Table 3.
Main outcomes of quantitative studies
| First author, year | Medical specialty | Main outcome | References |
|---|---|---|---|
| Exploration of work and disease work-relatedness by medical specialists | |||
| Barber 2007 | Pulmonology |
The reported clinical approach for diagnosis in a clinical case scenario of possible occupational asthma attributed to flour dust exposure, as percentage of total number of general respiratory physicians without a specific interest in occupational lung disease (n = 45): –History taking: 46% asked about the relationship between work and symptoms or improvement of health when away from work –Diagnostics: 14% explored work-related trends using specific software (OASYS-2); 47% used either skin prick tests of specific IgE to flour (agent of exposure in case scenario) |
[60] |
| Bayliss 2020 | Cardiology, obstetrics, and gynecology, oncology, orthopedic surgery | Percentage of doctors asking always or most of the time about patient’s occupation: 93% of total sample (n = 42); 93% of cardiology (n = 15); 67% of obstetrics and gynecology (n = 9); 50% of oncology (n = 6); and 100% of orthopedic surgery (n = 12) | [61] |
| Holness 2007 | Pulmonology, primary care |
Percentage of pulmonologists (n = 65): –Taking history of workplace exposure: always/most of the time, 92%; sometimes, 6%; and rarely/never, 2% –Conducting investigation of patients with possible occupational asthma: always diagnose condition myself, 27%; sometimes refer to specialist, 50%; mostly refer to specialist, 23% |
[70] |
| Moscato 2014 | Allergology | From cases of occupational asthma (n = 80), 27.5% of patients underwent specific exposure challenge with suspected professional agent during diagnostics | [77] |
| Michel 2018 | Rehabilitation |
Percentage of rehabilitation centers offering a functional restoration program for chronic lower back pain patients reported (n = 56): –89% collecting occupational information at inclusion –66% collecting occupational information at the end of the program –91% collecting occupational information during an individual interview –71% collecting occupational information through a self-administered questionnaire –100% investigating the link between lower back pain and occupational activity, especially in case of work injury The content of collected information mostly concerned the current social and occupational status. Opinions about fitness for work were collected in less than half of the cases. Workplace environment was the most poorly discussed aspect |
[87] |
| Tsang 2020 | Orthopedics | Percentage of surgeons identifying whether patients are working and intending to RTW after surgery (n = 78): 10% of orthopedic surgeons | [82] |
| Wada 2012 | Oncology |
As reported by oncologists (n = 668): –I learn the type and quantity of the patient’s work: 27.8% strongly agree, 38.3% agree, 27.0% disagree, and 6.9% strongly disagree –The medical institution facilitates an interview sheet that requires a description of information on the patient’s work: 52.8% strongly agree, 7.2% agree, 3.3% disagree, and 32.6% strongly disagree |
[83] |
| Discussing work-related concerns with patients | |||
| Allen 2010 | 23 medical specialties, not further specified | Percentage of training-grade doctors discussing work ability in patients off sick for four weeks or less (n = 918): 15% weekly, 68% rarely or never | [58] |
| Ladak 2021 | Rheumatology, dermatology, gastroenterology | Percentage of respondents reporting being asked for advice on RTW during the COVID-19 pandemic (n = 151): 94% | [72] |
| Meunier 2016 | Rheumatology |
–Percentage of rheumatologists reporting having a work-related discussion when asked to describe their most recent consultation with a rheumatoid arthritis patient (n = 153): 50%. Of this group, the frequency of discussing the following subjects was psychological problems related to work, 29%; physical problems related to work, 88%; adaptation of working conditions, 34%; impact of long-term sick leave, 26%; return to work, 10%; difficulties in going to work, 31%; and disclosure of the disease to the employer, 55% –Percentage of rheumatoid arthritis patients reporting having a work-related discussion when asked to describe their most recent consultation with a rheumatologist (n = 81): 52%. Of this group, the frequency of discussing the following subjects was psychological problems related to work, 24%; physical problems related to work, 88%; impact of long-term sick leave, 43%; return to work, 29%; difficulties in going to work, 21%; and disclosure of the disease to the employer, 36% |
[47] |
| Michel 2018 | Rehabilitation |
Percentage of rehabilitation centers offering a functional restoration program to chronic low back pain patients reported (n = 56): –84% discussed obstacles for RTW –90% discussed feasible workstation arrangements |
[87] |
| Takahashi 2018 | Oncology | Percentage of patients with cancer reporting to be asked about work-related difficulties by healthcare providers (n = 950): 23.5%; of this group, 140 (63.3%) reported this was asked by a physician | [95] |
| Thompson 2013 | Oncology | Oncologists’ practice (n = 6) of discussing strategies to integrate treatment with educational, employment, and social lives (on 5-point Likert scale from unlikely (1) to likely (5)): 1 (0.8), median (IQR) | |
| Tsang 2020 | Orthopedics |
Percentage of orthopedic surgeons providing RTW advice when a patient specifically asked (n = 78): 96% Percentage of surgeons reporting whether patients in work and intending to return to work after surgery receive additional advice and support during their in-patient stay or after discharge (n = 78): 8% |
[82] |
| Zegers 2020 | Oncology | Cancer survivors’ indication that a healthcare professional within the hospital had discussed the work-related consequences of cancer and/or its treatment with them (n = 3500): 992 (32%); of these conversations, 508 (53%) were with a physician or medical specialist | [96] |
| Nature of work-related advice given to patients | |||
| Barber 2007 | Pulmonology |
