{"text_format":"1","workbook":"xlsx","n_sheets":6,"sheets":["Front cover","Map framework","FULL MAP ","Keeping people in work","Managing sickness absence","Additional needs"],"not_rendered":{"charts":0,"images":1,"macros":1,"external_links":0,"defined_names":0,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Front cover","index":0,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":false,"merged":[]}

{"sheet":"Map framework","index":1,"n_rows":44,"n_cols":8,"rows_kept":44,"cut":false,"hidden":false,"merged":[[38,4,42,6],[43,4,46,6],[36,1,46,3],[11,7,14,9],[15,7,19,9],[20,7,24,9],[17,1,20,3],[21,1,27,3],[28,1,33,3],[17,4,25,6],[26,4,32,6],[33,4,37,6],[25,7,46,9],[10,4,10,6],[10,7,10,9],[10,1,10,3],[11,1,16,3],[11,4,16,6]]}
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[null,"Mynd i mewn i waith",null,null,"Yr amgylchedd gwaith",null,null,"Aros mewn gwaith"]
[null,"Argaeledd gwaith da.  Mentrau i greu swyddi e.e. cynlluniau adfywio ardal",null,null,"Amgylchedd ffisegol e.e. iechyd a diogelwch yn y gweithle, patrymau gwaith (oriau, gwaith sifft)  ",null,null,"Rheoli salwch tymor byr a hirdymor"]
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[null,null,null,null,null,null,null,"Cymorth ar gyfer y rheiny ag anghenion ychwanegol (e.e. cyflyrau iechyd hirdymor)"]
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[null,"Addysg, sgiliau a hyfforddiant, prentisiaethau, hyfforddeiaethau",null,null,"Amgylchedd seicogymdeithasol e.e. ymreolaeth, gwrthdaro, amgyffrediad o reolaeth, cydraddoldeb, cynhwysiant, cyflogaeth sector cyhoeddus, cyflogaeth sector preifat "]
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[null,null,null,null,null,null,null,"Hyblygrwydd i hwyluso cynhwysiant, cydbwysedd bywyd gwaith"]
[null,"Cymorth ar gyfer y rheiny ag anghenion ychwanegol neu o dan anfantais – ee iechyd, anabledd, patrymau diweithdra"]
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[null,null,null,null,null,null,null,"Ailsgilio gweithwyr hŷn a chymwysterau is, cefnogaeth benodol i weithwyr hŷn"]
[null,null,null,null,"Lefelau tâl, dosbarthiad tâl, argaeledd oriau digonol o waith, mynediad at bensiwn galwedigaethol"]
[]
[null,"Cymorth arall, er enghraift gofal plant fforddiadwy, trafnidiaeth, cymhellion"]
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[null,null,null,null,"Gwaith dros dro, diogelwch swydd, statws cyflogaeth, risg o ddileu swyddi, hyblygrwydd"]
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[null,null,null,null,"Bodlonrwydd swydd a llesiant, llais cyflogeion a chynrychiolaeth ar y cyd"]
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[null,null,null,null,"Cyfleoedd ar gyfer datblygu a gwneud cynnydd"]

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[null,null,null,null,null,null,"MYND I MEWN I WAITH"]
[null,null,null,null,null,null,"ARGALEDD GWAITH"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"What Works Centre for Local Economic Growth. Broadband. London: What Works Centre for Local Economic Growth; 2015. Available here","Broadband; private provision; direct public provision to improve broadband infrastructure; indirect public provision, such as grants, loans or vouchers to connect users to existing networks; demonstration projects, where a private company provides fast internet infrastucture and/or service","The evidence is inconsistent so it is not possible to tell whether access to broadband increases the availability of work","UK and other OECD countries","What are the local economic impacts of broadband?","Productivity, firm entry and business numbers, employment and other labour market outcomes, income and wages and other outcomes (e.g. sales and property prices)","Sixteen evaluations were included.\n\nExtending broadband to an area can affect firm productivity, number of businesses, and local labour market outcomes (such as employment, income and wages).\n\nThese effects are not always positive, are not necessarily large, and may depend on complementary investments by firms (for example, training workers, or reorganising sales strategy or supply chains to take advantage of faster internet connections).\n\nEffects can vary across different types of industries and workers with service industries and skilled workers possibly benefiting more than manufacturing industries and unskilled workers.\n\nThe economic effects of broadband tend to be larger in urban areas (or close to urban areas) than in rural areas.\n\nWhere there is a lack of evidence\n• Most studies look at the effect of broadband provision. Only two studies compare broadband adoption with provision. It is hard to generalise conclusions from these two studies but they do suggest that the effects of adoption and provision may differ\n• Only two studies look at the effects on profits and sales – one shows a positive effect (for US farms), but the other shows zero effect (for firms in East Yorkshire)\n• Only one study looks at the effects on property prices - showing a positive effect on domestic property prices\n• There was surprisingly little evaluation evidence of broadband’s impact on working patterns – one study found that broadband positively affects female labour force participation; another study, however, finds no net effects on working at home, telecommuting or operating a home-based business\n• The review only found three high quality evaluations of specific broadband policies (voucher schemes, direct public provision or public/private partnerships)\n• Costs are rarely addressed in the studies reviewed. Only one paper attempts a cost-benefit analysis\n• No studies that evaluate the kind of small to mid-size enterprise -targeted voucher scheme currently running in the UK were found\n• It would be very useful to know more about the relative effects of indirect vs direct provision (i.e., voucher schemes for services vs direct investment infrastructure). The UK has funded both approaches.\n• There is a lack of evidence in other areas of internet technology such as the effect of wi-fi networks, and fast mobile internet. Future evaluations in this area would greatly improve the evidence base.","Overall, of the 16 evaluations reviewed, 14 found that broadband had positive impacts on the local economy. However, effects are likely to vary across types of firms, workers and areas, and may not be large in aggregate.\n\nThe evidence review highlights a number of factors for policy makers to be aware of when considering broadband policy:\n\n• Broadband, like many information and communications technologies, is a ‘disruptive’ technology that creates winners and losers, and has spillover effects across local boundaries. It is not a silver bullet for local economic development\n\n• There is evidence that broadband has positive local economic impacts, but some of these may be due to in-migration. Existing households may not be the biggest beneficiaries\n\n• Broadband seems to benefit skilled workers more than low or un-skilled workers\n\n• The effects of adoption and provision may differ. More work needs to be done to understand whether and how to encourage adoption and productive business use\n\n• Rural areas may need to subsidise broadband provision but the economic benefits of doing so will not be as large as for urban areas."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"What Works Centre for Local Economic Growth. Innovation: grants, loans and subsidies.  London: What Works Centre for Local Economic Growth; 2015.  Available here","Programmes that support innovation by providing loans, grants and subsidies for research and development activity. Included: \n• Innovation-policy schemes providing public funding for innovation projects\n• National funds for research in science and technology\n• Subsidised government loans for research and development (R&D) activities\n• Regional subsidies to support public and private R&D activities","The evidence suggests that access to grants, loans and subsidies to encourage innovation may increase the availability of work","UK and other OECD countries","Not specified, looks at the effectiveness of public grants, loans and subsidies for R&D activity. It is part of a wider set of reviews summarising findings from evaluations of innovation policy","Effects on R&D, innovation and business growth, productivity, employment and firm performance","Included 42 evaluations\n\nWhat the evidence shows\n• R&D grants, loans and subsidies can positively impact R&D expenditure, although effects are not always positive\n• R&D grants, loans and subsidies can raise innovative activity in recipients, although again effects are not always positive. The effects differ across types of innovation, and are weaker for patents than for (self-reported) measures of process or product innovation\n• R&D grants, loans and subsidies can positively impact productivity, employment or firm performance (profit, sales or turnover). There is some evidence that support is more likely to increase employment than productivity\n• R&D grants, loans and subsidies are more likely to improve outcomes for small to medium size companies than for larger ones. In part this may be because for larger firms, public support makes up a relatively small amount of overall R&D spend, so positive effects are harder to detect. Smaller firms may also be more likely to formalise processes in anticipation of, or response to, a grant, so that some innovation-related spend is reclassified as R&D\n• Programmes that emphasise collaboration perform better than those that just support private firms (as well as those where the programme focus is unclear). Encouraging collaboration might have an additional positive effect on the likelihood that an R&D support programme generates positive effects on outcomes of interest\n• Programmes that target particular production sectors appear to do slightly worse in terms of increasing R&D expenditure and innovation, compared to those that are ‘sector neutral’.\n\nWhere the evidence is inconclusive\n• Evidence on the extent to which public support crowds out private investment is mixed.\n\nWhere there is a lack of evidence\n• There is little impact evaluation evidence on key aspects of programme design, such as eligibility criteria and targeting programmes by firm size\n• Relatively few evaluations consider the timing of effects. In particular, there is a lack of studies considering long-term impacts of interventions (ten years plus). However, the small number of studies that are able to consider the time profile of effects, do not suggest that programme effects get stronger over time\n• Relatively few evaluations consider more than one element of the ‘chain’ from increased R&D spend, through innovation, to improved firm performance. Results from these studies are mixed\n• Programme spend and operational cost data is rarely available to evaluators. This makes it very hard to assess the cost-effectiveness of public R&D grants and subsidy interventions.","This evidence review does not address the specifics of ‘what works where’ or ‘what will work for a particular locality’. An accurate diagnosis of the specific local challenges policy seeks to address needs to be the first step in understanding how the overall evidence applies in any given situation. \n\nHowever, while detailed local knowledge and context will be important in undertaking that analysis, as in most policy areas considered, the evidence presented here doesn’t make the case for local over national delivery (or vice-versa).\n\nThe evidence does urge caution on the role that more localised innovation policy could play in driving local economic growth. Local decision makers need to think carefully about their desired objectives. For example, this review shows that tax credits have a pretty good success rate in raising R&D spending (particularly for smaller / younger firms). Equally, R&D grants programmes which include a collaboration element seem effective at raising R&D activity. But in both cases we know much less about whether or how this increased R&D activity feeds through to greater innovation, better firm performance or longer term economic growth, particularly at the local level. These broader outcomes are the things most local economic decision makers ultimately care about.\n\nThere are also good reasons to think that many of these broader economic benefits are likely to ‘spill over’ beyond the immediate area in which the policy is implemented. This might still result in a net benefit for the place implementing the policy, but such spillovers reduce the economic benefits to individual areas and strengthen the case for national policy. \n\nLocal R&D support programmes could also result in inefficiently high levels of support if footloose firms are able to extract more generous support from competing local areas regardless of any net beneficial impact. Any moves to devolve policy in the UK would need to test for these issues.\n\nOverall, then, it is important to remember that evaluation of the impact of innovation policy is still limited and this review raises as many questions as answers. The limited evidence base, particularly in terms of the impact on local economic outcomes, highlights the need for realism about the capacity and evidence challenges of delivering innovation policy at a more local level."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"What Works Centre for Local Economic Growth. Innovation: R&D tax credits. London: What Works Centre for Local Economic Growth: 2015. Available here  ","Tax credit programmes designed to boost R&D","Evidence is lacking so it is not possible to tell whether tax credit programmes boost research and development and increase the availability of work","UK and other OECD countries","None specified looks at the impact of tax credit schemes that aim to encourage firms to undertake research and development","R&D expenditure, innovation and economic outcomes","Twenty one evaluations were included.\n\nWhat the evidence shows\n• R&D tax credits can positively impact R&D expenditure, although effects are not always positive\n• Impacts may depend on firm size with small firms slightly more likely to experience positive benefits. Smaller firms may face greater financial constraints, making them more responsive to changes in tax credits. However, smaller firms may also reclassify innovation-related spending as ‘formal’ R&D.\n\nWhere the evidence is inconclusive\n• It is hard to reach any strong conclusions on differences between the different programme types in terms of effectiveness.\n\nWhere there is a lack of evidence\n• Most shortlisted studies focus only on R&D effects of tax credits, and there is surprisingly little evidence on the impact of R&D tax credits on innovation (as measured by patents or self-reported innovative activity, for example). The available studies suggest that tax credits can have a positive impact on innovation, both at firm and area level\n• There is surprisingly little evidence on the effect of R&D tax credits on wider economic outcomes and it is hard to draw firm conclusions on the impact\n• Relatively few evaluations consider more than one element of the chain from increased R&D spend, through innovation, to improved firm performance. Results from these studies are generally positive\n• None of the shortlisted evaluations consider the timing of effects.","This evidence review does not address the specifics of ‘what works where’ or ‘what will work for a particular locality’. An accurate diagnosis of the specific local challenges policy seeks to address needs to be the first step in understanding how the overall evidence applies in any given situation.\n\nHowever, while detailed local knowledge and context will be important in undertaking that analysis, as in most policy areas we have considered, the evidence presented here doesn’t make the case for local over national delivery (or vice-versa).\n\nThe evidence urges some caution on the role that more localised innovation policy would play in driving local economic growth. Local decision makers need to think carefully about the desired objectives for local innovation policy. For example, this review shows that tax credits have a pretty good success rate in raising R&D spending (particularly for smaller / younger firms). But much less is known about whether, or how this increased R&D activity feeds through to greater innovation, better firm performance or longer term economic growth, particularly at the local level. These broader outcomes are the things most local economic decision makers ultimately care about. There are good reasons to think that many of these broader economic benefits are likely to ‘spill over’ so will be felt beyond the local area. This might still result in a net benefit for the place implementing the policy, but spillovers would need to be taken into account in evaluating impacts. \n\nR&D tax credits could also make limited sense as a local policy if they caused firms to relocate across boundaries, triggering a race to the bottom as local policymakers offered larger and larger tax breaks regardless of their impact. One study finds some evidence of firm relocation across US state borders in response to tax incentives. Any moves to devolve policy in the UK would need to test for these issues.\n\nOverall, then, it is important to remember that evaluation of the impact of innovation policy is still limited and this review raises as many questions as answers. The limited evidence base, particularly in terms of the impact on local economic outcomes, highlights the need for realism about the capacity and evidence challenges of delivering innovation policy at a more local level."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"What Works Centre for Local Economic Growth. Area Based Initiatives: EU Programmes.London: What Works Centre for Local Economic Growth; 2016. Available here","Structural funds -economic area based initiatives. These are policy initiatives aimed at tightly defined geographical areas, and provide a package of support aimed at improving economic, social or environmental outcomes within the zone","The evidence is inconsistent so it is not possible to tell whether economic area based initiatives increase the availability of work ","UK and other OECD countries","None specified, looks at the impact of European Union (EU) Cohesion Policy, especially Structural Funds spending","Gross Domestic Prodcut (GDP) per capita, employment","Fifty eight evaluations were included.\n\nWhat the evidence shows\n• EU support has a positive impact on regional GDP per capita in a little under half of the evaluations that consider GDP effects\n• Half of the studies which look at employment effects show a positive effect of EU support on employment\n• The evidence on a range of other outcomes is mixed (with only one study per outcome)\n• Positive impact is bigger in relatively more developed regions\n• Consistent with this, two out of three studies that consider the ‘dose’ (e.g. expenditure per capita) suggest an optimum ‘level’ of treatment.\n\nWhere there is a lack of evidence\n• There was no evidence on the extent to which the different components of spend change the effectiveness of support.\n\nLessons\n• EU studies demonstrate the limits to evaluating multi-strand area based initiatives (ABIs) at a large regional scale\n• It is essentially impossible to say anything on the cost-effectiveness of different types of expenditure from overall evaluations. Policymakers would be better off designing specific evaluations of each strand of expenditure, rather than attempting only a single overarching evaluation.","No separate conclusions."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"What Works Centre for Local Economic Growth. Area Based Initiatives: Enterprise Zones. London: What Works Centre for Local Economic Growth; 2016. Available here","Area based initiatives (ABIs) are policy initiatives aimed at tightly defined geographical areas, and provide a package of support aimed at improving economic, social or environmental outcomes within the zone. This review focuses on ABIs designed to improve economic outcomes in programme areas","The evidence is inconsistent so it is not possible to tell whether geographic area based initiatives increase the availability of work","UK and other OECD countries","None specified, looks at the impact of Enterprise Zones and other economic area based initiatives (such as Regional Selective Assistance)","Impact on employment, unemployment, wages, poverty, number of establishments, number of new firms, property prices and rents, displacement","Fifty eight evaluations were included.\n\nEnterprise Zones (EZ)\n\nWhat the evidence shows\n• The preponderance of the evidence relates to US Enterprise Zones, US Empowerment Zones, and French Enterprise Zones\n• A little over half the evaluations find positive impacts on zone employment. Evidence of employment effects is weakest for US EZs and better for US Empowerment Zones\n• Most of the studies that consider unemployment find positive effects\n• Half of the studies that consider the impact on poverty report positive effects\n• Half of the evaluations that consider wages report positive effects\n• Most of the studies that consider the number of businesses find positive effects.\n\nWhere there is a lack of evidence\n• A number of studies suggest that positive effects for Zones may be driven by displacement from nearby areas. However, is little evidence on whether overall effects at the wider area level are positive, or whether displacement is the main effect of EZ-type schemes\n• Very few studies look at differences in programme characteristics. As a result, it is not possible to know how characteristics of programmes (e.g. selection, local employment conditions) change effectiveness, including the extent to which they may reduce displacement\n• One study suggests that programmes with fewer target areas are more effective in attracting new jobs and business activity and that employment growth in existing target businesses is promoted only if programme incentives are tied to hiring requirements. It would be good to know if these findings generalise.\n\nLessons\n• Decision makers need to take concerns over displacement seriously. If much of the growth within the zone comes at the expense of nearby local areas, then this will mean less (or even no) overall growth at the wider area level\n• Even if displacement effects are strong, EZs may play a role in helping concentrating local employment from a number of dispersed sites.\n\nOther area based initiatives\n\nWhat the evidence shows\n• More than half of the studies that consider employment report positive effect\n• Only three studies look at unemployment, with all three reporting positive effects.\n\nWhere there is a lack of evidence\n• There were very few estimates for other outcomes of interest\n• There is some evidence that targeting of schemes to firms that provide traded goods and services could make a difference in determining the extent of displacement, but this finding is based on only two evaluations of different schemes.","In the UK, the devolution of business rates offers an opportunity for local authorities to make their own decisions about using EZ-type programmes to address local economic conditions. However, the relative power of this incentive (which represent a small proportion of business operating costs) should not be overestimated. \n\nIt is also clear that decision makers need to take concerns over displacement seriously. If much of the growth within the zone comes at the expense of nearby local areas (e.g. within the same same LEP or city-region), then this will mean less (or even no) overall growth at the wider area level. Even then, EZs and other ABIs may play a role in helping concentrating local employment from a number of dispersed sites. There has been some suggestion that this may lead to additional productivity effects via agglomeration benefits. Given existing estimates of the effect of increased concentration on productivity, and the extent of clustering involved, these effects are likely to be large in practice. Of more importance, are the implications for public service provision of more concentrated employment. For example, concentrating employment on a smaller number of sites, may help reduce costs of infrastructure provision such as transport, broadband and other services to business.\n\nGiven the small number of studies for other schemes, it is hard to draw any general conclusions in terms of policy effectiveness that might extend to EZ-type schemes. It is intriguing that a couple of UK studies suggest that the extent of displacement is much greater when schemes are non-selective and target non-traded services (LEGI) than when they are selective and target firms that serve non-local markets (RSA). This is certainly in line with a large body of theoretical and wider empirical literature, and taken together, this wider literature and the evaluation evidence urge some caution in the area specific targeting of firms that provide non-traded goods and services.\n\nThis review of ABIs reinforces two other overarching issues for policymakers in the UK:\n• Objectives of any area based policy must be very clearly defined, and the more specifically they can be targeted in terms of outcomes the better. The likely impacts of incentives across the targeted area, on adjacent areas, and over time, must be considered in the light of local conditions and objectives\n• Progress must be made in the evaluation of the UK-style EZs to be able to say with confidence whether they are providing good value for money."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"What Works Centre for Local Economic Growth. Business Advice. London: What Works Centre for Local Economic Growth: 2016. Available here","Business information, advice and mentoring programmes aimed at improving business growth and other outcomes","The evidence is inconsistent so it is not possible to tell if business advice increases the availability of work","UK and other OECD countries","None specified. This review considers the effectiveness of business advice in improving firm performance (in terms\nof productivity, employment and other performance measures)","Rates of firm creation, business survival, productivity, employment growth","Twenty three evaluations were included.\n\nWhat the evidence shows\n• Business advice had a positive impact on at least one business outcome in 14 out of 23 evaluations\n• Business advice programmes show somewhat better results for sales than they do for employment and productivity, but results are generally mixed\n• Programmes which used a hands-on, ‘managed brokerage’ approach may perform better than those using a light touch approach (although this conclusion is based on only one comparison study). Taken at face value, this suggests that a strong relationship and a high level of trust between advisor and client may be important to the delivery of positive programme outcomes. It is not clear, however, which of these two approaches is more cost effective.\n\nWhere the evidence is inconclusive\n• In most cases, programmes had vague or multiple objectives, which makes measuring success difficult\n• The reviewers found no strong differences in results between programmes with multiple objectives and programmes with more focused objectives\n• Reviewers found no evidence that would suggest one level of delivery – national or local – is more effective than another\n• It is difficult to reach any conclusions about the efectiveness of public-led versus private-led delivery\n• Overall, it is difficult to reach any strong conclusions on the link between specific programme features and better firm outcomes.\n\nWhere there is a lack of evidence\n• There is insufficient evidence to establish the effectiveness of sector specific programmes compared to more general programmes\n• The reviewers found no high quality impact evaluations that explicitly looked at the outcomes for female headed or black, minority & ethnic businesses\n• Reviewers found two high quality evaluations of programmes aimed at incubating start-ups. Both programmes were targeted at unemployed people and show mixed results overall. However, there is a lack of impact evaluation for Dragons’ Den-type accelerator programmes that aim to launch high-growth businesses and involve competitive entry.","Supporting and complementing local knowledge\nThe evidence review sets out a number of ‘Best Bets’ – approaches to business advice that have performed most strongly based on the best available impact evaluations. However, the ‘Best Bets’ do not address the specifics of ‘what works where’ or ‘what will work for a particular firm’. Detailed local knowledge and context remain crucial. ‘Best Bets’ also raise a note of caution for policymakers if they decide to introduce a programme which has not worked well elsewhere.\n\nSpecific recommendations\nThe 23 evaluations offer a rich source of material for policymakers to use in designing specific business advice policies. In particular, the evaluations will be of use to policymakers at two key stages in the policy design process: determining the policy options, and then selecting the preferred option:\n• To know what works in the area of business advice programme design and evaluation needs to be improved. When designing a programme, local policymakers should identify one or two clear programme objectives, and then identify outcome measures that are both clearly related to the programme objectives, and feasible to measure\n• Business advice programmes tend to be somewhat more successful in increasing firms’ sales and turnover than in increasing their employment or productivity\n• One comparative study suggests that smaller, better-resourced programmes are more likely to achieve success than larger ‘hands-off’ policies. But it is unclear which of these approaches is more cost-effective."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"What Works Centre for Local Economic Growth. Access to Finance. London: What Works Centre for Local Economic Growth; 2016. Available here\n","Policies designed to improve access to finance for businesses","The evidence suggests that policies designed to improve access to finance (for example loan subsidies or guarantees) may increase the availability of work","UK and other OECD countries","Not specified, aim was to identify robust evaluation evidence on the causal impact of access to finance programmes","Improved access to finance (credit availability, cost of borrowing etc.) Improved firm performance (including employment, productivity)","Twenty seven evaluations were included.\n\nWhat the evidence shows:\n• Access to finance programmes had a positive impact on at least one firm outcome (e.g. credit, employment, sales) in 17 out of 27 evaluations\n• Programmes have a positive effect on firm access to debt finance either in terms of the availability of credit or the cost of borrowing (or both). The impact on access to equity finance is mixed (and available evidence limited)\n• The impact of policies on investment and assets is mixed\n• There is some evidence that loan guarantees may increase default risk\n• Access to finance had a positive impact on at least one aspect of firm performance (e.g. employment and sales) in 14 out of 17 evaluations\n• However, these overall patterns hide much more mixed results for specific aspects of firm performance, with only half the evaluations typically recording a positive effect when looking at a specific aspect of firm performance (e.g. employment).\n\nWhere the evidence is incoclusive\n• There is no evidence that programmes targeted at Small and Medium Sized Enterprises are more or less effective than non-targeted programmes. Other targeted programmes (taken as a group) appear to perform slightly less well\n• The overall results for loan guarantees and alternative investment mechanisms are broadly similar. Loan guarantee schemes introduced in response to an economic crisis perform somewhat worse than long term development schemes\n• The overall results for public, private or hybrid programmes are broadly similar.\n\nWhere there is a lack of evidence\n• Review authors found very few studies that look at the impact of schemes on both access to finance (direct effect of the scheme) and on the subsequent performance of firms (indirect effects of the scheme)\n• While most programmes appear to improve access to finance, there is much weaker evidence that this leads to improved firm performance. This makes it much harder to assess whether access to finance interventions really improve the wider economic outcomes (e.g. productivity, employment) that policymakers care about\n• The review authors found very few studies that gathered (or had access to) information on scheme costs. As a result, there was very little evidence on the value for money of different interventions.","This review has not found answers to many of the questions that will be foremost in policy makers’ minds. This makes it much harder to assess whether access to finance interventions really perform against the economic performance measures policymakers care about. These gaps highlight the need for improved evaluation and greater experimentation, specifically experiments that focus on:\n\n• Setting out and evaluating whether access to finance models improve both access to finance and firm performance\n• Identifying how different types of access to finance programmes contribute to better or worse firm and economy outcomes; and,\n• The value for money of different access to finance approaches.\n\nAddressing these gaps requires evaluation to be embedded in the access to finance policy design process, and thinking differently about the access to finance policy cycle as a whole."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"What Works Centre for Local Economic Growth. Estate Renewal. London: What Works Centre for Local Economic Growth; 2015. Available here\n\n","Estate renewal programmes, those involving demolition, refurbishment or some combination of the two on a local scale but not limited to public housing estates. Also included New Deal for Communities","The evidence suggests that estate renewal may not be effective in increasing the availability of work","UK and OECD countries","Not clearly specified but considers the local economic impacts of estate renewal","Housing and land markets, housing quality, income and wages, employment, crime, health and well-being, education","Twenty one studies were included.\n\nWhat the evidence shows\n• Estate renewal programmes lead to increases in property and land prices and rents, although not necessarily for nearby properties that do not directly benefit from improvements\n• Estate renewal programmes tend to have a limited impact on the local economy in terms of improving income, deprivation or employment\n• Estate renewal programmes tend to have a limited impact on the local area in terms of reducing crime, improving health, well-being or education\n\nWhere there is a lack of evidene\n• Review authors found no impact evaluations that isolated effects for existing residents. This means that effects may be explained by changes in the composition of the neighbourhood (e.g. area level incomes increase as richer households move in)\n• There is little evidence on characteristics of schemes that might improve effectiveness or influence particular aspects of the local economy.","Overall, the evidence suggests that the measurable economic impacts on local economies (in terms of employment, wages or deprivation) tend not to be large and are often zero. In contrast, projects may have a positive impact on property prices."]
