performed a literature search in PubMed, Web of Science, Embase, CINAHL and Sportdiscuss from database inception to 2 December 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included systematic reviews if they contained a quantitative assessment of OPA and its relationship with at least one health-related outcome. RESULTS: We summarised the evidence of 17 reviews covering 23 unique health-related outcomes. We graded most evidence as low or very low, or moderate quality. We found health benefits for those engaging in high versus low OPA for multiple cancer outcomes (including colon and prostate), ischaemic stroke, coronary heart disease and mental health (ie, mental well-being and life satisfaction). High OPA was associated with unfavourable health outcomes for all-cause mortality in men, mental ill health (ie, depression and anxiety), osteoarthritis, and sleep quality and duration. CONCLUSIONS: We found favourable associations for most health-related outcomes with high OPA levels, but we also found some evidence for unfavourable associations due to high OPA levels. At this point, there is a need for better quality evidence to provide a unequivocal statement on the health effects of OPA.

The user and non-user perspective: Experiences of office workers with long-term access to sit-stand workstations.

OBJECTIVE: Sit-stand workstations have been shown to be effective in reducing sitting time in office workers. The aim of this study was to explore reasons for use and non-use of sit-stand workstations and strategies to decrease sitting and increase physical activity in the workplace from perspectives of users and non-users, as well as from managers and ergo-coaches. METHODS: Six group interviews with employees who have had access to sit-stand workstations for several years were conducted in a large semi-governmental organisation in the Netherlands. Verbatim transcripts were analysed using thematic analysis. Open coding was conducted by three researchers and codes and themes were discussed within the research team. RESULTS: Thematic analysis resulted in two major themes: 1) Reasons for use and non-use and 2) Strategies to increase standing and physical activity in the workplace. Shared and distinct reasons for use and non-use were identified between users and non-users of the sit-stand workstations. The most important reasons for use indicated by users were that they had experiencing immediate benefits, including staying alert and increasing focus; these benefits were not acknowledged by non-users. Non-users indicated that sitting was comfortable for them and that they were therefore not motivated to use the standing option. Strategies to increase the use of the standing option included an introductory phase to become familiar with working while standing and to experience the immediate benefits that come from using the standing option. Furthermore, providing reminders to use the standing option was suggested as a strategy to increase and sustain the use of sit-stand workstations. Increased use may lead to a change in the sitting culture within the organisation, as more employees would adopt active movement behaviours. CONCLUSION: Immediate benefits of the use of the standing option-only mentioned by the users-was the most distinct reason to use sit-stand workstations. Future research should explore how to motivate potential users to adhere to an introductory phase in order to experience these immediate benefits, whether it is linked to the use of sit-stand workstations or other interventions to reduce sitting time.

Proposal to extend the PROMIS® item bank v2.0 'Ability to Participate in Social Roles and Activities': item generation and content validity.

PURPOSE: Previous research indicated that the Patient-Reported Outcomes Measurement Information System (PROMIS®) item bank v2.0 'Ability to Participate in Social Roles and Activities' may miss subdomains of social participation. The purpose of this study was to generate items for these missing subdomains and to evaluate their content validity. METHODS: A three-step approach was followed: (1) Item generation for 16 International Classification of Functioning Disability and Health subdomains currently not covered by the item bank; (2) Evaluation of content validity of generated items through expert review (n = 20) and think-aloud interviews with a purposeful sample of people with and without (chronic) health conditions (n = 10), to assess item comprehensibility, relevance, and comprehensiveness; and 3) Item revision based on the results of step 2, in a consensus procedure. RESULTS: First, 48 items were generated. Second, overall, content experts indicated that the generated items were relevant. Furthermore, based on experts' responses, items were simplified and 'participation in social media' was identified as an important additional subdomain of social participation. Additionally, 'participating in various social roles simultaneously' was identified as a missing item. Based on the responses of the interviewed adults items were simplified. Third, in total 17 items, covering 17 subdomains, were proposed to be added to the original item bank. DISCUSSION: The relevance, comprehensibility and comprehensiveness of the 17 proposed items were supported. Whether the proposed extension of the item bank leads to better psychometric properties of the item bank should be tested in a large-scale field study.

