Background/Purpose: Despite improvements in the treatment of rheumatic and musculoskeletal diseases (RMDs), reduced work participation persists when compared to the general population. A Task Force within the European Alliance of Associations for Rheumatology (EULAR) aimed to establish Points to Consider to support people with RMDs in healthy and sustainable work participation. Non-pharmacological interventions could have an important role in this regard. The objective of the evidence synthesis was to summarize the effectiveness of non-pharmacological interventions to promote work participation in people with RMDs.

Methods: Randomized controlled trials (RCTs) and observational studies assessing non-pharmacological interventions until August 2020 were eligible. Records addressing people with any non-work-related RMD and assessing at least one work participation outcome domain (sick leave, work status, presenteeism) were eligible. Two reviewers screened titles, abstracts and full-texts. Data on study, population and intervention characteristics, and effectiveness were extracted for qualitative and quantitative synthesis. For quantitative synthesis per outcome domain, standardized mean differences (SMDs) were used as effect size measure, with a negative SMD favoring intervention. RCTs were included in Mixed Effects Meta-Regression Analyses and a fixed effect for the specific study, stratifying for population and intervention characteristics.

Results: Out of 8,864 records, 73 were included for extraction and analysis. These 73 records described 64 studies of 71 interventions. Studies included a mixed population of RMDs (42%), followed by musculoskeletal pain (36%). Sick leave was the most frequently assessed outcome domain (88% of studies). The majority of interventions were conducted in a clinical setting (62%) and had multiple components (80%), such as vocational support (46%) and physical training (61%). In the qualitative synthesis, including 64 studies, 30%/50%/29% of interventions were considered to be possibly effective (interpretations of reviewers) on sick leave/work status/presenteeism, respectively. In the quantitative synthesis, 37 RCTs (42 interventions) were included. Their population and intervention characteristics were largely similar to those of the total sample. Interventions showed significant, but small to moderate effect sizes, favoring intervention over comparator: SMD=-0.23 (95%CI -0.33 to -0.13) for sick leave, SMD=-0.38 (-0.63 to -0.12) for work status and SMD=-0.25 (-0.39 to -0.12) for presenteeism (Table). Stratified analyses showed that interventions were effective in both populations not at risk and populations at risk or already on sick leave. Both single- and multiple-component interventions had a small positive effect on sick leave and presenteeism respectively. Of note, there was substantial heterogeneity between studies.

Conclusion: Overall, non-pharmacological interventions may have a small effect on sick leave, work status and presenteeism in RMDs. This effect varies substantially between subgroups. This synthesis suggests tailoring non-pharmacological work-related support to individuals’ needs and contextual factors.

Stratified analyses of effectiveness of non-pharmacological interventions (disease, baseline risk status, setting and intervention components)

« Back to ACR Convergence 2021

ACR Meeting Abstracts - https://acrabstracts.org/abstract/effectiveness-of-non-pharmacological-interventions-to-promote-work-participation-of-people-with-rheumatic-and-musculoskeletal-diseases-a-systematic-review-and-meta-regression-analysis/