Advice from general respiratory physicians (n = 45) if occupational asthma would be confirmed: –63% advised some form of reduction in exposure (personal protective equipment or alternative employment) |
[60] |
| Braybrooke 2015 | Oncology |
28.6% of French (n = 77), 28.6% of German (n = 58), and 25.0% UK participants (n = 63) received information about RTW 35.7% of French (n = 77), 14.3% of German (n = 58), and 8.2% of UK participants (n = 63) received encouragement to RTW |
[91] |
| Clayton 2007 | Gynecology, orthopedic surgery, primary care, and occupational health care |
Gynecologist responses for benign abdominal hysterectomy procedures (n = 11): –Advice regarding office work: 6 (55%) gynecologists advised RTW within 6 weeks, 4 (36%) within 8 weeks, and 1 (9%) within 10 weeks –Advice regarding moving and handling (M + H) duties: 4 (36%) gynecologists advised RTW between 4 and 9 weeks, 6 (55%) within 10–12 weeks, and 1 (9%) at 12 weeks No information reported on return to work form hysterectomy ‘patient information’ leaflets (n = 10) Consultant responses for Birmingham hip resurfacing procedures (BHR) (n = 13): –Advice regarding office work: 6 (46%) orthopedic surgeons advised RTW within 6 weeks –Advice regarding moving and handling (M + H) duties: 8 (62%) orthopedic surgeons advised RTW within 12 weeks –Advice regarding heavy physical work: 10 (77%) orthopedic surgeons would only occasionally advice return to heavy physical work Note: 3 orthopedic surgeons (23%) advocated RTW within other periods of time, including a return to desk work within 2.5 weeks and longer than 12 weeks if other joint problems were present Specific return to work times were stated in 4 BHR ‘patient information’ leaflets (n = 11). Three advised RTW within 6–8 weeks of surgery Without stipulating any limitations on the type of work other than general activities to be avoided such as squatting, twisting, or prolonged standing. One advised return to office work after 6 weeks but if work involved prolonged standing, the patient should refrain from work for 3 months |
[64] |
| Clinch 2009 | Obstetrics |
There was substantial variation in the content of women’s RTW discussions with healthcare providers: –Content of RTW discussions with Prenatal Health Care Provider (n = 131) concerned: 19.5% maternal health (i.e., physical or mental); 10.6% infant’s health or development; 23.6% both mother and infant’s health; and 46.3% other –Content of RTW discussions with Infant’s Health Care Provider concerned (n = 125): 8.4% maternal health (i.e., physical or mental); 33.6% infant’s health or development; 22.7% both mother and infant’s health; and 35.3% other |
[98] |
| de Croon 2005 | Rheumatology |
Advice from rheumatologists (n = 78): –8% gave organizational advice, including advice such as adjustment of tasks or work schedules –3% gave technical advice, including advice such the application of assistive devices (e.g., application of a knee table to write) –13% gave personal advice including personal adjustments to maintain work ability, which were not specific (e.g., ‘do not force yourself’) Receiving advice on how to maintain work ability from other medical specialists: the surgeon (5%), the rehabilitation physician (4%), and the orthomanual physician (1%) |
[92] |
| Fowler 2019 | Colorectal surgery |
The reported surgeon’s choice of treatment in a clinical scenario describing a patient with grade IV hemorrhoids with preference of prompt RTW after surgery, percentage of surgeons (n = 82): –Stapled hemorrhoidectomy or Doppler-guided hemorrhoidectomy, in concordance with guideline recommendations, 58% –Conventional excisional hemorrhoidectomy; despite the reportedly longer return to normal activities post-procedure, 36% |
[65] |
| Grevnerts 2018 | Orthopedic surgery and physical therapy |
Percentage of orthopedic surgeons (n = 98): –Who would advise surgery when patient’s occupation is physically demanding for the knee and requires knee stability: 96% –Reporting knee instability in working situations as the most important factor for advising surgery: 2% –Reporting work in combination with other factors as the most important for advising surgery: 6% |
[66] |
| Grewal 2014 | General surgery |
Acute trusts providing inguinal hernia repair (n = 128) reported a wide variation in the advice given to patients by their operating surgeons regarding the time to return to work: –Open inguinal hernia repair: From 1 week to 4–6 weeks for office work; from 2 weeks to 6–12 weeks for manual labor –Laparoscopic inguinal hernia repair: From 1 week to 2–4 weeks for office work; from 2 weeks to 2–4 weeks for manual labor |
[86] |
| Hayman 2021 | Emergency health care |
Advice to remain home for minor illness (n = 182): most physicians answered that they advise patients to remain at home for minor illnesses; however, the duration of exclusion from work varied; for influenza-like illness, the median was 4 days, 6.5% answered until fever resolves; for upper respiratory tract infection, the median was 2 days, 7.1% answered until fever resolves; and for gastroenteritis, the median was 2 days, 9.0% answered until fever resolves Percentage of respondents who believed that a patient is capable of determining when to return to work (n = 182): most of the time 82.8%, sometimes 17.2%, and rarely 0% |
[69] |
| Holness 2007 | Pulmonology and primary care |
Percentage of pulmonologists (n = 65) advising patients with suspected occupational asthma to leave work until diagnosis is confirmed: 5% always and 27% most of the time (other 68% was not reported by the authors) |
[70] |
| Jauregui 2020 | Emergency medicine | Acute low back pain that was the result of a work-related injury was shown to have an inverse relationship with the likelihood that an opioid was prescribed by emergency physicians. Patients (n = 162) whose injury was work related were less likely to receive an opioid prescription (p = 0.027, 95% CI) | [105] |
| Jenny 2016 | Orthopedic surgery | From the study protocol, progressive RTW was allowed according to patient’s decision. No restriction was imposed by the physician at any follow-up time or for any work activity | [106] |
| Keegel 2007 | Dermatology |
