Introduction To evaluate the effectiveness of pre-employment examinations of job applicants in preventing occupational injury, disease and sick leave.
Methods We systematically searched in medical databases for randomised controlled trials, controlled before-after studies, and interrupted time-series studies up to March 2015.
Result Nine studies evaluated the screening process as a whole. Two studies evaluated measures to mitigate the risks found following the screening process. The studies were too heterogeneous for statistical pooling of results.
There is very low quality evidence based that a general examination for light duty work may not reduce the risk for sick leave (MD −0.09, 95% CI: −0.47 to 0.29). For army recruits, there is very low quality evidence that there is a positive effect on fitness for duty after 12 months follow-up (OR 0.40, 95% CI: 0.19 to 0.85).
There is inconsistent evidence of an effect of job-focused pre-employment examinations on the risk of musculoskeletal injuries in comparison with general or no pre-employment examination. There is very low quality evidence that incorporation of a bronchial challenge test may decrease occupational asthma (trend change −2.6, 95% CI: −3.6 to −1.5) compared to a general pre-employment examination with lung function tests. In six out of seven studies, the rates of rejecting job applicants increased because of the studied examinations.
There is very low quality evidence that risk mitigation among applicants considered not fit for work may result in a similar risk of work-related musculoskeletal injury during follow-up compared to workers considered fit for work.
Conclusion This evidence supports the current policy to restrict pre-employment examinations to only job-specific examinations. Better quality evaluation studies on pre-employment examinations are necessary, including the evaluation of the benefits of risk mitigation, given the effect on health and on the financial situation for those employees who do not pass the pre-employment examination.
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