Table 4.

Characteristics and findings of gray literature

Report name	Main finding(s)	n	Year	Source	References
Vision documents		2
Seoul Statement on the Development of Occupational Health Services for All	–To ensure sufficient coordination and exchange within countries, continuous dialogue should be maintained and close and regular collaboration between occupational health and general health services	1	2015	ICOH	[109]
Toward age-friendly work in Europe: a life-course perspective on work and aging from EU Agencies	–Individual doctors need to have return to work as an outcome objective when treating patients	1	2017	Eurofound, EU-OSHA	[110]
Policy reports		26
Occupational disease management
Alert and sentinel approaches for the identification of work-related diseases in the EU (including Alert and sentinel systems: SIGNAAL, Netherlands/Belgium; SUVA, Switzerland; SENSOR-Pesticides Program, USA; THOR, United Kingdom)	–Medical specialists play a minor role in the reporting of occupational diseases –Physicians did not consider reporting to public health authorities a priority in their clinical practice	5	2018	EU-OSHA	[111–115]
Forum 11—Monitoring occupational safety and health in the European Union	–The UK OHS system uses voluntary reporting of occupational diseases by doctors –Medical doctors are given little awareness training in the problems of occupational diseases during their professional training. This should be addressed by mainstreaming OSH into their education	1	2004	EU-OSHA	[116]
Occupational skin diseases and dermal exposure in the European Union (EU-25): policy and practice overview	–In some European countries (e.g., Germany, Austria) dermatologist have a role in reporting occupational skin disease –Many workers with occupational skin disease see a dermatologist first. The dermatologist diagnoses the disease and provides treatment and advice on preventive measures –The role of the occupational health physician is to provide information to the dermatologist about the products thought to be responsible for the occupational skin disease	1	2008	EU-OSHA	[117]
Stay in work and return to work policies
Rehabilitation and return to work: Analysis report on EU and Member States policies, strategies, and programs  Safer and healthier work at any age Country Inventorya: Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Ireland, Italy, Latvia, the Netherlands, Norway, Spain, and the UK	–Different policies exist between countries regarding rehabilitation and RTW, only some include a role for a medical specialist –In all countries, medical rehabilitation of the sick or injured worker takes place within the general healthcare system. In some countries with insurance-based systems, exceptions exist for workers suffering from occupational accidents or diseases who can follow medical treatment and rehabilitation in the facilities of insurance institutions –Medical doctors and occupational physicians have a pivotal role in the RTW process. In many countries, there is little or no coordination between medical doctors and the workplace, often as a result of medical confidentiality issues. In addition, in many countries, the lack of an appropriate cooperation structure significantly limits coordination between the primary physician and the medical experts of the organization coordinating the return to work process, such as a social security agency –In many European countries, a lack of coordination between medical doctors, vocational rehabilitation providers, and the workplace impedes or delays return to work –When they exist, coordination mechanisms intervene at different stages of the RTW process, starting at the very beginning of the process, when medical treatment is taking place, between medical doctors and the workplace (employer or occupational health services) –A characteristic of most RTW programs implemented by coordinating organization is their individualized approach. It starts with assessment of work capacity based on the principles of the biopsychosocial theoretical model, this assessment is likely to be done with the help of a multidisciplinary team, including medical, physical and mental health doctors, and therapists, but also social officers, vocational rehabilitation, and employment specialists	19	2015–2016	EU-OSHA	[118–136]
Research reviews to inform later policy making		3
Biological agents and prevention of work-related diseases: a review	–In some European countries, a specialist network with dermatologists and pulmonologists exists to help detect occupational exposure of biological agents	1	2020	EU-OSHA	[137]
Musculoskeletal disorders in workers with multiple sclerosis: a task-oriented view	–To support workers with multiple sclerosis to prevent musculoskeletal disorders that needs a multidisciplinary approach, this multidisciplinary team usually includes a physician	1	2022	EU-OSHA	[138]
Research review on rehabilitation and return to work	–In the UK, a doctor considers the patient’s ability to work in general, based on revised guidance that reflects a move away from job-specific assessments and provides the patient with a ‘fit note’ –Coordination and cooperation between health and social security institutions and employers should be promoted	1	2016	EU-OSHA	[139]
Medical guidelines		24
General
Workplace health: long-term sickness absence and capability to work (UK)	–Guideline on how to help people return to work after long-term sickness absence, reduce recurring sickness absence, and help prevent people moving from short-term to long-term sickness absence	1	2020	GIN	[140]
Cardiology