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[null,null,null,null,null,null,"ADDYSG, SGILIAU A HYFFORDDIANT"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Filges T, Smedslund G, Knudsen ASD, Jørgensen AMK. Active Labour Market Programme Participation for Unemployment Insurance Recipients: A Systematic Review. Campbell Systematic Reviews 2015:2 10.4073/csr.2015.2. Available here\n\n","Active labour market programmes (ALMPs). These include training (classroom training, on-the-job training and work experience) as well as interventions that are not relevant to education,skills and training","The evidence suggests that participation in active labour market programmes (including classroom and on the job training and work experience) may be effective in getting people into work","Those who were unemployed and receiving unemployment benefits","Objective was to study the effectiveness of ALMP participation on employment status ","Primary\n• Relative exit rate from unemployment to employment (measured as hazard ratio)\n• Difference in probability of employment (measured as risk difference) \nSecondary\n• Duration of first employment spell post-intervention\n• Relative exit rate from re-employment to unemployment (measured as hazard ratio) \n• Re-employment income","The available evidence suggests that there is a general effect of participating in ALMP. The findings are mixed however, depending on the approach used to investigate the effect, with no effect found of being assigned to ALMP participation at a particular moment. Reviewers found a statistically significant effect of ALMP post participation as measured by hazard ratios and risk difference in separate analyses. The overall impact of ALMP participation obtained using hazard ratios was 1.09, (meta-analysis of 14 studies, 95% confidence interval 1.04 to 1.14) which corresponds to a 52 per cent chance that a treated unemployed person will find a job before a non-treated unemployed person. The overall impact of ALMP participation was associated with a risk difference of 0.07, (14 studies, 95% CI 0.03 to 0.11) which corresponds to a number needed to treat of 15; i.e. for every 15 unemployed people who participate in ALMP, an additional unemployed person will be holding a job approximately one year after participation. The available evidence does not, however, suggest an effect of being assigned to ALMP participation at a particular moment.\n\nThere was inconclusive evidence that participation in ALMP has an impact on the quality of the job obtained.\n\nSensitivity analyses resulted in no appreciable change in effect size, suggesting that the results are robust. Reviewers found no strong indication of the presence of publication bias.\n\nThe available evidence does not suggest that the effect of ALMP participation differs by type of programme. \n\nIt was not possible to examine whether the participation effect varies with gender, age or educational group, or with labour market condition.","To the best of the reviewers knowledge, this was the first systematic review analysing the magnitude (and not merely the statistical significance) of the effect of ALMP participation in unemployed individuals receiving unemployment insurance benefits. \n\nOverall, ALMPs display a limited potential to alter the employment prospects of the individuals they intend to help. The available evidence does suggest that there is an effect of participating in ALMP, but the effect is small and the reviewers found no effect of being assigned to ALMP participation at a particular moment.\n\nThe four different types of ALMP (labour market training, private sector programmes, direct employment programmes in the public sector and job search assistance) were investigated. The available evidence does not suggest that the ALMP participation effect differs by type of ALMP.\n\nIt was not possible to examine a number of other factors which the reviewers felt might have an impact on the magnitude of the effect and which may be crucial to policy makers. The results of this review, however, merely suggest that across a number of different programmes there is an overall small effect of ALMP participation on job finding rates, and no evidence of differential effects for different programmes.\n\nWhile additional research is needed, the review does however suggest that there is a small increase in the probability of finding a job after participation in ALMP."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Kluve J, Puerto S, Robalino D, Romero J M, Rother F, Stöterau J, Weidenkaff F, Witte M. Interventions to improve the labour market outcomes of youth: a systematic review of training, entrepreneurship promotion, employment services, and subsidized employment interventions. Campbell Systematic Reviews 2017:12 \nDOI: 10.4073/csr.2017.12. Available here","Active labour market programmes (ALMPs) for young people. These included training programmes addressing a lack of trade or job specific technical skills, business skills training, literacy and numeracy programmes and programmes improving non-technical skills such as behavioural, life or soft skills of jobseekers","The evidence suggests that active labour market programmes for young people may be effective in getting them into work. Larger effects were seen in programmes targeting disadvantaged youth. Sensitivity analysis suggests that in high income countries only skills training had a small impact on employment ","Those aged 15 to 35 ","1. What is the impact of youth employment interventions on labour market outcomes of youth? In particular, the review investigates skills training, entrepreneurship promotion, employment services and subsidised employment interventions \n\n2. Which of these interventions are the most effective on average?","Employment, earnings, business performance","A total of 113 eligible impact evaluations were identified, encompassing a unique set of evaluation methods, interventions and geographical coverage. Meta-analysis methods were employed to synthesise the evidence, based on 2,259 imputed effect sizes. Overall, empirical results indicated positive effects of entrepreneurship promotion and skills training on employment and earnings. Effects of employment services and subsidised employment were generally small and non-significant. Larger programme effects were estimated in low and middle-income countries than in high-income countries, and in programmes targeting disadvantaged youth.\n\nEmployment: overall Standardised mean difference (SMD) 0.04 (95% confidence interval (CI) 0.03 to 0.06) 105 interventions, I2 64%.\n\nSub-group analysis by intervention categoy; entrepreneurship promotion (SMD 0.16; 95% CI 0.06 to 0.26; I2 71%, seven interventions) and skills training (SMD 0.05, 95% CI 0.02 to 0.07; I2 65%; 67 interventions), employment services (SMD 0.01; 95% CI -0.02 to 0.04; I2 0%, 10 interventions); subsidised employment (SMD 0.02; 95% CI -0.01 to 0.06; I2 50%; 16 interventions). \n\nEarnings: SMD 0.05 (95% CI 0.03 to 0.06, I2 82%, 92 interventions). Analysis by intervention categories entrepreneurship promotion (SMD 0.09; 95% CI 0.01 to 0.18; I2 64%, 12 interventions); skills training (SMD 0.07; 95% CI 0.05 to 0.08; I2 86%, 60 interventions); employment services (SMD 0.01; 95% CI 0.00 to 0.02; I2 0%, eight interventions); subsidised employment (SMD -0.01; 95% CI -0.05, 0.03; I-sq 61%; nine interventions).\n\nBusiness performance: SMD 0.03 (95% CI -0.05 to 0.12; I2 49% 14 interventions), entrepreneurship promotion interventions (SMD 0.10, 95% CI 0 to 0.19; I2 39%, 10 interventions). Skills training (SMD -0.09, 95% CI -0.19 to 0.01; I2 0%, 4 interventions).\n\nIn high-income countries, the overall effects of ALMPs on employment (SMD 0.04, 95% CI 0.01 to 0.07; I2 57%, 52 interventions) and earnings (SMD 0.01; 95% CI -0.01 to 0.02; I2 70%, 31 interventions). In sub-group analysis by intervention type, only skills training appeared to have a small impact on employment (SMD 0.04; 95% CI 0.01 to 0.07, I2 58%).\n\nFindings suggested that employment and earnings outcomes for women were marginally larger than those for men. No particular connection between soft skills and better labour market outcomes was found . Similarly, there was no systematic evidence about the role of public, private or civil entities in the implementation of a youth employment programme.","Active measures to support the (re)integration of young women and men into the labour market may succeed in enhancing employment and earnings outcomes and have potential to increase human capital and employment prospects in the long-term. The evidence suggested that programmes targeting disadvantaged youth are particularly effective. Entrepreneurship promotion and skills training programmes appear to be a particularly promising intervention for improving employment, earnings and business performance, but the evidence base is still relatively small. More rigorous impact evidence is needed for particular employment programmes more generally, including employment services, subsidised employment and entrepreneurship promotion."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Smedslund G, Hagen KB, Steiro A, Johme T, Dalsbø TK, Rud MG. Work programmes for welfare recipients Campbell Systematic Reviews 2006:9\nDOI: 10.4073/csr.2006.9. Available here","Welfare to work programmes including job search assistance, job search training, subsidised employment, job clubs, vocational training","The evidence suggests that welfare to work programmes may be effective in getting people into work","Welfare recipients and those who had applied for welfare, included those in receipt of food stamps. Excluded people entitled to unemployment benefit and those with pensions","The objective was to estimate the effects of work programmes for welfare recipients on work status, earnings and welfare receipt\n\n\n\n","Primary\n• Work status; a) proportion of attendants who obtained competitive work\nb) duration of employment during a given time interval. c) elapsed time until obtained work d) duration on welfare benefit during a given time interval (as above) e) proportion on welfare\n• Earnings a) mean or median earnings at different time points b) total individual earnings c) total household earnings\n• Welfare Payments\nSecondary\n• Skills and satisfaction a) quality of life\nb) social skills c) self confidence d) social activity, participation and integration\n• Adverse effects a) crime b) drug and alcohol use c) displacement  d) decrease in combined income e) other","Forty six programmes with more than 412 thousand participants were included in this review, most studies were from the USA. Participants were randomised to intervention or control group, follow-up outcomes from the end of the intervention and up to six years were reported.\n\nOverall, 60.9% of intervention and 57.9% of control participants were employed at the follow-ups. The random effects risk ratio (RR) for employment was 1.097 at the one-year follow-up with 95% confidence interval (CI) 1.006 to 1.196. At two years the random effects RR was 1.092 (95% CI 1.032 to 1.157), and at five years the random-effects RR was 1.037 (95% CI 1.004 to 1.071). Overall number needed to treat estimated to be 33 (95% CI 30 to 37). \n\nEffect on earnings was small. At one year follow-up, the random effects Hedges g was 0.043 (95% CI 0.011 to 0.076); at two years 0.044 (95% CI 0.022 to 0.066); at five years 0.011 (95% CI -0.029 to 0.050). Mean earnings (weighted by sample size) across all the intervention outcomes (in year 2005 US dollars) was $ 11,021 compared to $ 8,843 in the control groups. Using the Binominal Effect Size Display (BESD) this roughly corresponds to a positive impact for 51.1% in the intervention group and for 48.9% in the control group.\n\nEffect on welfare payments at one year was small (random-effects Hedges g 0.038, 95% CI -0.022 to 0.098); at two years 0.053 (95% CI -0.005 to -0.111); at five years the fixed-effects g was 0.044 (95% CI 0.028 to 0.060). The programmes reduced the welfare payments from $21,719 to $18,777 when averaging across all studies. Here the BESD indicated an improvement for 51.2 % of the participants in the intervention groups and for 48.8 % in the control groups.\n\nEffect on the proportion of participants on welfare after one year showed a random effects risk ratio of 0.967 (95% CI 0.926 to 1.009); after two years (random-effects RR: 0.946, 95% CI 0.886 to 1.010); after five years, the fixed-effects RR was 1.003 (95% CI 0.984 to 1.023). After taking part in a programme, 68% (weighted by sample size) were on welfare, compared to 72% in the control groups. The overall number needed to treat indicates that, on average, 27 welfare recipients (95% CI 24 to 30) had to take part in a programme in order to get an additional person off welfare (overall RR for all outcomes 0.963, 95% CI 0.948 to 0.978).\n\nFor all four outcomes, there was significant heterogeneity which could not be sufficiently explained by moderator analysis. The GRADE quality assessment showed that for all four outcomes, the quality of evidence was very low.","Welfare-to-work programmes in the USA have shown small, but consistent effects in moving welfare recipients into work, increasing earnings, and lowering welfare payments. The results are not clear for reducing the proportion of recipients receiving welfare. Little is known about the impacts of welfare-to-work programmes outside of the USA."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"What Works Centre for Local Economic Growth. Apprenticeships. London: What Works Centre for Local Economic Growth; 2015. Available here","Apprenticeships involving paid employment in a firm, alongside training provided by that employer (and sometimes others), typically leading to a formal qualification or title","The evidence suggests that apprenticeships may be effective for getting people into work","UK and other OECD countries","Not specified in report but looked at the impacts of apprenticeships on workers and firms","Returns to apprenticeships - their effect on one or more economic outcome; individual outcomes: skills and further training; wages; employment and labour market; firm level outcomes","Twenty seven impact evaluations were included.\n\nWhat the evidence shows\nThere is some evidence that apprenticeships improve skill levels, and stimulate further training or study. Apprenticeships can increase wages, although in two evaluations effects are negative. Impacts also vary by type of participant. Apprenticeships tend to have a positive effect on participants’ subsequent employment (and also reduce subsequent unemployment). Level 3 or higher apprenticeships deliver substantially higher lifetime wage gains relative to lower level apprenticeships (based on the limited UK evidence available). There is some evidence that apprenticeships are more likely to increase employment than other forms of employment training (unless that training also involves an in-firm element). The evidence of impact on wages is more mixed and appears to vary by gender.\n\nThere is some evidence that identifies mechanisms that may increase entry into apprenticeships and attendance during the programme (e.g. pre-qualifications, higher wages and subsidies to individuals). However, we have less evidence on what works to ensure people complete apprenticeships.\n\nWhere the evidence is unclear\nIt is unclear whether the duration of the apprenticeship matters for effects on wages or employment (although longer apprenticeships that deliver higher qualifications may have more positive effects).\n\nWhere there is a lack of evidence\nThere is some limited evidence that firms participating in apprenticeships experience economic gains, such as higher productivity or profits. This fits with survey evidence, but more impact evaluations are needed. There is too little evaluation evidence to draw clear conclusions on whether apprenticeships work better in some sectors than others.\nThere is some evidence that post-apprenticeship moves can increase wages although effects depend on circumstances.\n\nThere is no impact evaluation evidence looking at the effect of apprenticeships on a given local area (rather than individual participants or firms). There is no impact evaluation evidence comparing the effects of nationally run programmes versus locally run programmes. \n\nExisting ex-ante modelling suggests that the economic benefits of apprenticeships comfortably outweigh their costs. However, only one of the impact evaluations provides cost data in a form which allows us to calculate ex-post benefit-cost ratios for that programme. \n\nNone of the included studies look at the effects of substantially scaling up apprenticeship provision, as is currently happening in the UK. More evidence is needed on whether identified benefits also hold in a larger programmes. Given the other substantial changes to the UK apprenticeship system in the past decade and a half, more up to date UK impact evaluation evidence is also needed.","Apprenticeships are currently very high on the policy agenda, and the evidence review highlights a number of factors for policy makers to be aware of when considering apprenticeships:\n\n• While the evidence suggests that higher level apprenticeships (specifically, Level 3 and above) may offer better outcomes, it does not currently tell us whether this is because stronger candidates gravitate towards more demanding programmes. If this is the case, policymakers need to consider how to address the needs of those ‘left behind’ by this type of apprenticeship offering\n\n• Any policy should carefully consider how to recruit firms to provide apprenticeships, and trainees to fill them. A better understanding of the costs and benefits to firms will help in this, as will a better understanding of which policy design aspects increase take-up and reduce drop-out."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"What Works Centre for Local Economic Growth. Employment training. London: What Works Centre for Local Economic Growth; 2016. Available here","Employment training programmes targeting people over 18 years. Included day-release, short courses and retraining","The evidence is inconsistent so it is not possible to tell if employment training programmes targeting people over 18 years are effective at getting people into work ","UK and other OECD countries","Not specified, aimed to identify robust evaluation evidence on the causal impact of training programmes","Employment, wages","Seventy one evaluations were included.\n\nWhat the evidence shows\n• Training has a positive impact on participants’ employment or earnings in around half of the evaluations reviewed\n• Shorter programmes (below six months, and probably below four months) are more effective for less formal training activity. Longer programmes generate employment gains when the content is skill-intensive\n• In-firm/on the job training programmes tend to outperform classroom-based training programmes. Employer co-design and activities that closely mirror actual jobs appear to be key design elements\n• The state of the economy is not a major factor in the performance of training programmes; programme design features appear to be more important than macroeconomic factors.\n\nWhere the evidence is inconclusive\n• Comparing different skill content training – such as ‘basic’ versus ‘advanced’ interventions – is extremely difficult: finding suitable comparators (i.e. policies that target similar groups using different types of training) is challenging, and skill content usually reflects real participant differences\n• Training programmes that respond to structural shocks in the local economy are usually highly tailored to a given local context. This means that pulling out generalisable findings on impact is difficult\n• It is hard to reach any strong conclusions on private-led versus public-led delivery on the basis of the (limited) available evidence.\n\nWhere there is a lack of evidence\n• The reviewers found little evidence which provides robust, consistent insight into the relative value for money of different approaches. Most assessments of ‘cost per outcome’ fail to provide a control group for comparison\n• The reviewers found no evidence that would suggest local delivery is more or less effective than national delivery.","Supporting and complementing local knowledge\nThe evidence review sets out a number of ‘Best Bets’ which outline what tends to work in the employment training policy field based on the best available impact evaluations. The ‘Best Bets’ do not generally address the specifics of ‘what works where’ or ‘what will work for a particular individual’. In some cases evaluations do break out results by area type or different groups. But even when they do, detailed local knowledge and context remain crucial. Reflecting this, the overall findings from the evaluations should be regarded as a complement, not a substitute, for local, on-the-ground knowledge. Any policy intervention focused on employment training will need to be tailored and targeted. And an accurate diagnosis of the specific local employment and skills challenges this policy seeks to address needs to be the first step to understanding how the overall evidence applies in any given situation.\n\nProviding general guidance on what works\nThe ‘Best Bets’ highlight the common characteristics of employment training programmes and projects that have positive effects. For example:\n• If an employment training programme wants to improve the employment prospects for an individual, it’s probably a good idea to involve employers in the design of the programme and through providing on-the-job training\n• The greater the length of a training programme, the greater the need for extra support to participants to counteract the ‘lock-in’ effects of being taken away from job searching\n• Extending shorter length training programmes to a wider group of recipients is likely to produce a better success rate than providing longer training to a smaller group.\n\nWhile the ‘Best Bets’ cannot provide definitive guidance as to what will or won’t work in any specific context, they do provide useful overall guidance to policy-makers to use when designing an employment training programme. They also raise a note of caution for policy-makers if they decide to try out a programme which has not worked so well elsewhere."]
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[null,null,null,null,null,null,"CYMORTH AR GYFER ANGHENION YCHWANEGOL"]
[null,null,null,null,null,null,"PROBLEMAU IECHYD MEDDWL CYFFREDIN"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Underwood L, Thomas J, Williams T, Thieba A (2007) The effectiveness of interventions for people with common mental health problems on employment outcomes: a systematic rapid evidence assessment. In: Research Evidence in Education Library. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London. Available here","Interventions that impact on employment","There is a lack of evidence on employment interventions to help those with common mental health problems find work\n\nThe evidence suggests that mental health interventions may be effective in helping people with common mental health problems find work","People with common mental health problems","What is the evidence for the effectiveness of interventions for people with common mental health problems on improving employment outcomes?","Employment","Studies focusing on common mental health problems aimed either to improve the treatment of people’s mental health problems (mental health interventions) or to assist directly people with mental health problems to gain or retain employment (employment interventions). While the studies were variable in terms of their quality and relevance, the evidence suggests that mental health interventions can improve the employment status of people with common mental health problems, especially for those already employed. The evaluations of employment interventions tended to be less robust and could not provide conclusive evidence that these programmes are effective. However, there is some indication that these interventions can be implemented and are popular and acceptable among stakeholders.","On the basis of existing evidence, for those currently employed with common mental health problems (but not necessarily for those currently unemployed), the following conclusions were reached:\n• Improvements in mental health are associated with better employment outcomes. (It should be noted that this is an association so not necessarily causal)\n• Receiving recommended primary care improves employment outcomes\n• Interventions to improve mental health guideline implementation and adherence can improve employment outcomes. Implementation and process data from the studies on employment interventions provide some support for these interventions and could make a useful basis for the development and evaluation of future programmes.\n\nMore research needs to be undertaken on what works to help people with common mental health problems find work, if they are unemployed, or stay in work if they are employed. More research on how to help those currently unemployed is particularly important, given the paucity of evidence addressing this issue."]
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[null,null,null,null,null,null,"SALWCH MEDDWL DIFRIFOL"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Kinoshita  Y, Furukawa  TA, Kinoshita  K, Honyashiki  M, Omori  IM, Marshall  M, Bond  GR, Huxley  P, Amano  N, Kingdon  D. Supported employment for adults with severe mental illness. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD008297. DOI: 10.1002/14651858.CD008297.pub2. Available here \n\n","Supported employment for adults with a mental illness","The evidence suggests that supported employment may help people with severe mental illness to find work","Majority in the trials were (a) of working age (normally 16 to 70 years); (b) unemployed; and (c) suffering from severe mental illness (SMI). Trials were included where more that 50% of participants  had schizophrenia and schizophrenia‐like disorders; bipolar disorders; or depression with psychotic features. Substance abuse and post traumatic stress disorder were not considered SMI, but trials were eligible if participants had a problem with substance abuse and/or comorbidity of post traumatic stress disorder in addition to severe mental illness. Trials where a majority of participants more than 50% of participants had a learning disability as the sole psychiatric diagnosis were excluded","1. To review the effectiveness of supported employment compared with other approaches to vocational rehabilitation or treatment as usual\n\n2. Secondary objectives were to establish how far:\n(a) fidelity to the individual placement and support  (IPS) model affects the effectiveness of supported employment,\n(b) the effectiveness of supported employment can be augmented by the addition of other interventions","Primary\n• Days in competitive employment (long term)\nSecondary\n• Employment: Days in competitive employment (medium term): Days in any form of paid employment (such as competitive employment, transitional employment, or sheltered employment with wage): Earnings in the first year: Job tenure (weeks/work/person: for competitive employment and any paid employment): Time to first competitive employment\n• Education: Days in any form of employment or education (including training courses or full or part‐time education)\n• Leaving the study early\n• Global state\n• Mental state\n• Service Use \n• Quality of life \n• Adverse effects\n• Economic Costs (excluding housing costs)","A total of 14 randomised controlled trials were included in this review (2,265 people). For the primary outcome (employment: days in competitive employment, over one year follow‐up), supported employment seems to significantly increase levels of any employment obtained during the course of studies (7 RCTs, n= 951, RR 3.24 95% CI 2.17 to 4.82, very low quality of evidence). \n\nSupported employment also seems to increase length of competitive employment when compared with other vocational approaches (1 RCT, n= 204, MD 70.63 95% CI 43.22 to 94.04, very low quality evidence). \n\nSupported employment also showed some advantages in other secondary outcomes. It appears to increase length (in days) of any form of paid employment (2 RCTs, n= 510, MD 84.94 95% CI 51.99 to 117.89, very low quality evidence) and job tenure (weeks) for competitive employment (1 RCT, n= 204, MD 9.86 95% CI 5.36 to 14.36, very low quality evidence) and any paid employment (3 RCTs, n= 735, MD 3.86 95% CI ‐2.94 to 22.17, very low quality evidence). Furthermore, one study indicated a decreased time to first competitive employment in the long term for people in supported employment (1 RCT, n= 204, MD ‐161.60 95% CI ‐225.73 to ‐97.47, very low quality evidence). \n\nA large amount of data were considerably skewed, and therefore not included in meta‐analysis, which makes any meaningful interpretation of the vast amount of data very difficult.","The limited available evidence suggests that supported employment is effective in improving a number of vocational outcomes relevant to people with severe mental illness, though there appears to exist some overall risk of bias in terms of the quality of individual studies. \n\nAll studies should report a standard set of vocational and non‐vocational outcomes that are relevant to the consumers and policy‐makers. Studies with longer follow‐up should be conducted to answer or address the critical question about durability of effects."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Suijkerbuijk  YB, Schaafsma  FG, van Mechelen  JC, Ojajärvi  A, Corbière  M, Anema  JR. Interventions for obtaining and maintaining employment in adults with severe mental illness, a network meta‐analysis. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD011867. DOI:10.1002/14651858.CD011867.pub2. Available here\n\n","Vocational rehabilitation for people with severe mental illness","The evidence suggests that supported employment and augmented supported employment may help people with severe mental illness to find work","Adults aged between 18 and 70 years diagnosed with severe mental illness","Review objective was to assess the comparative effectiveness of various types of vocational rehabilitation interventions and to rank these interventions according to their effectiveness to facilitate competitive employment in adults with severe mental illness","Primary \n• Percentage or number of participants who obtained competitive employment, meaning work in the competitive labour market for which an individual is compensated at or above minimum wage\n• Follow‐up times, categorised as short‐term follow‐up if less than or up to 12 months, and long‐term follow‐up if longer than 12 months\nSecondary \n• Employment: number of weeks in competitive employment, number of days to first competitive employment, percentage of participants who obtained non‐competitive employment (such as employment in a sheltered workplace or volunteer work)\n• Clinical outcomes: Quality of life, mental health (psychiatric symptoms)\n• Adverse events: Dropouts, hospital admissions","Included 48 randomised controlled trials involving 8,743 participants. Thirty studied supported employment, 13 augmented supported employment, 17 prevocational training, and six transitional employment. Psychiatric care only was the control condition in 13 studies.\n\nDirect comparison meta‐analysis of obtaining competitive employment\nIncluded 18 trials with short‐term follow‐up in a direct meta‐analysis (n = 2,291) of the following comparisons. Supported employment was more effective than prevocational training (RR 2.52, 95% CI 1.21 to 5.24) and transitional employment (RR 3.49, 95% CI 1.77 to 6.89) and prevocational training was more effective than psychiatric care only (RR 8.96, 95% CI 1.77 to 45.51) in obtaining competitive employment. For the long‐term follow‐up direct meta‐analysis, included 22 trials (n = 5,233). Augmented supported employment (RR 4.32, 95% CI 1.49 to 12.48), supported employment (RR 1.51, 95% CI 1.36 to 1.68) and prevocational training (RR 2.19, 95% CI 1.07 to 4.46) were more effective than psychiatric care only. Augmented supported employment was more effective than supported employment (RR 1.94, 95% CI 1.03 to 3.65), transitional employment (RR 2.45, 95% CI 1.69 to 3.55) and prevocational training (RR 5.42, 95% CI 1.08 to 27.11). Supported employment was more effective than transitional employment (RR 3.28, 95% CI 2.13 to 5.04) and prevocational training (RR 2.31, 95% CI 1.85 to 2.89).\n\nNetwork meta‐analysis of obtaining competitive employment\nIncluded 22 trials with long‐term follow‐up in a network meta‐analysis. Augmented supported employment was the most effective intervention versus psychiatric care only in obtaining competitive employment (RR 3.81, 95% CI 1.99 to 7.31, SUCRA 98.5, moderate‐quality evidence), followed by supported employment (RR 2.72 95% CI 1.55 to 4.76; SUCRA 76.5, low‐quality evidence). Prevocational training (RR 1.26, 95% CI 0.73 to 2.19; SUCRA 40.3, very low‐quality evidence) and transitional employment were not considerably different from psychiatric care only (RR 1.00,95% CI 0.51 to 1.96; SUCRA 17.2, low‐quality evidence) in achieving competitive employment, but prevocational training stood out in the SUCRA value and rank.\n\nAugmented supported employment was slightly better than supported employment, but not significantly (RR 1.40, 95% CI 0.92 to 2.14). The SUCRA value and mean rank were higher for augmented supported employment. The results of the network meta‐analysis of the intervention sub-groups favoured augmented supported employment interventions, but also cognitive training. However, supported employment augmented with symptom‐related skills training showed the best results (RR compared to psychiatric care only 3.61 with 95% CI 1.03 to 12.63, SUCRA 80.3). The quality of the evidence of the network ranking was graded as very low because of potential risk of bias in the included studies, inconsistency and publication bias.\n\nReview authors did not find differences between interventions in the risk of dropouts or hospital admissions.","Supported employment and augmented supported employment were the most effective interventions for people with severe mental illness in terms of obtaining and maintaining employment, based on both the direct comparison analysis and the network meta‐analysis, without increasing the risk of adverse events. These results are based on moderate‐ to low‐quality evidence, meaning that future studies with lower risk of bias could change these results. Augmented supported employment may be slightly more effective compared to supported employment alone. However, this difference was small, based on the direct comparison analysis, and further decreased with the network meta‐analysis meaning that this difference should be interpreted cautiously. More studies on maintaining competitive employment are needed to get a better understanding of whether the costs and efforts are worthwhile in the long term for both the individual and society."]
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[null,null,null,null,null,null,"ANHWYLDERAU AR Y SBECTRWM AWTISTIG"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Westbrook JD, Fong CJ, Nye C, Williams A, Wendt O, Cortopassi T. Pre-Graduation Transition Services for Improving Employment Outcomes among Persons with Autism Spectrum Disorders: A Systematic Review. Campbell Systematic Reviews 2013:11\nDOI: 10.4073/csr.2013.11. Available here\n\n","Interventions for this review were included if they were designed as an approach to prepare and/or place transition‐age individuals with Autism Spectrum Disorder (ASD) in a gainful competitive employment setting earning minimum wage or above","Evidence is lacking so it is not possible to tell whether pre-graduation transition services for young people with autistic spectrum disorder help them to find work","Transition‐age individuals (14 to 22 years), with a diagnosis of ASD","Not specified aimed to identify and describe the effectiveness of behavioral and social interventions that prepare school-age youth with autism spectrum disorders for employment after graduation","Eligible outcomes included attainment of an employment placement and specific data about the duration and/or retention of that placement. Eligible gainful employment consisted of competitive, integrated, or supported employment. Employment at sheltered work or non-integrated work settings was not included. Employment included full or part-time placements","This review was not able to identify definitive interventions that predictably and positively supported the development of transition programmes designed to produce employment outcomes for individuals with ASD. No studies were identified that met all the inclusion criteria specified for the review. ","While no definitive conclusions can be drawn based upon the current review, the authors did identify qualitative research and other related studies that addressed elements of potential successful employment placements for transition-age individuals with ASD.\n\nGiven the regulations and funding often surrounding transition programming for students with disabilities, it is remarkable that such limited research attention has been paid to the effectiveness of interventions that produce the intended result of such programmes. \n\nFuture research efforts are needed to develop studies that utilise a rigorous experimental design to determine the relative effectiveness of the various interventions being utilised in transition programming for students with ASD. It is also important for such studies to identify actual employment outcomes that result from presumed preparatory or facilitating interventions utilised in transition programmes."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Westbrook J, Nye C, Fong C, Wan J, Cortopassi T, Martin F. Adult employment assistance for persons with autism spectrum disorders: Effects on employment outcomes. Campbell Systematic Reviews 2012:5 DOI: 10.4073/csr.2012.5. Available here\n\n\n\n","The types of employment included were competitive, supported, or integrated employment. Studies in which the experimental groups assigned to sheltered work or non‐integrated work interventions were excluded ","The evidence is inconsistent so it is not possible to tell if employment assistance helps adults with autistic spectrum disorder find work","Those aged 18 or over with a diagnosis of with autism spectrum disorders (ASD) ","Not specified. Aim was to determine the effectiveness of adult employment assistance in securing and maintaining employment for adults (18 years and older) with ASD","Competitive, supported or integrated employment","This review was not able to identify definitive interventions that predictably and positively supported the development of employment outcomes for individuals with ASD.\n\nThere were two included studies. One described outcomes directly related to employment by comparing an experimental group (n= 30) who received guidance from a support worker in the form of job finding, work preparation, and communication with the employers with a control group (n= 20) that did not receive any support. At the end of the two-year study period, the authors found that the experimental group demonstrated significantly higher rates of having found paid employment (d= 1.067, 95% CI 0.123 to 2.010), significantly longer periods of working time (d= 0.684, 95% CI 0.111 to 1.257), and significantly higher wages (d= 1.177, 95% CI 0.169 to 0.819). The experimental group also worked more hours per work week (d= 0.328, 95% CI -0.628 to 1.284), but this effect was not significant.\n\nThe second study described differential effects of supported employment and sheltered employment for persons with autism. The experimental group received supported employment, i.e. jobs working between 15 and 30 hours per week in their communities and received job coach support services. The control group received sheltered employment, i.e. jobs that were not in their communities and with no job coaching services. Using measures of the Childhood Autism Rating Scale (CARS), the supported employment group was not significantly different from the sheltered employment group after treatment (d= -0.229, 95% CI -0.764 to 0.306). The study did not report any differences in employment acquisition or maintenance between the two groups.\n\nIn an analysis of risk bias of the included studies, it was found that there was a high level of substantial potential for bias across three of the five sources of bias analysed including unit of assignment, unit of analysis, attrition, fidelity of implementation and blinding. The methodological quality of both included studies was low. Therefore, these review results should not be interpreted as indicating definitive results related to the development of employment outcomes for persons with ASD.","Qualitative and other relevant research studies connected to the employment of persons with ASD were also reviewed and suggest that the following may be elements of successful employment placement for persons with ASD: (1) identification of the most appropriate work settings and placements, (2) provision of effective supports on the job, (3) need for long‐term support services for the employer and the consumer, (4) costs for support, and (5) positive effects of employment on persons with ASD. While qualitative studies point to a number of promising issues for future research, they do not provide a definitive statement about what works.\n\nIn addition, the authors noted that costs for community‐based employment interventions such as those included in this review are more expensive than other employment alternatives such as sheltered non‐integrated workshops. However, the review authors were aware of two studies (not included in this review) showing that supported employment service interventions, such as those identified in their included studies, are becoming less expensive to deliver. The review authors felt that it was important to note that community‐based integrated employment interventions, while expensive, do expand options for mainstream social integration, competitive wages, and community involvement.\n"]
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[null,null,null,null,null,null,"SGLEROSIS YMLEDOL"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Khan  F, Ng  L, Turner‐Stokes  L. Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007256. DOI: 10.1002/14651858.CD007256.pub2. Available here\n\n","All categories of vocational rehabilitation (VR) programmes (individual and/or group level) which incorporate a clearly defined VR or work therapy element were included. These included structured multi-disciplinary/multi-agency interventions to preserve employment such as clinic or community based counselling, planning for disclosure and accommodation and work place accommodations","Evidence is lacking so it is not possible to tell whether vocational rehabilitation helps people with multiple sclerosis to find work","Those aged 18 to 65 years  with a diagnosis of multiple sclerosis (MS) including all sub-types of MS and irrespective of severity ","The primary objective was to evaluate the effectiveness of VR programmes compared to alternative programmes or care as usual on return to work, employment and work ability. The secondary objective was to evaluate the cost effectiveness of these VR programmes","Primary \n• Change in proportion of people with MS in competitive employment\n• Change in proportion of people in supported employment\nSecondary\n• The rate of return to work in days of pwMS\n• The change in proportion of people with MS (pwMS) on disability pension\n• The improvement of work ability in pwMS (such as the proportion of persons with MS who are engaged in attending a sheltered workshop and earn a modest living)\n• Costs of programmes and cost effectiveness of return to work or employment","Two trials (one RCT and one CCT) (total 80 participants) met the review criteria. Both trials scored poorly on the methodological quality assessment. There was insufficient evidence for VR programmes for (a)competitive employment, in altering rates of job retention, changes in employment, improvement in rates of re‐entry into the labour force; (b) for altering work ability by improving participants’ confidence in the accommodation request process, or employability maturity or job seeking activity. No evidence could be assimilated for changes in proportions of persons in supported employment or on disability pensions, nor for cost‐effectiveness.","There was inconclusive evidence to support vocational rehabilitation (VR) for pwMS. However, the review highlights some of the challenges in providing VR for pwMS. Clinicians need to be aware of vocational issues and to understand and manage barriers for maintaining employment. Proactive and timely VR programmes should incorporate practical solutions to deal with work disability, workplace accommodation and educate employers, and the wider community. Liaison with policy makers is imperative for government initiatives that encourage work focused VR programmes. Future research in VR should focus on improving methodological and scientific rigour of clinical trials, on the development of appropriate and valid outcome measures and on cost effectiveness of VR programmes."]
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[null,null,null,null,null,null,"CANSER"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Fong CJ, Murphy KM, Westbrook JD, Markle MM. Behavioral, Psychological, Educational, and Vocational Interventions to Facilitate Employment Outcomes\nfor Cancer Survivors: A Systematic Review Campbell Systematic Reviews 2015:5\nDOI: 10.4073/csr.2015.5. Available here\n\n","Included studies addressed the effectiveness of a behavioral, psychological,\neducational or vocational intervention or component of an intervention for cancer\nsurvivors that facilitated  employment outcomes","The evidence suggests that employment interventions for cancer survivors may help them to gain employment","Adults aged 18 or older who had a past or present cancer diagnosis which occurred whilst they were aged 18 or older. Particpants with an employment history and those without were included","Not clearly specified","Employment initiation, return-to-work or decreasing absenteeism and use of work disability or sick leave","Included 12 studies evaluating the effects of psychosocially related interventions on the employment of cancer survivors (n= 2,151). The results suggest that the included interventions may improve employment status (OR 1.71, 95% confidence interval (CI) 1.26 to 2.32) for cancer survivors. For RCTs (n= 6), the weighted mean effect size for employment status was OR 1.44 (95% CI 0.99 to 2.09), favoring the intervention groups. The mean odds ratio of 1.44 translates to an employment rate of about 68% for intervention participants compared to a baseline 60% for comparison group participants. For quasi experimental designs (QED) (n= 6), the weighted mean effect size for employment status was OR 2.18 95% CI 1.32 to 3.60), also favoring the intervention groups. The mean odds ratio of 2.18 for the quasi-experimental studies translates to an employment rate of about 77% for intervention participants, compared to the baseline rate of 60% for the comparison group participants. Although the mean effect size from QEDs was larger than that from the RCTs, there is no significant difference between the two types of experimental designs (p 0.19).\n\nThere was no evidence of an effect on the number of hours worked (OR 0.89, 95% CI 0.22 to 1.52) or number of sick leave days (OR 1.18, 95% CI 0.81 to 1.71). Overall, the assessment of the risk of bias was high, and conclusions about the effectiveness of the included interventions should be interpreted with caution.","This review highlights the positive effect psychosocial interventions may have on\nemployment outcomes for cancer survivors. However, the methodological shortcomings of the included studies overall makes it likely that there is bias in the results and too few studies to provide sufficiently strong evidence to recommend particular practices. This review brings attention to the need for additional rigorous studies in this area, in particular, RCTs with more detailed reporting of data and study design and methodology."]
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[null,null,null,null,null,null,"FFOADURIAID WEDI EU HADSEFYDLU"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Ott E, Montgomery P. Interventions to Improve the Economic Self-sufficiency and Well-being of Resettled Refugees: A Systematic Review. Campbell Systematic Reviews 2015:4\n10.4073/csr.2015.4. Available here\n\n","Interventions were eligible if designed to increase economic self-sufficiency and well-being of resettled refugees. There was no restriction on the type or the duration of the intervention. Such interventions could include employment casework, therapy sessions,or broad community support","Evidence is lacking so it is not possible to tell whether interventions to improve the self-sufficiency of settled refugees are effective in helping them to find work","The review included studies of individuals who meet the domestic legislative definition of a refugee for the country of the intervention and\na) were formally assisted to resettle by the government (i.e. were resettled refugees but not asylum-seekers); and\nb) had been served by a refugee resettlement entity;and\nc) fell between the ages of 18 and 64 years at the time of intervention","1) Do interventions designed to improve the economic self-sufficiency and well-being for refugees affect participants’ labour force participation, employment, use of cash assistance, income, job retention and quality of life?\n\n2) Do effects differ depending on programme content, programme provider, populations served or the setting?","Primary \nEconomic activity measured as employment rate or labour force participation rate.\n\nSecondary\nLevel of cash assistance (as measured by the percentage or portion of the population accessing specialised refugee cash assistance or public cash assistance), income (as measured by overall annual income, salary rate, or average hourly wage), job retention and quality of life ","Empty review - no studies met the review inclusion criteria.","The available evidence was insufficient to determine if programmes affect the economic self-sufficiency and well-being of resettled refugees as no studies met the review’s inclusion criteria. More research with rigorous designs, such as prospective, controlled studies, is needed to determine which interventions affect the economic self-sufficiency and well-being of resettled refugee."]
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[null,null,null,null,null,null,"CYMORTH ARALL"]
[null,null,null,null,null,null,"CYFYNGU BUDD-DALIADAU DIWEITHDRA"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Filges T, Geerdsen LP, Knudsen ASD, Jørgensen AMK, Kowalski K.\nUnemployment Benefit Exhaustion: Incentive Effects on Job Finding Rates:\nA Systematic Review.\nCampbell Systematic Reviews 2013:4\nDOI: 10.4073/csr.2013.4. Available here\n\n","Exhaustion of any kind of unemployment benefit with a known expiration date. The benefits may be unemployment insurance (UI) benefits or unemployment assistance (UA)/social assistance (SA) benefits as long as they have a known expiration date","The evidence suggests that the exhaustion of unemployment benefits, or the prospect of exhaustion, may be effective in getting people into work","Participants were required to be unemployed individuals who received some sort of time-limited benefit during their unemployment spell. The review included participants receiving all types of unemployment benefits with a known exhaustion date. The only restriction was that the benefits needed to be related to being unemployed","The primary objective of this systematic review was to study the impact of exhaustion of unemployment benefits","Primary \nExit rate from unemployment to employment \nSecondary outcomes \nExit rate from the re-employment job","A statistically significant exhaustion effect in the month/week of benefit exhaustion was found. The effect estimate translates into an increase of approximately 80% in the exit rate from unemployment into employment. The increase in the exit rate starts even earlier: two months before benefits expire. The analysis revealed a statistically significant exhaustion effect one and two months before benefit exhaustion, though these effects were smaller than the effect in the month/week of exhaustion. The effect estimate one month before benefit exhaustion translates into a 30% increase in the exit rate from unemployment into employment. The effect estimate two months before benefit exhaustion translates into a 10% increase in the exit rate from unemployment into employment. No significant effects were found more than two months before exhaustion and no significant effects were found after benefits had expired. Thus, available evidence supports the hypothesis that there is an incentive effect of approaching benefit exhaustion but only shortly prior to exhaustion and at the time of exhaustion. The incentive effect is stronger at the time of exhaustion than one and two months before expiration. However, in all time periods, the hazard rate into employment increases from a low level. There was insufficient evidence to address whether the prospect of benefit exhaustion has an impact on the exit rate from the re-employment job. \n\nThe results are robust in the sense that sensitivity analyses of the exhaustion effect evidenced no appreciable changes in the results. The reviewers found no strong indication of the presence of publication bias.\n\nThe reviewers found no evidence to support the hypothesis that the exhaustion effect differs by gender. It was not possible to examine if the exhaustion effect differs for particular age or educational groups, or if factors such as good/bad labour market conditions, high/low initial maximum entitlement, availability of alternative benefits, and whether compulsory activation is part of the institutional system have an impact on the exhaustion effect.\n\nWeek or month of exhaustion hazard ratio (HR) 1.78 (95% CI 1.33 to 2.38) (nine studies)\nOne month before exhaustion HR 1.30 (95% CI 1.12 to 1.50) (nine studies)\nTwo months before exhaustion HR 1.10 (95% CI 1.00 to 1.22) (seven studies)\nBetween two and four months before exhaustion HR 1.32 (95% CI 0.60 to 2.87) (three studies)\nOne month after exhaustion HR 0.98 (95% CI 0.57 to 1.67) (four studies).\n\nThere was significant heterogeneity in all the meta-analyses.\n","This review found clear evidence that the prospect of exhaustion of benefits results in a significantly increased incentive for finding work but only shortly (one and two months) prior to exhaustion and at the time of exhaustion. A significant benefit exhaustion effect is the result of a meta-analysis where we pooled measures from seven different European countries, the US and Canada. Thus, the theoretical suggestion that the prospect of exhaustion of benefits results in a significantly increased incentive for finding work has been confirmed empirically by measures from a variety of countries. Hence, shortening the benefit eligibility period may reduce the share of long and unproductive job searches. \n\nWhether the increased job finding rate close to benefit expiration implies a significant decrease in the overall unemployment level depends on how quickly those who found a job return to unemployment. Reviewers found studies from three different countries, which provided data for re-employment exit rates. Based on this low number of studies, the evidence is inconclusive with respect to the hypothesis that the prospect of benefit exhaustion has an impact on the quality of the job measured as the exit rate of re-employment. Thus, whether the unemployed workers who are affected may actually be worse off than policy-makers intend them to be, in the sense that they accept “bad” jobs, has not yet been fully investigated. While additional research is needed, the findings of the current review support the hypothesis of an increased incentive for finding work as unemployment benefit exhaustion approaches."]
