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Effectiveness of a targeted occupational health intervention in workers with high risk of sickness absence: baseline characteristics and adherence as effect modifying factors in a randomized controlled trial.

ABSTRACT:

Introduction

In a recently published randomized controlled trial (RCT), a targeted occupational health (OH) intervention was found effective in an intention-to-treat analysis in controlling sickness absence among workers with high risk of sickness absence, compared to usual care. We performed an exploratory subgroup analysis in order to detect possible effect modifiers and mediators.

Methods

Age, gender, working status, severity of physical impairment, depression score, self-rated working ability, co-morbidity, and sickness absence characteristics in the previous 12 months were identified as potential effect modifiers (n = 382). We conducted regression analyses with the potential effect modifiers and a mediator (treatment attendance as intended) as explanatory variables. The difference of sickness absence days during the previous year and the follow-up year was the dependent variable.

Results

The intervention was especially effective in the subgroups of workers who were certain that they will not be able to continue working in their current job due to health-related reasons (-74 days; 95% CI -105 to -43), had co-morbidities (-22.5 days; 95% CI -35.5 to -9.5), or severe physical impairment at work (-17.5 days; 95% CI -28.5 to -6.5). A modifying effect of age, gender, working status, depressive symptoms, or prior sickness absence on the effectiveness of this OH intervention was not found.

Conclusions

This targeted OH intervention seems especially suitable for workers who consider that they are no longer able to continue working due to health reasons and have high level of physical impairment or co-morbidities. The findings from these exploratory analyses should be tested in future RCTs.

SUBMITTER: Taimela S

PROVIDER: S-EPMC2832907 | biostudies-literature | 2010 Mar

REPOSITORIES: biostudies-literature

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Publications

Effectiveness of a targeted occupational health intervention in workers with high risk of sickness absence: baseline characteristics and adherence as effect modifying factors in a randomized controlled trial.

Taimela Simo S Aronen Pasi P Malmivaara Antti A Sintonen Harri H Tiekso Jaakko J Aro Timo T

Journal of occupational rehabilitation 20100301 1

<h4>Introduction</h4>In a recently published randomized controlled trial (RCT), a targeted occupational health (OH) intervention was found effective in an intention-to-treat analysis in controlling sickness absence among workers with high risk of sickness absence, compared to usual care. We performed an exploratory subgroup analysis in order to detect possible effect modifiers and mediators.<h4>Methods</h4>Age, gender, working status, severity of physical impairment, depression score, self-rated ...[more]

PMID: 20012343

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Project description:BackgroundDepression is highly prevalent in the working population and is associated with significant loss of workdays; however, access to evidence-based treatment is limited.ObjectiveThis study evaluated the effectiveness of a Web-based intervention in reducing mild to moderate depression and sickness absence.MethodsIn an open-label randomized controlled trial, participants were recruited from a large-scale statutory health insurance and were assigned to two groups. The intervention group had access to a 12 week Web-based program consisting of structured interactive sessions and therapist support upon request. The wait-list control group had access to unguided Web-based psycho-education. Depressive symptoms were self-assessed at baseline, post-treatment, and follow-up (12 weeks after treatment) using the Patient Health Questionnaire (PHQ-9) and Beck Depression Inventory (BDI-II) as primary outcome measures. Data on sickness absence was retrieved from health insurance records. Intention-to-treat (ITT) analysis and per-protocol (PP) analysis were performed.ResultsOf the 180 participants who were randomized, 88 completed the post-assessment (retention rate: 48.8%, 88/180). ITT analysis showed a significant between-group difference in depressive symptoms during post-treatment in favor of the intervention group, corresponding to a moderate effect size (PHQ-9: d=0.55, 95% CI 0.25-0.85, P<.001, and BDI-II: d=0.41, CI 0.11-0.70, P=.004). PP analysis partially supported this result, but showed a non-significant effect on one primary outcome (PHQ-9: d=0.61, 95% CI 0.15-1.07, P=.04, and BDI-II: d=0.25 95% CI -0.18 to 0.65, P=.37). Analysis of clinical significance using reliable change index revealed that significantly more participants who used the Web-based intervention (63%, 63/100) responded to the treatment versus the control group (33%, 27/80; P<.001). The number needed to treat (NNT) was 4.08. Within both groups, there was a reduction in work absence frequency (IG: -67.23%, P<.001, CG: -82.61%, P<.001), but no statistical difference in sickness absence between groups was found (P=.07).ConclusionsThe Web-based intervention was effective in reducing depressive symptoms among adults with sickness absence. As this trial achieved a lower power than calculated, its results should be replicated in a larger sample. Further validation of health insurance records as an outcome measure for eHealth trials is needed.Trial registrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 02446836; http://www.isrctn.com/ISRCTN02446836 (Archived by WebCite at http://www.webcitation.org/6jx4SObnw).