Acute coronary syndromes NICE guideline (UK)	Includes minor mentioning of work, that is, –Offer cardiac rehabilitation programs in a choice of venues and at a choice of times of day, for example, sessions outside of working hours –Take into account the physical and psychological status of the patient, the nature of their work and their work environment when giving advice on returning to work	1	2020	GIN	[141]
Neurology
Clinical Practice Guideline for the Management of Patients with Parkinson’s Disease (Spain)	Includes minor mentioning of work, that is, –Includes work as a factor to consider in the management –When the patient’s work capacity is compromised, this justifies starting pharmacological treatment	1	2014	GIN	[142]
Obesity
Management of Obesity in Adults (Qatar)	Includes minor mentioning of work, that is, –Sedentary and night-shift work listed as risk factors –Work-life balance listed as barrier to physical activity in management of obesity	1	2022	GIN	[143]
Oncology
American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline (USA)	Includes minor mentioning of work, that is, –Limited information on the impact of cancer to return to work support	1	2016	GIN	[144]
Blueprint cancer and occupation (in Dutch, the Netherlands)	–General guideline with regard to cancer and work for all phases of cancer targeted at different actors involved in treatment	1	2009	GIN	[145]
Breast cancer (in Dutch, the Netherlands)	Work is mentioned at several placed in this guideline: –Work/occupations should be mentioned during treatment –Refers to guideline ‘Blueprint cancer and occupation’	1	2012	GIN	[146]
	Work is mentioned at several places in this guideline: –Work/occupation should be mentioned during treatment –Mentions that one common complication has impact on work –Section on support for RTW –Refers to an update of guideline ‘Blueprint cancer and occupation’	1	2020	GIN	[147]
Hepatocellular carcinoma (in Dutch, the Netherlands)	Includes minor mentioning of work, that is, –Refers to guideline ‘Blueprint cancer and occupation’	1	2013	GIN	[148]
Intracranial meningioma (in Dutch, the Netherlands)	Includes minor mentioning of work, that is, –Mentions that work is covered as part of rehabilitation	1	2015	GIN	[149]
Screening for psychosocial distress (in Dutch, the Netherlands)	–General guideline on screening for psychosocial distress in cancer patients (including work)	1	2017	GIN	[150]
Ophthalmology
Clinical Practice Guideline for the Management of Glaucoma (Malaysia)	Includes a key recommendation on work, that is, - Patients should be referred to rehabilitation including vocational rehabilitation	1	2017	GIN	[151]
Respiratory disease
Clinical Practice Guideline: Allergic Rhinitis (USA)	Includes minor mentioning of work, that is, –Impairment of work listed as factor of disease classification as more severe	1	2015	GIN	[152]
Cough: Occupational and Environmental Considerations – ACCP Evidence-Based Clinical Practice Guidelines (Canada)	–Guideline on the role of occupational and environmental factors in causing and contributing to cough	1	2006	GIN	[153]
Managing the long-term effects of COVID-19 (UK)	Work is mentioned throughout this guideline included as follows: –Advice to discuss the effect of symptoms on work –RTW advice –Use an ability to return to usual activities, including work, as measure of recovery –Provide integrated, multidisciplinary rehabilitation services, including support to work –Refers also to guideline ‘Workplace health: long-term sickness absence and capability to work’	1	2022	GIN	[154]
The Assessment & Management of Chronic Obstructive Pulmonary disease in Adults (Qatar)	Includes minor mentioning of work, that is, –During history taking to assess the impact on patient’s life, including missed work and socioeconomic impact	1	2020	GIN	[155]
The Diagnosis and Management of Asthma in Adults (Qatar)	Includes minor mentioning of work, that is, –During history taking to elicit information about: Materials with which they work. Whether their symptoms improve regularly when away from work –Provide information that 1 in 6 cases of new or recurrent asthma is attributable to occupation –To consider Occupational Asthma –During monitoring to include asking about time off work	1	2019	GIN	[156]
Rehabilitation
Brain injury rehabilitation in adults (UK)	–Includes a chapter about vocational rehabilitation	1	2013	GIN	[157]
Cancer rehabilitation (in Dutch, the Netherlands)	–Includes a chapter about work participation after cancer	1	2013	GIN	[158]
Cardiac rehabilitation (UK)	–Includes a chapter about vocational rehabilitation	1	2017	GIN	[159]
Clinical Practice Guideline for the Rehabilitation of Adults with Moderate to Severe TBI (Traumatic Brain Injury) (Canada)	–Includes a section about vocational rehabilitation	1	2016	GIN	[160]
Rehabilitation after critical illness in adults Clinical guideline (UK)	Includes minor mentioning of work, that is, –To give patients information before their discharge to home or community care (if applicable) about driving, returning to work, housing, and benefits	1	2009	GIN	[161]
Rehabilitation for persons with traumatic brain injury (USA)	–Includes a chapter about rehabilitation for work to help a person return to work after a brain injury	1	2004	WHO	[162]
Stroke rehabilitation in adults Clinical guideline (UK)	–Includes a section about RTW –Refers also to guideline ‘Workplace health: long-term sickness absence and capability to work’	1	2013	GIN	[163]

EU-OSH European Agency for Safety and Health at Work; GIN Guidelines International Network; ICOH International Commission on Occupational Health; n number; OHS Occupational Health and Safety; OR odds ratio; UK United Kingdom; USA United States of America; WHO World Health Organization

^aIn total, 30 country inventories were made by the EU-OSHA. However, the excluded documents had no reference to a medical specialist within these documents