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[null,null,null,null,null,null,"GWAITH YN CYFRANNU AT IECHYD DA"]
[null,null,null,null,null,null,"AMGYLCHEDD FFISEGOL"]
[null,null,null,null,null,null,"PROBLEMAU CYHYRYSGERBYDOL"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Hoe VCW, Urquhart DM, Kelsall HL, Zamri EN, SimMR. Ergonomic interventions for preventing work-related musculoskeletal disorders of the upper limb and neck among office workers. Cochrane Database of Systematic Reviews 2018, Issue 10. Art. No.: CD008570. DOI:10.1002/14651858.CD008570.pub3. Available here\n\n","Prevention of upper limb and neck musculoskeletal disorders (MSDs)","The evidence is inconsistent so it is not possible to tell whether arm supports or an alternative mouse are effective in preventing upper limb and neck disorders in office workers. Evidence is lacking for other interventions","Office workers","Objective was to assess the effects of physical, cognitive and organisational ergonomic interventions, or combinations of those interventions for the prevention of work-related upper limb and neck MSDs among office workers","Primary outcomes\n• Number of workers with newly diagnosed or verified MSDs of the upper limb or neck, or both (incident cases)\n• Presence or severity or intensity of complaints or symptomsof pain or discomfort in the upper limb or neck, or both\n• Work-related function as measured by number of work days lost, loss of or change in job, work disability, and level of functioning\nSecondary outcomes\n• Time and comfort in work positions or postures\n• Change in productivity\n• Costs (including costs of implementation of the intervention and treatment)\n• Compliance (attitude and practice)","Included 15 RCTs (2,165 workers). One study was judged to have a low risk of bias and the remaining 14 studies to have a high risk of bias due to small numbers of participants and the potential for selection bias.\n\nPhysical ergonomic interventions\nThere is inconsistent evidence for arm supports and alternative computer mouse designs. There is moderate-quality evidence that an arm support with an alternative computer mouse (two studies) reduced the incidence of neck or shoulder MSDs (risk ratio (RR) 0.52; 95% confidence interval (CI) 0.27 to 0.99), but not the incidence of right upper limb MSDs (RR 0.73; 95% CI 0.32 to 1.66); and low-quality evidence that this intervention reduced neck or shoulder discomfort (standardised mean difference (SMD) −0.41; 95% CI −0.69 to −0.12) and right upper limb discomfort (SMD −0.34; 95% CI −0.63 to −0.06).\n\nThere is moderate-quality evidence that the incidence of neck or shoulder and right upper limb disorders were not considerably reduced when comparing an alternative computer mouse and a conventional mouse (two studies; neck or shoulder: RR 0.62; 95% CI 0.19 to 2.00; right upper limb: RR 0.91; 95% CI 0.48 to 1.72), and also when comparing an arm support with a conventional mouse and a conventional mouse alone (two studies) (neck or shoulder: RR 0.91; 95% CI 0.12 to 6.98; right upper limb: RR 1.07; 95% CI 0.58 to 1.96).\n\nWorkstation adjustment (one study) and sit-stand desks (one study) did not have an effect on upper limb pain or discomfort, compared to no intervention.\n\nOrganisational ergonomic interventions\nThere is very low-quality evidence that supplementary breaks (two studies) reduce discomfort of the neck (MD −0.25; 95% CI −0.40 to −0.11), right shoulder or upper arm (MD −0.33; 95% CI −0.46 to −0.19), and right forearm or wrist or hand (MD -0.18; 95% CI -0.29 to -0.08) among data entry workers.\n\nTraining in ergonomic interventions\nThere is low to very low-quality evidence in five studies that participatory and active training interventions may or may not prevent work-related MSDs of the upper limb or neck or both.\n\nMultifaceted ergonomic interventions\nFor multifaceted interventions there is one study (very low-quality evidence) that showed no effect on any of the six upper limb pain outcomes measured in that study.","The review authors found inconsistent evidence that the use of an arm support or an alternative mouse may or may not reduce the incidence of neck or shoulder MSDs. For other physical ergonomic interventions there is no evidence of an effect. For organisational interventions, in the form of supplementary breaks, there is very low-quality evidence of an effect on upper limb discomfort. For training and multifaceted interventions there is no evidence of an effect on upper limb pain or discomfort. Further high-quality studies are needed to determine the effectiveness of these interventions among office workers."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Luger T, Maher CG, Rieger MA, Steinhilber B. Work-break schedules for preventing musculoskeletal symptoms and disorders in healthy workers.\nCochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD012886. DOI: 10.1002/14651858.CD012886.pub2. Available here\n","Work break schedules for preventing musculoskeletal disorders ","The evidence suggests that changes to work break frequencies to prevent musculoskeletal disorders may not be effective","Healthy adult workers aged 18 years and above","Not specified, the objective was to compare the effectiveness of different work-break schedules for preventing work-related musculoskeletal symptoms and disorders in healthy workers","Primary outcomes\n• Newly diagnosed musculoskeletal disorders\n• Participant-reported musculoskeletal symptoms\n• Productivity or work performance\nSecondary outcomes\n• Workload changes (measures of force, force reduction, muscular load, muscular fatigue etc.)","Included six studies (373 workers), four parallel RCTs, one cross-over RCT, and one combined parallel plus cross-over RCT. At least 295 of the employees were female and at least 39 male; for the remaining 39 employees, the sex was not specified in the study. The studies investigated different work-break frequencies (five studies) and different work-break types (two studies). None of the studies investigated different work-break durations. Review authors judged all studies to have a high risk of bias. The quality of the evidence for the primary outcomes of self-reported musculoskeletal pain, discomfort and fatigue was low; the quality of the evidence for the primary outcomes of productivity and work performance was very low. The studies took place in Europe or Northern America. One study could not be included in the data analyses, because no detailed results have been reported.\n\nChanges in the frequency of work breaks\nThere is low-quality evidence that additional work breaks may not have a considerable effect on musculoskeletal pain, discomfort or fatigue, when compared with no additional work breaks (standardised mean difference (SMD) -0.08; 95% CI -0.35 to 0.18; three studies; 225 participants). Additional breaks may not have a positive effect on productivity or work performance, when compared with no additional work breaks (SMD -0.07; 95% CI -0.33 to 0.19; three studies; 225 participants; very low-quality evidence).\n\nReview authors found low-quality evidence that additional work breaks may not have a considerable effect on participant-reported musculoskeletal pain, discomfort or fatigue (MD 1.80 on a 100-mm VAS scale; 95% CI -41.07 to 64.37; one study; 15 participants), when compared to work breaks as needed (i.e. microbreaks taken at own discretion). There is very low-quality evidence that additional work breaks may have a positive effect on productivity or work performance, when compared to work breaks as needed (MD 542.5 number of words typed per 3-hour recording session; 95% CI 177.22 to 907.78; one study; 15 participants).\n\nAdditional higher frequency work breaks may not have a considerable effect on participant-reported musculoskeletal pain, discomfort or fatigue (MD 11.65 on a 100-mm VAS scale; 95% CI -41.07 to 64.37; one study; 10 participants; low-quality evidence), when compared to additional lower frequency work breaks. Review authors found very low-quality evidence that additional higher frequency work breaks may not have a considerable effect on productivity or work performance (MD -83.00 number of words typed per 3-hour recording session; 95% CI -305.27 to 139.27; one study; 10 participants), when compared to additional lower frequency work breaks.\n\nChanges in the duration of work breaks\nNo trials were identified that assessed the effect of different durations of work breaks.\n\nChanges in the type of work break\nReview authors found low-quality evidence that active breaks may not have a considerable positive effect on participant-reported musculoskeletal pain, discomfort and fatigue (MD -0.17 on a 1-7 NRS scale; 95% CI -0.71 to 0.37; one study; 153 participants), when compared to passive work breaks. Relaxation work breaks may not have a considerable effect on participant-reported musculoskeletal pain, discomfort or fatigue, when compared to physical work breaks (MD 0.20 on a 1-7 NRS scale; 95% CI -0.43 to 0.82; one study; 97 participants; low-quality evidence).","The review authors found low-quality evidence that different work-break frequencies may have no effect on participant-reported musculoskeletal pain, discomfort and fatigue. For productivity and work performance, evidence was of very low-quality that different work-break frequencies may have a positive effect. For different types of break, there may be no effect on participant-reported musculoskeletal pain, discomfort and fatigue according to low-quality evidence. Further high-quality studies are needed to determine the effectiveness of frequency, duration and type of work-break interventions among workers, if possible, with much higher sample sizes than the studies included in the current review. Furthermore, work-break interventions should be reconsidered, taking into account worker populations other than office workers, and taking into account the possibility of combining work-break intervention with other interventions such as ergonomic training or counselling, which may possibly have an effect on musculoskeletal outcomes and work performance."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"O’Connor D, Page MJ, Marshall SC, Massy-Westropp N. Ergonomic positioning or equipment for treating carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2012, Issue 1. Art. No.: CD009600. DOI: 10.1002/14651858.CD009600. Available here\n\n","Management of carpal tunnel syndrome (CTS)","Evidence is lacking so it is not possible to tell whether ergonomic positioning or equipment is effective in managing carpal tunnel syndrome","All those diagnosed with carpal tunnel syndrome, excluding those who had undergone previous surgery for this","Not specified the objective of this review was to compare the effectiveness of ergonomic positioning or equipment for CTS with no treatment, placebo or another non-surgical treatment for improving clinical outcome","Primary outcomes\n• Short-term overall improvement (any measure in which patients indicate the intensity of their complaints compared with baseline) (dichotomous outcome; three months or less)\n\nSecondary outcomes\n• Adverse effects\n• Short-term improvement in CTS symptoms (for example, pain, paraesthesiae, nocturnal paraesthesiae) (three months or less)\n• Short-term improvement in functional ability or health related quality of life (three months or less)\n• Short-term improvement in neurophysiologic parameters (three months or less)\n• Long-term improvement in CTS symptoms (greater than three months)\n• Long-term improvement in functional ability or health related quality of life (greater than three months)","Included two trials (105 participants) comparing ergonomic versus placebo keyboards. Neither trial assessed the primary outcome (short-term overall improvement) or adverse effects of interventions. \n\nIn one small trial (25 participants) an ergonomic keyboard significantly reduced pain after 12 weeks (MD -2.40; 95% CI -4.45 to -0.35) but not six weeks (MD -0.20; 95% CI -1.51 to 1.11). In this same study, there was no difference between ergonomic and standard keyboards in hand function at six or 12 weeks or palm wrist sensory latency at 12 weeks. \n\nThe second trial (80 participants) reported no significant difference in pain severity after six months when using either of the three ergonomic keyboards versus a standard keyboard. No trials comparing (i) ergonomic positioning or equipment with no treatment, (ii) ergonomic positioning or equipment with another non-surgical treatment, or (iii) different ergonomic positioning or equipment regimes, were found.","There is insufficient evidence from randomised controlled trials to determine whether ergonomic positioning or equipment is beneficial or harmful for treating carpal tunnel syndrome."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Verbeek JH, Martimo KP, Karppinen J, Kuijer PPFM, Viikari-Juntura E, Takala EP.\nManual material handling advice and assistive devices for preventing and treating back pain in workers Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD005958.\nDOI:10.1002/14651858.CD005958.pub3. Available here\n\n","Manual material handling (MMH) advice to prevent and treat back pain","The evidence suggests that manual handling advice and use of assistive devices may not be effective in preventing back pain or back pain related disability","Those aged 16 to 70 years who had jobs involving sufficient manual material handling to increase their risk for back pain","Objective was to determine the effectiveness of MMH advice and training and the use of assistive devices in preventing and treating back pain (or its recurrence) in workers","Primary outcome\nIncidence, duration, frequency of episodes or intensity of non-specific back pain, with or without radiating pain, during follow-up\nSecondary outcome\nNumber of days on sick leave due to back pain","Nine RCTs (20,101 employees) and nine cohort studies (1,280 employees) on the prevention of back pain in this updated review. Studies compared training to no intervention (4), professional education (2), a video (3), use of a back belt (3) or exercise (2). Other studies compared training plus lifting aids to no intervention (3) and to training only (1). The intensity of training ranged from a single educational session to very extensive personal biofeedback.\n\nSix RCTs had a high risk of bias.\n\nNone of the included studies showed evidence of a preventive effect of training on back pain.\n\nThere was moderate quality evidence from seven RCTs (19,317 employees) that those who received training reported levels of back pain similar to those who received no intervention, with an odds ratio of 1.17 (95% confidence intervals (CI) 0.68 to 2.02) or minor advice (video), with a relative risk of 0.93 (95% CI 0.69 to 1.25). Confidence intervals around the effect estimates were still wide due to the adjustment for the design effect of clustered studies.\n\nThe results of the cohort studies were similar to those of the randomised studies.","There is moderate quality evidence that MMH advice and training with or without assistive devices does not prevent back pain or back pain-related disability when compared to no intervention or alternative interventions. There is no evidence available from RCTs for the effectiveness of MMH advice and training or MMH assistive devices for treating back pain. More high quality studies could further reduce the remaining uncertainty"]
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[null,null,null,null,null,null,"ORIAU GWAITH/PATRYMAU SIFFT"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Cox A et al. The effectiveness and cost effectivness of methods of protecting and promoting the health of older workers. Brighton. Institute for Employment Studies. 2014. Available here\n","Protecting and promoting the health and well-being of older workers - shift patterns","Evidence is lacking so it is not possible to tell whether changes to shift patterns have positive impacts on the health and well-being of older workers","Adults at least age 50 years in full- or part- time employment, self-employed people working in micro, small, medium and large organisations with an appointed line manager and volunteers\n\nDeveloped/OECD countries, major European countries outside the EU, and European countries which acceded to the EU in or before 2004","What are the most effective and cost-effective methods of protecting and promoting the health and well-being of older workers, and of supporting workers who wish to continue in employment up to and beyond state pensionable age?\n\nWhat supports, or prevents the implementation of these methods?","Employee: individual levels of health and well-being, motivation, individual performance, stress and job satisfaction; perceptions of fair treatment; awareness, availability and uptake of training and support services; changes in work patterns and tasks (including changes in work/life balance); knowledge and awareness among managers and rest of workforce; impact on knowledge, skills and behaviour, including outcomes post-retirement such as financial status, social inclusion/isolation, civic participation, loneliness/mental health, physical health, self-reported quality of life","Shift patterns\nThere is weak evidence from one study ‘before and after’, non-random controlled and longitudinal study set in Finland on male aircraft maintenance workers aged at least 45 years that changing from a backwards to a rapidly forwards rotating shift system can result in significant positive changes in self-reported sleepiness after the morning shifts, sleep quality, quality of life indicators including sleep and vigilance, general well-being at work, family life), hobbies, and psychomotor performance with a significant decrease of the median reaction times at the end of the night shift among the older workers. This evidence appears to be mostly applicable to the UK because of likely standardisation in work content and processes due to international regulation of aircraft maintenance, but concerns about its quality in terms of the small sample sizes and participant selection need to be taken into account.","The lack of papers included in this review reflects a challenge that despite increasing policy interest in how the health and well-being of older workers can be supported, especially in the context of a decline in the proportions of people in some younger segments of the population and planned increases to the age for state pension eligibility, very few intervention studies were located. "]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Joyce K, Pabayo R, Critchley JA, Bambra C. Flexible working conditions and their effects on employee health and wellbeing. Cochrane Database of Systematic Reviews 2010, Issue 2. Art. No.: CD008009. DOI:10.1002/14651858.CD008009.pub2. Available here\n\n","Flexible working including self‐scheduling/flexible scheduling of shift work; flexitime; overtime; gradual/partial retirement; involuntary part‐time work and fixed‐term contract","Evidence on flexible working interventions such as self-scheduling is inconsistent and evidence on gradual/partial retirement is lacking so it is not possible to tell if these have positive effects on worker health and well-being","Study participants were defined as adults of working age working for profit or pay in formal labour. Studies were included if the mean age of participants was within the common working age range (16 to 64 years)","Not specified. Main review objective to evaluate the effects (benefits and harms) of flexible working interventions on physical and mental health and well-being","Primary: physical health/ill health, mental health/ill health and general health/ill health indicators measured using validated instruments\nSecondary: sickness absence, health service usage and health/lifestyle behavioural effects","Ten studies fulfilled the inclusion criteria. Six controlled before and after (CBA) studies reported on interventions relating to temporal flexibility: self-scheduling of shift work (n= 4), flexitime (n= 1) and overtime (n= 1). The remaining four CBA studies evaluated a form of contractual flexibility: partial/gradual retirement (n = 2), involuntary part-time work (n= 1) and fixed-term contract (n= 1). The studies retrieved had a number of methodological limitations including short follow-up periods, risk of selection bias and reliance on largely self-reported outcome data.\n\nFour CBA studies on self-scheduling of shifts and one CBA study on gradual/partial retirement reported statistically significant improvements in either primary outcomes (including systolic blood pressure and heart rate; tiredness;mental health, sleep duration, sleep quality and alertness; self-rated health status) or secondary health outcomes (co-workers social support and sense of community) and no ill health effects were reported. Flexitime was shown not to have significant effects on self-reported physiological and psychological health outcomes. Similarly, when comparing individuals working overtime with those who did not the odds of ill health effects were not significantly higher in the intervention group at follow up. The effects of contractual flexibility on self-reported health (with the exception of gradual/partial retirement, which when controlled by employees improved health outcomes) were either equivocal or negative. No studies differentiated results by socio-economic status, although one study did compare findings by gender but found no differential effect on self-reported health outcomes.","The findings of this review tentatively suggest that flexible working interventions that increase worker control and choice (such as self scheduling or gradual/partial retirement) are likely to have a positive effect on health outcomes. In contrast, interventions that were motivated or dictated by organisational interests, such as fixed-term contract and involuntary part-time employment, found equivocal or negative health effects. Given the partial and methodologically limited evidence base these findings should be interpreted with caution. Moreover, there is a clear need for well-designed intervention studies to delineate the impact of flexible working conditions on health, well-being and health inequalities."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Slanger TE, Gross JV, Pinger A, Morfeld P, Bellinger M, Duhme AL, Reichardt Ortega RA, Costa G, Driscoll TR, Foster RG, Fritschi L, Sallinen M, Liira J, Erren TC. Person-directed, non pharmacological interventions for sleepiness at work and sleep disturbances caused by shift work. Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD010641.\nDOI:10.1002/14651858.CD010641.pub2.  Available here\n\n","Interventions to help adaptation to night shift work","Evidence is lacking so it is not possible to tell whether interventions to help workers adapt to night shift work have positive effects on their health and well-being","Adult workers engaged in shift work schedules that include night‐shift work, irrespective of industry, country, age or co-morbidities","Not specified. Objective to assess the effects of person-directed, non-pharmacological interventions for reducing sleepiness at work and improving the length and quality of sleep between shifts for shift workers","Primary outcomes\n• Sleepiness on shift\n• Sleep length off shift\n• Sleep quality off shift\nSecondary outcomes\n• Costs for lighting interventions\n• Costs for napping interventions","Seventeen trials were included (with 556 review-relevant participants) categorised into three types of interventions: 1) various exposures to bright light (n= 10); 2) various opportunities for napping (n= 4); and 3) other interventions, such as physical exercise or sleep education (n= 3). In most instances, the studies were too heterogeneous to pool. Most of the comparisons yielded low to very low quality evidence. Only one comparison provided moderate quality evidence. Overall, the included studies’ results were inconclusive.\n\nBright light\nCombining two comparable studies (with 184 participants altogether) that investigated the effect of bright light during the night on sleepiness during a shift, revealed a mean reduction 0.83 score points of sleepiness (measured via the Stanford Sleepiness Scale (SSS) (95% confidence interval (CI) -1.3 to -0.36, very low quality evidence). Another trial did not find a significant difference in overall sleepiness on another sleepiness scale (16 participants, low quality evidence).\n\nBright light during the night plus sunglasses at dawn did not significantly influence sleepiness compared to normal light (1 study, 17 participants, assessment via reaction time, very low quality evidence).\n\nBright light during the day shift did not significantly reduce sleepiness during the day compared to normal light (1 trial, 61 participants, subjective assessment, low quality evidence) or compared to normal light plus placebo capsule (1 trial, 12 participants, assessment via reaction time, very low quality evidence).\n\nNapping during the night shift\nA meta-analysis on a single nap opportunity and the effect on the mean reaction time as a surrogate for sleepiness, resulted in a 11.87ms reduction (95% CI 31.94 to -8.2, very low quality evidence). Two other studies also reported statistically non-significant decreases in reaction time (1 study seven participants; 1 study 49 participants, very low quality evidence). A two-nap opportunity resulted in a statistically non-significant increase of sleepiness (subjective assessment) in one study (mean difference (MD) 2.32, 95% CI -24.74 to 29.38, 1 study, 15 participants, low quality evidence).\n\nOther interventions\nPhysical exercise and sleep education interventions showed promise, but sufficient data to draw conclusions are lacking.","Given the methodological diversity of the included studies, in terms of interventions, settings, and assessment tools, their limited reporting and the very low to low quality of the evidence they present, it is not possible to determine whether shift workers’ sleepiness can be reduced or if their sleep length or quality can be improved with these interventions.\n\nWe need better and adequately powered RCTs of the effect of bright light, and naps, either on their own or together and other non-pharmacological interventions that also consider shift workers’ chronobiology on the investigated sleep parameters."]
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[null,null,null,null,null,null,"AMGYLCHEDD GWAITH DIOGEL"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Mischke C, Verbeek JH, Job J, Morata TC, Alvesalo-Kuusi A, Neuvonen K, Clarke S, Pedlow RI. Occupational safety and health enforcement tools for preventing occupational diseases and injuries.\nCochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD010183.\nDOI:10.1002/14651858.CD010183.pub2. Available here\n\n","Enforcement of health and safety regulations, all types of enforcement activities by any agency offically assigned by government to enforce compliance with regulation","The evidence is lacking or is inconsistent so it is not possible to tell whether enforcement of health and safety regulations prevents occupational diseases and injuries","Included studies in which the intervention had been targeted either at whole companies or at individual workplaces\n\n\n","Not specified the review objective was to assess the effects of occupational safety and health regulation\nenforcement tools for preventing occupational diseases and injuries","Primary \n• The degree of exposure to health or safety hazards measured as being compliant with regulation or as a change in exposure after the enforcement activity\n• Incidence rates of injuries or occupational diseases\n\nTo measure the effect of enforcement on prevention of relapses the review authors used the recurrence of the measures above\n\nSecondary \nIndicators of preventive activity such as investment in health and safety, training and education, and observable policy changes","Twenty three studies: two RCTs with 1,414 workplaces, two CBAs with 9,903 workplaces, one interrupted time series with six outcome measurements, 12 panel studies and six qualitative studies with 310 participants. Studies evaluated the effects of inspections in general and the effects of their consequences, such as penalties. Studies on the effects of prosecution, warnings or closure were not available or were of such quality that their results could not be included. The effect was measured on injury rates, on exposure to physical workload and on compliance with regulation, with a follow-up varying from one to four years. All studies had serious limitations and therefore the quality of the evidence was low to very low. The injury rates in the control groups varied across studies from 1 to 23 injuries per 100 person-years and compliance rates varied from 40% to 75% being compliant. \n\nThe effects of inspections were inconsistent in seven studies: injury rates decreased or stayed at a similar level compared to no intervention at short and medium-term follow-up. In studies that found a decrease the effect was small with a 10% decrease of the injury rate. At long-term follow-up, in one study there was a significant decrease of 23% (95% CI 8% to 23%) in injury rates and in another study a substantial decrease in accident rates, both compared to no intervention. \n\nFirst inspections, follow-up inspections, complaint and accident inspections resulted in higher compliance rates compared to the average effect of any other type of inspections. \n\nIn small firms, inspections with citations or with more penalties could result in fewer injuries or more compliance in the short term but not in the medium term. \n\nLonger inspections and more frequent inspections probably do not result in more compliance. In two studies, there was no adverse effect of inspections on firm survival, employment or sales. \n\nQualitative studies show that there is support for enforcement among workers. However, workers doubt if the inspections are effective because inspections are rare and violations can be temporarily fixed to mislead inspectors.","There is evidence that inspections decrease injuries in the long term but not in the short term. The magnitude of the effect is uncertain. There are no studies that used chemical or physical exposures as outcome. Specific, focused inspections could have larger effects than inspections in general. The effect of fines and penalties is uncertain. The quality of the evidence is low to very low and therefore these conclusions are tentative and can be easily changed by better future studies. There is an urgent need for better designed evaluations, such as pragmatic randomised trials, to establish the effects of existing and novel enforcement methods, especially on exposure and disorders."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Tikka C, Verbeek JH, Kateman E, Morata TC, Dreschler WA, Ferrite S. Interventions to prevent occupational noise-induced hearing loss. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD006396. DOI: 10.1002/14651858.CD006396.pub4. Available here\n\n","Prevention of occupational noise induced hearing loss ","Evidence is lacking so it is not possible to tell whether interventions to prevent occupational noise induced hearing loss are effective","Included studies with male and female workers at workplaces exposed to noise levels of more than 80 dB(A) as a time weighted average (TWA) over a period of an entire work shift or working day or part of the work shift","Not specified the review objective was to assess the effectiveness of non-pharmaceutical interventions for preventing occupational noise exposure and occupational hearing loss compared to no or alternative interventions","Noise exposure; noise level, exposure dose, immediate hearing threshold changes\n\nHearing loss; short and long term effects","Included 29 studies. One study evaluated legislation to reduce noise exposure in a 12-year time-series analysis but there were no controlled studies on engineering controls for noise exposure. Eleven studies with 3725 participants evaluated effects of personal hearing protection devices and 17 studies with 84,028 participants evaluated effects of hearing loss prevention programmes (HLPPs).\n\nEffects on noise exposure\nEngineering interventions following legislation\nOne ITS study found that new legislation in the mining industry reduced the median personal noise exposure dose in underground coal mining by 27.7 percentage points (95% CI −36.1 to −19.3 percentage points) immediately after the implementation of stricter legislation. This roughly translates to a 4.5 dB(A) decrease in noise level. The intervention was associated with a favourable but statistically non-significant downward trend in time of the noise dose of −2.1 percentage points per year (95% CI −4.9 to 0.7, 4 year follow-up, very low-quality evidence).\n\nEngineering intervention case studies\nIncluded 12 studies that described 107 uncontrolled case studies of immediate reductions in noise levels of machinery ranging from 11.1 to 19.7 dB(A) as a result of purchasing new equipment, segregating noise sources or installing panels or curtains around sources. However, the studies lacked long-term follow-up and dose measurements of workers, and review authors did not use these studies for their conclusions.\n\nHearing protection devices\nIn general hearing protection devices reduced noise exposure on average by about 20 dB(A) in one RCT and three CBAs (57 participants, low-quality evidence). Two RCTs showed that, with instructions for insertion, the attenuation of noise by earplugs was 8.59 dB better (95% CI 6.92 dB to 10.25 dB) compared to no instruction (2 RCTs, 140 participants, moderate-quality evidence).\n\nAdministrative controls: information and noise exposure feedback\nOn-site training sessions did not have an effect on personal noise-exposure levels compared to information only in one cluster-RCT after four months’ follow-up (mean difference (MD) 0.14 dB; 95% CI −2.66 to 2.38). Another arm of the same study found that personal noise exposure information had no effect on noise levels (MD 0.30 dB(A), 95% CI −2.31 to 2.91) compared to no such information (176 participants, low-quality evidence).\n\nEffects on hearing loss\nHearing protection devices\nTwo studies compared the effect of different devices on temporary threshold shifts at short-term follow-up but reported insufficient data for analysis. In two CBA studies the authors found no difference in hearing loss from noise exposure above 89 dB(A) between muffs and earplugs at long-term follow-up (OR 0.8, 95% CI 0.63 to 1.03 ), very low-quality evidence). Authors of another CBA study found that wearing hearing protection more often resulted in less hearing loss at very long-term follow-up (very low-quality evidence).\n\nCombination of interventions: hearing loss prevention programmes\nOne cluster-RCT found no difference in hearing loss at three- or 16-year follow-up between an intensive HLPP for agricultural students and audiometry only. One CBA study found no reduction of the rate of hearing loss (MD −0.82 dB per year (95% CI −1.86 to 0.22) for a HLPP that provided regular personal noise exposure information compared to a programme without this information.\n\nThere was very-low-quality evidence in four very long-term studies, that better use of hearing protection devices as part of a HLPP decreased the risk of hearing loss compared to less well used hearing protection in HLPPs (OR 0.40, 95% CI 0.23 to 0.69). Other aspects of the HLPP such as training and education of workers or engineering controls did not show a similar effect.\n\nIn three long-term CBA studies, workers in a HLPP had a statistically non-significant 1.8 dB (95% CI −0.6 to 4.2) greater hearing loss at 4 kHz than non-exposed workers and the confidence interval includes the 4.2 dB which is the level of hearing loss resulting from 5 years of exposure to 85 dB(A). In addition, of three other CBA studies that could not be included in the meta-analysis, two showed an increased risk of hearing loss in spite of the protection of a HLPP compared to non-exposed workers and one CBA did not.","There is very low-quality evidence that implementation of stricter legislation can reduce noise levels in workplaces. Controlled studies of other engineering control interventions in the field have not been conducted. There is moderate-quality evidence that training of proper insertion of earplugs significantly reduces noise exposure at short-term follow-up but long-term follow-up is still needed.\n\nThere is very low-quality evidence that the better use of hearing protection devices as part of HLPPs reduces the risk of hearing loss, whereas for other programme components of HLPPs review authors did not find such an effect. The absence of conclusive evidence should not be interpreted as evidence of lack of effectiveness. Rather, it means that further research is very likely to have an important impact."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"van der Molen HF, Basnet P, Hoonakker PLT, Lehtola MM, Lappalainen J, Frings-Dresen MHW, Haslam R, Verbeek JH.\nInterventions to prevent injuries in construction workers. Cochrane Database of Systematic Reviews 2018, Issue 2. Art. No.: CD006251.\nDOI:10.1002/14651858.CD006251.pub4.  Available here\n\n","All interventions aimed at preventing occupational injuries","Evidence is lacking so it is not possible to tell whether interventions to prevent occupational injuries are effective","Construction workers - company or self-employed","Objective was to assess the effects of interventions for preventing injuries in\nconstruction workers","Primary\nFatal or non-fatal occupational injuries\n\nSecondary\nNumber of lost working days, behviour changes","Seventeen studies (14 interrupted time series (ITS) and three controlled before and after (CBA) studies) met the inclusion criteria in this updated version of the review. The ITS studies evaluated the effects of; introducing or changing regulations that laid down safety and health requirements for the construction sites (nine studies), a safety campaign (two studies), a drug-free workplace programme (one study), a training programme (one study), and safety inspections (one study) on fatal and non-fatal occupational injuries. One CBA study evaluated the introduction of occupational health services such as risk assessment and health surveillance, one evaluated a training programme and one evaluated the effect of a subsidy for upgrading to safer scaffoldings. The overall risk of bias of most of the included studies was high, and it was uncertain for the ITS studies whether the intervention was independent from other changes and thus could be regarded as the main reason of change in the outcome. Therefore, the quality of the evidence was rated as very low for all comparisons.\n\nCompulsory interventions\nRegulatory interventions at national or branch level may or may not have an initial effect (effect size (ES) of −0.33; 95% confidence interval (CI) −2.08 to 1.41) and may or may not have a sustained effect (ES −0.03; 95% CI −0.30 to 0.24) on fatal and non-fatal injuries (9 ITS studies) due to highly inconsistent results (I² = 98%). Inspections may or may not have an effect on non-fatal injuries (ES 0.07; 95% CI −2.83 to 2.97; 1 ITS study).\n\nEducational interventions\nSafety training interventions may result in no significant reduction of non-fatal injuries (1 ITS study and 1 CBA study).\n\nInformational interventions\nNo studies that had evaluated informational interventions alone such as campaigns for risk communication were found.\n\nPersuasive interventions\nNo studies that had evaluated persuasive interventions alone such as peer feedback on workplace actions to increase acceptance of safe working methods were found\n\nFacilitative interventions\nMonetary subsidies to companies may lead to a greater decrease in non-fatal injuries from falls to a lower level than no subsidies (risk ratio (RR) at follow-up: 0.93; 95% CI 0.30 to 2.91 from RR 3.89 at baseline; 1 CBA study).\n\nMultifaceted interventions\nA safety campaign intervention may result in an initial (ES −1.82; 95% CI −2.90 to −0.74) and sustained (ES −1.30; 95% CI −1.79 to −0.81) decrease in injuries at the company level (1 ITS study), but not at the regional level (1 ITS study). A multi-faceted drug free workplace programme at the company level may reduce non-fatal injuries in the year following implementation by −7.6 per 100 person-years (95% CI −11.2 to −4.0) and in the years thereafter by −2.0 per 100 person-years (95% CI −3.5 to −0.5) (1 ITS study). Introducing occupational health services may result in no decrease in fatal or non-fatal injuries (one CBA study).","The vast majority of interventions to adopt safety measures recommended by standard texts on safety, consultants and safety courses have not been adequately evaluated. \n\nThere is very low-quality evidence that introducing regulations as such may or may not result in a decrease in fatal and non-fatal injuries. \n\nThere is also very low-quality evidence that regionally oriented safety campaigns, training, inspections or the introduction of occupational health services may not reduce non-fatal injuries in construction companies. \n\nThere is very low-quality evidence that company-oriented safety interventions such as a multifaceted safety campaign, a multifaceted drug workplace programme and subsidies for replacement of scaffoldings may reduce non-fatal injuries among construction workers. \n\nMore studies, preferably cluster-randomised controlled trials, are needed to evaluate different strategies to increase the employers’ and workers’ adherence to the safety measures prescribed by regulation"]
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[null,null,null,null,null,null,"LLEIHAU YMDDYGIAD EISTEDDOG"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Hosking J, Macmillan A, Connor J, Bullen C, Ameratunga S. Organisational travel plans for improving health. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD005575. DOI: 10.1002/14651858.CD005575.pub3. Available here\n\n","Organisational travel plans","The evidence is inconsistent so it is not possible to tell whether organisational travel plans are effective for reducing sedentary behaviour ","Working age adults, tertiary students or school children however, health effects may occur to people not participating in the intervention so also included studies that defined their population as those who might be affected by the intervention","Not specified, objective to assess the effects of organisational travel plans","Any health outcomes. Physical activity was a secondary outcome, changes in travel mode, also considered the distribution of any relevant health effects, so that if organisational travel plans were shown to have effects on health inequalities, this was considered a relevant outcome","Seventeen studies were included. Ten were conducted in a school setting, two in universities, and five in workplaces. One study directly measured health outcomes, and all included studies measured travel outcomes. Two cluster randomised controlled trials in the school setting showed either no change in travel mode or mixed results. A randomised controlled trial in the workplace setting, conducted in a pre-selected group who were already contemplating or preparing for active travel, found improved health-related quality of life on some sub scales, and increased walking. Two controlled before-after studies found that school travel interventions increased walking. Other studies were judged to be at high risk of bias. No studies measured the social distribution of effects or adverse effects, such as injury.","There is insufficient evidence to determine whether organisational travel plans are effective for improving health or changing travel mode. Organisational travel plans should be considered as complex health promotion interventions, with considerable potential to influence community health outcomes depending on the environmental context in which they are introduced. Given the current lack of evidence, organisational travel plans should be implemented in the context of robustly-designed research studies, such as well-designed cluster randomised trials."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Shrestha N, Kukkonen-Harjula KT, Verbeek JH, Ijaz S, Hermans V, Pedisic Z. Workplace interventions for reducing sitting at work. Cochrane Database of Systematic Reviews 2018, Issue 12. Art. No.: CD010912.\nDOI: 10.1002/14651858.CD010912.pub5. Available here\n\n","Interventions to reduce time spent sitting including physical changes in the workplace designs and environment, policies to change the organisation of work, provision of information and counselling and multi-component interventions","The evidence suggests that sit stand desks may reduce sitting in the short to medium term. Evidence on longer-term effects is lacking.              \n\nThe evidence is inconsistent so it is not possible to tell whether workplace policy changes, provision of information and counselling and multi-component interventions are effective in reducing sitting","Studies conducted with participants aged 18 years or more, whose occupations involved spending the majority of their working time sitting at a desk, such as administrative workers, customer service operators, help‐desk professionals, call‐centre representatives, and receptionists\n","Not specified. Objective to evaluate the effectiveness of workplace interventions for reducing sitting at work","Primary\n• Self-reported time spent sitting at work by questionnaires; or\n• device-based measures of sitting assessed by means of an accelerometer-inclinometer, which assesses intensity of physical activity and body posture; or\n• self-reported or device-based measures of time spent in prolonged sitting bouts (e.g. 30 minutes or more) and number of such bouts\nSecondary \n• Estimated energy expenditure in metabolic equivalent (MET) hours per workday as a proxy measure to detect changes in sitting time\n• Self-reported or device-measured total time spent sitting, including sitting at and outside work\n• Self-reported or device-measured time spent standing and stepping at work\n• Work productivity\n• Adverse events including any reported musculoskeletal symptoms due to prolonged standing as a possible side-effect of using a sit-stand desk","Thirty four studies - including two cross-over RCTs, 17 RCTs, seven cluster-RCTs, and eight controlled before and after studies with a total of 3,397 participants, all from high-income countries. The studies evaluated physical workplace changes (16 studies), workplace policy changes (four studies), information and counselling (11 studies), and multi-component interventions (four studies). One study included both physical workplace changes and information and counselling components. Review authors did not find any studies that specifically investigated the effects of standing meetings or walking meetings on sitting time.\n\nPhysical workplace changes\nInterventions using sit-stand desks, either alone or in combination with information and counselling, reduced sitting time at work on average by 100 minutes per workday at short-term follow-up (up to three months) compared to sit-desks (95% confidence interval (CI) −116 to −84, 10 studies, low-quality evidence). The pooled effect of two studies showed sit-stand desks reduced sitting time at medium-term follow-up (3 to 12 months) by an average of 57 minutes per day (95% CI −99 to −15) compared to sit-desks. Total sitting time (including sitting at and outside work) also decreased with sit-stand desks compared to sit-desks (mean difference (MD) −82 minutes/day, 95% CI −124 to −39, two studies) as did the duration of sitting bouts lasting 30 minutes or more (MD −53 minutes/day, 95% CI −79 to −26, two studies, very low-quality evidence).\n\nNo significant difference was found between the effects of standing desks and sit-stand desks on reducing sitting at work. Active workstations, such as treadmill desks or cycling desks, had unclear or inconsistent effects on sitting time.\n\nWorkplace policy changes\nNo significant effects were found for implementing walking strategies on workplace sitting time at short-term (MD −15 minutes per day, 95% CI −50 to 19, low-quality evidence, one study) and medium-term (MD −17 minutes/day, 95% CI −61 to 28, one study) follow-up. Short breaks (one to two minutes every half hour) reduced time spent sitting at work on average by 40 minutes per day (95% CI −66 to −15, one study, low-quality evidence) compared to long breaks (two 15 minute breaks per workday) at short-term follow-up.\n\nInformation and counselling\nProviding information, feedback, counselling, or all of these resulted in no significant change in time spent sitting at work at short-term follow-up (MD −19 minutes per day, 95% CI −57 to 19, two studies, low-quality evidence). However, the reduction was significant at medium-term follow-up (MD −28 minutes per day, 95% CI −51 to −5, two studies, low-quality evidence).\n\nComputer prompts combined with information resulted in no significant change in sitting time at work at short-term follow-up (MD −14 minutes per day, 95% CI −39 to 10, three studies, low-quality evidence), but at medium-term follow-up they produced a significant reduction (MD −55 minutes per day, 95% CI −96 to −14, one study). Furthermore, computer prompting resulted in a significant decrease in the average number (MD −1.1, 95% CI −1.9 to −0.3, one study) and duration (MD -74 minutes per day, 95% CI −124 to −24, one study) of sitting bouts lasting 30 minutes or more.  \nComputer prompts with instruction to stand reduced sitting at work on average by 14 minutes per day (95% CI 10 to 19, one study) more than computer prompts with instruction to walk at least 100 steps at short-term follow-up.\n\nNo significant reduction was found in workplace sitting time at medium-term follow-up following mindfulness training (MD −23 minutes per day, 95% CI −63 to 17, one study, low-quality evidence). Similarly a single study reported no change in sitting time at work following provision of highly personalised or contextualised information and less personalised or contextualised information. One study found no significant effects of activity trackers on sitting time at work.\n\nMulti-component interventions\nCombining multiple interventions had significant but heterogeneous effects on sitting time at work (573 participants, three studies, very low-quality evidence) and on time spent in prolonged sitting bouts (two studies, very low-quality evidence) at short-term followup.","At present there is low-quality evidence that the use of sit-stand desks reduce workplace sitting at short-term and medium-term followups. However, there is no evidence on their effects on sitting over longer follow-up periods. Effects of other types of interventions, including workplace policy changes, provision of information and counselling, and multi-component interventions, are mostly inconsistent. The quality of evidence is low to very low for most interventions, mainly because of limitations in study protocols and small sample sizes. There is a need for larger cluster-RCTs with longer-term follow-ups to determine the effectiveness of different types of interventions to reduce sitting time at work."]
