Article Text


Work absence and return 1
Insurance-based case management to reintegrate patients on sick leave: systematic review and meta-analysis
  1. Stefan Schandelmaier1,
  2. Anna Burkhardt1,
  3. Shanil Ebrahim2,
  4. Wout deBoer1,
  5. Gordon Guyatt2,
  6. Jason Busse3,
  7. Regina Kunz1,
  8. Thomas Zumbrunn4
  1. 1Academy of Swiss Insurance Medicine, Basel, Switzerland
  2. 2McMaster University, Hamilton, Canada
  3. 3Institute for Work and Health, Toronto, Canada
  4. 4University Hospital, Basel, Switzerland


Objectives Work disability due to accident or illness results in considerable socioeconomic burden. Case management (CM) with individually tailored return-to-work (RTW) plans promise improved reintegration into the work force. We conducted a meta-analysis to determine the impact of CM on RTW.

Methods We conducted a search of 5 electronic databases for trials an insurance or similar setting that enrolled patients on sick leave for >4 weeks and randomised them to CM or a control group. Outcomes were time-to-RTW/lasting RTW/cumulative sickness absence. Two investigators performed quality assessment and data extraction independently and in duplicate.

Results From 2200 records, we identified 9 studies from 7 countries including patients with musculoskeletal complaints (n=6), injuries (n=1), unspecific pain (n=1) and mental disorders (n=1) in an insurance (n=5) or insurance-like (n=4) setting. Sick-leave varied from 1–55 months. Risk of bias was moderate to high in most studies. Pooling of 5 studies reporting “time-to-RTW” showed a HR of 1.69 (95% CI: 1.38 to 2.07; heterogeneity: I2=0%) favouring CM. Two studies reported cumulative sickness absence after 12 months: OR of 2.5 (95% CI: 1.2 to 5.1) and shortening of 42 days (95% CI: 6 to 79; 34%) favouring CM. One study found no difference.

Conclusions The relevant benefit of CM for RTW compared to usual care was consistent across intervention and control conditions. Limited methodological quality, ambiguous definitions for “successful” RTW and lack of important details for transfer into practice (eg, precise description of intervention) require cautious interpretation. Evidence about CM on lasting RTW is promising, but remains limited.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.