Advice from dermatologist in cases of workers suspected of occupational contact dermatitis (n = 44): –Percentage of dermatologists providing general advice on medical treatment and preventive measures: oral steroids/immunosuppressive agent, 54.5%; corticosteroid creams, 9.1%; corticosteroid ointment, 43.2%; topical corticosteroid not specified, 34.1%; moisturizing cream, 9.1%; moisturizer not specified, 18.2%; using gloves, 38.6%; using soap substitute/avoiding soap, 0%; antibiotics, 22.7%; and antihistamines, 0% –Percentage of dermatologists providing general advice for further diagnostics: fungal scrapings or radioallergosorbent test, 4.5% –Percentage of dermatologists providing specific work advice: avoidance/modify duties, 20.5%; change of job, 4.5% –Referring practices: treat patients independently, 2.3%; refer on initial presentation to tertiary occupational dermatology clinic, 81.8%; and no information, 15.9% |
[97] |
| Kirchhoff 2017 | Oncology | 23.9% of oncologists (n = 91) reported that their adolescent and young adult (AYA) cancer patients needed assistance with employment support; this support is always or often unmet for AYAs according to 16.9% of oncologists | [71] |
| Mirmohammadi 2013 | Cardiology | From patients not returning to work after first myocardial infarction (n = 40), 7.5% gave physician’s order as the reason and 22.5% gave physician’s recommendation as the reason | [100] |
| Naidu 2012 | Gynecology and obstetrics |
Advice given by obstetrician and gynecologists (n = 472) regarding time in days before return to convalescence activities (median, 25–75 percentiles): diagnostic hysteroscopy, 2 days (1–2); operative hysteroscopy, 7 days (2–7); diagnostic laparoscopy, 7 days (2–7); operative laparoscopy, 10 days (5–14); abdominal surgery, 42 days (42–56); and vaginal surgery, 42 days (28–56) In addition, conditional advice for RTW as an open-ended question response (number of respondents), when comfortable (n = 14) and depends on work (n = 12) |
[78] |
| Newington 2018 | Surgery and occupational and physical therapy |
Advice for patients undergoing carpal tunnel release surgery given by surgeons (n = 173) regarding time in days before return to work (median, IQR): desk-based duties (e.g., keyboard, mouse, writing, telephone), 7 days (2–14); repetitive light manual duties (e.g., driving, delivery, stacking), 14 days (14–28); and heavy manual duties (e.g., construction), 30 days (21–42) Additional recommendations from open-ended question (% of surgeons): advice to limit function to clean and/or dry activities until the wound was healed (31%); avoiding activities that might aggravate the surgical site, such as heavy gripping or weight-bearing through the hand during 2–6 weeks (34%); advice to resume driving ranged from the day of surgery to 6 weeks postoperatively (30%); and advice was dependent on the patient’s individual circumstances (42%) |
[79] |
| O'Hagan 2011 | Cardiac rehabilitation | Perceived physician support to RTW for patients (n = 214) on 5-point Likert scale (1–5) (SD): working patients: 4.21 (0.74) and disabled patients: 3.71 (1.10); p = 0.002 | [94] |
| Ratzon 2006 | Surgery |
Surgeon’s recommendation on RTW after carpal tunnel release surgery (n = 50): 1–36 days (median 21; IQR 14–30) Surgeon’s recommendations were the strongest predictor of delayed RTW (> 21 days), this was not correlated with objective findings |
[101] |
| Rowe 2018a | Emergency medicine |
Frequency of recommendation to stay home from work following a concussion after emergency department discharge by emergency physicians (n = 197): 69% Patients provided with the ‘Electronic Clinical Practice Guidelines’ handout (n = 119) were more frequently recommended to avoid work (OR 1.95, 95% CI 1.10–3.48) than those who did not receive the handout (n = 131) Patients injured at work (n = 28) were more likely to receive advice to miss work (OR 3.1; 95% CI 1.0–9.2) than those not injured at work (n = 169) |
[99, 102] |
| Salit 2020 | Oncology |
Advice on RTW of transplantation centers performing > 50 total Hematopoietic Cell Transplantations (HCT) per year based on their local guidelines (n = 45): –Autologous HCT: 70%, 1–3 months post-HCT, 70%; 4–6 months post-HCT, 30% –Allogeneic HCT: 4–6 months post-HCT, 20%; 6–12 months post-HCT, 60%; until cessation of immune suppression, 11%; and no specific guideline, 5% –Job types that require longer absence from work: interacting with sick people, 70%; interacting with children, 65%; interacting with people, 40%; interacting with animals, 50%; jobs with significant physical activity, 35%; no specific guideline, 25%; and jobs with significant travel, 10% |
[88] |
| Wada 2012 | Oncology |
As reported by oncologists (n = 668): –I explain the impact of treatment on work: 53.0% strongly agree, 40.0% agree, 6.1% disagree, 0.9% strongly disagree |
[83] |
| Watson 2009 | Orthopedic surgery |
Probability (%, CI) of surgeons (n = 125) recommending to RTW with radiographic union in different scenarios at two points in time after injury: Motivated athlete with pain: 24wks, 85% (78–90); 52wks 88% (82–92) | Motivated athlete no pain: 24wks, 100% (99–100); 52wks 100% (99–100) | Unmotivated office worker with pain: 24wks, 98% (97–99); 52wks 99% (97–99) | Unmotivated office worker no pain: 24wks, 100% (99–100); 52wks 100% (99–100) | Unmotivated laborer with pain: 24wks, 85% (78–90); 52wks 89% (84–93) | Unmotivated laborer no pain: 24wks, 100% (99–100); 52wks 100% (99–100) | Motivated laborer with pain: 24wks, 96% (93–97); 52wks 96% (94–98) |Motivated laborer no pain: 24wks, 100% (99–100); 52wks 100% (99–100) Probability (%, CI) of surgeons (n = 125) recommending to RTW with radiographic nonunion in different scenarios at three points in time after injury: Motivated athlete with pain: 6wks, 7% (4–10); 24wks, 15% (10–22); 52wks 18% (41–58) | Motivated athlete no pain: 6wks, 24% (17–23); 24wks, 44% (36–53); 52wks 50% (82–92) | Unmotivated office worker with pain: 6wks, 62% (53–70); 24wks, 67% (57–75); 52wks 68% (59–76) | Unmotivated office worker no pain: 6wks, 94% (88–97); 24wks, 95% (90–98); 52wks 96% (90–98) | Unmotivated laborer with pain: 6wks, 4% (2–6); 24wks, 15% (10–22); 52wks 20% (15–28)| Unmotivated laborer no pain: 6wks, 13% (8–21); 24wks, 43% (34–52); 52wks 52% (43–60) | Motivated laborer with pain: 6wks, 25% (18–33); 24wks, 40% (32–49); 52wks 45% (36–53) | Motivated laborer no pain: 6wks, 59% (49–67); 24wks, 74% (66–81); and 52wks 77% (70–84) |