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[null,null,null,null,null,null,"GOLAU YN GWEITHLE"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Pachito DV, Eckeli AL, Desouky AS, Corbett MA, Partonen T, Rajaratnam SMW, Riera R.\nWorkplace lighting for improving alertness and mood in daytime workers. Cochrane Database of Systematic Reviews 2018, Issue 3. Art. No.: CD012243.\nDOI:10.1002/14651858.CD012243.pub2. Available here\n","Workplace lighting for improving alertness and mood","Evidence is lacking so it is not possible to tell whether changes to workplace lighting improve worker alertness and mood","Included studies conducted with adults aged 18 years and above performing work exclusively indoors, in the period restricted to 7:00 a.m. to 10:00 p.m., irrespective of type of work, industry and comorbidities","Objective was to assess the effectiveness and safety of lighting interventions to improve alertness and mood in daytime workers","Primary\nAlertness and mood\n\nSecondary\nAdverse events","Five studies (three RCTs and two CBAs) with 282 participants altogether. These studies evaluated four types of comparisons: cool-white light, technically known as high correlated colour temperature (CCT) light versus standard illumination; different proportions of indirect and direct light; individually applied blue-enriched light versus no treatment; and individually applied morning bright light versus afternoon bright light for subsyndromal seasonal affective disorder.\n\nNo studies comparing one level of illuminance versus another were found.\n\nTwo CBA studies (163 participants) compared high CCT light with standard illumination. Pooling their results via meta analysis found that high CCT light may improve alertness (SMD −0.69, 95% CI −1.28 to −0.10; Columbia Jet Lag Scale and the Karolinska Sleepiness Scale) when compared to standard illumination. In one of the two CBA studies with 94 participants there was no difference in positive mood (mean difference (MD) 2.08, 95% CI −0.1 to 4.26) or negative mood (MD −0.45, 95% CI −1.84 to 0.94) assessed using the Positive and Negative Affect Schedule (PANAS) scale. High CCT light may have fewer adverse events than standard lighting (one CBA; 94 participants). Both studies were sponsored by the industry. Quality of evidence was graded as very low.\n\nNo studies comparing light of a particular illuminance and light spectrum or CCT versus another combination of illuminance and light spectrum or CCT were found.\n\nNo studies comparing daylight versus artificial light were found.\n\nOne RCT (64 participants) compared the effects of different proportions of direct and indirect light: 100% direct lighting, 70% direct lighting plus 30% indirect lighting, 30% direct lighting plus 70% indirect lighting and 100% indirect lighting. There was no substantial difference in mood, as assessed by the Beck Depression Inventory, or in adverse events, such as ocular, reading or concentration problems, in the short or medium term. The quality of evidence was graded as low.\n\nTwo RCTs compared individually administered light versus no treatment. According to one RCT with 25 participants, blue-enriched light individually applied for 30 minutes a day may enhance alertness (MD −3.30, 95% CI −6.28 to −0.32; Epworth Sleepiness Scale) and may improve mood (MD −4.8, 95% CI −9.46 to −0.14; Beck Depression Inventory). The quality of evidence was graded as very low. One RCT with 30 participants compared individually applied morning bright light versus afternoon bright light for subsyndromal seasonal affective disorder. There was no substantial difference in alertness levels (MD 7.00, 95% CI −10.18 to 24.18), seasonal affective disorder symptoms (RR 1.60, 95% CI 0.81, 3.20; number of participants presenting with a decrease of at least 50% in SIGH-SAD scores) or frequency of adverse events (RR 0.53, 95% CI 0.26 to 1.07). Among all participants, 57% had a reduction of at least 50% in their SIGH-SAD score. The quality of evidence was graded as low.\n\nPublication bias could not be assessed for any of these comparisons.","There is very low-quality evidence based on two CBA studies that high CCT light may improve alertness, but not mood, in daytime workers. \n\nThere is very low-quality evidence based on one CBA study that high CCT light may also cause less irritability, eye discomfort and headache than standard illumination. \n\nThere is low-quality evidence based on one RCT that different proportions of direct and\nindirect light in the workplace do not affect alertness or mood. \n\nThere is very low-quality evidence based on one RCT that individually applied blue-enriched light improves both alertness and mood. \n\nThere is low-quality evidence based on one RCT that individually administered bright light during the afternoon is as effective as morning exposure for improving alertness and mood in subsyndromal seasonal affective disorder."]
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[null,null,null,null,null,null,"TEITHIO I'R GWAITH"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Hosking J, Macmillan A, Connor J, Bullen C, Ameratunga S. Organisational travel plans for improving health. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD005575. DOI: 10.1002/14651858.CD005575.pub3. Available here\n\n","Organisational travel plans","Evidence is lacking so it is not possible to tell whether organisational travel plans are effective for improving workers health","Working age adults, tertiary students or school children however, health effects may occur to people not participating in the intervention so also included studies that defined their population as those who might be affected by the intervention","Not specified objective to assess the effects of organisational travel plans","Any health outcomes. Physical activity was a secondary outcome, changes in travel mode, also considered the distribution of any relevant health effects, so that if organisational travel plans were shown to have effects on health inequalities, this was considered a relevant outcome","Seventeen studies were included. Ten were conducted in a school setting, two in universities, and five in workplaces. One study directly measured health outcomes, and all included studies measured travel outcomes. Two cluster randomised controlled trials in the school setting showed either no change in travel mode or mixed results. A randomised controlled trial in the workplace setting, conducted in a pre-selected group who were already contemplating or preparing for active travel, found improved health-related quality of life on some sub scales, and increased walking. Two controlled before-after studies found that school travel interventions increased walking. Other studies were judged to be at high risk of bias. No studies measured the social distribution of effects or adverse effects, such as injury.","There is insufficient evidence to determine whether organisational travel plans are effective for improving health or changing travel mode. Organisational travel plans should be considered as complex health promotion interventions, with considerable potential to influence community health outcomes depending on the environmental context in which they are introduced. Given the current lack of evidence, organisational travel plans should be implemented in the context of robustly-designed research studies, such as well-designed cluster randomised trials."]
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[null,null,null,null,null,null,"AMGYLCHEDD ECONOMAIDD-GYMDEITHASOL"]
[null,null,null,null,null,null,"BWLIO"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Gillen PA, Sinclair M, Kernohan WG, Begley CM, Luyben AG. Interventions for prevention of bullying in the workplace. Cochrane Database of Systematic Reviews 2017, Issue 1. Art. No.: CD009778.DOI: 10.1002/14651858.CD009778.pub2. Available here\n\n","Prevention of bullying","Evidence is lacking so it is not possible to tell whether interventions prevent bullying in the workplace","Employees in paid work within public, private or voluntary organisations","What are the benefits of different ways of trying to prevent bulying in the workplace?","Cases of self-reported bullying, whether recorded by perpetrator or victim. Consequential measures of bullying; stress, depression, absenteeism or sick leave","Five studies met the inclusion criteria. They had altogether 4,116 participants. They were underpinned by theory and measured behaviour change in relation to bullying and related absenteeism. The included studies measured the effectiveness of interventions on the number of cases of self-reported bullying either as perpetrator or victim or both. Some studies referred to bullying using common synonyms such as mobbing and incivility and antonyms such as civility.\n\nOrganisational/employer level interventions\nTwo studies with 2,969 participants found that the Civility, Respect, and Engagement in the Workforce (CREW) intervention produced a small increase in civility that translates to a 5% increase from baseline to follow-up, measured at six to 12 months (mean difference (MD) 0.17; 95% CI 0.07 to 0.28). One of the two studies reported that the CREW intervention produced a small decrease in supervisor incivility victimisation (MD -0.17; 95% CI -0.33 to -0.01) but not in co-worker incivility victimisation (MD -0.08; 95% CI -0.22 to 0.08) or in self-reported incivility perpetration (MD -0.05 95% CI -0.15 to 0.05). The study did find a decrease in the number of days absent during the previous month (MD 0.63; 95% CI -0.92 to -0.34) at 6-month follow-up.\n\nIndividual/job interface level interventions\nOne controlled before-after study with 49 participants compared expressive writing with a control writing exercise at two weeks followup. Participants in the intervention arm scored significantly lower on bullying measured as incivility perpetration (MD -3.52; 95% CI -6.24 to -0.80). There was no difference in bullying measured as incivility victimisation (MD -3.30 95% CI -6.89 to 0.29). One controlled before-after study with 60 employees who had learning disabilities compared a cognitive-behavioural intervention with no intervention. There was no significant difference in bullying victimisation after the intervention (risk ratio (RR) 0.55; 95% CI 0.24 to 1.25), or at the three-month follow-up (RR 0.49; 95% CI 0.21 to 1.15), nor was there a significant difference in bullying perpetration following the intervention (RR 0.64; 95% CI 0.27 to 1.54), or at the three-month follow-up (RR 0.69; 95% CI 0.26 to 1.81).\n\nMultilevel Interventions\nA five-site cluster-RCT with 1041 participants compared the effectiveness of combinations of policy communication, stress management training, and negative behaviours awareness training. The authors reported that bullying victimisation did not change (13.6% before intervention and 14.3% following intervention). The study authors reported insufficient data for the reviewers to conduct their own analysis.\n\nThe evidence for all outcomes was graded as very low quality because there was a high risk of bias and imprecision","There is very low quality evidence that organisational and individual interventions may prevent bullying behaviours in the workplace. Large well-designed controlled trials of bullying prevention interventions operating on the levels of society/policy, organisation/ employer, job/task and individual/job interface are needed. Future studies should employ validated and reliable outcome measures of bullying and a minimum of 6 months follow-up."]
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[null,null,null,null,null,null,"POLISI AC ARFERION Y GWEITHLE"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Hillage et al. Workplace policy and management practices to improve the health of employees. Review 1. Brighton. Institute for Employment Studies. 2014. Available here\n\n\n\n","Workplace interventions, policies or practices to support line managers to enhance the the well-being of people they manage","Evidence is lacking so it is not possible to tell which supervisory level approaches enhance employee health and well-being","All adults aged 16 and over in full or part time employment, bith paid and unpaid, OECD countries\n\nAll employers in the public, private and ‘not for profit’ sectors who employ at least one employee","Primary: What workplace policies, practices or interventions implemented by line managers in employing organisations are effective and cost effective in enhancing the well-being of the people they manage?\n\nSecondary: Are there actions or activities by line managers which discourage or hinder the health and wel-lbeing of employees?","None specified in inclusion criteria\n\nWell-being was defined as the emotional, physical and mental health and happiness of individuals as it is affected by a number of factors at the workplace which could include organisational, managerial, social and physical dimensions","There is moderate evidence from two studies that the impact of organisational changes on employees’ job satisfaction can be enhanced by positive supervisory intervention. The evidence is only partially applicable to the UK because of the different settings and the outcomes relate to job satisfaction rather than more central well-being measures.\n\nThere is weak evidence from a UK controlled quasi-experimental study based on a small sample that female healthcare assistants working in UK hospitals, care homes and residential homes under a less favourably perceived supervisor experienced significant increases in blood pressure (12mmHg (systolic) (p=0.001) and 6mmHg (diastolic) (p=0.038)), compared with when they worked under a favourably perceived supervisor or on a non-working day. While this study appears to be directly applicable to the UK, being set in an unspecified number of UK hospitals, nursing and residential homes, there are concerns about its quality which need to be taken into account.\n\nThere is moderate evidence from a ‘before and after’ longitudinal study set in Israel that providing feedback to supervisors on their interactions concerning safety with their subordinates on workers’ safety behaviour in three production plants can result in significant positive changes in workers’ safety behaviour and safety climate scores. This evidence does not appear to be applicable to the UK because it is set in Israel where health and safety systems and cultures are different from that in the UK and the workforce is predominantly male and in one case mainly non-native speaking migrants.\n\nThere is moderate evidence from a cost-utility analysis set in the Netherlands that a low intensity intervention by supervisors in the form of an additional telephone contact had no effect on the well-being of 500 employees on maternity leave from a mix of companies. This evidence appears to be not applicable to the UK. The maternity leave regime in the UK is significantly different to that in the Netherlands and the intervention would not be appropriate.\n\nThere is weak evidence from two studies that show that support for interventions at supervisory level by middle managers can have a positive effect on employee well-being. In each study middle management support was seen as a contributory factor, although detailed results of the impact they had are not reported. The evidence is only partially applicable to the UK because of the different settings and the lack of full data.","This review includes evidence from five studies about the way in which supervisors can affect the well-being of the people they manage. While four of the five studies generally indicate that a positive relationship between supervisor and supervisee enhanced the latter’s well-being, the studies tend to focus on either one particular aspect of the supervisor/supervisee relationship, a particular aspect of employee well-being or a particular group of workers and are of limited applicability to the UK. Therefore it is difficult to draw any general conclusions on the basis of this evidence alone.\n\nThe paucity of papers may reflect the nature of the research question for this review, which focussed on supervisory-level rather than organisational-level interventions. The lack of papers may also reflect the fact that management-level interventions are rarely evaluated sufficiently rigorously to pass the inclusion criteria that have been applied to this evidence review."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Hillage et al. Workplace policy and management practices to improve the health of employees. Review 2. Brighton. Institute for Employment Studies 2014. Available here\n\n","Workplace interventions, policies or practices to support line managers to enhance the the well-being of people they manage","The evidence is inconsistent so it is not possible to tell whether workplace interventions to support line managers enhance employee health and well-being","All adults aged 16 and over in full or part time employment, both paid and unpaid, OECD countries\n\nAll employers in the public, private and ‘not for profit’ sectors who employ at least one employee","Primary: What workplace policies, practices or interventions implemented by line managers in employing organisations are effective and cost effective in enhancing the well-being of the people they manage?\n\nSecondary: Are there actions or activities by line managers which discourage or hinder the health and well-being of employees?","None specified in inclusion criteria.\n\nWell-being was defined as the emotional, physical and mental health and happiness of individuals as it is affected by a number of factors at the workplace which could include organisational, managerial, social and physical dimensions","There is mixed evidence from three studies (all in Japan) about the effect of training supervisors in mental health issues on the well-being of the people they manage. These three studies, from the same research group, are all set in Japan and because of the different workplace and management culture to that prevailing in the UK are of partial applicability.\n\nThere is inconsistent evidence from three studies that training supervisors to adopt more a positive management style can have a positive effect on employee well-being. Although set in a more similar workplace environment the quality of the intervention and the overall study severely limits its applicability to the UK.\n\nThere is weak evidence from a controlled before and after study that a four-day training programme in health and safety management delivered to supervisors in motor vehicle repair establishments in Norway may have had a positive effect on employees’ perceptions of management support (+0.14, p<0.001) and a reduction in self-reported musculoskeletal pain (-0.12, p<0.01). This evidence is partially applicable to the UK.\n\nThere is mixed evidence that interventions to increase employee participation in the workplace may have a positive effect on their well-being. This evidence is only partially applicable to the UK. One of the interventions was set in the UK and the other three would appear to be similar to those that could be applied in the UK and the workplace settings in the USA and Scandinavia bear some similarity to those in the UK.\n\nThere is weak evidence from a before and after study that a team building exercise among nurses, nursing assistants and nursing staff in a general hospital in North Carolina, USA had no significant effect on their job satisfaction. Although health care systems in the USA and UK are different, the intervention would appear to be similar to those that could be applied in the UK and therefore this evidence is partially applicable to the UK.\n\nThere is moderate evidence from two studies that a poorly implemented intervention can have a negative impact on employee well-being.This evidence is partially applicable to the UK. One of the interventions was set in the UK and the other in Scandinavia however there may be unique contextual factors in each of the workplace settings which led to the difficulties in implementing the intervention.","This review includes evidence from 11 studies about the effect of workplace interventions on employee well-being. The studies provide a mixture of evidence, partly due to the varying nature of the interventions under investigation and also due to the varying quality of the studies reviewed and their different settings and applicability to the UK.\n\nMost of the studies found a positive effect on employee well-being from their intervention. The most common form of intervention involved training supervisors to improve the way they managed their employees and/or how to be more aware of their mental health condition and take appropriate action. The other studies involved more complex changes to the way people worked, for example to increase employee involvement in solving workplace problems and how their jobs were organised.\n\nNone of the studies were set in the UK and although some were set in the USA or Western Europe their applicability to the UK setting is to some extent limited. The relevance of the evidence base is also limited by the quality of the studies included. Four have been given a negative (-) rating and in two cases the intervention under investigated was poorly conceived and implemented. In one of these cases the poor implementation was suggested to have resulted in negative impacts on the psychosocial work environment as employee expectations had been raised and unfulfilled. This indicates the importance of ensuring that any intervention is well planned and delivered if it is to have the desired effect."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Hillage et al. Workplace policy and management practices to improve the health of employees. Evidence Review 3. Brighton. Institute for Employment Studies. 2014. Available here\n\n\n\n","Workplace interventions, policies or practices to support line managers to enhance the the well-being of people they manage.\n\nThis review only included qualitative and cross sectional studies","This review did not include evidence from studies of a design that is appropriate to assess effectiveness","All adults aged 16 and over in full or part time employment, both paid and unpaid, OECD countries.\n\nAll employers in the public, private and ‘not for profit’ sectors who employ at least one employee","Primary: What workplace factors facilitate or constrain the ability of line managers to enhance the well-being of the people they manage","None specified in the inclusion criteria\n\n","Supervisor support and well-being\nThere is strong evidence from 14 studies, based on multivariate analysis of survey data,  that there is a small to medium positive relationship between supervisory support and employee well-being (generally measured by job satisfaction but also employee emotional exhaustion and self-reported health), although effect sizes are generally small. The evidence is partially applicable to the UK.\n\nSupervisor support and sickness absence\nThere is strong evidence from four studies that there is an association between supervisor support and sickness absence. However the direction of the relationship depends on the context and precise nature of supervisory supportive behaviour. The evidence is partially applicable to the UK.\n\nSupervisor support and work/family conflict\nThere is mixed but generally positive evidence from four studies that managerial support in helping employees handle conflicts between work and family life is positively associated with employee well-being. The evidence is partially applicable to the UK.\n\nSupervisor relationships and well-being\nThere is consistent, but moderate evidence from three studies, in a mix of sectoral settings, that a strong relationship based on a reciprocal exchange between supervisors and employees is positively associated with job satisfaction and other measures of well-being. The evidence is partially applicable to the UK.\n\nConsistency of management support\nThere is evidence from one study that employees who perceived the level of support from both line and senior management was appropriate and consistently offered, experienced greater work satisfaction and were less inclined to quit their jobs. Line and senior management relationships were strengthened when communication between senior managers and human resource managers was frequent.\n\nLeadership style and well-being\nThere is moderate and consistent evidence from nine survey-based studies, that there is a positive relationship between transformational leadership styles (embracing an open visionary and empowering approach) and employee well-being. Three of the studies indicate that the relationship is affected by other factors including trust in one’s supervisor, affinity with the organisation and the existence of work-life conflict. The evidence is partially applicable to the UK.\n\nThere is moderate evidence from three studies, partially applicable to the UK, that an authentic leadership style (involving acting in a way consistent with espoused organisational values) is positively associated with job satisfaction and well-being.\n\nPositive leadership behaviours\nThere is moderate evidence of partial applicability to the UK from five studies that identifies specific leadership behaviours associated with employee well-being. \n\nSupervisors' safety behaviours\nThere is evidence from three studies from a range of settings, that supervisors and managers play an important role in creating a safer working environment by prioritising safety issues, correcting unsafe working practices and empowering employees to raise safety concerns. This evidence is of partial applicability to the UK.\n\nSelf centred leadership\nThere is moderate evidence from two studies, that a self centred leadership style is negatively associated with employee well-being. The evidence is partially applicable to the UK.\n\nNegative leadership behaviours\nThere is evidence from one study of employees in the health sector in Australia which found that negative supervisor behaviour was a significant predictor of presenteeism (p<.01). The study is partially applicable to the UK.\n\nWorkplace justice\nTwo studies found that higher level of perceived organisational justice and fairness was positively associated with employee well-being. Two other studies show that the effects of organisational justice are mediated by other workplace factors including the existence of organisational support and trust in supervisors.\n\nJob demand and control\nThere is moderate evidence from two studies both of health care employees and one set in Australia and one in the UK, that excessive job demand and work overload was negatively related to job satisfaction and well-being. A third study  in Australian hospitals found that increased job control and autonomy were positive predictors of job satisfaction. This evidence is partially applicable to the UK.\n\nRewards\nThere is evidence from one wide-scale survey of a survey of managers in the pulp and paper, consumer and food services and the public sectors in Canada that the use of contingent rewards (such as praising good performance) was more effective in promoting positive attitudes at work than using contingent punishments (eg reprimanding poor performance). This evidence is partially applicable to the UK.","This review has found a clear positive relationship between the degree and form of line management support and style and employee well-being. While the effect sizes are generally small the influence of the line manager on employee well-being may still be important, although as the studies in this review show, that influence is mediated and moderated to a greater or lesser extent by other workplace factors. The studies in this review also identify some of the key characteristics and behaviours associated with supportive line management including: having an open approachable style; regularly consulting employees treating employees fairly; being flexible about work content organisation and scheduling, placing a high priority on safety and recognising good performance. Negative behaviours such as being aggressive can have a detrimental effect employee on well-being."]
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[null,null,null,null,null,null,"RHEOLI AC ATAL STRAEN"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Kuster AT, Dalsbø TK, Luong Thanh BY, Agarwal A, Durand-Moreau QV, Kirkehei I. Computer-based versus in-person interventions for preventing and reducing stress in workers. CochraneDatabase of Systematic Reviews 2017, Issue 8. Art.No.: CD011899.DOI:10.1002/14651858.CD011899.pub2. Available here\n\n","Interventions to prevent and reduce stress","The evidence is inconsistent  so it is not possible to tell whether computer based interventions prevent or reduce worker stress","Full or part time employed or self-employed people aged over 18","Objective was to compare the effects of computer-based interventions to in-person interventions for preventing and reducing stress in employees","Primary \n• Stress with Perceived Stress Scale (PSS), Occupational Stress Inventory or similar;\nor\n• Burnout with Maslach Burnout Inventory (MBI)or similar\nSecondary\n• Sick leave\n• Absenteeism\n• Return to work","Two studies met the inclusion criteria, including a total of 159 participants in the included arms of the studies (67 participants completed computer-based interventions; 92 participants completed in-person interventions). Workers were primarily white, Caucasian, middle aged, and college-educated. Both studies delivered education about stress, its causes, and strategies to reduce stress (e.g. relaxation or mindfulness) via a computer in the computer-based arm, and via small group sessions in the in-person arm. Both studies measured stress using different scales at short-term follow-up only (less than one month). Because of considerable heterogeneity in the results the data could not be pooled so the results of the studies were analysed separately. The SMD of stress levels in the computer-based intervention group was 0.81 standard deviations higher (95% CI 0.21 to 1.41) than the in-person group in one study, and 0.35 standard deviations lower (95% CI -0.76 to 0.05) than the in-person group in another study. Both studies were judged as having a high risk of bias.","The review found very low-quality evidence with conflicting results, when comparing the effectiveness of computer-based stress management interventions with in-person stress management interventions in employees. The review authors could include only two studies with small sample sizes, they have very little confidence in the effect estimates. It is very likely that future studies will change these conclusions."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Naghieh A, Montgomery P, Bonell CP, Thompson M, Aber JL. Organisational interventions for improving wellbeing and reducing work-related stress in teachers. Cochrane Database of Systematic Reviews 2015, Issue 4. Art. No.: CD010306.\nDOI:10.1002/14651858.CD010306.pub2. Available here\n\n","Organisational interventions to modify the workplace psychosocial environment","The evidence suggests that organisational interventions may be effective for reducing work related stress in teachers\n\nEvidence is lacking for changing task characteristics and multi-component interventions so it is not possible to tell if these are effective","Studies conducted with teachers working at primary and secondary schools, serving children aged between 4 and 18 years","Objective was to evaluate the effectiveness of organisational interventions for improving well-being and reducing work-related stress in teachers","Primary\n• Subjective measures: validated measures of work stress and well-being e.g. Maslach Burnout Inventory, Teacher Stress Inventory, Occupational Stress Inventory, Work Ability Index, Minnesota Satisfaction Questionnaire, Organisational Climate Description Questionnaire, Organisational Health Inventory\n• Objective measures: teacher turnover (retention rates) and sickness absence\n\nSecondary\n• Biological measures such as cardiovascular outcomes and cortisol levels\n• Where possible, the reviewers planned to consider the relationship between teacher well-being and student attainment, but no studies provided these data","Four studies met the inclusion criteria. They were three cluster-randomised controlled trials and one with a stepped-wedge design.\n\nChanging task characteristics\nOne study with 961 teachers in eight schools compared a task-based organisational change intervention along with stress management training to no intervention. It found a small reduction at 12 months in 10 out of 14 of the subscales in the Occupational Stress Inventory, with a mean difference (MD) varying from -3.84 to 0.13, and a small increase in the Work Ability Index (MD 2.27; 95% confidence interval (CI) 1.64 to 2.90; 708 participants, low-quality evidence).\n\nChanging organisational characteristics\nTwo studies compared teacher training combined with school-wide coaching support to no intervention. One study with 59 teachers in 43 schools found no significant effects on job-related anxiety (MD -0.25 95% CI -0.61 to 0.11, very low-quality evidence) or depression (MD -0.26 95% CI -0.57 to 0.05, very low-quality evidence) after 24 months. The other study with 77 teachers in 18 schools found no significant effects on the Maslach Burnout Inventory subscales (e.g. emotional exhaustion subscale: MD -0.05 95% CI -0.52 to 0.42, low-quality evidence) or the Teacher Perceived Emotional Ability subscales (e.g. regulating emotions subscale: MD 0.11 95% CI -0.11 to 0.33, low-quality evidence) after six months.\n\nMulti-component intervention\nOne study with 1102 teachers in 34 schools compared a multi-component intervention containing performance bonus, job promotion opportunities and mentoring support to a matched-comparison group consisting of 300 schools. It found moderately higher teacher retention rates (MD 11.50 95% CI 3.25 to 19.75 at 36 months follow-up, very low-quality evidence). However, the authors reported results only from one cohort out of four (eight schools), demonstrating a high risk of reporting bias.","The review authors found low-quality evidence that organisational interventions lead to improvements in teacher well-being and retention rates. We need further evaluation of the effects of organisational interventions for teacher well-being. These studies should follow a complex interventions framework, use a cluster-randomised design and have large sample sizes."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Patterson GT, Chung IW, Swang PG. The effects of stress management interventions among police officers and recruits. Campbell Systematic Reviews 2012:7 DOI: 10.4073/csr.2012.7. Available here\n\n","Stress management interventions for police officers","The evidence suggests that interventions for stress management in police officers may not be effective","Veteran police officers, police recruits, and/or civilian (non-sworn) police personnel","What are the effects of officer stress management interventions on stress outcomes?","Included; psychological (attitudes, knowledge, perceptions of stress and coping); behavioral (performance or skills); or physiological outcome(s) based on self report or objective data (cardiac autonomic control, salivary free cortisol response) including observation","The results of the present review indicate that stress management interventions had no significant effect on psychological, behavioral or physiological outcomes. Whereas stress can contribute to negative psychological, behavioral and physiological outcomes the 12 primary studies examined psychological stress outcomes. Only three studies examined behavioral outcomes, and two examined physiological outcomes. Near null effects were found for psychological, behavioral, and physiological outcomes. Moderator analyses, although difficult and exploratory with so few studies, also failed to find any meaningful differences across the studies. These results do not provide evidence to support the efficacy of stress management interventions for police officers or recruits. Given the weakness of the research designs, we can neither claim that these programmes are effective or ineffective","More rigorous studies are needed that evaluate the efficacy of stress management interventions among police officers and recruits. Several recommendations are proposed for future research. First, police organisations should conduct evaluation research of their current stress management interventions that includes random assignment. Second, stress management interventions for police officers and recruits should focus on specific types of stress (i.e., organisational or personal). The type of stress that is the focus of the intervention should be described in studies. Finally, more qualitative data are needed to contextualise participants’ experiences with the intervention."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Ruotsalainen JH, Verbeek JH, Mariné A, Serra C. Preventing occupational stress in healthcare workers.\nCochrane Database of Systematic Reviews 2015, Issue 4. Art. No.: CD002892. DOI: 10.1002/14651858.CD002892.pub5. Available here\n\n\n","Occupational stress prevention in healthcare workers","The evidence suggests that interventions to reduce occupational stress in healthcare workers may be effective","Included studies in which the interventions were directed at workers who had not actively sought help for conditions such\nas burnout, depression or anxiety disorder. This included interventions\ndirected at healthcare workers officially employed in any healthcare setting or at student nurses or physicians otherwise in\ntraining to become a professional who were also doing clinical work. This excluded studies in which the participants were simply caregivers and were not employed by a healthcare organisation","To evaluate the effectiveness of work- and person-directed interventions compared to no intervention or alternative interventions in preventing stress at work in healthcare workers","Primary\nAll validated self-report questionnaires measuring occupational stress or burnout\n\nSecondary\nAs secondary outcomes reviewers considered all outcome measures of the detrimental effects of stress or burnout. These included measures such as:\n(a) Psychological symptoms\n(b) Physical symptoms and physiological parameters\n(c) Measures on the cost effectiveness of interventions, such as incremental cost-effectiveness ratios (ICERs), incremental costper-QALY (quality-adjusted life year) and cost-benefit ratios","This update added 39 studies, making a total of 58 studies (54 RCTs and four CBA studies), with 7188 participants. Interventions were categorised as cognitive-behavioural training (CBT) (n= 14), mental and physical relaxation (n= 21), combined CBT and relaxation (n= 6) and organisational interventions (n= 20). Follow-up was less than one month in 24 studies, one to six in 22 studies and more than six months in 12 studies. We categorised outcomes as stress, anxiety or general health.\n\nThere was low-quality evidence that CBT with or without relaxation was no more effective in reducing stress symptoms than no intervention at one month follow-up in six studies (SMD -0.27 (95% Confidence Interval (CI) -0.66 to 0.13; 332 participants). But at one to six months follow-up in seven studies (SMD -0.38, 95% CI -0.59 to -0.16; 549 participants, 13% relative risk reduction), and at more than six months follow-up in two studies (SMD -1.04, 95% CI -1.37 to -0.70; 157 participants) CBT with or without relaxation reduced stress more than no intervention.\n\nCBT interventions did not lead to a considerably greater effect than an alternative intervention, in three studies.\n\nPhysical relaxation (e.g. massage) was more effective in reducing stress than no intervention at one month follow-up in four studies (SMD -0.48, 95% CI -0.89 to -0.08; 97 participants) and at one to six months follow-up in six studies (SMD -0.47; 95% CI -0.70 to -0.24; 316 participants). Two studies did not find a considerable difference in stress between massage and taking extra breaks.\n\nMental relaxation (e.g. meditation) led to similar stress symptom levels as no intervention at one to six months follow-up in six studies (SMD -0.50, 95% CI -1.15 to 0.15; 205 participants) but to less stress in one study at more than six months follow-up. One study showed that mental relaxation reduced stress more effectively than attending a course on theory analysis and another that it was more effective than just relaxing in a chair.\n\nOrganisational interventions consisted of changes in working conditions, organising support, changing care, increasing communication skills and changing work schedules. Changing work schedules (from continuous to having weekend breaks and from a four-week to a two-week schedule) reduced stress with SMD -0.55 (95% CI -0.84 to -0.25; 2 trials, 180 participants). Other organisational interventions were not more effective than no intervention or an alternative intervention.\n\nThe quality of the evidence, for all but one comparison, was graded as low. For CBT this was due to the possibility of publication bias, and for the other comparisons to a lack of precision and risk of bias. Only for relaxation versus no intervention was the evidence of moderate quality.","There is low-quality evidence that CBT and mental and physical relaxation reduce stress more than no intervention but not more than alternative interventions. There is also low-quality evidence that changing work schedules may lead to a reduction of stress. Other organisational interventions have no effect on stress levels. More randomised controlled trials are needed with at least 120 participants that compare the intervention to a placebo-like intervention. Organisational interventions need better focus on reduction of specific stressors."]