Project description:BackgroundFrequent sickness absence-that is, 3 or more episodes of sickness absence in 1 year-is a problem for employers and employees. Many employees who have had frequent sickness absence in a prior year also have frequent sickness absence in subsequent years: 39% in the first follow-up year and 61% within 4 years. Moreover, 19% have long-term sickness absence (≥6 weeks) in the first follow-up year and 50% within 4 years. We developed an electronic health (eHealth) intervention, consisting of fully automated feedback and advice, to use either as a stand-alone tool (eHealth intervention-only) or combined with consultation with an occupational physician (eHealth intervention-occupational physician).ObjectiveThis study aimed to evaluate the effect of the eHealth intervention, with or without additional occupational physician consultation, to reduce sickness absence frequency for employees with frequent sickness absence, versus care as usual (CAU).MethodsThis study was a three-armed randomized controlled trial. Employees with frequent sickness absence received invitational letters, which were distributed by their employers. The primary outcome measure was the number of register-based sickness absence episodes 12 months after completing the baseline questionnaire. Secondary outcome measures were register-based total sickness absence days and self-assessed burnout, engagement, and work ability. In a process evaluation 3 months after baseline, we examined adherence to the intervention and additional actions such as general practitioner and occupational physician visit, communication with the manager, and lifestyle change.ResultsA total of 82 participants were included in the analyses, 21 in the eHealth intervention-only group, 31 in the eHealth intervention-occupational physician group, and 30 in the CAU group. We found no significant difference in sickness absence frequency between the groups at 1-year follow-up. Sickness absence frequency decreased in the eHealth intervention-only group from 3 (interquartile range, IQR 3-4) to 1 episode (IQR 0.3-2.8), in the eHealth intervention-occupational physician group from 4 (IQR 3-5) to 3 episodes (IQR 1-4), and in the CAU group from 3 (IQR 3-4) to 2 episodes (IQR 1-3). For secondary outcomes, we found no significant differences between the intervention groups and the control group. The process evaluation showed that only 3 participants from the eHealth intervention-occupational physician group visited the occupational physician on invitation.ConclusionsAmong employees with frequent sickness absence, we found no effect from the eHealth intervention as a stand-alone tool in reducing sickness absence frequency, nor on total sickness absence days, burnout, engagement, or work ability. This might be due to low adherence to the intervention because of insufficient urgency to act. We cannot draw any conclusion on the effect of the eHealth intervention tool combined with an occupational physician consultation (eHealth intervention-occupational physician), due to very low adherence to the occupational physician consultation. An occupational physician consultation could increase a sense of urgency and lead to more focus and appropriate support. As this was the first effectiveness study among employees with frequent sickness absence, strategies to improve recruitment and adherence in occupational eHealth are included.Trial registrationNetherlands Trial Register NTR4316; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4316 (Archived by WebCite at http://www.webcitation.org/713DHhOFU).

Project description:ObjectivesSocioeconomic position has been linked to sickness absence (SA). However, less is known about the role of occupational prestige, a measure of social status afforded by one's occupation, in SA. We investigated the association between occupational prestige and SA and the distribution of the association in women and men. We also examined the effect of intersections of gender and occupational prestige on SA.DesignLongitudinal.SettingA nationwide representative sample of Swedish working population.Participants97 397 employed individuals aged 25-59 years selected from the 2004, 2007 and 2010 waves of the Swedish Labour Force Survey and prospectively linked to the Swedish Longitudinal Integration Database for Health Insurance and Labour Market Studies.Outcome measuresThe number of SA days in any particular year during a 3-year follow-up and long-term (>120 days) SA based on those with at least one sick leave spell during the follow-up.ResultsOccupational prestige was weakly associated with SA in the total sample after adjusting for potential confounders. In the gender-stratified analysis, women in lower prestige occupations had higher absenteeism rates than women in high prestige occupations; men in lower prestige occupations had higher odds for long-term SA than men in high prestige occupations. In the intersectional analysis, women regardless of prestige level and men in lower prestige occupations had higher probability of SA compared with men in high prestige occupations. Women in high prestige occupations had the highest absenteeism rates (incidence rate ratio (IRR), 2.25, 95% CI, 2.20 to 2.31), while men in medium prestige occupations had the lowest rates (IRR, 1.17, 95% CI, 1.13 to 1.20). Compared with the rest of the groups, men in low and medium prestige occupations had higher odds for long-term absence.ConclusionThere is need to pay close attention to occupational prestige as a factor that may influence health and labour market participation.

Dataset Information

Effectiveness of a targeted occupational health intervention in workers with high risk of sickness absence: baseline characteristics and adherence as effect modifying factors in a randomized controlled trial.

Introduction

Methods

Results

Conclusions

Publications

Effectiveness of a targeted occupational health intervention in workers with high risk of sickness absence: baseline characteristics and adherence as effect modifying factors in a randomized controlled trial.

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