[85] |
| Zirkzee 2008 | Rheumatology |
Usage of professional guidance from rheumatologist with respect to arthritis-related problems at work for patients with early arthritis (n = 69): at study entry, 54%; at 12-month follow-up, 30% |
[104] |
| Other work-related support for patients | |||
| Alexander 2012 | All medical specialties | Frequency of writing sick note certificate (n = 40): 15% every week, 35% every month, and 45% rarely | [57] |
| Allen 2010 | 23 medical specialties, not further specified | Frequency of writing sickness certificates (n = 918): 14% monthly or more, 85% rarely or never | [58] |
| Arrelöv 2007 | Orthopedic surgery and primary care |
Frequency for orthopedic surgeons (n = 149): –Having consultations that include considerations of sickness certification: 97.3% weekly, 2.7% monthly, 0.0% yearly, 0.0% never –Issuing sickness certificates without personal appointment: 36.5% weekly, 23.0% monthly, 16.2% yearly, 24.3% never –Having contact with social insurance office about matters concerning sickness certification: 10.7% weekly, 28.9% monthly, 42.3% yearly, 18.1% never |
[59] |
| Barber 2007 | Pulmonology | 28% of general respiratory physicians (n = 45) specifically mentioned either providing compensation advice or writing a referral for the opinion of a specialist in occupational asthma | [60] |
| Lindholm 2010b | All medical specialties |
Physicians having sickness certification consultations at least a few times a year (n (% of total group)) and the frequencies during a week of these consultations (% of subgroup): –Overall: 14,210, 63.6%; 6% > 20 times a week, 34% 6–20 times a week, 42% 1–5 times a week, 12% about once a month, 5% a few times a year –Internal medicine: 1963, 97.4%; 2.4% > 20 times a week, 19.1% 6–20 times a week, 50.0% 1–5 times a week, 28.5% < once a week –Surgery: 1376, 88.1%; 4.6% > 20 times a week, 33.4% 6–20 times a week, 48.1% 1–5 times a week, 13.8% < once a week –Gynecology: 930, 86.9%; 1.8% > 20 times a week, 29.6% 6–20 times a week, 50.6% 1–5 times a week, 18.0% < once a week –Orthopedics: 898, 95.6%; 19.2% > 20 times a week, 59.3% 6–20 times a week, 18.5% 1–5 times a week, 3.1% < once a week –Ophthalmology: 358, 73.2%; 0.0% > 20 times a week, 3.8% 6–20 times a week, 21.8% 1–5 times a week, 74.4% < once a week –Ear, nose, and throat: 445, 91.6%; 0.9% > 20 times a week, 21.0% 6–20 times a week, 60.0% 1–5 times a week, 18.0% < once a week –Infectious diseases: 331, 97.0%; 1.6% > 20 times a week, 18.6% 6–20 times a week, 60.7% 1–5 times a week, 19.2% < once a week –Oncology: 334, 96.0%; 20.2% > 20 times a week, 50.9% 6–20 times a week, 23.9% 1–5 times a week, 5.0% < once a week –Dermatology: 208, 78.5%; 0.0% > 20 times a week, 3.5% 6–20 times a week, 22.0% 1–5 times a week, 74.5% < once a week –Neurology: 244, 94.2%; 2.6% > 20 times a week, 42.7% 6–20 times a week, 47.8% 1–5 times a week, 6.9% < once a week –Rheumatology: 191, 99.0%; 3.3% > 20 times a week, 45.6% 6–20 times a week, 45.6 1–5 times a week, 10.7% < once a week –Rehabilitation: 177, 93.2%; 17.9% > 20 times a week, 45.2% 6–20 times a week, 26.2% 1–5 times a week, 10.7% < once a week –Pain management: 85, 75.9%; 17.8% > 20 times a week, 56.2% 6–20 times a week, 20.5% 1–5 times a week, 5.5% < once a week |
[63, 73, 74] |
| Bränström 2014 | Oncology |
Frequency of sickness certification consultations by physicians working mainly at oncology clinics (n = 348): 67.2% > 6 times a week, 23.6% 1–5 times a week, 9.2% < sometimes each month |
[62] |
| Gustavsson 2013&2016c | Gynecology/obstetrics |
Frequency of sickness certification consultations by physician working in gynecology/obstetrics: –In 2004 (n = 315): 33.7% > 6 times a week, 37.5% 1–5 times a week, 18.4% a few time per month or year, 10.2% never of almost never –In 2008 (n = 1037): 27.4% > 6 times a week, 43.9% 1–5 times a week, 16.9% a few time per month or year, 11.3% never of almost never –In 2012 (n = 992): 18.8% > 6 times a week, 48.0% 1–5 times a week, 21.6% a few time per month or year, 11.5% never of almost never |
[67, 68] |
| Hayman 2021 | Emergency health care | Percentage of physicians providing sick notes (n = 182): 76.4% at least once a day, of which 4.2% 5 or more a day | [69] |
| Ladak 2021 | Rheumatology, dermatology, gastroenterology |
Percentage of physician providing a note for delayed RTW or modified duties (n = 151): 25% (range 0–100%; 10–77.5, interquartile range 67.5) Percentage of physicians providing a delayed RTW/modified duties note in seven clinical scenarios (n = 151): 1. DMARDs only, 5.4% (3.1% was unsure); 2. DMARDs and poly-pharma, 8.0% (9.6% was unsure); 3. DMARDs, poly-pharma, biologics and risk during commute, 21.0% (5.6% was unsure); 4. DMARDs, poly-pharma and steroids, 32.3% (8.9% was unsure); 5. Poly-pharma, biologics, steroids, vulnerable individuals at home, risk at work, comorbidity, and over age 60, 57.3% (15.3% was unsure); 6. DMARDs, poly-pharma, biologics, risk during commute, vulnerable individuals at home and risk at work, 59.7% (14.5% was unsure); 7. DMARDs, poly-pharma, biologics, risk during commute, vulnerable individuals at home, risk at work, and comorbidity, 74.2% (8.9% was unsure) |
[72] |
| Ljungquist 2015 | All medical specialties |
Frequency of sickness certification consultations: –Orthopedics (n = 850): 71% > 5 times per week, 26% 1–5 times per week –Rehabilitation (n = 168): 59% > 5 times per week, 33% 1–5 times per week –Pain management (n = 73): 68% > 5 times per week, 23% 1–5 times per week –Oncology (n = 322): 60% > 5 times per week, 31% 1–5 times per week –Rheumatology (n = 182): 27% > 5 times per week, 59% 1–5 times per week –Neurology (n = 232): 35% > 5 times per week, 51% 1–5 times per week –Surgery (n = 1307): 29% > 5 times per week, 50% 1–5 times per week –Gynecology/obstetrics (n = 878): 21% > 5 times per week, 54% 1–5 times per week –Infectious diseases (n = 318): 15% > 5 times per week, 58% 1–5 times per week –Internal medicine (n = 1875): 14% > 5 times per week, 48% 1–5 times per week –Dermatology (n = 200): 2% > 5 times per week, 7% 1–5 times per week |