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[null,null,null,null,null,null,"CYDNABYDDIAETH TÂL"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Pega F, Carter K, Blakely T, Lucas PJ. In-work tax credits for families and their impact on health status in adults. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD009963. DOI: 10.1002/14651858.CD009963.pub2. Available here\n\n\n","In work tax credits which was defined as:\n• a tax credit implemented as part of a welfare-to-work policy\n• received by families (at least one parent or principal child\ncarer with at least one dependent child)\n• received by adults currently in work; and\n• not time limited (permanent, that is, the in-work tax credit","The evidence suggests that access to in work tax credits may have no effect on adults health status","Working age adults 18 to 64 years","Not specified, objective was to assess the effects of in-work tax credits for families on health outcomes in working-age adults (18 to 64 years)","Primary outcomes\n• self rated general health;\n• mental health or psychological distress;\n• mental illness;\n• overweight and obesity;\n• alcohol use; and\n• tobacco use\n\nSecondary outcomes\n• any other measures of physical health status;\n• change in income; and\n• change in employment","Five studies (one CBA and four ITS) comprising a total of 5,677,383 participants (all women) fulfilled the inclusion criteria and were synthesised narratively. The in-work tax credit intervention assessed in all included studies is the permanent Earned Income Tax Credit in the United States, established in 1975. This intervention distributed nearly USD 62 billion to over 27 million individuals in 2011, and its administration costs were less than one per cent of its total costs. All included studies carried a high risk of bias (especially from confounding and insufficient control for underlying time trends). Due to the small number of (observational) studies and their high risk of bias, review authors judged this body of evidence to have very low overall quality.\n\nOne study found that IWTC had no detectable effect on self rated general health and mental health/psychological distress five years after its implementation (i.e. a considerable change in the generosity of the permanent IWTC) and on overweight/obesity eight years after implementation. One study found no effect of IWTC on tobacco use five years after implementation, one a moderate reduction in tobacco use one year after implementation (odds ratio 0.95, 95% confidence interval (CI) 0.94 to 0.96), and one differential effects, with no effect in African-Americans and a large reduction in European-Americans two years after implementation (risk difference - 11.1%, 95% CI -20.9% to -1.3%). No evidence was available for the effect of IWTC on mental illness and alcohol use. No adverse effects of IWTC were identified.\n\nOne study also found no detectable effect of IWTC on the number of bad physical health days and of risky biomarkers for inflammation, cardiovascular disease and metabolic conditions eight years after implementation. One study found that IWTC had a large, positive effect on income from wages or salaries one year after implementation. Two studies found no effect on employment two and five years after implementation, whereas two found a moderate increase five and eight years after implementation and one a large increase in employment due to IWTC one year after implementation.\n\nNo differences in outcomes between groups with different educational status were found for self rated health and mental health/psychological distress. In one study European-American women with lower levels of education were more likely to reduce tobacco use, while tobacco use did not change among African-American women with lower levels of education. However, no differences in tobacco use by educational status were observed in a second study. Two studies found that the intervention may have reduced inequity with respect to employment, where women with less education were more likely to move into employment (although one did not establish whether this difference was statistically significant), while two studies found no such difference and no studies found differences by ethnic group on employment rates.","In summary, the small and methodologically limited existing body of evidence with a high risk of bias provides no evidence for an effect of in-work tax credit for families interventions on health status (except for mixed evidence for tobacco smoking) in adults."]
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[null,null,null,null,null,null,"CADW POBL MEWN GWAITH"]
[null,null,null,null,null,null,"RHEOLI ABSENOLDEB SALWCH"]
[null,null,null,null,null,null,"YMYRIADAU PENODOL"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"National Institute for Health and Care Excellence. Workplace health: long-term sickness absence and capability to work. [A] Evidence review for reducing recurrent short-term sickness absence. London, NICE. 2019. Available here\n\n\n\n","Interventions to reduce recurrent short term sickness absence","Evidence is lacking and it is not possible to tell whether interventions to reduce short term sickness absence are effective","Adult employess aged 16 years or over, full or part time, paid or unpaid who have experienced four or more episodes of short term sickness absence in a 12 month period (each episode lasting less than four weeks) or are currently absent from work for less than four weeks because of sickness (with a minimum study follow up of 12 months to enabale patterns of recurrent absence to be identified)\n\nOrganisational level -  all employers in the public, private and not-for-profit sectors","What interventions, programmes, policies or strategies are effective and cost-effective in preventing or reducing recurrence of short-term sickness absence among employees?\n\nAre the interventions, programmes, policies or strategies acceptable to employees, employers and other key stakeholders, and what are the barriers and facilitators to their successful delivery?","Primary\n• Short-term sickness absence, as measured and reported by the authors \nSecondary \n• Health-related quality of life - using validated patient-report measures, for example EQ-5D \n• Psychological and/or social functioning - using any patient-report measure \n• Adverse / unintended effects: - Self-reported presenteeism or work performance (individual-level studies); - Job satisfaction (individual or organisational-level) - Rate of staff turnover (organisational-level studies) - Number of grievances (organisational-level studies)\n\nQualitative studies (second question) Participant views on: \n• Intervention acceptability (including preferences for content, frequency, location, etc.) \n• Barriers and facilitators to successful intervention delivery","There were two studies included, a cluster RCT and an RCT. These were not pooled by outcome into a meta-analysis, they included different interventions and had reported outcomes in different ways. The short-term sickness absence data from one of the studies have been presented in a forest plot to enable discussion. Evidence statements have been presented on an individual study basis.\n\nShort-term sickness absence rate over 29 weeks\nThere was low quality evidence from one cluster RCT, conducted in Denmark with a total of 3,039 employees of 78 pre-school organisations with relatively high rates of short-term sickness absence of 14 or more days per episode. The intervention consisted of focusing on the core task at work, based on the theory that illegitimate tasks (those regarded by employees as unreasonable or unnecessary) lead to higher levels of stress, poor self-esteem and employee resentment, resulting in higher rates of short-term sickness absence. No difference was found in the rates of short term sickness absence over 29 months follow-up, compared with pre-schools with no intervention (8.7 vs. 9.2 STSA days per person-year; RR: 0.93; 95%CI 0.86 to 1.01), the proportion returning to work within 3 months (61% vs. 80%; RR 0.76; 95%CI 0.49 to 1.49). However, when adjusted for age, sex, type of workplace, workplace size, a reduction was found in the workplace average level of short-term sickness absence in the previous 12 months; RR 0.89 (95%CI 0.83 to 0.95). \n\nProportion with frequent short-term sickness absence at 12 month follow-up\nThere was low quality evidence from one RCT, conducted in the Netherlands, with a total of 82 employees at 21 different organisations with a history of frequent sickness absence (three or more episodes in the past 12 months). The intervention consisted of access to e-health advice and support, with or without an additional preventive consultation with an occupational physician. No difference was found in the reduced frequency and duration of sickness absence, or in the number of sickness absence episodes, or in the total duration of all sickness absence in days.","Due to the lack of evidence relating to recurrent short-term sickness absence the overall recommendations relating to return to work would be applicable for this group. Following the completion of the evidence reviews for review questions B and C it was discussed and agreed by the committee that in practice the interventions that may be effective in supporting return to work after long-term absence may also help with recurrent short-term absences and to prevent the movement from short to long-term absence. \nRecommendations were therefore not made that distinguished between the types of absence. Though the committee did also note that evidence specifically relating to short term sickness absence, in a UK context, could contribute substantially to supporting those who have recurrent sickness absence in employment and so developed a research recommendation in this area."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"National Institute for Health and Care Excellence. Workplace health: long-term sickness absence and capability to work. [B] Evidence review for reducing movement from short-term to long-term sickness absence. London, NICE. 2019. Available here\n\n\n","To reduce movement from short to long term sickness absence","Evidence is lacking and it is not possible to tell whether interventions reduce movement from short to long term sickness absence","Individual level \n• Adult employees (≥16 years, full- or part-time, paid or unpaid) who are currently absent from work for less than 4 consecutive weeks due to sickness. \n\nOrganisation level \n• All employers in the public, private and ‘not-for-profit’ sectors","What interventions, programmes, policies or strategies are effective and cost effective in reducing the number of employees who move from short- to long-term sickness absence?\n\nAre the interventions, programmes, policies or strategies acceptable to employees,  employers and other key stakeholders, and what are the barriers and facilitators to their  successful delivery?","Primary  \n• Return to work. Measured as any of: -     \n      -Proportion returning to work within four weeks of start of absence\n      -Time taken to return to work\nor\n• Sickness absence, as reported by the authors, including:\n      - Proportion with any long-term sickness absence (≥4 consecutive weeks duration)\n     - Total number of sickness absence days\n\nSecondary\n• Health-related quality of life - using validated patient-report measures, for example EQ-5D\n • Psychological and/or social functioning - using any patient-report measure \n• Adverse / unintended effects:\n     - Self-reported 'presenteeism' or work performance (individual-level studies) \n    - Job satisfaction (individual or organisational-level)\n    - Rate of staff turnover (organisational-level studies)\n    - Number of grievances (organisational-level studies)\n\nQualitative studies (second question) Participant views on: \n• Sickness absence recurrence following RTW (individual-level studies) \n• Intervention acceptability (including preferences for content, frequency, location, etc.) \n• Barriers and facilitators to successful intervention delivery","There were six studies included for these review questions. Three RCT studies, two non-randomised control studies and one observational study with no control group. It was not considered reasonable to pool the studies by outcome into a meta-analysis. The studies included very different interventions and had reported outcomes in different ways.\n\nEarly multidisciplinary assesssment: There is low quality evidence from 1 RCT conducted in Sweden, in a total of 33 patients with musculoskeletal or mental health disorders. The intervention consisted of early multidisciplinary assessment in the primary care centre compared with usual GP care. No difference was found in the proportion returning to work within 3 months (61% vs. 80%; RR 0.76; 95%CI 0.49 to 1.49), the proportion returning to work within 12 months (78% vs. 93%; RR 0.83; 95%CI 0.63 to 1.10), or in the total number of sickness absence (full) days over 12 months (MD: 40.0; 95%CI -19.33 to 99.33).\n\nStress counselling and case management: There was very low quality evidence from 1 non-randomised controlled study, conducted in Denmark with a total of 161 patients with emotional distress. The intervention consisted of an outpatient stress counselling and case management compared to usual care. This found a reduction in the proportion of patients returning to the labour market within 4 weeks (7% vs. 19%; RR 0.36; 95%CI 0.14 to 0.94). No difference was found in the proportion returning to the labour market by 3 months (28% vs. 43%; RR 0.65; 95%CI 0.42 to 1.01), or by 12 months (75% vs. 76%; RR 0.98; 95%CI 0.82 to 1.17). Nor was there any difference in those not resuming labour market activity in over 68 weeks (unadjusted HR 0.84; 95%CI 0.60 to 1.18).\n\nOccupational health programme: There was very low quality evidence from 1 case series, conducted in the USA with a total of 190 people with work-related injury events. The intervention consisted of before and after implementation of an internal occupational health programme with early access to treatment or workplace rehabilitation, compared with usual care. This found an increase post-intervention, in the proportion returning to work within 4 weeks (55% vs. 36%; RR 1.54; 95%CI 1.06 to 2.23) and a reduction in the total number of lost work days per injury event (44.6 lost work days from 128 injuries) compared with before the intervention (100.3 lost work days from 62 injuries; MD -55.7; 95%CI -87.8 to -23.8).\n\nParticipatory workplace intervention: There was low quality evidence from 1 RCT conducted in the Netherlands, with a total of 145 employees with emotional distress. The intervention consisted of early access to treatment or workplace rehabilitation, compared with usual care and usual occupational physician care. No difference was found in the proportion returning to work by 12 months (90% vs. 92%; RR 0.99; 95%CI: 0.89 to 1.09), or time to return to work over 12 months (unadjusted HR: 0.99; 95%CI: 0.70 to 1.40). Nor was any difference found in total sickness absence over 12 months (MD -0.1; 95%CI -36.24 to 36.04), or in the proportion of those with one or more recurrence episodes of sickness (8% vs. 8%; RR 0.99; 95%CI 0.33 to 2.92).\n\nEarly part time sick leave: There was moderate quality evidence from 1 RCT conducted in Finland, with a total of 62 employees with musculoskeletal disorders. The intervention consisted of early part time sick leave compared to usual full-time sick leave. This found a difference in self-reported health-related quality of life over 12 weeks (MD: -0.60; 95%CI -0.91 to -0.29). No difference was found in the proportion returning to work by 4 weeks (12% vs. 64%; RR 1.10; 95%CI 0.78 to 1.55), or by 3 months (100% vs. 87%; RR 1.15; 95%CI 0.99 to 1.33). Nor was any difference found in the time to return to the labour market over 12 months (HR adjusted for age:1.60; 95%CI 0.98 to 2.61), or in number of recurrent sick leave episodes per person-year (MD: -2.1; 95%CI -4.54 to 0.44).\n\nEducational intervention delivered to occupational health physicians: There was very low quality evidence from 1 non-randomised controlled study  conducted in Finland, with a total of 30 employees with musculoskeletal pain or depressive symptoms. The intervention consisted of an educational intervention delivered to occupational health physicians and a case management intervention, compared to usual care. No difference was found in the proportion returning to regular work by 4 weeks (42% vs. 72%; RR 0.58; 95%CI 0.28 to 1.19), or by 3 months (84% vs. 83%; RR 1.00; 95%CI 0.72 to 1.39), or by 12 months (92% vs. 100%; RR 0.91; 95%CI 0.74 to 1.12).","Following the completion of the evidence reviews for review questions A and C it was discussed and agreed by the committee that in practice the interventions that may be effective in supporting return to work after long-term absence may also help with recurrent short-term absences and to prevent the movement from short- to long-term absence. Recommendations were therefore not made that distinguished between the types of absence."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"National Institute for Health and Care Excellence. Workplace health: long-term sickness absence and capability to work. [C] Evidence review for facilitating the return to work of employees on long-term sickness absence and reducing risk of recurrence.  London, NICE. 2019. Available here\n\n","Any interventions, programmes, policies or strategies that aim to increase the return to work of employees who experience an episode of long-term sickness absence (≥4 consecutive weeks) and / or prevent the recurrence of long-term absence Where interventions are not delivered in a workplace or primary care setting, there should be some element of employer or primary care involvement in the design, content, implementation or funding of the intervention.","SHORT TERM OUTCOMES\nThe evidence suggests that individual employee focused interventions for those with musculoskeletal conditions may be effective in supporting return to work in the short term\n\nEvidence is lacking so it is not possible to tell whether individual employee focused interventions for those with musculoskeletal  or mental health problems are effective in reducing days of sickness absence in the short term\n\nThe evidence suggests combined interventions (workplace and individual employee focused) for those with mental health problems may not be effective in increasing return to work in the short term\n\nMEDIUM TERM OUTCOMES\nThe evidence suggests that individual employee focused interventions for people with musculoskeletal conditions may not be effective in increasing the proportion returning to work in the medium term\n\nEvidence is lacking so it is not possible to tell whether individual employee focused interventions  for people with mental health problems increase the proportion returning to work in the medium term\n\nEvidence is lacking so it is not possible to tell whether individual employee focused interventions  for people with musculoskeletal problems reduce days of sickness absence in the medium term \n\nThe evidence suggests that individual employee focused interventions for people with mental health problems may not be effective in reducing days of sickness absence in the medium term\n\nThe evidence suggests that individual employee focused interventions for people with musculoskeletal disorders and people with mental health problems may not be  effective in reducing the time to return to work in the medium term\n\nThe evidence suggests that workplace focussed interventions for people with musculoskeletal conditions may be effective in reducing the time to return to work in the medium term\n\nEvidence is lacking so it is not possible to tell whether workplace focussed interventions for mixed populations reduce time to return to work in the medium term\n\nThe evidence suggests combined interventions (workplace and individual employee focused) for those with musculoskeletal conditions and for those with mental health problems may not be effective in increasing the proportion returning to work in the medium term\n\nThe evidence suggests combined interventions (workplace and individual employee focused) for those with mental health problems may not be effective in reducing the number of days of sickness absence in the medium term\n\nThe evidence suggests combined interventions (workplace and individual employee focused) for those with musculoskeletal conditions and for those with mental health problems may not be effective in reducing the time to return to work in the medium term\n\n\n","Adult employees (≥16 years; full- or part-time; paid or unpaid) who \n• are currently absent from work for 4 or more consecutive weeks due to sickness or \n• have returned to work in the past 6 months after an episode of long-term sickness absence (lasting 4 or more consecutive weeks) \n\nOrganisation level All employers in the public, private and ‘not-for-profit’ sectors","What interventions, programmes, policies or strategies are effective and cost-effective in:\n• Helping employees on long-term sickness absence to return to work?\n• Reducing the recurrence of long-term sickness absence following a return to work?\n\nAre the interventions, programmes, policies or strategies acceptable to employees, employers and other key stakeholders, and what are the barriers and facilitators to their successful delivery?","Primary  \n• Return to work. Measured as any of: -     \n      -Proportion returning to work within four weeks of start of absence\n      -Time taken to return to work\nor\n• Sickness absence, as reported by the authors, including:\n      - Proportion with any long-term sickness absence (≥4 consecutive weeks duration)\n     - Total number of sickness absence days\n\nSecondary\n• Health-related quality of life - using validated patient-report measures, for example EQ-5D\n • Psychological and/or social functioning - using any patient-report measure \n• Adverse / unintended effects:\n     - Self-reported 'presenteeism' or work performance (individual-level studies) \n    - Job satisfaction (individual or organisational-level)\n    - Rate of staff turnover (organisational-level studies)\n    - Number of grievances (organisational-level studies)\n\nQualitative studies (second question) Participant views on: \n• Sickness absence recurrence following RTW (individual-level studies) \n• Intervention acceptability (including preferences for content, frequency, location, etc.) \n• Barriers and facilitators to successful intervention delivery","Individual focused interventions: \nLong term sickness absence due to musculoskeletal conditions \nFull RTW in short-term: Moderate quality evidence from 2 RCTs. Graded activity, and multidisciplinary outpatient treatment with a biopsychosocial focus. Increase in full RTW favouring the intervention compared with controls. Full RTW in medium term: Moderate quality evidence from 4 RCTs. Graded activity, problem-solving therapy, and multidisciplinary outpatient treatment with a biopsychosocial focus. No difference was found in full return to work compared with controls. Sickness absence short-term: Very low quality evidence from 1 RCT. Outpatient CBT-based RTW programme conducted as group sessions. No difference was found in sickness absence over 3 months compared with controls for short and long-term absent groups. Sickness absence over medium term: Low quality evidence from 1 RCT. Group-based problem-solving therapy plus graded activity and group education. A decrease was found in sickness absence over the medium-term favouring the  intervention compared with controls. Time to return to work over the medium term: Very low quality evidence from 3 RCTs. Graded activity / work hardening, and education. No difference in time to RTW compared with controls. Recurrence of sickness absence over medium term: Low quality evidence from 1 RCT. Graded activity and education. No difference was found in the incidence of recurrent sickness absence per person-year compared with controls\n\nLong term sickness absence due to mental health disorders:\nFull RTW in the medium term: Low quality evidence from 1 RCT. Guided e-health RTW intervention, (which included problem-solving, cognitive restructuring, pain and fatigue management), and occupational physician collaborative care. No difference was found in full RTW compared with controls. Sickness absence over short term: Low quality evidence from 1 RCT. Acceptance and commitment therapy. No difference was found in sickness absence over 3 months compared with controls. Sickness absence over medium term: Very low quality evidence from 2 RCTs. Activating and problem-solving intervention delivered by social workers in primary care, a guided e-health RTW intervention (which included problem-solving, cognitive restructuring, pain and fatigue management) and occupational physician collaborative care. No difference was found in sickness absence over 12 months compared with controls. Recurrence of sickness absence - 12 months: Low quality evidence from 1 RCT. (1) a passive awareness-raising intervention to promote GPs use of ‘active sick leave’ (that is, a return to modified duties in the workplace) as an option for sickness certification among employees and (2) a proactive intervention to promote use of active sick leave. No difference was found associated with either intervention in recurrence of sickness absence for back pain over follow-up.\n\nLong term sickness absence due to mental health conditions:\nFull RTW in medium term: Moderate quality evidence from 1 RCT. Return to work intervention (which included basic CBT and graded exposure to the workplace) and a return to work intervention plus CBT. No difference was found in full RTW compared with controls. Sickness absence over short term: Low quality evidence from 1 RCT. Workplace dialogue  intervention to agree a return-to-work plan including any facilitating modifications. No difference was found in the number of sickness absence days compared with controls. Sickness absence over medium term: Moderate quality evidence from 1 RCT. Return to work intervention (which included basic CBT and graded exposure to the workplace) and a return to work intervention plus CBT. No difference was found in the number of days sickness absence days compared with controls.\n\nLong term sickness absence - mixed health conditions\nFull RTW in the medium term: Very low quality evidence from 1 RCT in UK. Addressing issues in the workplace, typically through ergonomic assessment and employer liaison or mediation. Return to full work (lasting ≥13 weeks) 246/545 (45.1%) vs 205/458 (44.7%). Sickness absence over medium term: very low quality evidence from 1 RCT. Minimal awareness-raising postal intervention. No difference was found between the intervention and control groups in number of sickness absence days over 12 months follow-up. Low quality evidence from 1 RCT. 1-day training workshop for GPs in undertaking structured functional assessments with patients on long-term sick leave. No difference was found in total sickness absence days between sick-listed patients consulting GPs during the study period who had received the training, compared with those who consulted control group GPs who were not trained in structured functional assessments. Time to return to work over medium term: Very low quality evidence from 1 RCT. Minimal awareness-raising postal intervention. No difference was found between intervention and control groups in time to RTW over 12 months. Quality of life: Low quality evidence from 1 RCT in the UK. Addressing issues in the workplace, typically through ergonomic assessment and employer  liaison or mediation. At 42 weeks follow-up, no differences were found on any SF36 subscale scores between intervention group and controls. Time to RTW over medium term: Very low quality evidence from 3 RCTs. Stress treatment with gradual work exposure, coping skills plus workplace contact to agree a return to work plan and any facilitating modifications, occupational physician-delivered CBT-based stress inoculation and gradual return to work with facilitating modifications, an occupational physician-delivered activating and problem-solving intervention plus contacts with workplace, and a psychologist-delivered work-focused CBT  for stress, plus the offer of participation in meeting with workplace. No difference was found in time to RTW compared with controls. Low quality evidence from 1 RCT. Psychologist-delivered individual CBT and the offer of attendance by the psychologist at a meeting with employers. No difference was found in time to RTW compared with controls. Time to RTW over long term: Low quality evidence from 1 RCT.  Occupational therapist-delivered work reintegration programme, plus CBT treatment. No difference was found in time to RTW compared with controls. Recurrence of sickness absence: Moderate quality evidence from 1 RCT. Occupational physician-delivered CBT-based stress inoculation and gradual return-to-work with facilitating modifications. No difference was found between intervention and control groups in the mean number of recurrences of sickness absence episodes following return-to-work, nor in the average duration of recurrent absence episodes\n\nLong term sickness absence - mixed health conditions:\nFull RTW over medium term: Very low quality evidence from 1 RCT in UK. Tailored health treatment intervention plus an intervention addressing issues in the workplace, typically through ergonomic assessment and employer liaison or mediation. No difference in RTW. Long term sickness absence: Very low quality evidence from 1 observational before and after study with a control group in the UK. Multidisciplinary case management return to work service for employees on long-term sickness absence, delivered jointly by the Human Resource and Occupational Health services. A reduction was found (from baseline to one year following the implementation of the intervention) in the percentage of 4-week absences continuing beyond 8 weeks, compared  with the control site. However no  difference was found in the overall reduction of mean days lost beyond 4  weeks, for all long-term sickness absence. Full RTW in medium term: Very low quality evidence from 1 RCT in UK. Tailored treatment intervention for health problems. A reduction was found in return to work for at least a 13 week spell of full time work, with health only interventions 255/587  (43.5%) in the intervention group returning versus 205/458 (44.7%) in the control group. Quality of life: Very low quality evidence from 1 RCT conducted in  UK. Tailored  treatment intervention for health problems. At 42 weeks follow-up, differences were found favouring the intervention group in SF36 scores on the  energy/fatigue subscale on the mental health subscale and on general health. No differences were found between the intervention and  control participants on any other SF36 domains.\n\nWork- focused interventions\nLong term sickness absence due to musculo skeletal conditions\nFull RTW short term: Moderate quality evidence from 1 RCT. Multidisciplinary assessment and tailored work rehabilitation coordinated by a caseworker. No difference was found compared with controls. Full RTW medium term: Moderate quality evidence from 1 RCT. Multidisciplinary assessment and tailored work rehabilitation coordinated by a caseworker and early guideline-based occupational physician management of employees. This included identifying barriers to returning to work, implementing adaptions (to work or hours) and advising supervisors. No difference was found in full RTW compared with controls. Low quality evidence from 1 RCT. (1) a passive awareness-raising intervention to promote GPs use of ‘active sick leave’ (that is, a return to modified duties in the workplace) as an option for sickness certification among employees and (2) a proactive intervention to promote use of ‘active sick leave’. No difference was found compared with a ‘no intervention’ control group in full return to work within 12 months, associated with either intervention. Sickness absence medium term: Low quality evidence from 1 RCT, participants absent from work with back pain.(1) a passive awareness-raising intervention to promote GPs use of ‘active sick leave’ (that is, a return to modified duties in the workplace) as an option for sickness certification among employees and (2) a proactive intervention to promote the use of active sick leave. No difference was found at population level associated with either intervention compared with a ‘no intervention’ control group. This applied to total days of absence due to the index condition (back pain), or for any reason over the 12 months follow-up. Time to RTW over medium term: Moderate quality evidence from 2 RCTs. Participatory worksite assessment, and agreement and implementation of a participatory ergonomics intervention or other job modifications. A reduction was found in the time to RTW favouring the intervention compared with controls.\n\nCombined (individual and work-focused interventions): \nLong-term sickness absence due to muculoskeletal conditions:\nFull RTW in the medium-term: Moderate quality evidence from 3 RCTs. Outpatient multidisciplinary rehabilitation with workplace contact and vocational support of a caseworker. No difference was found in full RTW compared with controls. Time to RTW over medium term: Moderate quality evidence from 5 RCTs. Participatory worksite assessment, agreement and implementation of a participatory ergonomics intervention or other job modifications plus graded activity, an outpatient multidisciplinary rehabilitation within a biopsychosocial framework plus workplace contact, and vocational support of caseworker. No difference was found between the intervention and control groups in time to RTW.\n\nLong term sickness absence due to mental health conditions:\nFull RTW over short-term: Low quality evidence from 4 RCTs, 1  UK. Case management with low intensity psychological interventions, a self-help handbook and workplace facilitation, a  multidisciplinary stress treatment with gradual work exposure plus workplace dialogue, a return to work consultation with a psychiatrist plus occupational physician-delivered CBT and workplace modifications, and occupational physician delivered activating and problem-solving intervention, plus contacts with workplace. No difference was found in full RTW compared with controls. Low quality evidence from 1 RCT. Occupational therapist-delivered work reintegration programme plus CBT treatment. RTW in what was reported to be good health between 1-6 months 5/78 (6%) vs 4/39 (10%). Full RTW over medium-term: Very low quality evidence from 3 RCTs. Occupational physician-delivered CBT-based stress inoculation and gradual return to work with facilitating modifications; an occupational physician-delivered activating and problem-solving intervention plus contacts with the workplace; collaborative stepped-care (including problem-solving therapy and guided self-help) plus a workplace dialogue intervention to agree a return-to-work plan coordinated by an occupational physician-care manager. No difference was found in full RTW compared with controls. Low quality evidence from 1 RCT. Occupational therapist-delivered work reintegration programme plus CBT treatment. RTW in what was reported to be good health between 7-12 months 27/78 (34%) vs 9/39 (23%). Sickness absence over short term: Low quality evidence from 1 RCT. Acceptance and  commitment therapy, plus a workplace convergence dialogue intervention to agree a return-to-work plan including any facilitating modifications. No difference was found in the number of sickness absence days compared with controls. Sickness absence over medium term: Moderate quality evidence from 3 RCTs. CBT-based return to work interventions delivered by psychologists (including gradual exposure, psychoeducation, problem-solving and agreement of return to work plans with the employer, plus CBT treatment), a return to work consultation with a psychiatrist plus occupational physician-delivered CBT and workplace modifications, and a collaborative stepped-plus workplace dialogue intervention to agree a return-to-work plan coordinated by an occupational physician care manager. No difference was found in the number of sickness absence days compared with controls.\n\nQualitative evidence not included here. ","Overall the committee discussed that there was greater variation in terms of content, intensity and mode of delivery in the studies involving those with mental health conditions than was observed in the individual-focused RTW interventions evaluated in populations with musculoskeletal conditions. This can be seen in that most mental health studies included in the review consisted of combined interventions. There was a large amount of heterogeneity in terms of both interventions and comparators studied and no significant effects were found on any outcome. The committee discussed the low-quality assessment of most of the included studies, the lack of evidence of effectiveness and the variety in the interventions included. Nonetheless the committee considered it important to provide guidance for returning to work after long-term absence relating to mental health conditions. Specifically, the committee discussed the overall importance of facilitating the most effective return to work for those who have been on long-term sickness absence. They noted that continuing long-term absence from the workplace can have a serious detrimental impact on individuals’ long-term health, financial security and social inclusion.\n\nMental health issues increasingly account for a significant proportion of long-term sickness absence from work. This is reflected by the availability of more new evidence from studies in mental health populations since the original guideline was published in 2009. The committee discussed the lack of any clear evidence of effectiveness of any RTW interventions in these studies. They discussed the possibility that to some degree this could be due to greater heterogeneity both in interventions and comparators than was the case for studies in musculoskeletal populations. Recruitment difficulties are frequently experienced in mental health research. Lack of target numbers of participants combined with wider variability in the outcomes of interest may differentially impact on the precision of effect estimates generated in mental health compared with musculoskeletal studies in this area.\n\nThe committee considered one large UK based study that had considered before and after a joint working initiative between OH and HR departments. This study was of a mixed population of employees of two NHS hospital trusts. It identified a reduction in baseline of 4-week absences but no overall reduction in days beyond 4 weeks for all long-term sickness absence. The committee noted that this UK based observational study was the only non RCT evidence included and that it had additional limitations, such as that there were differences between sites in the workforces, proportions of full and part time employees and rates of long term sickness attributable to mental health disorders. Nonetheless they considered that it provided support for importance of wider management support to enable the facilitation of return to work initiatives and the need to evaluate implemented programmes.\n\nConsidering the low quality of the evidence identified and presented in the evidence reviews and the committee concern that most of the evidence reported on settings that are very different from the UK workplace context, it was agreed to seek further views from UK expert organisations.\n\n"]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"van Vilsteren M, van Oostrom SH, de Vet HCW, Franche RL, Boot CRL, Anema JR. Workplace interventions to prevent work disability in workers on sick leave. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD006955. DOI:\n10.1002/14651858.CD006955.pub3. Available here\n\n\n","Workplace interventions focusing on changes in the workplace or equipment, work design and organisation (including working relationships), working conditions or work environment, and occupational (case) management with active stakeholder involvement of (at least) the worker and the employer","The evidence is inconsistent so it is not possible to tell whether workplace interventions for people on sick leave are effective in reducing sickness absence","Studies in working-age adults (18 to 65 years) who were on sick leave, full-and part-time workers","No question specified, the objective was to determine the effectiveness of workplace interventions in preventing work disability among sick-listed workers, when compared to usual care or clinical interventions","Primary\n• Time until first RTW: a period of absence from work because of sickness both preceded and followed by a period of at least one day at work \n• Time until lasting RTW: a period of absence from the first day of sick leave to full RTW in previous or equal work for at least four weeks without dropping out\n• Cumulative duration of sickness absence: total days of sick leave during the follow-up period (resulting from one or more periods of sickness absence)\n• Recurrences of sickness absence: the number of days until a recurrence; or the frequency and duration of recurrent episodes of sick leave\n\nSecondary\n• functional status\n• quality of life\n• general health\n• depression\n• pain levels\n• direct and indirect costs of work disability","Included 14 RCTs with 1897 workers. Eight studies included workers with musculoskeletal disorders, five workers with mental health problems, and one workers with cancer. Six studies were judged to have low risk of bias for the outcome sickness absence.\n\nWorkplace interventions significantly improved time until first RTW compared to usual care, moderate-quality evidence (hazard ratio (HR) 1.55, 95% confidence interval (CI) 1.20 to 2.01). Workplace interventions did not considerably reduce time to lasting RTW compared to usual care, very low-quality evidence (HR 1.07, 95% CI 0.72 to 1.57). The effect on cumulative duration of sickness absence showed a mean difference of -33.33 (95% CI -49.54 to -17.12), favouring the workplace intervention, high-quality evidence. One study assessed recurrences of sick leave, and favoured usual care, moderate-quality evidence (HR 0.42, 95% CI 0.21 to 0.82). Overall, the effectiveness of workplace interventions on work disability showed varying results.\n\nIn subgroup analyses workplace interventions reduced time to first and lasting RTW among workers with musculoskeletal disorders more than usual care (HR 1.44, 95% CI 1.15 to 1.82 and HR 1.77, 95% CI 1.37 to 2.29, respectively; both moderate quality evidence). In studies of workers with musculoskeletal disorders, pain also improved (standardised mean difference (SMD) - 0.26, 95% CI -0.47 to -0.06), as well as functional status (SMD -0.33, 95% CI -0.58 to -0.08). In studies of workers with mental health problems, there was a significant improvement in time until first RTW (HR 2.64, 95% CI 1.41 to 4.95), but no considerable reduction in lasting RTW (HR 0.79, 95% CI 0.54 to 1.17). One study of workers with cancer did not find a considerable reduction in lasting RTW (HR 0.88, 95% CI 0.53 to 1.47).\n\nIn another subgroup analysis there was no evidence that offering a workplace intervention in combination with a cognitive behavioural intervention (HR 1.93, 95% CI 1.27 to 2.93) is considerably more effective than offering a workplace intervention alone (HR 1.35, 95% CI 1.01 to 1.82, test for subgroup differences P = 0.17).\n\nWorkplace interventions did not considerably reduce time until first RTW compared with a clinical intervention in workers with mental health problems in one study (HR 2.65, 95% CI 1.42 to 4.95, very low-quality evidence).","The review authors found moderate-quality evidence that workplace interventions reduce time to first RTW, high-quality evidence that workplace interventions reduce cumulative duration of sickness absence, very low-quality evidence that workplace interventions reduce time to lasting RTW, and moderate-quality evidence that workplace interventions increase recurrences of sick leave. Overall, the effectiveness of workplace interventions on work disability showed varying results. Workplace interventions reduce time to RTW and improve pain and functional status in workers with musculoskeletal disorders. We found no evidence of a considerable effect of workplace interventions on time to RTW in workers with mental health problems or cancer.\n\nReview authors found moderate-quality evidence to support workplace interventions for workers with musculoskeletal disorders. The quality of the evidence on the effectiveness of workplace interventions for workers with mental health problems and cancer is low, and results do not show an effect of workplace interventions for these workers. Future research should expand the range of health conditions evaluated with high-quality studies."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Vogel N, Schandelmaier S, Zumbrunn T, Ebrahim S, de Boer WEL, Busse JW, Kunz R. Return-to-work coordination programmes for improving return to work in workers on sick leave. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD011618. DOI:10.1002/14651858.CD011618.pub2.  Available here","Return-to-work coordination programmes. No uniform definition of return to-\nwork coordination programmes exists. Review authors defined such programmes as \n• The objective is to promote return to work\n• The return-to-work coordinator(s) and the affected worker have at least one face-to-face contact\n• The process starts with an assessment of the worker’s needs and leads to an individually tailored return-to-work plan\n• The implementation of the return-to-work plan is managed by the return-to-work coordinator(s)","The evidence suggests that return to work (RTW) coordination programmes may not be effective in reducing time to return to work at 6, 12 and more than 12 months\n\nEvidence is lacking so it is not possible to tell whether RTW coordination programmes reduce cumulative sickness absence days in the short term (6 months) and very long term (beyond 12 months)\n\nThe evidence suggests that RTW coordination programmes may not be effective in reducing cumulative sickness absence at 12 months\n\n","Studies in adults of working age (16 to 65 years) who:\n• were on full- or part-time sick leave continuously for at least four weeks or were receiving long-term disability benefits; and\n• were employed at the time of sick-listing\n\nAt least 80% of the participants in a study had to fulfil both criteria. Studies were included  irrespective of the cause of sick leave or disability, the setting or the benefit scheme (e.g. private or government provider)","Not specified the review objective was to assess the effects of return-to-work coordination programmes versus usual practice for workers on sick leave or disability","Primary\n• Time to return to work\n• Cumulative sickness absence\n• Proportion at work at end of the follow-up\n• Proportion ever returned to work\n\nSecondary\nPhysical, mental, social or overall functioning\n• Pain, depression and anxiety\n• Quality of life\n• Satisfaction of patients, employers, and social insurance organisations","Included 14 studies from nine countries that enrolled 12,568 workers. Eleven studies focused on musculoskeletal problems, two on mental health and one on both. Most studies (11 of 14) followed workers 12 months or longer. Risk of bias was low in 10 and high in 4 studies, but findings were not sensitive to their exclusion.\n\nNo benefits were found for return-to-work coordination programmes on return-to-work outcomes.\n\nFor short-term follow-up of six months, no effect was found on time to return to work (hazard ratio (HR) 1.32, 95% confidence interval (CI) 0.93 to 1.88, low-quality evidence), cumulative sickness absence (mean difference (MD) −16.18 work days per year, 95% CI −32.42 to 0.06, moderate-quality evidence), the proportion of participants at work at end of the follow-up (risk ratio (RR) 1.06, 95% CI 0.86 to 1.30, low-quality evidence) or on the proportion of participants who had ever returned to work, that is, regardless of whether they had remained at work until last follow-up (RR 0.87, 95% CI 0.63 to 1.19, very low-quality evidence).\n\nFor long-term follow-up of 12 months, no effect was found on time to return to work (HR 1.25, 95% CI 0.95 to 1.66, low-quality evidence), cumulative sickness absence (MD −14.84 work days per year, 95% CI −38.56 to 8.88, low-quality evidence), the proportion of participants at work at end of the follow-up (RR 1.06, 95% CI 0.99 to 1.15, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 1.03, 95% CI 0.97 to 1.09, moderate-quality evidence).\n\nFor very long-term follow-up of longer than 12 months, no effect was found on time to return to work (HR 0.93, 95% CI 0.74 to 1.17, low-quality evidence), cumulative sickness absence (MD 7.00 work days per year, 95% CI −15.17 to 29.17, moderate-quality evidence), the proportion of participants at work at end of the follow-up (RR 0.94, 95% CI 0.82 to 1.07, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 0.95, 95% CI 0.88 to 1.02, low-quality evidence).\n\nOnly small benefits were found for return-to-work coordination programmes on patient-reported outcomes. All differences were below the minimal clinically important difference (MID).","Offering return-to-work coordination programmes for workers on sick leave for at least four weeks results in no benefits when compared to usual practice. The review authors found no significant differences for the outcomes time to return to work, cumulative sickness absence, the proportion of participants at work at end of the follow-up or the proportion of participants who had ever returned to work at short-term, long-term or very long-term follow-up. For patient-reported outcomes, they found only marginal effects below the MID. The quality of the evidence ranged from very low to moderate across all outcomes."]
