RCTJournal of occupational rehabilitation2017

Effectiveness of an Intervention to Enhance Occupational Physicians' Guideline Adherence on Sickness Absence Duration in Workers with Common Mental Disorders: A Cluster-Randomized Controlled Trial.

Karlijn M van Beurden, Evelien P M Brouwers, Margot C W Joosen and 4 others

PMID 27904985

WHAT IT FOUND

Training occupational physicians to better follow mental health guidelines did not help their sick-listed workers return to work sooner.

Workers in both groups took about the same number of days to fully return, suggesting that physician knowledge alone does not overcome workplace barriers.

Key findings

01The intervention had no significant effect on the time to full return to work, with a hazard ratio of 0.96 indicating similar likelihoods between groups.

02Total hours of sickness absence over one year were statistically similar between the intervention and control groups.

03Despite improved physician guideline adherence in prior work, this study found no reduction in sickness absence duration for workers with common mental disorders.

STILL TO COME

How it was doneWhat they found

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What it does not show

The study relied on anonymized registration data, which meant important factors like diagnosis severity, work context, and other treatments could not be analyzed as confounders. Actual physician adherence to the guidelines was not directly measured in this trial, relying instead on prior evidence of self-reported improvement. The control group received usual care that was already based on the same guidelines, potentially reducing the contrast between the two groups.

Declared interests

The study was funded by ZonMw, a Dutch research organization.

The easy way to misread this

Do not conclude that guideline-based care is ineffective for mental health return-to-work. The null result may reflect insufficient contrast between the trained and usual-care physicians, rather than a failure of the guidelines themselves.

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The study

Participants
3228 workers (analyzed)
Certainty of evidence
Moderate

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    Cite

    Karlijn M van Beurden, Evelien P M Brouwers, Margot C W Joosen, et al. Effectiveness of an Intervention to Enhance Occupational Physicians' Guideline Adherence on Sickness Absence Duration in Workers with Common Mental Disorders: A Cluster-Randomized Controlled Trial. Journal of occupational rehabilitation. 2017.

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