[75] |
| Löfgren 2007 | All medical specialties |
Percentage of respondents having sickness certification consultations at least a few times a year: All specializations (n = 5455), 74%; internal medicine (n = 396), 92%; surgery (n = 218), 93%; gynecology / obstetrics (n = 215), 90%; orthopedics (n = 200), 95%; oncology (n = 108), 97%; rehabilitation care (n = 75), 77 Frequency of sickness certification consultations for physicians having these consultations at least a few times a year (n = 4019): 9.4% > 20 times a week, 41.0% 6–20 times a week, 34.3% 1–5 times a week, 8.5% about once a month, 5.8% a few times a year |
[76] |
| Michel 2018 | Rehabilitation |
Percentage of rehabilitation centers offering a functional restoration program for chronic lower back pain patients reported (n = 56): –29% offered a specific work rehabilitation program –77% involved a rehabilitation physicians in RTW management –100% investigated the patient’s work plan –18% adapted their programs regarding workplace information Main actions to improve a patient’s transition from the healthcare setting to the workplace were: to refer the patient to the occupational physician for a pre-RTW medical examination (94%), to contact the occupational physician (89%), to request the recognition of disabled worker status (66%), and to refer the patient to a social worker (62%) |
[87] |
| Nilsing 2014 | Primary health care, occupational health services, private clinics, and hospital care |
Prescription of part-time sick leave by physicians at hospitals (n = 245): 6% Prescribed intervention of physicians at hospitals in context of sickness certificate (n = 245): 26% no intervention, 39% medical intervention, 27% early rehabilitation (< 28 days after starting current sick leave period), and 7% late rehabilitation (> 28 days after starting current sick leave period) |
[93] |
| Salit 2020 | Oncology |
Percentage of transplantation centers performing > 50 total hematopoietic cell transplantations (HCT) per year (n = 45) that have a RTW program: 36% Composition of the RTW programs: –Programs entailed paperwork, 81%; formal group program, 19%; one-on-one counseling, 100%; videos, 13%; and vocational rehabilitation, 25% –Program is run/maintained by physician, 38%; advanced practice provider, 19%; nurse, 6%; social worker, 81%; psychologist, 25%; rehabilitation specialist, 25%; and financial counselor, 6% –Number of sessions: one-time offering, 19%; three sessions per year, 6%; unlimited depending on need, 13%; and not applicable, 62% –Start of the program: when the patient arrives for transplantation, 6%; as the patient is preparing to leave the center, 19%; at the one-year follow-up visit, 6%; and when the patient is ready to participate, 38% Sickness certification: 85% of all centers completed disability paperwork at > 1 year post-HCT for patients who are actively under their care –Criteria for considering a patient disabled include: the patient reports an inability to work, 38%; the patient has persistent or relapsed disease, 78%; the patient is still on immune suppression drugs, 38%; the patient has ongoing health complications and/or chronic graft versus host disease, 89%; and to maintain the patient’s health insurance, 4% |
[88] |
| Skudlik 2008 | Dermatology |
Tertiary individual prevention (TIP) is a specific tertiary interdisciplinary in-patient prevention measure program developed for severe cases of occupational skin disease (OSD), in which outpatient prevention measures are not successful. This program was established in 1994 as part of regular health care. In total, 1486 patients took part in TIP between 1994 and 2003 TIP consists of several components: –In-patient phase of 2–3 weeks in which dermatological and health educational measures are central. Dermatological therapy is carried out by dermatologists specialized in occupational dermatology. The health educational measures are organized interdisciplinary and run parallel –Outpatient no exposure phase of 3 weeks in which dermatological therapy is continued by the local dermatologist –Each patient will stay out of work for usually 6 weeks to allow full recovery. At the end of this period the patient returns to his workplace under further dermatological care and with the provision of optimized skin protective measures as well as optimized work organization measures. The medical course is continuously documented –In parallel, an intensified health educational intervention is carried out via group seminars and individual consultations with regard to the required, occupation-specific skin protection in each individual case (i.e., skin protective measures are tested with the support of occupational therapists in models of workplace environments; health-psychological interventions are offered; consultations with specialized job consultants of the statutory employers’ liability insurances are provided regarding insurance/legal questions or to initiate changes in the work organization and work environment) |
[103] |
| Snöljung 2017 | Neurology |
Frequency of sickness certification consultations by neurologists (n = 265): 32.8% > 5 times a week, 48.7% 1–5 times a week, 10.6% about once month, 2.6% a few times a year, and 5.3% never / no answer Frequency of issuing sickness certificates without seeing them (e.g., by telephone) by neurologists (n = 265): 23.2% at least once a week, 64.0% about once a month or a few times per year, and 12.8% never or almost never |
[80] |
| Söderman 2021 | Oncology |
Frequency of sickness certification consultations (n = 342): 36.6% > 10 times/week; 24,6% 6–10 times/week; 31.0% 1–5 times/week; 5.9% sometimes/monthly; and 2.1% sometimes/yearly |
[81] |
| Steenbeek 2014 | Not specified | Medical specialist playing a role in preventing sickness absence for workers who reported no sickness absence at all during the study period and who reported that a health care provider had played a role in preventing sickness absence (n = 86): 3.5% | [107] |