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[null,null,null,null,null,null,"RHEOLI ABSENOLDEB SALWCH - YMYRIADAU PENODOL"]
[null,null,null,null,null,null,"POEN GWDDF"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Aas RW, Tuntland H, Holte KA, Røe C, Lund T, Marklund S, Moller A. Workplace interventions for neck pain in workers. Cochrane Database of Systematic Reviews 2011, Issue 4. Art. No.: CD008160.\nDOI:10.1002/14651858.CD008160.pub2. Available here","Interventions for neck pain aimed at modifying body function, activity performance, participation, environment or personal factors. Interventions could be single or combination","Evidence is lacking so it is not possible to tell whether interventions reduce sickness absence in people on sick leave because of neck pain","Working age male and female adults (18 to 67 years). Workers at work or absent from work (on sick leave, early retirement or disability pension), but still connected to a workplace by employment agreements (permanent or temporary). All sectors, branches and types of jobs. Workers with reported neck pain of acute (less than six weeks), subacute (six to 12 weeks) or chronic (12 weeks or more) duration were included. Studies were included if at least 50% of the baseline population had neck pain","Objective was to determine the effectiveness of workplace interventions in adult workers with neck pain","Primary\n• Pain severity or pain prevalence (self-reported on a VAS or NSR scale, or measured as the proportion of those with pain)\n• Work absenteeism (time on benefits, number of hours/days on sick leave/lost time, proportion of individuals returning to work, employment status, and shift in employment status to working/part-time working/sick listed, disability pension and early retirement)\n\nSecondary\n• Global improvement (proportion of participants recovered or improved, measured by an overall judgment of improvement or treatment effectiveness)\n• Functional status\n• Well-being / Quality of Life","Included 10 RCTs (2745 workers). Two studies were assessed with low risk of bias. Most trials (n = 8) examined office workers. Few workers were sick-listed. Thus, workplace interventions (WIs) were seldom designed to improve return-to-work. Overall, there was low quality evidence that showed no significant differences between WIs and no intervention for pain prevalence or severity. If present, significant results in favour of WIs were not sustained across follow-up times. There was moderate quality evidence (1 study, 415 workers) that a four-component WI was significantly more effective in reducing sick leave in the intermediate-term (OR 0.56 95% CI 0.33 to 0.95), but not in the short- (OR 0.83  95% CI 0.52 to 1.34) or long-term (OR 1.28  95% CI 0.73 to 2.26). These findings might be because only a small proportion of the workers were sick-listed.","Overall, this review found low quality evidence that neither supported nor refuted the benefits of any specific WI for pain relief and moderate quality evidence that a multiple-component intervention reduced sickness absence in the intermediate-term, which was not sustained over time. Further research is very likely to have an important impact on the review authors confidence in the estimate of effect and is likely to change the estimate. There is an urgent need for high quality RCTs with well designed WIs"]
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[null,null,null,null,null,null,"ANHWYLDER ADDASU"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Arends I, Bruinvels DJ, Rebergen DS, Nieuwenhuijsen K, Madan I, Neumeyer-Gromen A, Bültmann U, Verbeek JH. Interventions to facilitate return to work in adults with adjustment disorders.\nCochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD006389.DOI:10.1002/14651858.CD006389.pub2. Available here ","All interventions that aimed at facilitating RTW of workers on sick leave because of adjustment disorders, using individual or group approaches were included. These included pharmacological interventions, psychological interventions, relaxation techniques, exercise programmes, employee assistance programmes and any combination of these","The evidence suggests that problem solving therapies may be effective in reducing time to partial return to work in people with adjustment disorder\n\nThe evidence suggests that CBT may not be effective in reducing time to return to work in people with adjustment disorder","Workers (18 to 65 years of age) with work disability related to an adjustment disorder causing sick leave","The review objective was to assess the effects of interventions facilitating return to work for workers with acute or chronic adjustment disorders ","Primary\nTime until partial return to work (RTW); time until full RTW\n\nSecondary\nSymptoms related to adjustment disorder, work functioning, generic functional status","Included nine studies reporting on 10 psychological interventions and one combined intervention, 1546 participants. \nNo RCTs were found of pharmacological interventions, exercise programmes or employee assistance programmes. \nAssessed seven studies as having low risk of bias and the studies that were pooled together were comparable. \n\nFor those who received no treatment, compared with CBT, the assumed time to partial and full RTW was 88 and 252 days respectively. Based on two studies with a total of 159 participants, moderate-quality evidence showed that CBT had similar results for time (measured in days) until partial RTW compared to no treatment at one-year follow-up (mean difference (MD) -8.78, 95% confidence interval (CI) -23.26 to 5.71). \n\nReview authors found low-quality evidence of similar results for CBT and no treatment on the reduction of days until full RTW at one year follow-up (MD -35.73, 95% CI -113.15 to 41.69) (one study with 105 participants included in the analysis). \n\nBased on moderate quality evidence, problem solving therapy (PST) significantly reduced time until partial RTW at one-year follow-up compared to non guideline based care (MD -17.00, 95% CI -26.48 to -7.52) (one study with 192 participants clustered among 33 treatment providers included in the analysis), but reviewers found moderate-quality evidence of no significant effect on reducing days until full RTW at one-year follow-up (MD -17.73, 95% CI -37.35 to 1.90) (two studies with 342 participants included in the analysis).","The review authors found moderate-quality evidence that CBT did not significantly reduce time until partial RTW and low-quality evidence that it did not significantly reduce time to full RTW compared with no treatment. Moderate-quality evidence showed that PST significantly enhanced partial RTW at one-year follow-up compared to non-guideline based care but did not significantly enhance time to full RTW at one-year follow-up. An important limitation was the small number of studies included in the meta-analyses and the small number of participants, which lowered the power of the analyses."]
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[null,null,null,null,null,null,"CANSER"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"de Boer AGEM, Taskila TK, Tamminga SJ, Feuerstein M, Frings-Dresen MHW, Verbeek JH. Interventions to enhance\nreturn-to-work for cancer patients. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD007569. DOI:\n10.1002/14651858.CD007569.pub3.  Available here","Interventions aiming to enhance return to work. Including psycho-educational, vocational, physical, medical or pharmacological, or any combination of these ","The evidence suggests that multidisciplinary physical, psycho-educational and/or vocational interventions may be effective in supporting people with cancer to return to work","Adults (>= 18 years old) who had been diagnosed with cancer (any type) and were in paid employment (employee or self employed) at the time of diagnosis","Review objective was to evaluate the effectiveness of interventions aimed at enhancing return to work (RTW) in cancer patients compared to alternative programmes including usual care or no intervention","Primary\nRTW measured as event data such as RTW rates or (change in) disability pension rates. RTW measured as time-to-event data, such as number of days between reporting sick and any work resumption or the number of days on sick leave during the follow-up period\n\nSecondary\nQoL which included overall QoL, physical QoL and emotional QoL measured with validated and unvalidated questionnaires","Fifteen RCTs including 1835 cancer patients met the inclusion criteria and because of multiple arms studies 19 evaluations were included. Reviewers judged six studies to have a high risk of bias and nine to have a low risk of bias. All included studies were conducted in high income countries and most studies were aimed at breast cancer patients (seven trials) or prostate cancer patients (two trials).\n\nTwo studies involved psycho-educational interventions including patient education and teaching self-care behaviours. Results indicated low quality evidence of similar RTW rates for psycho-educational interventions compared to care as usual (RR 1.09, 95% CI 0.88 to 1.35, n = 260 patients) and low quality evidence that there is no difference in the effect of psycho-educational interventions compared to care as usual on quality of life (standardised mean difference (SMD) 0.05, 95% CI -0.2 to 0.3, n = 260 patients). No studies were found on vocational interventions. In one study breast cancer patients were offered a physical training programme. Low quality evidence suggested that physical training was not more effective than care as usual in improving RTW (RR 1.20, 95% CI 0.32 to 4.54, n = 28 patients) or quality of life (SMD -0.37, 95% CI -0.99 to 0.25, n = 41 patients).\n\nSeven RCTs assessed the effects of a medical intervention on RTW. In all studies a less radical or functioning conserving medical intervention was compared with a more radical treatment. Low quality evidence was found that less radical, functioning conserving approaches had similar RTW rates as more radical treatments (RR 1.04, 95% CI 0.96 to 1.09, n = 1097 patients) and moderate quality evidence of no differences in quality of life outcomes (SMD 0.10, 95% CI -0.04 to 0.23, n = 1028 patients).\n\nFive RCTs involved multidisciplinary interventions in which vocational counselling, patient education, patient counselling, biofeedback- assisted behavioral training and/or physical exercises were combined. Moderate quality evidence showed that multidisciplinary interventions involving physical, psycho-educational and/or vocational components led to higher RTW rates than care as usual (RR 1.11, 95% CI 1.03 to 1.16, n = 450 patients). No differences were found in the effect of multidisciplinary interventions compared to care as usual on quality of life outcomes (SMD 0.03, 95% CI -0.20 to 0.25, n = 316 patients).","Review authors found moderate quality evidence that multidisciplinary interventions enhance the RTW of patients with cancer."]
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[null,null,null,null,null,null,"RHAGLENNI RHEOLI ANABLEDD YN Y GWEITHLE"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Gensby U, Lund T, Kowalski K, Saidj M, Jørgensen AMK, Filges T, Irvin E, Amick BC III, Labriola M. Workplace Disability Management Programs Promoting Return-to-Work: A Systematic Review. Campbell Systematic Reviews 2012:17\nDOI: 10.4073/csr.2012.17 Available here","This review focused on workplace disability management (WPDM) programmes that were:\n• Characterised as an ‘onsite’ WPDM or RTW programme\n• Provided by the employer or initiated by the employer in collaboration with key players in the workplace\n• Addressed the duration or extent of an inability to work due to physical injury or mental illness\n• Implemented within the workplace setting","Evidence is lacking (identified studies were of a design inappropriate to assess interventions) so it is not possible to tell whether workplace disability management programmes help to reduce sickness absence","Employees (from the public or private sector) on sick-leave with an inability to work due to physical injury, illness or mental health disorders","The objective of this review was to assess the effectiveness of Workplace Disability Management Programmes (WPDM) promoting RTW\n• Compare WPDM programmes to no treatment, treatment as usual or alternative intervention\n• Examine components of WPDM programmes which appear more highly related to positive outcome\n","Primary\n• Return to work \n• Duration of sickness absence \n• Reduction in lost days from work \nSecondary\n• The functional health consequences \n• Return to fulltime or part-time work (yes/no)\n• Whether RTW was completed at the current employer\nSustainability of return to work:\n• Relapse to sickness absence in the follow-up period ","Thirteen studies (two non-randomised studies (NRS) and eleven single group ‘before and after’ studies (B & A)), including data from eleven different WPDM programmes, met the inclusion criteria. There were insufficient data on the characteristics of the sample and the effect sizes were uncertain. However, narrative descriptions of the included programme characteristics were rich, and provide valuable insights into programme scope, components, procedures and human resources involved.\n\nThere is a lack of evidence to draw unambiguous conclusions on the effectiveness of employer provided WPDM programmes promoting RTW. It was not possible to determine if specific programme components or specific sets of components are driving effectiveness.\n\nThe review adds to the existing knowledge base on WPDM programme development, characteristics and evaluation. At an organisational level intervention, employer provided WPDM programmes are multi-component constructs, offering a suite of policies and practices for injured or ill employees. The review identified 15 constituent programme components, covering individual, organisational, and system level policies and practices, depicting key human resources involved in workplace programme procedures and administration.\n\nFuture programme evaluations ought to broaden their focus beyond the first phases of the RTW process and incorporate sustainable outcomes (e.g. job retention, satisfactory and productive job performance, work role functioning, and maintenance of job function).\n\nGiven the lack of WPDM programmes evaluated in peer-reviewed publications, more attention needs to be given to locate and rigorously evaluate efforts from company studies that may still exist outside the peer reviewed published literature.\n\nWhile many employers recognise the importance of WPDM and are adopting policies and practices to promote RTW, judging from this review, the existing evidence leaves room for more rigorous methodological studies to develop the present WPDM knowledge base. Prospectively, WPDM evaluation research also needs to enlarge its perspective and refine its analytic tools to examine information that is meaningful and cost effective to those who will benefit from it, to further advance the field.","The review findings might help explicate WPDM programmes and their potential impact on RTW outcomes, and provide a more complete understanding of the research in the field of WPDM. This may inspire researchers, employers, and policy makers, who are interested not only in questions regarding the impact of programmes, but also their nature, to promote future design and evaluation of DM in organisations."]
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[null,null,null,null,null,null,"CLEFYD CORONAIDD Y GALON"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Hegewald J, Wegewitz UE, Euler U, van Dijk JL, Adams J, Fishta A, Heinrich P, Seidler A. Interventions to support return to work for people with coronary heart disease. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD010748.\nDOI: 10.1002/14651858.CD010748.pub2. Available here","Interventions  that aim to support the return-to-work process with individual or group approaches.\n• Work-directed interventions: these can include changes in the work environment, work tasks or working methods\n• Person-directed interventions:\ni) psychological interventions \nii) physical conditioning interventions\n• Any combination of the above","The evidence suggests that psychological interventions (including health education) for people with coronary heart disease may not be effective in reducing sickness absence (days until return to work) \n\nThe evidence suggests that work directed counselling may not be effective for people with coronary heart disease in reducing sickness absence (days to return to work)\n\nThe evidence suggests exercise programmes and combined cardiac rehabilitation programmes for people with coronary heart disease may not be effective  reducing time needed to return to work. \n\n","Adults (18 years or older) who had been diagnosed with CHD, who experienced a MI, or a coronary revascularisation procedure like CABG or PCI, as well as people with angina pectoris or angiographically-defined CHD. Within each study, at least 80% of participants had to fulfil these criteria.\nParticipants should also have been employed (either in paid employment\nor self-employed) at the time of diagnosis and on sick leave or otherwise not working at the time of the study because of the CHD ","Review objective was to assess the effects of person- and work-directed interventions aimed at enhancing return to work in patients with coronary heart disease compared to usual care or no intervention","Primary\nReturn to work, including return to\neither full- or part-time employment, to the previous job, and to the same role or with changes in work status (change of duties,\nworking location, function). Return to work included number of days on sick leave during the follow-up period\n\nSecondary\n• Health-related quality of life within the return-to-work process, either measured with generic instruments or with disease-specific instruments\n•  Number of participants who returned to work and were still working after an extended period of at least one year\n• Number of participants who were still working after five years ","Included 39 RCTs (including one cluster- and four three-armed RCTs). Return-to-work results of 34 studies were included in the meta-analyses.\n\nPerson-directed, psychological counselling versus usual care\nIncluded 11 studies considering return to work following psychological interventions among a subgroup of 615 participants in the meta-analysis. Most interventions used some form of counselling to address participants’ disease-related anxieties and provided information on the causes and course of CHD to dispel misconceptions. Cannot tell whether these interventions increase return to work up to six months (risk ratio (RR) 1.08, 95% confidence interval (CI) 0.84 to 1.40; six studies; very low-certainty evidence) or at six to 12 months (RR 1.24, 95% CI 0.95 to 1.63; seven studies; very low-certainty evidence). Cannot tell whether psychological interventions shorten the time until return to work. Psychological interventions may have little or no effect on the proportion of participants working between one and five years (RR 1.09, 95% CI 0.88 to 1.34; three studies; low-certainty evidence).\n\nPerson-directed, work-directed counselling versus usual care\nFour studies examined work-directed counselling. These counselling interventions included advising patients when to return to work based on treadmill testing or extended counselling to include co-workers’ fears and misconceptions regarding CHD. Work-directed counselling may result in little to no difference in the mean difference (MD) in days until return to work (MD −7.52 days, 95% CI −20.07 to 5.03 days; four studies; low-certainty evidence). Work-directed counselling probably results in little to no difference in cardiac deaths (RR 1.00, 95% CI 0.19 to 5.39; two studies; moderate-certainty evidence).\n\nPerson-directed, physical conditioning interventions versus usual care\nNine studies examined the impact of exercise programmes. Compared to usual care, cannot tell if physical interventions increase return to work up to six months (RR 1.17, 95% CI 0.97 to 1.41; four studies; very low-certainty evidence). Physical conditioning interventions may result in little to no difference in return-to-work rates at six to 12 months (RR 1.09, 95% CI 0.99 to 1.20; five studies; low-certainty evidence), and may also result in little to no difference on the rates of patients working after one year (RR 1.04, 95% CI 0.82 to 1.30; two studies; low-certainty evidence). Physical conditioning interventions may result in little to no difference in the time needed to return to work (MD −7.86 days, 95% CI −29.46 to 13.74 days; four studies; low-certainty evidence). Physical conditioning interventions probably do not increase cardiac death rates (RR 1.00, 95%CI 0.35 to 2.80; two studies; moderate-certainty evidence).\n\nPerson-directed, combined interventions versus usual care\nIncluded 13 studies considering return to work following combined interventions in the meta-analysis. Combined cardiac rehabilitation programmes may have increased return to work up to six months (RR 1.56, 95% CI 1.23 to 1.98; number needed to treat for an additional beneficial outcome (NNTB) 5; four studies; low-certainty evidence), and may have little to no difference on return to- work rates at six to 12 months’ follow-up (RR 1.06, 95% CI 1.00 to 1.13; 10 studies; low-certainty evidence). Reviewers could not tell if combined interventions increased the proportions of participants working between one and five years (RR 1.14, 95% CI 0.96 to 1.37; six studies; very low-certainty evidence) or at five years (RR 1.09, 95% CI 0.86 to 1.38; four studies; very low-certainty evidence). Combined interventions probably shortened the time needed until return to work (MD −40.77, 95% CI −67.19 to −14.35; two studies; moderate-certainty evidence). Combining interventions probably results in little to no difference in reinfarctions (RR 0.56, 95% CI 0.23 to 1.40; three studies; moderate-certainty evidence).\n\nWork-directed, interventions\nNo studies exclusively examining strictly work-directed interventions at the workplace were found","Combined interventions may increase return to work up to six months and probably reduce the time away from work. Otherwise, no evidence was found of either a beneficial or harmful effect of person-directed interventions. The certainty of the evidence for the various interventions and outcomes ranged from very low to moderate. Return to work was typically a secondary outcome of the studies, and as such, the results pertaining to return to work were often poorly reported. Adhering to RCT reporting guidelines could greatly improve the evidence of future research. A research gap exists regarding controlled trials of work-directed interventions, health-related quality of life within the return-to-work process, and adverse effects."]
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[null,null,null,null,null,null,"ARTHRITIS LLIDIOL"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Hoving JL, Lacaille D, Urquhart DM, Hannu TJ, Sluiter JK, Frings-Dresen MHW. Non-pharmacological interventions for preventing job loss in workers with inflammatory arthritis. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD010208. DOI: 10.1002/14651858.CD010208.pub2. Available here","Included interventions where the focus was on job loss prevention or improving work function. Interventions that fulfilled at least two of the following components:\na) An evaluation of the work challenges or work adaptations as a step in the main intervention of the study\nb) Interventions directed at the person, meaning job coaching, job or vocational training, vocational\ncounselling; or empowerment for work; or self-management, including support or information regarding work or both\nc) Interventions directed at the work environment, meaning work adaptations, ergonomic measures, job accommodations; or interventions targeted directly at the employer, supervisor\nor co-workers","Evidence is lacking so it is not possible to tell if non- pharmacological interventions reduce sickness absence for people with inflammatory arthritis","Included trials in which the population was limited to adults of working age (18 to 65 years) of which at least half of all workers\n(>50%) had been diagnosed with inflammatory arthritis (IA), including rheumatoid arthritis (RA), ankylosing spondylitis (AS),  psoriatic arthritis (PsA) or\nundifferentiated spondyloarthritis (SpA), or IA associated with connective tissue diseases such as Systemic\nLupus Erythematosus (SLE)","The review objective was to assess the effects of non-pharmacological interventions that aim to prevent job loss, work absenteeism or improve work functioning for employees with IA","Primary outcomes\n• Job loss measured as: the number of people that become unemployed at some stage following diagnosis, regardless of disability pension status; or the time to job loss\n• Sickness absenteeism measured as: time lost from work (number of work days or hours missed at work due to sick leave, or absenteeism); or time to return to work; or the proportion of workers on sick leave at a certain moment of follow-up\n\nSecondary outcomes\nWork functioning measured using any at-work productivity, work functioning or presenteeism questionnaire","Included three RCTs with a total of 414 participants at risk of job loss. The majority of participants had IA, most with RA and to a lesser degree AS. The interventions aimed to prevent job loss and improve work functioning in several ways: firstly by evaluating work changes or adaptations and secondly by providing any person-directed interventions including vocational counselling, advice or education. Interventions directly targeted at the work environment were minimal and included workplace visits (one trial) or any actions by an occupational physician (one trial). The duration or dose of the interventions varied from two 1.5-hour sessions (one RCT) over five months, two consultation and multidisciplinary treatments during three months (one RCT), to six to eight individual or group sessions over six months (also one RCT). All participants were recruited through rheumatology clinics, both in or outside hospitals. Included trials investigated job loss (n = two RCTs; 382 participants), work absenteeism and work functioning (n = one RCT; 32 participants). The two smaller trials were assessed as having a high risk of bias and the large trial as having a low risk of bias. Trials showed marked differences in how they performed on risk of bias items, particularly on performance bias.\n\nUsing the GRADE there was judged to be to be very low quality evidence across the three reported outcomes. Of the two RCTs investigating job loss, the larger one (n = 242 participants) reported a large statistically significant reduction in job loss (relative risk (RR) = 0.35, 95% confidence interval (CI) 0.18 to 0.68) and the other RCT (n = 140) reported similar effects in both groups, although the CI was very wide (RR = 1.05, 95% CI 0.53 to 2.06). The latter one probably suffered from performance bias and reviewers judged it to have a high risk of bias. The one small trial investigating sickness absenteeism found uncertain results at six months’ follow-up (MD = -2.42 days, 95% CI -5.03 to 0.19). Finally, in the same small trial investigating work functioning using the Rheumatoid Arthritis-Work Instability Scale (RA-WIS), there was a moderate improvement of intermediate term work functioning (six months; scale range 0 to 23; mean improvement -4.67 points, 95% CI -8.43 to -0.91). No adverse effects were identified in the publications of the three trials.","This Cochrane review of three RCTs found very low quality evidence overall for job loss prevention interventions having an effect on job loss, work absenteeism and work functioning in workers with inflammatory arthritis. While this review highlights that further high quality RCTs are required, the results suggest that these strategies have potential to be effective."]
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[null,null,null,null,null,null,"SGLEROSIS YMLEDOL"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Khan F, Ng L, Turner-Stokes L. Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis.\nCochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007256.\nDOI: 10.1002/14651858.CD007256.pub2. Available here","All categories of  vocational rehabilitation (VR) programmes which incorporate a clearly defined vocational rehabilitation or work therapy element. These included\nstructured multi-disciplinary / multi-agency interventions to preserve employment such as clinic or community based counselling, planning for disclosure and accommodation and work place accommodations. All three types of VR programmes were included, such as those offered by ‘general rehabilitation programmes’, ‘MS specialised VR programmes’ and ‘pan -disability VR programmes’ ","Evidence is lacking so it is not possible to tell whether vocational rehabilitation improves employment outcomes in people with multiple sclerosis","Trials were included if the study population was working age (i.e. mean age between 18-65 years) and had the diagnosis of MS (sub types of MS were included- relapsing remitting, secondary progressive and primary progressive MS), irrespective of MS severity","The primary objective of this review is to evaluate the effectiveness of vocational rehabilitation (VR) programmes compared to alternative programmes or care as usual on return to work, employment and work ability in persons with multiple sclerosis. A secondary objective is to evaluate the cost effectiveness of these VR programmes","Primary outcomes\n• The change in proportion of pwMS in competitive employment (full time or part time employment position held by a person in an ordinary work setting, for which they were receiving payment at the market rate \n• The change in proportions of persons in supported employment (employment in an ’open work’ setting but with ongoing support such as government funded programmes)\nSecondary outcomes\n• The rate of return to work in days of pwMS\n• The change in proportion of pwMS on disability pension\n• The improvement of work ability in pwMS (such as the proportion of persons with MS who are engaged in attending a sheltered workshop and earn a modest living)\n• Costs of programmes and cost effectiveness of return to work or employment","Two trials (one RCT and one CCT) (total 80 participants) met the review criteria. Both trials scored poorly on the methodological quality assessment. There was ’insufficient evidence’ for VR programmess for (a)‘competitive employment’, in altering rates of job retention, changes in employment, improvement in rates of re-entry into the labour force; (b) for altering ‘work ability’ by improving participants’ confidence in the accommodation request process, or employability maturity or job seeking activity. No evidence could be assimilated for changes in proportions of persons in supported employment or on disability pensions, nor for cost-effectiveness.","There was inconclusive evidence to support VR for pwMS. However, the review highlights some of the challenges in providing VR for pwMS. Clinicians need to be aware of vocational issues, and to understand and manage barriers for maintaining employment. Proactive and timely VR programmes should incorporate practical solutions to deal with work disability, workplace accommodation and educate employers, and the wider community. Liaison with policy makers is imperative for government initiatives that encourage work focused VR programmes. Future research in VR should focus on improving methodological and scientific rigour of clinical trials; on the development of appropriate and valid outcome measures; and on cost effectiveness of VR programmes."]
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[null,null,null,null,null,null,"ISELDER"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Nieuwenhuijsen K, Faber B, Verbeek JH, Neumeyer-Gromen A, Hees HL, Verhoeven AC, van der Feltz-Cornelis CM, Bültmann U. Interventions to improve return to work in depressed people. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD006237. DOI: 10.1002/14651858.CD006237.pub3. Available here","1. work-directed interventions, i.e. addressing the work or the work-worker interface as part of the clinical treatment or as a\nstand-alone intervention; and\n2. clinical interventions, i.e. treatment of depressive disorder without a focus on work","The evidence suggests that work directed interventions added to clinical intervention may reduce sickness absence in people with depression","Adult (that is over 17 years old) workers (employees or self-employed) from occupational health settings, primary care, or outpatient care settings","The review objective was to evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders","Primary outcomes\nDays of sickness absence during the follow-up period\n\nSecondary outcomes\n• Depression (either dichotomously or continuously measured)\n• Work functioning \n• Employment status after a period of time \n\nOther outcomes such as employee satisfaction, general social functioning (not work specific), or quality of life scales were excluded","Included 23 studies with 26 study arms, involving 5996 participants with either a major depressive disorder or a high level of depressive symptoms. Fourteen studies were judged to have a high risk of bias and nine to have a low risk of bias.\n\nWork-directed interventions\nFive work-directed interventions. There was moderate quality evidence that a work-directed intervention added to a clinical intervention reduced sickness absence (SMD -0.40; 95% CI -0.66 to -0.14; 3 studies) compared to a clinical intervention alone. There was moderate quality evidence based on a single study that enhancing the clinical care in addition to regular work-directed care was not more effective than work-directed care alone (SMD -0.14; 95% CI -0.49 to 0.21). There was very low quality evidence based on one study that regular care by occupational physicians that was enhanced with an exposure-based return to work programme did not reduce sickness absence compared to regular care by occupational physicians (nonsignificant finding: SMD 0.45; 95% CI -0.00 to 0.91).\n\nClinical interventions, antidepressant medication\nThree studies compared the effectiveness of selective serotonin reuptake inhibitor (SSRI) to selective norepinephrine reuptake inhibitor (SNRI) medication on reducing sickness absence and yielded highly inconsistent results.\n\nClinical interventions, psychological\nModerate quality evidence based on three studies that telephone or online cognitive behavioural therapy was more effective in reducing sick leave than usual primary or occupational care (SMD -0.23; 95% CI -0.45 to -0.01).\n\nClinical interventions, psychological combined with antidepressant medication\nLow quality evidence based on two studies that enhanced primary care did not substantially decrease sickness absence in the medium term (4 to 12 months) (SMD -0.02; 95% CI -0.15 to 0.12). A third study found no substantial effect on sickness absence in favour of this intervention in the long term (24 months). Reviewers found high quality evidence, based on one study, that a structured telephone outreach and care management program was more effective in reducing sickness absence than usual care (SMD - 0.21; 95% CI -0.37 to -0.05).\n\nClinical interventions, exercise\nLow quality evidence based on one study that supervised strength exercise reduced sickness absence compared to relaxation (SMD -1.11; 95% CI -1.68 to -0.54). Moderate quality evidence based on two studies that aerobic exercise was no more effective in reducing sickness absence than relaxation or stretching (SMD -0.06; 95% CI -0.36 to 0.24","Review authors found moderate quality evidence that adding a work-directed intervention to a clinical intervention reduced the number of days on sick leave compared to a clinical intervention alone. They also found moderate quality evidence that enhancing primary or occupational care with cognitive behavioural therapy reduced sick leave compared to the usual care. A structured telephone outreach and care management programme that included medication reduced sickness absence compared to usual care. However, enhancing primary care with a quality improvement programme did not have a considerable effect on sickness absence. There was no evidence of a difference in effect on sickness absence of one antidepressant medication compared to another. More studies are needed on work-directed interventions. Clinical intervention studies should also include work outcomes to increase our knowledge on reducing sickness absence in depressed workers."]
