From sickness absence to return to work

Although research has been conducted on return to work, we still do not know enough about which interventions are most effective in helping people return to work after sickness absence. We therefore need to understand what works, for whom, and under what circumstances.

In this work package, concrete return-to-work interventions are developed, evaluated, and implemented for people on sickness absence due to depression, anxiety, reactions to severe stress, or long-term musculoskeletal pain. The interventions are co-created with people who are currently or have previously been on sickness absence, employers, and primary care. By combining effect evaluations with qualitative studies, we aim to generate knowledge about how and why the interventions work and contribute to better support for return to work.

What are we researching?

The purpose of the work package is to develop, evaluate, and implement co-created interventions aimed at return to work after sickness absence due to depression, anxiety, reactions to severe stress, or long-term musculoskeletal pain.

We focus on individually tailored methods for return to work. The interventions are co-created with people who are currently or have previously been on sickness absence, employers, primary care, occupational health services, and the Swedish Social Insurance Agency, and are implemented in primary care.

More specifically, we will

• Explore factors that promote sustainable and equitable return to work.
• Develop and evaluate co-created interventions aimed at return to work.
• Identify the active components of the interventions for individually tailored return to work.
• Develop and evaluate strategies for implementing return-to-work interventions in primary care.

How is the research conducted?

The research is conducted through a combination of qualitative studies, clinical effect evaluations, and literature reviews.

A metasynthesis is carried out in accordance with the GRADE-CERQual protocol. Qualitative interviews are conducted with people before and during their return to work (RTW) in connection with sickness absence, focusing on agency, motivation, and expectations. Data will, for example, be analysed using thematic analysis or content analysis. These studies provide the basis for the randomised controlled trials.

We will conduct two randomised controlled trials (RCTs). The first RCT builds on previous research as well as results from the metasynthesis and the qualitative interview studies. The interventions are provided as an addition to usual care, and their effects are compared with usual care alone. A process evaluation will examine, among other things, mechanisms of change and effect, as well as the acceptability and feasibility of the interventions.

The second RCT will be co-created with patient groups and other relevant stakeholders and designed using the results from the first RCT as well as from the other work packages within UGot ReWork. For example, Work Package 2 will contribute knowledge about how return to work can be individually tailored using digital solutions and digital support. Using the results from Work Packages 4 and 5, we will be able to identify individual and structural factors that are important for return to work after sickness absence. Taken together, the results will provide more detailed knowledge about how implementation strategies for return to work can be adapted to the needs of individuals and workplaces.

Outcome measures

The primary outcome measure in the RCTs is return to work and sustainable return to work. We will also study sickness absence, sick leave, self-efficacy, work ability, and work-environment factors. Detailed cost data (intervention costs, healthcare utilisation, social insurance, and production losses) will enable health-economic evaluations.

Using data from the two effect evaluations, we will examine which components of the interventions are particularly important. These findings will provide a basis for determining how interventions can be adapted to individuals' needs and when during the sickness-absence or return-to-work process they should be offered.

Implementation strategies will also be developed on the basis of the combined results from qualitative interviews, the metasynthesis, and the RCTs. We hope to be able to evaluate the strategies in primary care using an implementation framework.

Why is the research needed?

Sick leave due to reduced work ability as a result of illness or injury may sometimes be necessary to allow time for recovery and rehabilitation. However, prolonged sickness absence can affect individuals' health and their opportunities to return to work. For many people, long-term sick leave entails financial insecurity, social isolation, and difficulties returning to the workplace. Although research has evaluated various interventions intended to support return to work after sickness absence, it remains unclear which interventions work best and under what circumstances, particularly with regard to sustainable return to work.

By increasing knowledge about how individuals can be supported in returning to work, our work package can contribute to:

• better support for people on sickness absence
• reduced risk of prolonged sickness absence
• more equitable return to work.

Participating researchers

More work packages at UGot ReWork

Learn more about the different work packages on the research centre's website.