| van Velzen 2020 | Rehabilitation |
Institutes providing vocational rehabilitation services (n = 55): 34 (62%) –Timing of vocational rehabilitation (n = 34): during outpatient rehabilitation: 68%; during in-patient and outpatient rehabilitation: 29%; and during in-patient and outpatient rehabilitation and after termination regular rehabilitation treatment: 3% –Assessment of the gap between the patients’ abilities and work (n = 34): making an overview of job requirements: 97%; making an overview of the patient’s abilities: 82%; and comparing job requirements and patient’s abilities: 97% –Vocational rehabilitation goal setting, work training, and work samples (n = 34): setting goals for vocational rehabilitation: 88%; training focusing on working skills: 82%; and simulated work situations as part of the training: 71% –job coaches (n = 34): Directing patients to job coaches after vocational rehabilitation: 74% |
[89] |
| Wada 2012 | Oncology |
As reported by oncologists (n = 668): –I give consideration to minimizing the patient’s absence from work: 38.2% strongly agree, 44.9% agree, 13.8% disagree, 3.0% strongly disagree –I write the prospects for treatment and necessary considerations in the medical certificate to be submitted to the company: 25.7% strongly agree, 44.8% agree, 23.8% disagree, 5.6% strongly disagree –The medical institution facilitates patients seeing the oncologist at the appointment time: 18.9% strongly agree, 40.0% agree, 24.9% disagree, and 15.6% strongly disagree –The medical institution facilitates chemotherapy being adjusted according to work-related matters: 9.5% strongly agree, 32.4% agree, 32.7% disagree, and 22.9% strongly disagree –The medical institution facilitates radiation therapy scheduling being adjusted according to work-related matters: 7.3% strongly agree, 20.7% agree, 31.3% disagree, and 25.0% strongly disagree |
[83] |
| Walker 2007 | Emergency care |
Frequency of issuing sick notes: Scottish accident and emergency departments (n = 25), 16%; Scottish fracture clinics (n = 25), 32%; English accident and emergency departments (n = 25), 20%; and English fracture clinics (n = 25), 48% Local policies on sick listing: –Give sick notes: Scottish accident and emergency departments (n = 25), 16%; English accident and emergency departments (n = 25), 20% –Not give sick notes: Scottish accident and emergency departments (n = 25), 12%; English accident and emergency departments (n = 25), 16% –No clear policy but ‘‘just don’t give them’’: Scotland accident and emergency departments (n = 25), 72%; England accident and emergency departments (n = 25), 64% –See the general practitioner if the patient required a sick note: Scottish accident and emergency departments (n = 25), 68%; English accident and emergency departments (n = 25), 52% |
[90] |
| Walters 2010 | General surgery, internal medicine, emergency medicine, general practice, orthopedics |
Before issuing a sickness certification, registered doctors in specialty training (n = 51) ask about patient’s occupation, 96%; job type, 80%; and any adjustments that could be made to enable a patient to return to work, 50% |
[84] |
| Interdisciplinary cooperation between medical specialists and other healthcare providers | |||
| Arrelöv 2007 | Orthopedic surgery and primary care | Frequency of orthopedic surgeons (n = 149) making a referral to occupational health: weekly 10.0%, monthly 30.9%, yearly 32.2%, and never 26.8% | [59] |
| Barber 2007 | Pulmonology |
Advice from general respiratory physicians (n = 45) if occupational asthma is confirmed: –14% referred for advice with a specialist in occupational asthma –23% advised patients to discuss the issues at work with the employer, occupational health provider, trade union representative, or the Health and Safety Executive |
[60] |
| Bränström 2014 | Oncology |
In relation to sickness certification, frequency of physicians working mainly at oncology clinics (n = 348) who: –Collaborate or refer patients to physical or occupational therapists: 5.4% at least once a week, 10.9% ~ once a month, and 83.7% a few times a year or less –Collaborate or refer patients to counselors and/or psychologists: 4.9% at least once a week, 13.8% ~ once a month, and 81.4% a few times a year or less –Confer with other physicians: 2.3% at least once a week, 18.3% ~ once a month, and 79.4% a few times a year or less –Referring/sending patients to occupational health services: 0.3% at least once a week, 5.0% ~ once a month, and 94.7% a few times a year or less –Participate in a healthcare team in coordination meetings with social insurance and/or employers: 0.6% at least once a week, 2.3% ~ once a month, and 97.1% a few times a year or less –Contact employers by care team: 0.3% at least once a week, 0.3% ~ once a month, and 99.4% a few times a year or less –Contact social services: 0.0% at least once a week, 1.0% ~ once a month, and 99.0% a few times a year or less –Contact employment offices: 0.0% at least once a week, 1.0% ~ once a month, and 99.0% a few times a year or less |
[62] |
| Gustavsson 2013&2016c | Gynecology/obstetrics |
In relation to sickness certification, frequency of referring/sending patients to occupational health services by physician working in gynecology/obstetrics: –In 2004 (n = 315): 0.4% at least once a week, 23.2% a few times per month or year, and 75.4% never or almost never –In 2008 (n = 1037): 0.9% at least once a week, 16.1% a few times per month or year, and 79.8% never or almost never |
[67, 68] |
| Keegel 2007 | Dermatology | Referring practices of dermatologists in cases of workers suspected of occupational contact dermatitis (n = 44): no referral, treat patients independently, 2.3%; refer on initial presentation to tertiary occupational dermatology clinic, 81.8%; and no information, 15.9% | [97] |
| Michel 2018 | Rehabilitation |