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[null,null,null,null,null,null,"POEN CEFN"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Schaafsma FG, Whelan K, van der Beek AJ, van der Es-Lambeek LC, Ojajärvi A, Verbeek JH. Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain.\nCochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD001822.\nDOI: 10.1002/14651858.CD001822.pub Available here","Included studies on physical conditioning programmes when they included the following three key elements:\n• (advice about) exercises specifically designed to restore an individual’s systemic, neurological, musculoskeletal (strength,\nendurance, movement, flexibility and motor control) or cardiopulmonary function, or a combination\n• explicitly stated to have an intended improvement of work\nstatus\n• a stated relationship between the intervention and\nfunctional job demands","The evidence is inconsistent so it is not possible to tell if physical conditioning is effective in improving employment outcomes in people on sick leave because of back pain","Male and female adults (> 16 years) with work disability related to back pain","Objective to assess the effectiveness of physical conditioning as part of a return to work strategy in reducing time lost from work and improving work status for workers with back pain","• Time between intervention and return-to-work\n• Return-to-work status in terms of ’at work’ or ‘off work’\n• Time on light or modified duties","Included 41 articles reporting on 25 RCTs with 4404 participants. Risk of bias was low in 16 studies. \n\nThree studies involved workers with acute back pain, eight studies workers with subacute back pain, and 14 studies workers with chronic back pain.\n\nIn 14 studies, physical conditioning as part of a return to work strategy was compared to usual care. The physical conditioning mostly consisted of graded activity with work-related exercises aimed at increasing back strength and flexibility, together with a set date for return to work. The programmes were divided into a light version with a maximum of five sessions, or an intense version with more than five sessions up to full time or as inpatient treatment. \n\nFor acute back pain, there was low quality evidence that both light and intense physical conditioning programmes made little or no difference in sickness absence duration compared with care as usual at three to 12 months follow-up (3 studies with 340 workers). \n\nFor subacute back pain, the evidence on the effectiveness of intense physical conditioning combined with care as usual compared to usual care alone was conflicting (four studies with 395 workers). However, subgroup analysis showed low quality evidence that if the intervention was executed at the workplace, or included a workplace visit, it may have reduced sickness absence duration at 12 months follow-up (3 studies with 283 workers; SMD -0.42, 95% CI -0.65 to -0.18). \n\nFor chronic back pain, there was low quality evidence that physical conditioning as part of integrated care management in addition to usual care may have reduced sickness absence days compared to usual care at 12 months follow-up (1 study, 134 workers; SMD - 4.42, 95% CI -5.06 to -3.79). What part of the integrated care management was most effective remained unclear. There was moderate quality evidence that intense physical conditioning probably reduced sickness absence duration only slightly compared with usual care at 12 months follow-up (5 studies, 1093 workers; SMD -0.23, 95% CI -0.42 to -0.03). \n\nPhysical conditioning compared to exercise therapy showed conflicting results for workers with subacute and chronic back pain. Cognitive behavioural therapy was probably not superior to physical conditioning as an alternative or in addition to physical conditioning.","The effectiveness of physical conditioning as part of a return to work strategy in reducing sick leave for workers with back pain, compared to usual care or exercise therapy, remains uncertain. For workers with acute back pain, physical conditioning may have no effect on sickness absence duration. There is conflicting evidence regarding the reduction of sickness absence duration with intense physical conditioning versus usual care for workers with subacute back pain. It may be that including workplace visits or execution of the intervention at the workplace is the component that renders a physical conditioning programme effective. For workers with chronic back pain physical conditioning has a small effect on reducing sick leave compared to care as usual after 12 months follow-up. To what extent physical conditioning as part of integrated care management may alter the effect on sick leave for workers with chronic back pain needs further research."]
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[null,null,null,null,null,null,"CYMORTH I GADW'R RHEINY AG ANGHENION YCHWANEGOL MEWN CYFLOGAETH"]
[null,null,null,null,null,null,"POBL Â CANSER"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"de Boer AGEM, Taskila TK, Tamminga SJ, Feuerstein M, Frings-Dresen MHW, Verbeek JH. Interventions to enhance\nreturn-to-work for cancer patients. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD007569. DOI:\n10.1002/14651858.CD007569.pub3. Available here","Interventions aiming to enhance return to work. Including psychoeducational, vocational, physical, medical or pharmacological, or any combination of these ","The evidence suggests that multidisciplinary physical, psycho-educational and/or vocational interventions may be effective in supporting people with cancer to return to work","Adults (>= 18 years old) who had been diagnosed with cancer (any type) and were in paid employment (employee or self employed) at the time of diagnosis","Review objective was to evaluate the effectiveness of interventions aimed at enhancing return to work (RTW) in cancer patients compared to alternative programmes including usual care or no intervention","Primary\n• RTW measured as event data such as RTW rates or (change in) disability pension rates\n• RTW measured as time-to-event data, such as number of days between reporting sick and any work resumption or the number of days on sick leave during the follow-up period\n\nSecondary\nQoL which included overall QoL, physical QoL and emotional QoL measured with validated and unvalidated questionnaires","Fifteen RCTs including 1835 cancer patients met the inclusion criteria and because of multiple arms studies 19 evaluations were included. Review authors judged six studies to have a high risk of bias and nine to have a low risk of bias. All included studies were conducted in high income countries and most studies were aimed at breast cancer patients (seven trials) or prostate cancer patients (two trials).\n\nTwo studies involved psycho-educational interventions including patient education and teaching self-care behaviours. Results indicated low quality evidence of similar RTW rates for psycho-educational interventions compared to care as usual (RR 1.09, 95% CI 0.88 to 1.35, n = 260 patients) and low quality evidence that there is no difference in the effect of psycho-educational interventions compared to care as usual on quality of life (standardised mean difference (SMD) 0.05, 95% CI -0.2 to 0.3, n = 260 patients). No studies were found on vocational interventions. In one study breast cancer patients were offered a physical training programme. Low quality evidence suggested that physical training was not more effective than care as usual in improving RTW (RR 1.20, 95% CI 0.32 to 4.54, n = 28 patients) or quality of life (SMD -0.37, 95% CI -0.99 to 0.25, n = 41 patients).\n\nSeven RCTs assessed the effects of a medical intervention on RTW. In all studies a less radical or functioning conserving medical intervention was compared with a more radical treatment. Low quality evidence was found that less radical, functioning conserving approaches had similar RTW rates as more radical treatments (RR 1.04, 95% CI 0.96 to 1.09, n = 1097 patients) and moderate quality evidence of no differences in quality of life outcomes (SMD 0.10, 95% CI -0.04 to 0.23, n = 1028 patients).\n\nFive RCTs involved multidisciplinary interventions in which vocational counselling, patient education, patient counselling, biofeedback- assisted behavioral training and/or physical exercises were combined. Moderate quality evidence showed that multidisciplinary interventions involving physical, psycho-educational and/or vocational components led to higher RTW rates than care as usual (RR 1.11, 95% CI 1.03 to 1.16, n = 450 patients). No differences were found in the effect of multidisciplinary interventions compared to care as usual on quality of life outcomes (SMD 0.03, 95% CI -0.20 to 0.25, n = 316 patients).","Review authors found moderate quality evidence that multidisciplinary interventions enhance the RTW of patients with cancer."]
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[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Fong CJ, Murphy KM, Westbrook JD, Markle MM. Behavioral, Psychological, Educational, and Vocational Interventions to Facilitate Employment Outcomes\nfor Cancer Survivors: A Systematic Review Campbell Systematic Reviews 2015:5\nDOI: 10.4073/csr.2015.5. Available here","Included studies addressed the effectiveness on employment outcomes of behavioral, psychological,\neducational, or vocational interventions or component of an intervention for cancer\nsurvivors","The evidence suggests that employment interventions for cancer survivors may help them to maintain employment","Adults aged 18 or older who had a past or present cancer diagnosis which occurred whilst they were aged 18 or older. Particpants with an employment history and those without were included","Not clearly specified","Employment initiation, return-to-work, or decreasing absenteeism and use of work disability or sick leave","Included 12 studies evaluating the effects of psychosocially-related interventions on the employment of cancer survivors (n = 2151). The results suggest that the included interventions may improve employment status (OR = 1.71, 95% confidence interval (CI) 1.26 to 2.32) for cancer survivors. For RCTs (n = 6), the weighted mean effect size for employment status was OR = 1.44 (95% CI 0.99 to 2.09), favouring the intervention groups. The mean odds ratio of 1.44 translates to an employment rate of about 68% for intervention participants compared to a baseline 60% for comparison group participants. For QEDs (n = 6), the weighted mean effect size for employment status was OR = 2.18 95% CI 1.32 to 3.60), also favoring the intervention groups. The mean odds ratio of 2.18 for the quasi-experimental studies translates to an employment rate of about 77% for intervention participants, compared to the baseline rate of 60% for the comparison group participants. Although the mean effect size from QEDs was larger than that from the RCTs, there is no significant difference between the two types of experimental designs (p = 0.19).\n\nThere was no evidence of an effect on the number of hours worked (OR = 0.89, 95% CI 0.22 to 1.52) or number of sick leave days (OR = 1.18, 95% CI 0.81 to 1.71). Overall, the assessment of the risk of bias was high, and conclusions about the effectiveness of the included interventions should be interpreted with caution.","This review highlights the positive effect psychosocial interventions may have on\nemployment outcomes for cancer survivors. However, the methodological\nshortcomings of the included studies overall makes it likely that there is bias in the results and too few studies to provide sufficiently strong evidence to recommend particular practices. This review brings attention to the need for additional rigorous studies in this area, in particular, randomised controlled trials with more detailed reporting of data and study design and methodology."]
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[null,null,null,null,null,null,"RHAGLENNI RHEOLI ANABLEDD YN Y GWEITHLE"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Gensby U, Lund T, Kowalski K, Saidj M, Jørgensen AMK, Filges T, Irvin E, Amick BC III, Labriola M. Workplace Disability Management Programs Promoting Return-to-Work: A Systematic Review. Campbell Systematic Reviews 2012:17\nDOI: 10.4073/csr.2012.17. Available here","This review focused on workplace disability management (WPDM) programmes that were:\n• Characterised as an ‘onsite’ WPDM or RTW programme\n• Provided by the employer or initiated by the employer in collaboration with key players in the workplace\n• Addressed the duration or extent of an inability to work due to physical injury or mental illness\n• Implemented within the workplace setting","Evidence is lacking so it is not possible to tell whether workplace disability management programmes support people to maintain employment","Employees (from the public or private sector) on sick-leave with an inability to work due to physical injury, illness or mental health disorders","The objective of this review was to assess the effectiveness of Workplace Disability Management Programmes (WPDM) promoting RTW \n• Compare WPDM programmes to no treatment, treatment as usual or alternative intervention\n• Examine components of WPDM programmes which appear more highly related to positive outcome\n","Primary\n• Return to work \n• Duration of sickness absence \n• Reduction in lost days from work \n\nSecondary\n• The functional health consequences \n• Return to fulltime or part-time work (yes/no)\n• Whether RTW was completed at the current employer\nSustainability of return to work:\n• Relapse to sickness absence in the follow-up period ","Thirteen studies (two non-randomized studies (NRS) and eleven single group ‘before and after’ studies (B & A), including data from eleven different WPDM programmes, met the inclusion criteria. There were insufficient data on the characteristics of the sample and the effect sizes were uncertain. However, narrative descriptions of the included programme characteristics were rich, and provide valuable insights into programme scope, components, procedures and human resources involved.\n\nThere is a lack of evidence to draw unambiguous conclusions on the effectiveness of employer provided WPDM programmes promoting RTW. It was not possible to determine if specific program components or specific sets of components are driving effectiveness.\n\nThe review adds to the existing knowledge base on WPDM programme development, characteristics and evaluation. At an organisational level intervention, employer provided WPDM programmes are multi-component constructs, offering a suite of policies and practices for injured or ill employees. The review identified 15 constituent programme components, covering individual, organisational, and system level policies and practices, depicting key human resources involved in workplace program procedures and administration.\n\nFuture programme evaluations ought to broaden their focus beyond the first phases of the RTW process and incorporate sustainable outcomes (e.g. job retention, satisfactory and productive job performance, work role functioning, and maintenance of job function).\n\nGiven the lack of WPDM programmes evaluated in peer-reviewed publications, more attention needs to be given to locate and rigorously evaluate efforts from company studies that may still exist outside the peer reviewed published literature.\n\nWhile many employers recognize the importance of WPDM and are adopting policies and practices to promote RTW, judging from this review, the existing evidence leaves room for more rigorous methodological studies to develop the present WPDM knowledge base. Prospectively,WPDM evaluation research also needs to enlarge its perspective and refine its analytic tools to examine information that is meaningful and cost effective to those who will benefit from it, to further advance the field.","The review findings might help explicate WPDM programmes and their potential impact on RTW outcomes, and provide a more complete understanding of the research in the field of WPDM. This may inspire researchers, employers, and policy makers, who are interested not only in questions regarding the impact of programmes, but also their nature, to promote future design and evaluation of DM in organisations."]
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[null,null,null,null,null,null,"CLEFYD CORONAIDD Y GALON"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Hegewald J, Wegewitz UE, Euler U, van Dijk JL, Adams J, Fishta A, Heinrich P, Seidler A. Interventions to support return to work for people with coronary heart disease. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD010748.\nDOI: 10.1002/14651858.CD010748.pub2. Available here","Interventions  that aim to support the return-to-work process with individual or group approaches.\n1. Work-directed interventions: these can include changes in the work environment, work tasks or working methods\n2. Person-directed interventions:\ni) psychological interventions \nii) physical conditioning interventions\n3. Any combination of the above","The evidence suggests that psychological interventions (including health education) may not be effective for keeping people with coronary heart disease in employment\n\nThe evidence suggests that physical conditioning and combined interventions for people with coronary heart disease may have no effect on the proportion of participants working after one year.","Adults (18 years or older) who had been diagnosed with CHD, who experienced a MI, or a coronary revascularisation procedure like CABG or PCI, as well as people with angina pectoris or angiographically-defined CHD. Within each study, at least 80% of participants had to fulfil these criteria.\nParticipants should also have been employed (either in paid employment\nor self-employed) at the time of diagnosis and on sick leave or otherwise not working at the time of the study because of the CHD ","Review objective was to assess the effects of person- and work-directed interventions aimed at enhancing return to work in patients with coronary heart disease compared to usual care or no intervention","Primary\nReturn to work, including return to\neither full- or part-time employment, to the previous job, and to the same role or with changes in work status (change of duties,\nworking location, function). Return to work included number of days on sick leave during the follow-up period\n\nSecondary\n• Health-related quality of life within the return-to-work process, either measured with generic instruments or with disease-specific instruments\n• Number of participants who returned to work and were still working after an extended period of at least one year\n• Number of participants who were still working after five years ","Included 39 RCTs (including one cluster- and four three-armed RCTs). Reviewers included the return-to-work results of 34 studies in the meta-analyses.\n\nPerson-directed, psychological counselling versus usual care\nIncluded 11 studies considering return to work following psychological interventions among a subgroup of 615 participants in the meta-analysis. Most interventions used some form of counselling to address participants’ disease-related anxieties and provided information on the causes and course of CHD to dispel misconceptions. Cannot tell whether these interventions increase return to work up to six months (risk ratio (RR) 1.08, 95% confidence interval (CI) 0.84 to 1.40; six studies; very low-certainty evidence) or at six to 12 months (RR 1.24, 95% CI 0.95 to 1.63; seven studies; very low-certainty evidence). Cannot tell whether psychological interventions shorten the time until return to work. Psychological interventions may have little or no effect on the proportion of participants working between one and five years (RR 1.09, 95% CI 0.88 to 1.34; three studies; low-certainty evidence).\n\nPerson-directed, work-directed counselling versus usual care\nFour studies examined work-directed counselling. These counselling interventions included advising patients when to return to work based on treadmill testing or extended counselling to include co-workers’ fears and misconceptions regarding CHD. Work-directed counselling may result in little to no difference in the mean difference (MD) in days until return to work (MD −7.52 days, 95% CI −20.07 to 5.03 days; four studies; low-certainty evidence). Work-directed counselling probably results in little to no difference in cardiac deaths (RR 1.00, 95% CI 0.19 to 5.39; two studies; moderate-certainty evidence).\n\nPerson-directed, physical conditioning interventions versus usual care\nNine studies examined the impact of exercise programmes. Compared to usual care, cannot tell if physical interventions increase return to work up to six months (RR 1.17, 95% CI 0.97 to 1.41; four studies; very low-certainty evidence). Physical conditioning interventions may result in little to no difference in return-to-work rates at six to 12 months (RR 1.09, 95% CI 0.99 to 1.20; five studies; low-certainty evidence), and may also result in little to no difference on the rates of patients working after one year (RR 1.04, 95% CI 0.82 to 1.30; two studies; low-certainty evidence). Physical conditioning interventions may result in little to no difference in the time needed to return to work (MD −7.86 days, 95% CI −29.46 to 13.74 days; four studies; low-certainty evidence). Physical conditioning interventions probably do not increase cardiac death rates (RR 1.00, 95%CI 0.35 to 2.80; two studies; moderate-certainty evidence).\n\nPerson-directed, combined interventions versus usual care\nIncluded 13 studies considering return to work following combined interventions in the meta-analysis. Combined cardiac rehabilitation programmes may have increased return to work up to six months (RR 1.56, 95% CI 1.23 to 1.98; number needed to treat for an additional beneficial outcome (NNTB) 5; four studies; low-certainty evidence), and may have little to no difference on return to- work rates at six to 12 months’ follow-up (RR 1.06, 95% CI 1.00 to 1.13; 10 studies; low-certainty evidence). Cannot tell if combined interventions increased the proportions of participants working between one and five years (RR 1.14, 95% CI 0.96 to 1.37; six studies; very low-certainty evidence) or at five years (RR 1.09, 95% CI 0.86 to 1.38; four studies; very low-certainty evidence). Combined interventions probably shortened the time needed until return to work (MD −40.77, 95% CI −67.19 to −14.35; two studies; moderate-certainty evidence). Combining interventions probably results in little to no difference in reinfarctions (RR 0.56, 95% CI 0.23 to 1.40; three studies; moderate-certainty evidence).\n\nWork-directed, interventions\nNo studies exclusively examining strictly work-directed interventions at the workplace were found","Combined interventions may increase return to work up to six months and probably reduce the time away from work. Otherwise, no evidence was found of either a beneficial or harmful effect of person-directed interventions. The certainty of the evidence for the various interventions and outcomes ranged from very low to moderate. Return to work was typically a secondary outcome of the studies, and as such, the results pertaining to return to work were often poorly reported. Adhering to RCT reporting guidelines could greatly improve the evidence of future research. A research gap exists regarding controlled trials of work-directed interventions, health-related quality of life within the return-to-work process, and adverse effects."]
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[null,null,null,null,null,null,"ARTHRITIS LLIDIOL"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Hoving JL, Lacaille D, Urquhart DM, Hannu TJ, Sluiter JK, Frings-Dresen MHW. Non-pharmacological interventions for preventing job loss in workers with inflammatory arthritis. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD010208. DOI: 10.1002/14651858.CD010208.pub2. Available here","Included intervention where the focus was on job loss prevention or improving work function. Interventions that fulfilled at least two of the following components:\n• An evaluation of the work challenges or work adaptations as a step in the main intervention of the study\n• Interventions directed at the person, meaning job coaching, job or vocational training, vocational\ncounselling; or empowerment for work; or self-management, including support or information regarding work or both\n• Interventions directed at the work environment, meaning work adaptations, ergonomic measures, job accommodations; or interventions targeted directly at the employer, supervisor\nor co-workers","Evidence is lacking so it is not possible to tell whether non-pharmacological interventions for people with inflammatory arthritis reduce job loss","Included trials in which the population was limited to adults of working age (18 to 65 years) of which at least half of all workers\n(>50%) had been diagnosed with inflammatory arthritis (IA), including rheumatoid arthritis (RA), ankylosing spondylitis (AS),  psoriatic arthritis (PsA) or\nundifferentiated spondyloarthritis (SpA), or IA associated with connective tissue diseases such as Systemic Lupus Erythematosus (SLE)","The review objective was to assess the effects of non-pharmacological interventions that aim to prevent job loss, work absenteeism or improve work functioning for employees with IA","Primary outcomes\n• Job loss measured as: the number of people that become unemployed at some stage following diagnosis, regardless of disability pension status; or the time to job loss\n• Sickness absenteeism measured as: time lost from work (number of work days or hours missed at work due to sick leave, or absenteeism); or time to return to work; or the proportion of workers on sick leave at a certain moment of follow-up\n\nSecondary outcomes\nWork functioning measured using any at-work productivity, work functioning or presenteeism questionnaire","Included three RCTs with a total of 414 participants at risk of job loss. The majority of participants had IA, most with RA and to a lesser degree AS. The interventions aimed to prevent job loss and improve work functioning in several ways: firstly by evaluating work changes or adaptations and secondly by providing any person-directed interventions including vocational counselling, advice or education. Interventions directly targeted at the work environment were minimal and included workplace visits (one trial) or any actions by an occupational physician (one trial). The duration or dose of the interventions varied from two 1.5-hour sessions (one RCT) over five months, two consultation and multidisciplinary treatments during three months (one RCT), to six to eight individual or group sessions over six months (also one RCT). All participants were recruited through rheumatology clinics, both in or outside hospitals. Included trials investigated job loss (n = two RCTs; 382 participants), work absenteeism and work functioning (n = one RCT; 32 participants). The two smaller trials were assessed as having a high risk of bias and the large trial as having a low risk of bias. Trials showed marked differences in how they performed on risk of bias items, particularly on performance bias.\n\nUsing the GRADE there was judged to be to be very low quality evidence across the three reported outcomes. Of the two RCTs investigating job loss, the larger one (n = 242 participants) reported a large statistically significant reduction in job loss (relative risk (RR) = 0.35, 95% confidence interval (CI) 0.18 to 0.68) and the other RCT (n = 140) reported similar effects in both groups, although the CI was very wide (RR = 1.05, 95% CI 0.53 to 2.06). The latter one probably suffered from performance bias and we judged it to have a high risk of bias. The one small trial investigating sickness absenteeism found uncertain results at six months’ follow-up (MD = -2.42 days, 95% CI -5.03 to 0.19). Finally, in the same small trial investigating work functioning using the Rheumatoid Arthritis-Work Instability Scale (RA-WIS), there was a moderate improvement of intermediate term work functioning (six months; scale range 0 to 23; mean improvement -4.67 points, 95% CI -8.43 to -0.91). No adverse effects were identified in the publications of the three trials.","This Cochrane review of three RCTs found very low quality evidence overall for job loss prevention interventions having an effect on job loss, work absenteeism and work functioning in workers with inflammatory arthritis. While this review highlights that further high quality RCTs are required, the results suggest that these strategies have potential to be effective."]
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[null,null,null,null,null,null,"SGLEROSIS YMLEDOL"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Khan F, Ng L, Turner-Stokes L. Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis.\nCochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007256.\nDOI: 10.1002/14651858.CD007256.pub2. Available here","All categories of  vocational rehabilitation (VR) programmes which incorporate a clearly defined vocational rehabilitation or work therapy element. These included\nstructured multi-disciplinary / multi-agency interventions to preserve employment such as clinic or community based counselling, planning for disclosure and accommodation, and work place accommodations.\nAll three types of VR programmes were included, such as those offered by ‘general rehabilitation programmes’, ‘MS\nspecialised VR programmes’ and ‘pan -disability VR programmes’ ","Evidence is lacking so it is not possible to tell whether vocational rehabilitation programmes for people with multiple sclerosis helps them to maintain employment","Trials were included if the study population was working age (i.e. mean age between 18-65 years) and had the diagnosis of MS (sub types of MS were included-relapsing remitting, secondary progressive and primary progressive MS), irrespective of MS severity","The primary objective of this review is to evaluate the effectiveness of vocational rehabilitation (VR) programmes compared to alternative programmes or care as usual on return to work, employment and work ability in persons with multiple sclerosis. A secondary objective was to evaluate the cost effectiveness of these VR programmes","Primary outcomes\n• The change in proportion of pwMS in competitive employment (full time or part time employment position held by a person in an ordinary work setting, for which they were receiving payment at the market rate \n• The change in proportions of persons in supported employment (employment in an ’open work’ setting but with ongoing support such as government funded programmes)\nSecondary outcomes\n• The rate of return to work in days of pwMS\n• The change in proportion of pwMS on disability pension\n• The improvement of work ability in pwMS (such as the proportion of persons with MS who are engaged in attending a sheltered workshop and earn a modest living)\n• Costs of programmes and cost effectiveness of return to work or employment","Two trials (one RCT and one CCT) (total 80 participants) met the review criteria. Both trials scored poorly on the methodological quality assessment. There was insufficient evidence for VR programmes for (a)competitive employment, in altering rates of job retention, changes in employment, improvement in rates of re-entry into the labour force; (b) for altering work ability by improving participants’ confidence in the accommodation request process, or employability maturity or job seeking activity. No evidence could be assimilated for changes in proportions of persons in supported employment or on disability pensions, nor for cost-effectiveness.","There was inconclusive evidence to support VR for pwMS. However, the review highlights some of the challenges in providing VR for pwMS. Clinicians need to be aware of vocational issues, and to understand and manage barriers for maintaining employment. Proactive and timely VR programmes should incorporate practical solutions to deal with work disability, workplace accommodation and educate employers, and the wider community. Liaison with policy makers is imperative for government initiatives that encourage work focused VR programmes. Future research in VR should focus on improving methodological and scientific rigour of clinical trials; on the development of appropriate and valid outcome measures; and on cost effectiveness of VR programmes"]
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[null,null,null,null,null,null,"ANHWYLDERAU AR Y SBECTRWM AWTISTIG "]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Westbrook J, Nye C, Fong C, Wan J, Cortopassi T, Martin F. Adult employment assistance for persons with autism spectrum disorders: Effects on employment outcomes. Campbell Systematic Reviews 2012:5 DOI: 10.4073/csr.2012.5. Available here","Interventions to assist in gaining competitive, supported, or integrated employment","Evidence is lacking so it is not possible to tell whether employment assistance is effective in helping adults with autistic spectrum disorder maintain employment","Adults 18 years or older with a diagnosis of ASD, who were no longer enrolled in a school-to-work programme or secondary-level education programme","To determine the effectiveness of adult employment assistance in securing and maintaining employment for adults (18 years and older) with autism spectrum disorders (ASD)","Attainment and duration and/or retention gainful employment. Gainful employment included competitive, integrated, or supported employment. Sheltered work or non-integrated work was not considered as an outcome measure for this review","This review was not able to identify definitive interventions that predictably and positively supported the development of employment outcomes for individuals with ASD.\n\nThere were two included studies. One described outcomes directly related to employment by comparing an experimental group (n = 30) who received guidance from a support worker in the form of job finding, work preparation, and communication with the employers with a control group (n = 20) that did not receive any support. At the end of the two-year study period, the authors found that the experimental group demonstrated significantly higher rates of having found paid employment (d = 1.067, 95% CI = 0.123 to 2.010), significantly longer periods of working time (d = 0.684, 95% CI = 0.111 to 1.257), and significantly higher wages (d = 1.177, 95% CI = 0.169 to 0.819). The experimental group also worked more hours per work week (d = 0.328, 95% CI = -0.628 to 1.284), but this effect was not significant.\n\nThe second included study described differential effects of supported employment and sheltered employment for persons with autism. The experimental group received supported employment, i.e., jobs working between 15 and 30 hours per week in their communities and received job coach support services. The control group received sheltered employment, i.e. jobs that were not in their communities and with no job coaching services. Using measures of the Childhood Autism Rating Scale (CARS), the supported employment group was not significantly different from the sheltered employment group after treatment (d = -0.229, 95% CI = -0.764 to 0.306). The study did not report any differences in employment acquisition or maintenance between the two groups.\n\nIn an analysis of risk bias of the included studies, it was found that there was a high level of substantial potential for bias across three of the five sources of bias analysed including unit of assignment, unit of analysis, attrition, fidelity of implementation, and blinding. The methodological quality of both included studies was low. Therefore, these review results should not be interpreted as indicating definitive results related to the development of employment outcomes for persons with ASD.","Qualitative and other relevant research studies connected to the employment of persons with ASD were also reviewed and suggest that the following may be elements of successful employment placement for persons with ASD: (1) identification of the most appropriate work settings and placements, (2) provision of effective supports on the job, (3) need for long-term support services for the employer and the consumer, (4) costs for support, and (5) positive effects of employment on persons with ASD. While qualitative studies point to a number of promising issues for future research, they do not provide a definitive statement about what works.\n\nIn addition, the authors noted that costs for community-based employment interventions such as those included in this review are more expensive than other employment alternatives such as sheltered non-integrated workshops. However, the review authors were aware of other studies showing that supported employment service interventions, such as those identified in their included studies, are becoming less expensive to deliver. It seems important to note that community-based integrated employment interventions, while expensive, do expand options for mainstream social integration, competitive wages, and community involvement."]
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[null,null,null,null,null,null,"GWEITHWYR HŶN"]
[null,null,null,null,null,null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,null,null,null,null,null,"Cox A et al. Factors facilitating or constraining interventions to protect and promote health of older workers and to help plan and prepare for retirement.   Brighton. Institute for Employment Studies. 2015. Available here","Interventions to enhance the well-being of older workers and support them in continuing to work beyond state pensionable age","Evidence is lacking so it is not possible to tell whether interventions support older workers to remain in employment","All adults aged at least 50 in full or part-time employment, both paid and unpaid, self-employed people working in micro, small, medium and large organisations with an appointed line manager, and volunteers\n\nAll employers in the public, private and ‘not for profit’ sectors who employ at least one employee","What factors facilitate or constrain workplaces to enhance the well-being of older workers, to support them in continuing to work up to and beyond state pensionable age and affect the quality and outcomes of pre-retirement planning?","Organisation: employee health and well-being and engagement; levels of employee recruitment and retention for the relevant age group; days lost to sickness absence  health related behaviours/diseases\nEmployee: individual levels of health and well-being","Flexible impacts for older workers: There is moderate evidence from five studies, that offering flexible working to older employees is associated with positive attitudinal outcomes, and in one study reportedly affects staff retention. The studies are mostly directly applicable to the UK.\n\nManagement initiatives: training and rewards: There is weak evidence from one qualitative study that providing training and small informal rewards positively influences older workers intention to stay with the current employer. The findings are partially applicable to the UK.\n\nGradual retirement: There is weak and mixed evidence on the benefits of gradual retirement from one study. The evidence is partially applicable to the UK\n\n","The limitations of the evidence base reviewed here reflect wider challenges also associated with earlier reviews on this topic concerning the effectiveness and cost-effectiveness of interventions to promote and support the health and well-being of older workers and in the area of pre-retirement planning and training. There is a dearth of evidence on the outcomes and impact of management-initiated interventions in this field, and the overall quality of research in this area was both disappointing and surprising, consistent with the evidence of large scale literature reviews on related topics.\n\nDespite some prominent examples of reportedly good practice in managing older workers available via case studies in grey literature and the trade press, little documented process or impact evaluation was located, and many of the studies on employer practices included in this review are up to a decade old. Since then, both the labour market context and the employment policy context has changed significantly, and indeed recession and consequent more abundant labour supply for some occupations may have reduced employer need and appetite to consider the management of older employees. Moreover, the studies from an employer perspective considered for this review may reflect a degree of employer passivity in taking action in this area, albeit with evidence of emerging awareness of the need to manage older workers and to consider the impact of the abolition of the default retirement age. For some employers this appears to be coupled with a degree of ignorance in the growth and potential issues presented by an ageing workforce and a ‘mainstreaming’ approach to the management of diversity. This is of concern on at least two grounds. First, the abolition of the default retirement age in 2011 means that employers will have to start considering how to manage workers whose transition to retirement can no longer be assumed. Second, government reforms to increase the age at which people are eligible for the state pension will lead to those lacking adequate alternative pension provision in particular seeking to remain in work for longer.\n\nThere are also clear methodological considerations arising from this review for research in this field. There is an urgent need for research which uses mixed methods and deploys both employer and worker perspectives to examine employer practices with regard to recruitment, retirement planning and transitions. Those commissioning, designing and undertaking research also need to confront the challenge that to examine long-term impacts of working in later life, it will be essential to conduct longitudinal studies. This review urges research commissioners to prioritise funding of high quality studies into the impact of workplace level interventions on health and well-being outcomes which will seek to track the health and well-being of individuals during the lifespan of the intervention and onwards beyond the end of their working lives."]

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[null,"CADW POBL MEWN GWAITH"]
[null,"RHEOLI ABSENOLDEB SALWCH"]
[null,"GENERIC INTERVENTIONS"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"National Institute for Health and Care Excellence. Workplace health: long-term sickness absence and capability to work. [A] Evidence review for reducing recurrent short-term sickness absence. London, NICE. 2019. Available here\n\n\n\n","Interventions to reduce recurrent short term sickness absence","Evidence is lacking and it is not possible to tell whether interventions to reduce short term sickness absence are effective","Adult employess aged 16 years or over, full or part time, paid or unpaid who have experienced four or more episodes of short term sickness absence in a 12 month period (each episode lasting less than four weeks) or are currently absent from work for less than four weeks because of sickness (with a minimum study follow up of 12 months to enabale patterns of recurrent absence to be identified)\n\nOrganisational level -  all employers in the public, private and not-for-profit sectors","What interventions, programmes, policies or strategies are effective and cost-effective in preventing or reducing recurrence of short-term sickness absence among employees?\n\nAre the interventions, programmes, policies or strategies acceptable to employees, employers and other key stakeholders, and what are the barriers and facilitators to their successful delivery?","Primary\n• Short-term sickness absence, as measured and reported by the authors \nSecondary \n• Health-related quality of life - using validated patient-report measures, for example EQ-5D \n• Psychological and/or social functioning - using any patient-report measure \n• Adverse / unintended effects: - Self-reported presenteeism or work performance (individual-level studies); - Job satisfaction (individual or organisational-level) - Rate of staff turnover (organisational-level studies) - Number of grievances (organisational-level studies)\n\nQualitative studies (second question) Participant views on: \n• Intervention acceptability (including preferences for content, frequency, location, etc.) \n• Barriers and facilitators to successful intervention delivery","There were two studies included, a cluster RCT and an RCT. These were not pooled by outcome into a meta-analysis, they included different interventions and had reported outcomes in different ways. The short-term sickness absence data from one of the studies have been presented in a forest plot to enable discussion. Evidence statements have been presented on an individual study basis.\n\nShort-term sickness absence rate over 29 weeks\nThere was low quality evidence from one cluster RCT, conducted in Denmark with a total of 3,039 employees of 78 pre-school organisations with relatively high rates of short-term sickness absence of 14 or more days per episode. The intervention consisted of focusing on the core task at work, based on the theory that illegitimate tasks (those regarded by employees as unreasonable or unnecessary) lead to higher levels of stress, poor self-esteem and employee resentment, resulting in higher rates of short-term sickness absence. No difference was found in the rates of short term sickness absence over 29 months follow-up, compared with pre-schools with no intervention (8.7 vs. 9.2 STSA days per person-year; RR: 0.93; 95%CI 0.86 to 1.01), the proportion returning to work within 3 months (61% vs. 80%; RR 0.76; 95%CI 0.49 to 1.49). However, when adjusted for age, sex, type of workplace, workplace size, a reduction was found in the workplace average level of short-term sickness absence in the previous 12 months; RR 0.89 (95%CI 0.83 to 0.95). \n\nProportion with frequent short-term sickness absence at 12 month follow-up\nThere was low quality evidence from one RCT, conducted in the Netherlands, with a total of 82 employees at 21 different organisations with a history of frequent sickness absence (three or more episodes in the past 12 months). The intervention consisted of access to e-health advice and support, with or without an additional preventive consultation with an occupational physician. No difference was found in the reduced frequency and duration of sickness absence, or in the number of sickness absence episodes, or in the total duration of all sickness absence in days.","Due to the lack of evidence relating to recurrent short-term sickness absence the overall recommendations relating to return to work would be applicable for this group. Following the completion of the evidence reviews for review questions B and C it was discussed and agreed by the committee that in practice the interventions that may be effective in supporting return to work after long-term absence may also help with recurrent short-term absences and to prevent the movement from short to long-term absence. \nRecommendations were therefore not made that distinguished between the types of absence. Though the committee did also note that evidence specifically relating to short term sickness absence, in a UK context, could contribute substantially to supporting those who have recurrent sickness absence in employment and so developed a research recommendation in this area."]
