Alexander L1, Mitchell D1, Cooper K1
1Robert Gordon University, Aberdeen, United Kingdom
Background: Vocational rehabilitation (VR) has been identified as a solution to address the impact of musculoskeletal disorders (MSD) in working age adults. Vocational rehabilitation is a multi-component approach that includes different interventions specific to a condition which should begin early and address the physical musculoskeletal problem, any psychological disorders and employment factors to facilitate a sustained return to work. As a number of systematic reviews relating to work outcomes and rehabilitation for MSDs have been published, it was identified that an umbrella review (systematic review of existing reviews) would provide the highest level of evidence synthesis on the effectiveness of VR for MSDs.
Purpose: This umbrella review was conducted in accordance with Joanna Briggs Institute umbrella review methodology and guided by an a-priori protocol with the objectives:
1. Is vocational rehabilitation effective at improving work participation, reducing sickness absence and reducing disability due to musculoskeletal disorders in working age adults?
2. Which types/modes of vocational rehabilitation are most effective for improving work participation, reducing sickness absence and reducing disability due to musculoskeletal disorders in working age adults?
3. Which musculoskeletal disorders is vocational rehabilitation most beneficial for?
Methods: The protocol detailed the population of interest, interventions, context, outcomes and search strategy. Quantitative reviews of working age adults with MSD that focused on VR for work participation or aimed to assist return to work (RTW) via interventions such as physiotherapy, exercise or education were included. To ensure relevance, both published and unpublished evidence available from the last ten years was included. Two independent reviewers assessed all studies for inclusion, methodological quality and extracted data.
Results: Seventeen reviews were included which represented over 53,000 participants mainly from Europe, Scandinavia and North America. The majority of reviews focused on low back pain (LBP) (11 reviews) and the others on neck/arm pain (2), general MSDs (3) and inflammatory arthritis (1). All reviews included outcomes on RTW with exercise and brief education demonstrating moderate effectiveness for LBP; early, active multidisciplinary treatment and workplace interventions were moderately effective for general MSDs; workplace interventions were moderately effective for neck/arm problems and there was very low quality evidence for the effectiveness of non-pharmacological interventions for IA. The secondary outcomes demonstrated strong evidence for effectiveness of workplace interventions for general MSDs in terms of pain and function. Brief education and multidisciplinary biopsychosocial rehabilitation were moderately effective for function in LBP.
Conclusion(s): VR is effective for improving work participation, reducing pain and disability in adults with MSDs. The most effective VR intervention elements include exercise, brief education, workplace interventions and multidisciplinary biopsychosocial rehabilitation.
Implications: The results of this study have demonstrated that VR can be effective in MSDs but more high quality research is required due to heterogeneity of interventions and modest effects.
Keywords: Voccational rehabilitation, musculoskeletal disorders, systematic review
Funding acknowledgements: This review was partly funded by the Police Treatment Centres, UK
Purpose: This umbrella review was conducted in accordance with Joanna Briggs Institute umbrella review methodology and guided by an a-priori protocol with the objectives:
1. Is vocational rehabilitation effective at improving work participation, reducing sickness absence and reducing disability due to musculoskeletal disorders in working age adults?
2. Which types/modes of vocational rehabilitation are most effective for improving work participation, reducing sickness absence and reducing disability due to musculoskeletal disorders in working age adults?
3. Which musculoskeletal disorders is vocational rehabilitation most beneficial for?
Methods: The protocol detailed the population of interest, interventions, context, outcomes and search strategy. Quantitative reviews of working age adults with MSD that focused on VR for work participation or aimed to assist return to work (RTW) via interventions such as physiotherapy, exercise or education were included. To ensure relevance, both published and unpublished evidence available from the last ten years was included. Two independent reviewers assessed all studies for inclusion, methodological quality and extracted data.
Results: Seventeen reviews were included which represented over 53,000 participants mainly from Europe, Scandinavia and North America. The majority of reviews focused on low back pain (LBP) (11 reviews) and the others on neck/arm pain (2), general MSDs (3) and inflammatory arthritis (1). All reviews included outcomes on RTW with exercise and brief education demonstrating moderate effectiveness for LBP; early, active multidisciplinary treatment and workplace interventions were moderately effective for general MSDs; workplace interventions were moderately effective for neck/arm problems and there was very low quality evidence for the effectiveness of non-pharmacological interventions for IA. The secondary outcomes demonstrated strong evidence for effectiveness of workplace interventions for general MSDs in terms of pain and function. Brief education and multidisciplinary biopsychosocial rehabilitation were moderately effective for function in LBP.
Conclusion(s): VR is effective for improving work participation, reducing pain and disability in adults with MSDs. The most effective VR intervention elements include exercise, brief education, workplace interventions and multidisciplinary biopsychosocial rehabilitation.
Implications: The results of this study have demonstrated that VR can be effective in MSDs but more high quality research is required due to heterogeneity of interventions and modest effects.
Keywords: Voccational rehabilitation, musculoskeletal disorders, systematic review
Funding acknowledgements: This review was partly funded by the Police Treatment Centres, UK
Topic: Musculoskeletal
Ethics approval required: No
Institution: Robert Gordon University
Ethics committee: School of Health Sciences Research Review Group
Reason not required: No ethical approval was required as this was a systematic review using secondary research. To ensure rigor in the review process an a-priori protocol was developed to guide the review and has been published
All authors, affiliations and abstracts have been published as submitted.
