Background Sickness absence is highly prevalent and has a complex multifactorial aetiology. A multitude of approaches exist aimed at health, personal, work related and cultural factors. But also the context of legislation has to be addressed when developing, evaluating or implementing preventive interventions.
Aims 1) To substantiate the role of legislation in research on the effect of strategies aimed at reducing long term sickness absence; 2) Elaborate on methodological prerequisites for advancing the evidence base of interventions, focussing on (legal) contextual factors.
Results Role of legislation can be threefold:
1. Direct, as (part of) intervention
2. Indirect, such as changing definitions of sickness absence, or (early) pensioning.
3. Facilitating/hindering factor in implementation of proven interventions
To address the context of legislation, ideally large multinational trials with large sample sizes are needed, requiring substantial resources. An alternative efficient approach might be to combine: 1) Address the impact of contextual (legal) factors by integrating contextual data from (new) trials on the effectiveness of preventive strategies by means of meta regression; 2) Use multi-regional or multi-national databases to compare intervention uptake, outcome and contextual factors in workers (registry data) testing prior hypotheses regarding the impact of legal differences on sickness absence indicators.
Conclusion Large potential gains by reducing long term sickness absence and work disability require innovative but methodologically sound approaches, and should consider the impact of the (legal) context. Enhanced access to multinational data-bases and better reporting of contextual and legal factors related to trials (extension of STROBE, CONSORT) are prerequisites.
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