Article

OBJECTIVES: To determine the effectiveness of early multidisciplinary
interventions in promoting work participation and reducing work absence in adults
with regional musculoskeletal pain. DATA SOURCES: Seven databases (CENTRAL, CINAHL, EMBASE, MEDLINE, Scopus, OT Seeker, PEDro; 1990 to December 2016) were
searched for eligible studies. REVIEW METHODS: Trials were included if they
reported on work-based outcomes for participants experiencing difficulties at
work or </= three months' sick leave. Interventions had to include two or more
elements of the biopsychosocial model delivered as a coordinated programme.
Quality was assessed using the GRADE criteria. Results were analysed by hazard
ratios for return to work data; continuous outcomes were analysed as standardised
mean difference with 95% confidence intervals. RESULTS: A total of 20 randomized
controlled trials, with 16,319 participants were included; the interventions were
grouped according to their main components for meta-analyses. At 12-months
follow-up, moderate quality evidence suggests that programmes involving a stepped
care approach (four studies) were more effective than the comparisons in
promoting return to work (hazard ratio (HR) 1.29 (95% confidence interval (CI)
1.03 to 1.61), p = 0.03), whereas case management (two studies) was not (HR 0.92
(95% CI 0.69 to 1.24), p = 0.59). Analyses suggested limited effectiveness in
reducing sickness absences, in pain reduction or functional improvement across
the intervention categories. CONCLUSION: There is uncertainty as to the
effectiveness of early multicomponent interventions owing to the clinical
heterogeneity and varying health and social insurance systems across the trials.

Langue : ANGLAIS