Frequency of rehabilitation centers offering a functional restoration program (FRP) to chronic lower back pain patients reported (n = 56): –Disciplines involved in FRP teams (percentage of people from that discipline handling questions relative to work): rehabilitation physicians 51 (84%); rheumatologists 14 (79%); physiotherapists 54 (7%); APA teachers 46 (0%); psychologists 51 (16%); psychiatrists 16 (6%); occupational therapists 56 (55%); ergonomists 11 (91%); social workers 50 (82%); occupational physicians 8 (100%); and others 21 (38%) –Information sharing between FRP teams and Occupational Health Physician (OP) was systematic or frequent in 31 centers, rare or occasional in 20 centers, and never took place in 4 centers. These exchanges were perceived as difficult by 34 centers, mostly because of the OP’s lack of availability or for legal reasons –Information sharing was mostly undertaken through the patient (72%) or OP-addressed (57%) correspondence –FRP team composition seemed to influence the information sharing. There was a near significant relation between the frequency and the facility of information sharing and the presence of an ergonomist or of an OP in the FRP team –Half of the centers considered the information content to be insufficient because of the lack of workplace information details |
[87] |
| Moscato 2014 | Allergists | From cases of occupational asthma (n = 80), two-thirds were referred to the National Workers Compensation Authority (INAIL) for an occupational disease | [77] |
| Newington 2018 | Surgery and occupational and physical therapy | Additional recommendations of surgeons from open-ended questions (n = 173) (% of surgeons): Involve the patients’ employers in the RTW decision-making (4%) | [79] |
| Salit 2020 | Oncology |
18% of transplantation centers performing > 50 total Hematopoietic Cell Transplantations (HCT) per year (n = 45) had someone (physician, advanced practice provider, nurse, social worker, or assigned liaison) contacting the patient’s employer once the patient was discharged from the transplantation team back to their primary oncologist Means of making contact: by phone, 55%; by email, 9%; and by letter, 36% Correspondence may include patient discharge summary, 19%; handout with precautions for immunocompromised patients, 19%; discussion regarding expectations for RTW, 38%; and comprehensive survivorship care plan, 13% |
[88] |
| Snöljung 2017 | Neurology |
In relation to sickness certification, frequency of neurologists (n = 265) who –Participated independently or in a healthcare team in coordination meeting with social insurance and/or employer: 2.8% at least once a week, 47.6% about once a month or a few times per year, and 49.6% never or almost never –Independently or in a healthcare team had contact with employers in ways other than via the coordination meetings: 0.0% at least once a week, 33.1% about once a month or a few times per year, and 66.9% never or almost never –Collaborated with or referred patients to a counselor/psychologist: 10.4% at least once a week, 63.9% about once a month or a few times per year, and 25.7% never or almost never –Collaborated with or refer patients to physical or occupational therapists: 15.6% at least once a week, 66.8% about once a month or a few times per year, and 17.6% never or almost never –Conferred with other physicians: 3.2% at least once a week, 63.2% about once a month or a few times per year, and 33.6% never or almost never –Referred patients to occupational health services: 0.0% at least once a week, 55.6% about once a month or a few times per year, and 44.4% never or almost never –Had contact with social services: 0.0% at least once a week, 17.2% about once a month or a few times per year, and 82.8% never or almost never –Had contact with employment offices: 0.4% at least once a week, 53.6% about once a month or a few times per year, and 46.0% never or almost never |
[80] |
| van Velzen 2020 | Rehabilitation |
From the institutes providing vocational rehabilitation services: –Disciplines involved in vocational rehabilitation (n = 34): rehabilitation physicians, 88%; occupational therapists, 94%; (neuro)psychologists, 82%; social workers, 91%; physiotherapists, 50%; speech therapists, 59%; nurses, 3%; and other, 29% –Involvement of external partners and transfer of information to external partners (n = 34): employer, 77%; occupational physician, 88%; work colleague of the patient, 38%; and other, 29% –Professionals that coordinate the vocational rehabilitation process (n = 34): vocational rehabilitation specialist, 29%; occupational therapist, 32%; neuropsychologist or psychologist, 6%; rehabilitation physician, 44%; social worker, 35%; physiotherapist, 3%; labor advisor, 3%; vocational rehabilitation team, 9%; and (standard) rehabilitation team, 3%, depending on the individual situation of the patient but most of the time occupational therapist, psychologist, or social worker, 3% |
[89] |
| Wada 2012 | Oncology |
As reported by oncologists (n = 668): –I consider the involvement of a nurse in work-related counseling to be important: 34.6% strongly agree, 42.1% agree, 15.1% disagree, and 3.9% strongly disagree –I consider the involvement of a medical social worker in work-related counseling to be important: 65.0% strongly agree, 30.2% agree, 3.1% disagree, and 0.7% strongly disagree –I advise the patient to tell their supervisor about the prospects for treatment and ask for understanding: 18.1% strongly agree, 35.5% agree, 33.1% disagree, and 13.0% strongly disagree –The medical institution facilitates there being a nurse involved in work-related counseling: 8.6% strongly agree, 20.2% agree, 29.3% disagree, and 35.7% strongly disagree –The medical institution facilitates there being a medical social worker involved in work-related counseling: 25.5% strongly agree, 36.7% agree, 18.1% disagree, and 14.8% strongly disagree |
[83] |
| Medical guidelines integrating work and their use by medical specialists | |||
| Barber 2007 | Pulmonology |