Natural Patterns of Sitting, Standing and Stepping During and Outside Work-Differences between Habitual Users and Non-Users of Sit-Stand Workstations.

Sit-stand workstations have shown to reduce sitting time in office workers on a group level. However, movement behaviour patterns might differ between subgroups of workers. Therefore, the objective of this study was to examine sitting, standing and stepping outcomes between habitual users and non-users of sit-stand workstations. From an international office population based in the Netherlands, 24 users and 25 non-users of sit-stand workstations were included (all had long-term access to these workstations). Using the ActivPAL, sitting, standing and stepping were objectively measured during and outside working hours. Differences in outcomes between users and non-users were analysed using linear regression. During working hours, users sat less (-1.64; 95% IC= -2.27--1.01 hour/8 hour workday) and stood more (1.51; 95% IC= 0.92-2.10 hour/8 hour workday) than non-users. Attenuated but similar differences were also found for total sitting time over the whole week. Furthermore, time in static standing bouts was relatively high for users during working hours (median= 0.56; IQR = 0.19-1.08 hour/8 hour workday). During non-working hours on workdays and during non-working days, no differences were found between users and non-users. During working hours, habitual users of their sit-stand workstation sat substantially less and stood proportionally more than non-users. No differences were observed outside working hours, leading to attenuated but similar differences in total sitting and standing time between users and non-users for total days. This indicated that the users of sit-stand workstations reduced their sitting time at work, but this seemed not to be accompanied by major carry-over or compensatory effects outside working hours.

Cost-Effectiveness and Return-on-Investment of the Dynamic Work Intervention Compared With Usual Practice to Reduce Sedentary Behavior.

OBJECTIVE: To assess the cost-effectiveness and return-on-investment (ROI) of the Dynamic Work (DW) Intervention, a worksite intervention aimed at reducing sitting time among office workers. METHODS: In total, 244 workers were randomized to the intervention or control group. Overall sitting time, standing time, step counts, quality-adjusted life years (QALYs), and costs were measured over 12 months. The cost-effectiveness analysis was performed from the societal perspective and the ROI analysis from the employers' perspective. RESULTS: No significant differences in effects and societal costs were observed between groups. Presenteeism costs were significantly lower in the intervention group. The probability of the intervention being cost-effective was 0.90 at a willingness-to-pay of 20,000&OV0556;/QALY. The probability of financial savings was 0.86. CONCLUSION: The intervention may be considered cost-effective from the societal perspective depending on the willingness-to-pay. From the employer perspective, the intervention seems cost-beneficial.

Predicting Long-Term Sickness Absence and Identifying Subgroups Among Individuals Without an Employment Contract.

Purpose Today, decreasing numbers of workers in Europe are employed in standard employment relationships. Temporary contracts and job insecurity have become more common. This study among workers without an employment contract aimed to (i) predict risk of long-term sickness absence and (ii) identify distinct subgroups of sick-listed workers. Methods 437 individuals without an employment contract who were granted a sickness absence benefit for at least two weeks were followed for 1 year. We used registration data and self-reported questionnaires on sociodemographics, work-related, health-related and psychosocial factors. Both were retrieved from the databases of the Dutch Social Security Institute and measured at the time of entry into the benefit. We used logistic regression analysis to identify individuals at risk of long-term sickness absence. Latent class analysis was used to identify homogenous subgroups of individuals. Results Almost one-third of the study population (n = 133; 30%) was still at sickness absence at 1-year follow-up. The final prediction model showed fair discrimination between individuals with and without long-term sickness absence (optimism adjusted AUC to correct for overfitting = 0.761). Four subgroups of individuals were identified based on predicted risk of long-term sickness absence, self-reported expectations about recovery and return to work, reason of sickness absence and coping skills. Conclusion The logistic regression model could be used to identify individuals at risk of long-term sickness absence. Identification of risk groups can aid professionals to offer tailored return to work interventions.