Introduction Musculoskeletal disorders (MSDs) are one of the main causes of work disability (TMS), yet some rehabilitation programs (RPs) effectively promote return to work. However, the level of implementation of these RPs remains low. Better understanding of what works in these programs is needed to improve implementation.

Objective Explain which contextual elements and components of these RPs work, for whom and in what circumstances.

Method A realist review of the literature was conducted using Pawson’s approach (2006). Searches were performed in the Cochrane Work Trials Register, CENTRAL, MEDLINE, Embase and PsycINFO databases using pertinent keyword combinations. Each member of a group of experts (n=4) analysed the articles independently and generated configurations (Context-Mechanism-Outcome). The configurations were compared and discussed to produce a final list by consensus. Demi-regularities (patterns) were sought in the configurations as a whole to discern groupings. A Web survey of potential users was conducted to assess the clarity, pertinence and exhaustiveness of the recommendations.

Results A total of 24 articles were retained and analysed. Around 50 configurations were developed and then grouped. Five RP components emerged:

• assessment of the individual, including the work situation;

• timeliness of the workplace intervention;

• diversity of stakeholders;

• intersectoral information–sharing, and

• workplace accommodations.

These RP components yield positive RTW outcomes for various types of workers (manual or sedentary), regardless of MSD site (back or upper limb) and MSD phase (acute, sub-acute or chronic). The results of the 31-user survey revealed that the recommendations were mostly deemed clear, pertinent and exhaustive. However, four were considered difficult to implement in workplaces.

Discussion This realist review revealed that effective RPs depend largely on strong intersectoral actions involving leadership shared among healthcare, workplace and insurance stakeholders. These findings confirm the complex nature of program implementation.