National guidelines for the management of occupational asthma for the British Thoracic Society includes topics on diagnostics and advice Guideline recommendation on diagnostics compared to actions of general respiratory physicians (n = 45): –Recommends accurate history taking, in particular asking whether symptoms improve away from work and on holiday: mentioned by 46% –Does not mention diagnostic imaging: 100% would do chest x-ray and 21% CT scan to exclude other conditions –Recommends at least four peak flow measurements a day should be recorded: majority fulfilled these criteria; however, the frequency varied –Recommends immunological testing, using specific IgE measurements: 47% used either skin prick tests of specific IgE –Does not mention specific inhalation challenges; also not mentioned as diagnostic approach by physicians Guideline recommended advice compared to actions of general respiratory physicians (n = 45): –advice that workers diagnosed as having occupational asthma should be removed from exposure, and that relocation should occur within 12 months of the first work-related asthma symptoms, premature advice to leave the occupation is inadvisable; 63% advised some form of reduction in exposure (personal protective equipment or alternative employment) |
[60] |
| Clayton 2007 | Gynecology, orthopedic surgery, primary care, and occupational health care |
Existing guideline: Department of Work and Pensions (DWP) evidence-based guidance No gynecologists (n = 11) or orthopedic surgeons (n = 13) were aware of this guideline |
[64] |
| Fowler 2019 | Colorectal surgery | Several clinical practice guidelines for the management of hemorrhoids exist with information on healing time for surgical procedures, which are of influence for return to work | [65] |
| Gustavsson 2013&2016c | Gynecology/obstetrics |
Frequency of use of national sickness certification guidelines by physician working in gynecology/obstetrics: –In 2008 (n = 1037): every week, 8.7%, never, 52.5% (other 61.2% was not reported by the authors) –In 2012 (n = 992): every week, 26.7%; never, 26.4% (other 53.1% was not reported by the authors) |
[67, 68] |
| Grewal 2014 | General surgery | Recommendations to surgeons regarding post-operative care after inguinal hernia repair are available from the Royal College of Surgeons website and from the European Hernia Society guidelines. Return to work is classified into 1–2 weeks for light work, 2–3 weeks for minimal lifting, and 6 weeks for heavy labor-intensive work. The recommendations given were found to be inconsistent with these guidelines | [86] |
| Hayman 2021 | Emergency health care |
Percentage of practice environments with sick note policy (n = 182): –No policy, 75.1%; unsure about policy, 10.7%; and charge patients for sick note, 13% |
[69] |
| Holness 2007 | Pulmonology and primary care |
No guidelines exist. Frequency of sources of information about occupational lung disease that are used by pulmonologists (n = 65): continuing medical education and conferences, 43%; journal articles, 58%; consultation reports from specialists, 25%; newsletters from professional organizations, 9%; information booklets from government or professional organizations, 2%; and websites, 5% |
[70] |
| Jenny 2016 | Orthopedic surgery | No consensus on RTW exists after anterior cruciate ligament reconstruction | [106] |
| Keegel 2007 | Dermatology | Best practice guidelines for contact dermatitis and occupational contact dermatitis (OCD) exist. In no case of OCD (n = 44) did the dermatologists report recommending all 3 of the best practice treatment recommendations (i.e., use a soap substitute, moisturizer, and topical corticosteroid) | [97] |
| Moscato 2014 | Allergists | Two guidelines exist (Global Strategy for Asthma Management and Prevention (GINA) and guidelines in allergic rhinitis (ARIA-GA2LEN)), but none include information on work support | [77] |
| Naidu 2012 | Gynecology and obstetrics | Royal College of Obstetricians and Gynecologists advice on RTW: operative laparoscopy, 2–5 weeks; diagnostic laparoscopy, 1 week; operative laparoscopy, 2–3 weeks; abdominal surgery, 6–8 weeks; vaginal surgery (hysterectomy), 4–6 weeks; and vaginal surgery (prolapse), 3–4 weeks | [78] |
| Newington 2018 | Surgery and occupational and physical therapy | Royal College of Surgeons’ patient guidance document (2014) recommends for RTW: desk-based duties, 7 days; light manual duties, 15 days; and heavy manual duties, 42 days | [79] |
| Rowe 2018a | Emergency health care | No RTW guideline present | [99, 102] |
| Salit 2020 | Oncology |
46% of transplantations centers performing > 50 total Hematopoietic Cell Transplantations (HCT) per year (n = 45) had local RTW guidelines: –Mechanisms by which guidelines are provided to the patient: handout, 65%; physician/advanced practice provider visit, 80%; nurse visit, 80%; social worker visit, 45%; group class, 10% –Centers that did not have guidelines commented that they determined RTW recommendations on a case-by-case basis |
[88] |
| Söderman 2021 | Oncology | Clinical units with joint routines/policies for handling sickness certification tasks (n = 342): 29.7% | [81] |
| Tsang 2020 | Orthopedics | No use of guidelines, when advice was given, it was based on personal judgment only | [82] |
| van Velzen 2020 | Rehabilitation | A Dutch guideline on acquired brain injury and RTW process is available but does not contain a protocol for a vocational rehabilitation intervention. Rehabilitation centers that use a local vocation rehabilitation protocol (n = 34): 59% | [89] |
| Walters 2010 | General surgery, internal medicine, emergency medicine, general practice, orthopedics | Frequency of following a guideline when issuing sickness certificates by registered doctors in specialty training (n = 51): none, 71%; Department for Work and Pensions guidance, 2%; guideline from previous primary care trust, 15%; guideline from previous hospital department, 10%; and yes, unspecified, 2% | [84] |
aRowe 2018 and Gaudet 2019 reported on the same data; bLindholm 2010, Bränström 2013, and Ljungquist 2013 reported on the same data; cGustavsson 2013 and Gustavsson 2016 reported on the same data
CI confidence interval; DMARDs disease-modifying antirheumatic drugs; IQR interquartile range; n number; OR odds ratio; RTW return to work; SD standard deviation; UK United Kingdom; wks weeks