Table 2

Outcomes 1–4 by population sample

Population sample	Paper	Outcome 1: ‘May be fit for’ work option selected		Outcome 2: work solution: structured and free-text advice		Outcome 3+4: return to work outcomes and length of sickness absence	Newcastle-Ottawa Scale (adapted)
Population sample	Paper	By fit note	By case*	On all fit notes	On fit notes with ‘may be fit’ selected		Newcastle-Ottawa Scale (adapted)
All GP patients	Shiels et al 31	6% (3670/58 700)	12% (2990/25 000)		82% structured advice 7% (273) no structured or free-text advice 64% free-text advice 10% (376) free-text advice only	Reduction in certifications length among those >4 weeks and >12 weeks in 3/7 individual practices but not overall†	High 12/12
	Shiels et al 32	6.4% (5080/79 375)			83% of MBF notes had some structured advice given. Over 26% had structured advice but no free-text advice.		High 10/10
	Gabbay et al‡36	3.5% (286/8127) of fit notes for depression				17% of maybe fit notes and 35% of all fit notes were for over 4 weeks	High 10/10
	Digital NHS37	6.5% (361 801/5 603 986)			More than 80% recommended an adaptation in the workplace, working hours or duties.	34% of fit notes were for 5 weeks or longer in 2016–2017	High 10/12
Occupational health-trained GPs seeing all GP patients	Coole et al 26	FFWS 32% (160/500) GP 10% (73/712)			FFWS: 98% (157) advice of any type GPs: 72% (53) advice of any type		Medium 4/10
Occupational health-trained GPs seeing all GP patients	Hussey et al 27		25% (209/835)§	16% (131/835)§ of cases had structured advice§			Medium 8/12
Employed patients only	Coole et al 28†	27% (25/94)		Free-text comment types: 23 work-related advice 11 functional effects of a patient’s condition 8 information on a health condition	84% (21/25) of GP MBF notes had structured advice.		Medium 4/10
	Coole et al 30†	10% (51/498)				42% (211/498) RTW	Medium 5/10
	Chenery25	9% overall (4% of first fit notes, 19% of secondary fit notes)			>78% MBF had structured advice.	82% RTW	High 8/10
	Gabbay et al 33	8.5% (2151)		12% (1602) of all sickness episodes concluded with MBF and work solutions. Return to work advice from the GP was included in: 17% (210/1205) of sickness episodes due to a fracture or other injury 16% (295/1858) certified sickness episodes due to MSK 10% (393/3950) of certified sickness episodes due to MMMD	44% (955) amended duties, 34% phased return, 20% altered hours and 9% workplace adaptations	Significant reduction in sickness episode length >12 weeks OR 0.65 (0.58–0.72) MBF predicts shorter sickness absence for all patients except those with mental health problems	High 11/12
	Gabbay et al 34¶	7% (562/8074) of fit notes for employed patients with CMD			57% (318) phased return, 30% (169) altered hours, 23% (129) amended duties, 8%(43), workplace adaptations. 57% (321) some written advice.		High 9/10
	Shiels et al 35	9% (2865) of first fit note episodes ended with a MBF note					High 9/10

*Patient.
†Coole et al 28(2015) combine these two studies.
‡Fit notes for depression only.
§First year of study, not reported after that.
¶Fit notes for CMD only.
CMD, common mental disorder; FFWS, Fit For Work scheme; GP, general practitioner; MBF, maybe fit; MMMD, mild to moderate mental disorder; NHS; National Health Service; RTW, return to work; MSK, musculoskeletal disorder.