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[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"National Institute for Health and Care Excellence. Workplace health: long-term sickness absence and capability to work. [B] Evidence review for reducing movement from short-term to long-term sickness absence. London, NICE. 2019. Available here\n\n\n","To reduce movement from short to long term sickness absence","Evidence is lacking and it is not possible to tell whether interventions reduce movement from short to long term sickness absence","Individual level \n• Adult employees (≥16 years, full- or part-time, paid or unpaid) who are currently absent from work for less than 4 consecutive weeks due to sickness. \n\nOrganisation level \n• All employers in the public, private and ‘not-for-profit’ sectors","What interventions, programmes, policies or strategies are effective and cost effective in reducing the number of employees who move from short- to long-term sickness absence?\n\nAre the interventions, programmes, policies or strategies acceptable to employees,  employers and other key stakeholders, and what are the barriers and facilitators to their  successful delivery?","Primary  \n• Return to work. Measured as any of: -     \n      -Proportion returning to work within four weeks of start of absence\n      -Time taken to return to work\nor\n• Sickness absence, as reported by the authors, including:\n      - Proportion with any long-term sickness absence (≥4 consecutive weeks duration)\n     - Total number of sickness absence days\n\nSecondary\n• Health-related quality of life - using validated patient-report measures, for example EQ-5D\n • Psychological and/or social functioning - using any patient-report measure \n• Adverse / unintended effects:\n     - Self-reported 'presenteeism' or work performance (individual-level studies) \n    - Job satisfaction (individual or organisational-level)\n    - Rate of staff turnover (organisational-level studies)\n    - Number of grievances (organisational-level studies)\n\nQualitative studies (second question) Participant views on: \n• Sickness absence recurrence following RTW (individual-level studies) \n• Intervention acceptability (including preferences for content, frequency, location, etc.) \n• Barriers and facilitators to successful intervention delivery","There were six studies included for these review questions. Three RCT studies, two non-randomised control studies and one observational study with no control group. It was not considered reasonable to pool the studies by outcome into a meta-analysis. The studies included very different interventions and had reported outcomes in different ways.\n\nEarly multidisciplinary assesssment: There is low quality evidence from 1 RCT conducted in Sweden, in a total of 33 patients with musculoskeletal or mental health disorders. The intervention consisted of early multidisciplinary assessment in the primary care centre compared with usual GP care. No difference was found in the proportion returning to work within 3 months (61% vs. 80%; RR 0.76; 95%CI 0.49 to 1.49), the proportion returning to work within 12 months (78% vs. 93%; RR 0.83; 95%CI 0.63 to 1.10), or in the total number of sickness absence (full) days over 12 months (MD: 40.0; 95%CI -19.33 to 99.33).\n\nStress counselling and case management: There was very low quality evidence from 1 non-randomised controlled study, conducted in Denmark with a total of 161 patients with emotional distress. The intervention consisted of an outpatient stress counselling and case management compared to usual care. This found a reduction in the proportion of patients returning to the labour market within 4 weeks (7% vs. 19%; RR 0.36; 95%CI 0.14 to 0.94). No difference was found in the proportion returning to the labour market by 3 months (28% vs. 43%; RR 0.65; 95%CI 0.42 to 1.01), or by 12 months (75% vs. 76%; RR 0.98; 95%CI 0.82 to 1.17). Nor was there any difference in those not resuming labour market activity in over 68 weeks (unadjusted HR 0.84; 95%CI 0.60 to 1.18).\n\nOccupational health programme: There was very low quality evidence from 1 case series, conducted in the USA with a total of 190 people with work-related injury events. The intervention consisted of before and after implementation of an internal occupational health programme with early access to treatment or workplace rehabilitation, compared with usual care. This found an increase post-intervention, in the proportion returning to work within 4 weeks (55% vs. 36%; RR 1.54; 95%CI 1.06 to 2.23) and a reduction in the total number of lost work days per injury event (44.6 lost work days from 128 injuries) compared with before the intervention (100.3 lost work days from 62 injuries; MD -55.7; 95%CI -87.8 to -23.8).\n\nParticipatory workplace intervention: There was low quality evidence from 1 RCT conducted in the Netherlands, with a total of 145 employees with emotional distress. The intervention consisted of early access to treatment or workplace rehabilitation, compared with usual care and usual occupational physician care. No difference was found in the proportion returning to work by 12 months (90% vs. 92%; RR 0.99; 95%CI: 0.89 to 1.09), or time to return to work over 12 months (unadjusted HR: 0.99; 95%CI: 0.70 to 1.40). Nor was any difference found in total sickness absence over 12 months (MD -0.1; 95%CI -36.24 to 36.04), or in the proportion of those with one or more recurrence episodes of sickness (8% vs. 8%; RR 0.99; 95%CI 0.33 to 2.92).\n\nEarly part time sick leave: There was moderate quality evidence from 1 RCT conducted in Finland, with a total of 62 employees with musculoskeletal disorders. The intervention consisted of early part time sick leave compared to usual full-time sick leave. This found a difference in self-reported health-related quality of life over 12 weeks (MD: -0.60; 95%CI -0.91 to -0.29). No difference was found in the proportion returning to work by 4 weeks (12% vs. 64%; RR 1.10; 95%CI 0.78 to 1.55), or by 3 months (100% vs. 87%; RR 1.15; 95%CI 0.99 to 1.33). Nor was any difference found in the time to return to the labour market over 12 months (HR adjusted for age:1.60; 95%CI 0.98 to 2.61), or in number of recurrent sick leave episodes per person-year (MD: -2.1; 95%CI -4.54 to 0.44).\n\nEducational intervention delivered to occupational health physicians: There was very low quality evidence from 1 non-randomised controlled study  conducted in Finland, with a total of 30 employees with musculoskeletal pain or depressive symptoms. The intervention consisted of an educational intervention delivered to occupational health physicians and a case management intervention, compared to usual care. No difference was found in the proportion returning to regular work by 4 weeks (42% vs. 72%; RR 0.58; 95%CI 0.28 to 1.19), or by 3 months (84% vs. 83%; RR 1.00; 95%CI 0.72 to 1.39), or by 12 months (92% vs. 100%; RR 0.91; 95%CI 0.74 to 1.12).","Following the completion of the evidence reviews for review questions A and C it was discussed and agreed by the committee that in practice the interventions that may be effective in supporting return to work after long-term absence may also help with recurrent short-term absences and to prevent the movement from short- to long-term absence. Recommendations were therefore not made that distinguished between the types of absence."]
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[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"National Institute for Health and Care Excellence. Workplace health: long-term sickness absence and capability to work. [C] Evidence review for facilitating the return to work of employees on long-term sickness absence and reducing risk of recurrence.  London, NICE. 2019. Available here\n\n","Any interventions, programmes, policies or strategies that aim to increase the return to work of employees who experience an episode of long-term sickness absence (≥4 consecutive weeks) and / or prevent the recurrence of long-term absence Where interventions are not delivered in a workplace or primary care setting, there should be some element of employer or primary care involvement in the design, content, implementation or funding of the intervention.","SHORT TERM OUTCOMES\nThe evidence suggests that individual employee focused interventions for those with musculoskeletal conditions may be effective in supporting return to work in the short term\n\nEvidence is lacking so it is not possible to tell whether individual employee focused interventions for those with musculoskeletal  or mental health problems are effective in reducing days of sickness absence in the short term\n\nThe evidence suggests combined interventions (workplace and individual employee focused) for those with mental health problems may not be effective in increasing return to work in the short term\n\nMEDIUM TERM OUTCOMES\nThe evidence suggests that individual employee focused interventions for people with musculoskeletal conditions may not be effective in increasing the proportion returning to work in the medium term\n\nEvidence is lacking so it is not possible to tell whether individual employee focused interventions  for people with mental health problems increase the proportion returning to work in the medium term\n\nEvidence is lacking so it is not possible to tell whether individual employee focused interventions  for people with musculoskeletal problems reduce days of sickness absence in the medium term \n\nThe evidence suggests that individual employee focused interventions for people with mental health problems may not be effective in reducing days of sickness absence in the medium term\n\nThe evidence suggests that individual employee focused interventions for people with musculoskeletal disorders and people with mental health problems may not be  effective in reducing the time to return to work in the medium term\n\nThe evidence suggests that workplace focussed interventions for people with musculoskeletal conditions may be effective in reducing the time to return to work in the medium term\n\nEvidence is lacking so it is not possible to tell whether workplace focussed interventions for mixed populations reduce time to return to work in the medium term\n\nThe evidence suggests combined interventions (workplace and individual employee focused) for those with musculoskeletal conditions and for those with mental health problems may not be effective in increasing the proportion returning to work in the medium term\n\nThe evidence suggests combined interventions (workplace and individual employee focused) for those with mental health problems may not be effective in reducing the number of days of sickness absence in the medium term\n\nThe evidence suggests combined interventions (workplace and individual employee focused) for those with musculoskeletal conditions and for those with mental health problems may not be effective in reducing the time to return to work in the medium term\n\n\n","Adult employees (≥16 years; full- or part-time; paid or unpaid) who \n• are currently absent from work for 4 or more consecutive weeks due to sickness or \n• have returned to work in the past 6 months after an episode of long-term sickness absence (lasting 4 or more consecutive weeks) \n\nOrganisation level All employers in the public, private and ‘not-for-profit’ sectors","What interventions, programmes, policies or strategies are effective and cost-effective in:\n• Helping employees on long-term sickness absence to return to work?\n• Reducing the recurrence of long-term sickness absence following a return to work?\n\nAre the interventions, programmes, policies or strategies acceptable to employees, employers and other key stakeholders, and what are the barriers and facilitators to their successful delivery?","Primary  \n• Return to work. Measured as any of: -     \n      -Proportion returning to work within four weeks of start of absence\n      -Time taken to return to work\nor\n• Sickness absence, as reported by the authors, including:\n      - Proportion with any long-term sickness absence (≥4 consecutive weeks duration)\n     - Total number of sickness absence days\n\nSecondary\n• Health-related quality of life - using validated patient-report measures, for example EQ-5D\n • Psychological and/or social functioning - using any patient-report measure \n• Adverse / unintended effects:\n     - Self-reported 'presenteeism' or work performance (individual-level studies) \n    - Job satisfaction (individual or organisational-level)\n    - Rate of staff turnover (organisational-level studies)\n    - Number of grievances (organisational-level studies)\n\nQualitative studies (second question) Participant views on: \n• Sickness absence recurrence following RTW (individual-level studies) \n• Intervention acceptability (including preferences for content, frequency, location, etc.) \n• Barriers and facilitators to successful intervention delivery","Individual focused interventions: \nLong term sickness absence due to musculoskeletal conditions \nFull RTW in short-term: Moderate quality evidence from 2 RCTs. Graded activity, and multidisciplinary outpatient treatment with a biopsychosocial focus. Increase in full RTW favouring the intervention compared with controls. Full RTW in medium term: Moderate quality evidence from 4 RCTs. Graded activity, problem-solving therapy, and multidisciplinary outpatient treatment with a biopsychosocial focus. No difference was found in full return to work compared with controls. Sickness absence short-term: Very low quality evidence from 1 RCT. Outpatient CBT-based RTW programme conducted as group sessions. No difference was found in sickness absence over 3 months compared with controls for short and long-term absent groups. Sickness absence over medium term: Low quality evidence from 1 RCT. Group-based problem-solving therapy plus graded activity and group education. A decrease was found in sickness absence over the medium-term favouring the  intervention compared with controls. Time to return to work over the medium term: Very low quality evidence from 3 RCTs. Graded activity / work hardening, and education. No difference in time to RTW compared with controls. Recurrence of sickness absence over medium term: Low quality evidence from 1 RCT. Graded activity and education. No difference was found in the incidence of recurrent sickness absence per person-year compared with controls\n\nLong term sickness absence due to mental health disorders:\nFull RTW in the medium term: Low quality evidence from 1 RCT. Guided e-health RTW intervention, (which included problem-solving, cognitive restructuring, pain and fatigue management), and occupational physician collaborative care. No difference was found in full RTW compared with controls. Sickness absence over short term: Low quality evidence from 1 RCT. Acceptance and commitment therapy. No difference was found in sickness absence over 3 months compared with controls. Sickness absence over medium term: Very low quality evidence from 2 RCTs. Activating and problem-solving intervention delivered by social workers in primary care, a guided e-health RTW intervention (which included problem-solving, cognitive restructuring, pain and fatigue management) and occupational physician collaborative care. No difference was found in sickness absence over 12 months compared with controls. Recurrence of sickness absence - 12 months: Low quality evidence from 1 RCT. (1) a passive awareness-raising intervention to promote GPs use of ‘active sick leave’ (that is, a return to modified duties in the workplace) as an option for sickness certification among employees and (2) a proactive intervention to promote use of active sick leave. No difference was found associated with either intervention in recurrence of sickness absence for back pain over follow-up.\n\nLong term sickness absence due to mental health conditions:\nFull RTW in medium term: Moderate quality evidence from 1 RCT. Return to work intervention (which included basic CBT and graded exposure to the workplace) and a return to work intervention plus CBT. No difference was found in full RTW compared with controls. Sickness absence over short term: Low quality evidence from 1 RCT. Workplace dialogue  intervention to agree a return-to-work plan including any facilitating modifications. No difference was found in the number of sickness absence days compared with controls. Sickness absence over medium term: Moderate quality evidence from 1 RCT. Return to work intervention (which included basic CBT and graded exposure to the workplace) and a return to work intervention plus CBT. No difference was found in the number of days sickness absence days compared with controls.\n\nLong term sickness absence - mixed health conditions\nFull RTW in the medium term: Very low quality evidence from 1 RCT in UK. Addressing issues in the workplace, typically through ergonomic assessment and employer liaison or mediation. Return to full work (lasting ≥13 weeks) 246/545 (45.1%) vs 205/458 (44.7%). Sickness absence over medium term: very low quality evidence from 1 RCT. Minimal awareness-raising postal intervention. No difference was found between the intervention and control groups in number of sickness absence days over 12 months follow-up. Low quality evidence from 1 RCT. 1-day training workshop for GPs in undertaking structured functional assessments with patients on long-term sick leave. No difference was found in total sickness absence days between sick-listed patients consulting GPs during the study period who had received the training, compared with those who consulted control group GPs who were not trained in structured functional assessments. Time to return to work over medium term: Very low quality evidence from 1 RCT. Minimal awareness-raising postal intervention. No difference was found between intervention and control groups in time to RTW over 12 months. Quality of life: Low quality evidence from 1 RCT in the UK. Addressing issues in the workplace, typically through ergonomic assessment and employer  liaison or mediation. At 42 weeks follow-up, no differences were found on any SF36 subscale scores between intervention group and controls. Time to RTW over medium term: Very low quality evidence from 3 RCTs. Stress treatment with gradual work exposure, coping skills plus workplace contact to agree a return to work plan and any facilitating modifications, occupational physician-delivered CBT-based stress inoculation and gradual return to work with facilitating modifications, an occupational physician-delivered activating and problem-solving intervention plus contacts with workplace, and a psychologist-delivered work-focused CBT  for stress, plus the offer of participation in meeting with workplace. No difference was found in time to RTW compared with controls. Low quality evidence from 1 RCT. Psychologist-delivered individual CBT and the offer of attendance by the psychologist at a meeting with employers. No difference was found in time to RTW compared with controls. Time to RTW over long term: Low quality evidence from 1 RCT.  Occupational therapist-delivered work reintegration programme, plus CBT treatment. No difference was found in time to RTW compared with controls. Recurrence of sickness absence: Moderate quality evidence from 1 RCT. Occupational physician-delivered CBT-based stress inoculation and gradual return-to-work with facilitating modifications. No difference was found between intervention and control groups in the mean number of recurrences of sickness absence episodes following return-to-work, nor in the average duration of recurrent absence episodes\n\nLong term sickness absence - mixed health conditions:\nFull RTW over medium term: Very low quality evidence from 1 RCT in UK. Tailored health treatment intervention plus an intervention addressing issues in the workplace, typically through ergonomic assessment and employer liaison or mediation. No difference in RTW. Long term sickness absence: Very low quality evidence from 1 observational before and after study with a control group in the UK. Multidisciplinary case management return to work service for employees on long-term sickness absence, delivered jointly by the Human Resource and Occupational Health services. A reduction was found (from baseline to one year following the implementation of the intervention) in the percentage of 4-week absences continuing beyond 8 weeks, compared  with the control site. However no  difference was found in the overall reduction of mean days lost beyond 4  weeks, for all long-term sickness absence. Full RTW in medium term: Very low quality evidence from 1 RCT in UK. Tailored treatment intervention for health problems. A reduction was found in return to work for at least a 13 week spell of full time work, with health only interventions 255/587  (43.5%) in the intervention group returning versus 205/458 (44.7%) in the control group. Quality of life: Very low quality evidence from 1 RCT conducted in  UK. Tailored  treatment intervention for health problems. At 42 weeks follow-up, differences were found favouring the intervention group in SF36 scores on the  energy/fatigue subscale on the mental health subscale and on general health. No differences were found between the intervention and  control participants on any other SF36 domains.\n\nWork- focused interventions\nLong term sickness absence due to musculo skeletal conditions\nFull RTW short term: Moderate quality evidence from 1 RCT. Multidisciplinary assessment and tailored work rehabilitation coordinated by a caseworker. No difference was found compared with controls. Full RTW medium term: Moderate quality evidence from 1 RCT. Multidisciplinary assessment and tailored work rehabilitation coordinated by a caseworker and early guideline-based occupational physician management of employees. This included identifying barriers to returning to work, implementing adaptions (to work or hours) and advising supervisors. No difference was found in full RTW compared with controls. Low quality evidence from 1 RCT. (1) a passive awareness-raising intervention to promote GPs use of ‘active sick leave’ (that is, a return to modified duties in the workplace) as an option for sickness certification among employees and (2) a proactive intervention to promote use of ‘active sick leave’. No difference was found compared with a ‘no intervention’ control group in full return to work within 12 months, associated with either intervention. Sickness absence medium term: Low quality evidence from 1 RCT, participants absent from work with back pain.(1) a passive awareness-raising intervention to promote GPs use of ‘active sick leave’ (that is, a return to modified duties in the workplace) as an option for sickness certification among employees and (2) a proactive intervention to promote the use of active sick leave. No difference was found at population level associated with either intervention compared with a ‘no intervention’ control group. This applied to total days of absence due to the index condition (back pain), or for any reason over the 12 months follow-up. Time to RTW over medium term: Moderate quality evidence from 2 RCTs. Participatory worksite assessment, and agreement and implementation of a participatory ergonomics intervention or other job modifications. A reduction was found in the time to RTW favouring the intervention compared with controls.\n\nCombined (individual and work-focused interventions): \nLong-term sickness absence due to muculoskeletal conditions:\nFull RTW in the medium-term: Moderate quality evidence from 3 RCTs. Outpatient multidisciplinary rehabilitation with workplace contact and vocational support of a caseworker. No difference was found in full RTW compared with controls. Time to RTW over medium term: Moderate quality evidence from 5 RCTs. Participatory worksite assessment, agreement and implementation of a participatory ergonomics intervention or other job modifications plus graded activity, an outpatient multidisciplinary rehabilitation within a biopsychosocial framework plus workplace contact, and vocational support of caseworker. No difference was found between the intervention and control groups in time to RTW.\n\nLong term sickness absence due to mental health conditions:\nFull RTW over short-term: Low quality evidence from 4 RCTs, 1  UK. Case management with low intensity psychological interventions, a self-help handbook and workplace facilitation, a  multidisciplinary stress treatment with gradual work exposure plus workplace dialogue, a return to work consultation with a psychiatrist plus occupational physician-delivered CBT and workplace modifications, and occupational physician delivered activating and problem-solving intervention, plus contacts with workplace. No difference was found in full RTW compared with controls. Low quality evidence from 1 RCT. Occupational therapist-delivered work reintegration programme plus CBT treatment. RTW in what was reported to be good health between 1-6 months 5/78 (6%) vs 4/39 (10%). Full RTW over medium-term: Very low quality evidence from 3 RCTs. Occupational physician-delivered CBT-based stress inoculation and gradual return to work with facilitating modifications; an occupational physician-delivered activating and problem-solving intervention plus contacts with the workplace; collaborative stepped-care (including problem-solving therapy and guided self-help) plus a workplace dialogue intervention to agree a return-to-work plan coordinated by an occupational physician-care manager. No difference was found in full RTW compared with controls. Low quality evidence from 1 RCT. Occupational therapist-delivered work reintegration programme plus CBT treatment. RTW in what was reported to be good health between 7-12 months 27/78 (34%) vs 9/39 (23%). Sickness absence over short term: Low quality evidence from 1 RCT. Acceptance and  commitment therapy, plus a workplace convergence dialogue intervention to agree a return-to-work plan including any facilitating modifications. No difference was found in the number of sickness absence days compared with controls. Sickness absence over medium term: Moderate quality evidence from 3 RCTs. CBT-based return to work interventions delivered by psychologists (including gradual exposure, psychoeducation, problem-solving and agreement of return to work plans with the employer, plus CBT treatment), a return to work consultation with a psychiatrist plus occupational physician-delivered CBT and workplace modifications, and a collaborative stepped-plus workplace dialogue intervention to agree a return-to-work plan coordinated by an occupational physician care manager. No difference was found in the number of sickness absence days compared with controls.\n\nQualitative evidence not included here. ","Overall the committee discussed that there was greater variation in terms of content, intensity and mode of delivery in the studies involving those with mental health conditions than was observed in the individual-focused RTW interventions evaluated in populations with musculoskeletal conditions. This can be seen in that most mental health studies included in the review consisted of combined interventions. There was a large amount of heterogeneity in terms of both interventions and comparators studied and no significant effects were found on any outcome. The committee discussed the low-quality assessment of most of the included studies, the lack of evidence of effectiveness and the variety in the interventions included. Nonetheless the committee considered it important to provide guidance for returning to work after long-term absence relating to mental health conditions. Specifically, the committee discussed the overall importance of facilitating the most effective return to work for those who have been on long-term sickness absence. They noted that continuing long-term absence from the workplace can have a serious detrimental impact on individuals’ long-term health, financial security and social inclusion.\n\nMental health issues increasingly account for a significant proportion of long-term sickness absence from work. This is reflected by the availability of more new evidence from studies in mental health populations since the original guideline was published in 2009. The committee discussed the lack of any clear evidence of effectiveness of any RTW interventions in these studies. They discussed the possibility that to some degree this could be due to greater heterogeneity both in interventions and comparators than was the case for studies in musculoskeletal populations. Recruitment difficulties are frequently experienced in mental health research. Lack of target numbers of participants combined with wider variability in the outcomes of interest may differentially impact on the precision of effect estimates generated in mental health compared with musculoskeletal studies in this area.\n\nThe committee considered one large UK based study that had considered before and after a joint working initiative between OH and HR departments. This study was of a mixed population of employees of two NHS hospital trusts. It identified a reduction in baseline of 4-week absences but no overall reduction in days beyond 4 weeks for all long-term sickness absence. The committee noted that this UK based observational study was the only non RCT evidence included and that it had additional limitations, such as that there were differences between sites in the workforces, proportions of full and part time employees and rates of long term sickness attributable to mental health disorders. Nonetheless they considered that it provided support for importance of wider management support to enable the facilitation of return to work initiatives and the need to evaluate implemented programmes.\n\nConsidering the low quality of the evidence identified and presented in the evidence reviews and the committee concern that most of the evidence reported on settings that are very different from the UK workplace context, it was agreed to seek further views from UK expert organisations.\n\n"]
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[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"van Vilsteren M, van Oostrom SH, de Vet HCW, Franche RL, Boot CRL, Anema JR. Workplace interventions to prevent work disability in workers on sick leave. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD006955. DOI:\n10.1002/14651858.CD006955.pub3. Available here\n\n\n","Workplace interventions focusing on changes in the workplace or equipment, work design and organisation (including working relationships), working conditions or work environment, and occupational (case) management with active stakeholder involvement of (at least) the worker and the employer","The evidence is inconsistent so it is not possible to tell whether workplace interventions for people on sick leave are effective in reducing sickness absence","Studies in working-age adults (18 to 65 years) who were on sick leave, full-and part-time workers","No question specified, the objective was to determine the effectiveness of workplace interventions in preventing work disability among sick-listed workers, when compared to usual care or clinical interventions","Primary\n• Time until first RTW: a period of absence from work because of sickness both preceded and followed by a period of at least one day at work \n• Time until lasting RTW: a period of absence from the first day of sick leave to full RTW in previous or equal work for at least four weeks without dropping out\n• Cumulative duration of sickness absence: total days of sick leave during the follow-up period (resulting from one or more periods of sickness absence)\n• Recurrences of sickness absence: the number of days until a recurrence; or the frequency and duration of recurrent episodes of sick leave\n\nSecondary\n• functional status\n• quality of life\n• general health\n• depression\n• pain levels\n• direct and indirect costs of work disability","Included 14 RCTs with 1897 workers. Eight studies included workers with musculoskeletal disorders, five workers with mental health problems, and one workers with cancer. Six studies were judged to have low risk of bias for the outcome sickness absence.\n\nWorkplace interventions significantly improved time until first RTW compared to usual care, moderate-quality evidence (hazard ratio (HR) 1.55, 95% confidence interval (CI) 1.20 to 2.01). Workplace interventions did not considerably reduce time to lasting RTW compared to usual care, very low-quality evidence (HR 1.07, 95% CI 0.72 to 1.57). The effect on cumulative duration of sickness absence showed a mean difference of -33.33 (95% CI -49.54 to -17.12), favouring the workplace intervention, high-quality evidence. One study assessed recurrences of sick leave, and favoured usual care, moderate-quality evidence (HR 0.42, 95% CI 0.21 to 0.82). Overall, the effectiveness of workplace interventions on work disability showed varying results.\n\nIn subgroup analyses workplace interventions reduced time to first and lasting RTW among workers with musculoskeletal disorders more than usual care (HR 1.44, 95% CI 1.15 to 1.82 and HR 1.77, 95% CI 1.37 to 2.29, respectively; both moderate quality evidence). In studies of workers with musculoskeletal disorders, pain also improved (standardised mean difference (SMD) - 0.26, 95% CI -0.47 to -0.06), as well as functional status (SMD -0.33, 95% CI -0.58 to -0.08). In studies of workers with mental health problems, there was a significant improvement in time until first RTW (HR 2.64, 95% CI 1.41 to 4.95), but no considerable reduction in lasting RTW (HR 0.79, 95% CI 0.54 to 1.17). One study of workers with cancer did not find a considerable reduction in lasting RTW (HR 0.88, 95% CI 0.53 to 1.47).\n\nIn another subgroup analysis there was no evidence that offering a workplace intervention in combination with a cognitive behavioural intervention (HR 1.93, 95% CI 1.27 to 2.93) is considerably more effective than offering a workplace intervention alone (HR 1.35, 95% CI 1.01 to 1.82, test for subgroup differences P = 0.17).\n\nWorkplace interventions did not considerably reduce time until first RTW compared with a clinical intervention in workers with mental health problems in one study (HR 2.65, 95% CI 1.42 to 4.95, very low-quality evidence).","The review authors found moderate-quality evidence that workplace interventions reduce time to first RTW, high-quality evidence that workplace interventions reduce cumulative duration of sickness absence, very low-quality evidence that workplace interventions reduce time to lasting RTW, and moderate-quality evidence that workplace interventions increase recurrences of sick leave. Overall, the effectiveness of workplace interventions on work disability showed varying results. Workplace interventions reduce time to RTW and improve pain and functional status in workers with musculoskeletal disorders. We found no evidence of a considerable effect of workplace interventions on time to RTW in workers with mental health problems or cancer.\n\nReview authors found moderate-quality evidence to support workplace interventions for workers with musculoskeletal disorders. The quality of the evidence on the effectiveness of workplace interventions for workers with mental health problems and cancer is low, and results do not show an effect of workplace interventions for these workers. Future research should expand the range of health conditions evaluated with high-quality studies."]
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[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Vogel N, Schandelmaier S, Zumbrunn T, Ebrahim S, de Boer WEL, Busse JW, Kunz R. Return-to-work coordination programmes for improving return to work in workers on sick leave. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD011618. DOI:10.1002/14651858.CD011618.pub2.  Available here","Return-to-work coordination programmes. No uniform definition of return to-\nwork coordination programmes exists. Review authors defined such programmes as \n• The objective is to promote return to work\n• The return-to-work coordinator(s) and the affected worker have at least one face-to-face contact\n• The process starts with an assessment of the worker’s needs and leads to an individually tailored return-to-work plan\n• The implementation of the return-to-work plan is managed by the return-to-work coordinator(s)","The evidence suggests that return to work (RTW) coordination programmes may not be effective in reducing time to return to work at 6, 12 and more than 12 months\n\nEvidence is lacking so it is not possible to tell whether RTW coordination programmes reduce cumulative sickness absence days in the short term (6 months) and very long term (beyond 12 months)\n\nThe evidence suggests that RTW coordination programmes may not be effective in reducing cumulative sickness absence at 12 months\n\n","Studies in adults of working age (16 to 65 years) who:\n• were on full- or part-time sick leave continuously for at least four weeks or were receiving long-term disability benefits; and\n• were employed at the time of sick-listing\n\nAt least 80% of the participants in a study had to fulfil both criteria. Studies were included  irrespective of the cause of sick leave or disability, the setting or the benefit scheme (e.g. private or government provider)","Not specified the review objective was to assess the effects of return-to-work coordination programmes versus usual practice for workers on sick leave or disability","Primary\n• Time to return to work\n• Cumulative sickness absence\n• Proportion at work at end of the follow-up\n• Proportion ever returned to work\n\nSecondary\nPhysical, mental, social or overall functioning\n• Pain, depression and anxiety\n• Quality of life\n• Satisfaction of patients, employers, and social insurance organisations","Included 14 studies from nine countries that enrolled 12,568 workers. Eleven studies focused on musculoskeletal problems, two on mental health and one on both. Most studies (11 of 14) followed workers 12 months or longer. Risk of bias was low in 10 and high in 4 studies, but findings were not sensitive to their exclusion.\n\nNo benefits were found for return-to-work coordination programmes on return-to-work outcomes.\n\nFor short-term follow-up of six months, no effect was found on time to return to work (hazard ratio (HR) 1.32, 95% confidence interval (CI) 0.93 to 1.88, low-quality evidence), cumulative sickness absence (mean difference (MD) −16.18 work days per year, 95% CI −32.42 to 0.06, moderate-quality evidence), the proportion of participants at work at end of the follow-up (risk ratio (RR) 1.06, 95% CI 0.86 to 1.30, low-quality evidence) or on the proportion of participants who had ever returned to work, that is, regardless of whether they had remained at work until last follow-up (RR 0.87, 95% CI 0.63 to 1.19, very low-quality evidence).\n\nFor long-term follow-up of 12 months, no effect was found on time to return to work (HR 1.25, 95% CI 0.95 to 1.66, low-quality evidence), cumulative sickness absence (MD −14.84 work days per year, 95% CI −38.56 to 8.88, low-quality evidence), the proportion of participants at work at end of the follow-up (RR 1.06, 95% CI 0.99 to 1.15, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 1.03, 95% CI 0.97 to 1.09, moderate-quality evidence).\n\nFor very long-term follow-up of longer than 12 months, no effect was found on time to return to work (HR 0.93, 95% CI 0.74 to 1.17, low-quality evidence), cumulative sickness absence (MD 7.00 work days per year, 95% CI −15.17 to 29.17, moderate-quality evidence), the proportion of participants at work at end of the follow-up (RR 0.94, 95% CI 0.82 to 1.07, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 0.95, 95% CI 0.88 to 1.02, low-quality evidence).\n\nOnly small benefits were found for return-to-work coordination programmes on patient-reported outcomes. All differences were below the minimal clinically important difference (MID).","Offering return-to-work coordination programmes for workers on sick leave for at least four weeks results in no benefits when compared to usual practice. The review authors found no significant differences for the outcomes time to return to work, cumulative sickness absence, the proportion of participants at work at end of the follow-up or the proportion of participants who had ever returned to work at short-term, long-term or very long-term follow-up. For patient-reported outcomes, they found only marginal effects below the MID. The quality of the evidence ranged from very low to moderate across all outcomes."]
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[null,"RHEOLI ABSENOLDEB SALWCH - YMYRIADAU PENODOL "]
[null,"POEN GWDDF"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Aas RW, Tuntland H, Holte KA, Røe C, Lund T, Marklund S, Moller A. Workplace interventions for neck pain in workers. Cochrane Database of Systematic Reviews 2011, Issue 4. Art. No.: CD008160.\nDOI:10.1002/14651858.CD008160.pub2. Available here","Interventions for neck pain aimed at modifying body function, activity performance, participation, environment or personal factors. Interventions could be single or combination","Evidence is lacking so it is not possible to tell whether interventions reduce sickness absence in people on sick leave because of neck pain","Working age male and female adults (18 to 67 years). Workers at work or absent from work (on sick leave, early retirement or disability pension), but still connected to a workplace by employment agreements (permanent or temporary). All sectors, branches and types of jobs. Workers with reported neck pain of acute (less than six weeks), subacute (six to 12 weeks) or chronic (12 weeks or more) duration were included. Studies were included if at least 50% of the baseline population had neck pain","Objective was to determine the effectiveness of workplace interventions in adult workers with neck pain","Primary\n• Pain severity or pain prevalence (self-reported on a VAS or NSR scale, or measured as the proportion of those with pain)\n• Work absenteeism (time on benefits, number of hours/days on sick leave/lost time, proportion of individuals returning to work, employment status, and shift in employment status to working/part-time working/sick listed, disability pension and early retirement)\n\nSecondary\n• Global improvement (proportion of participants recovered or improved, measured by an overall judgment of improvement or treatment effectiveness)\n• Functional status\n• Well-being / Quality of Life","Included 10 RCTs (2745 workers). Two studies were assessed with low risk of bias. Most trials (n = 8) examined office workers. Few workers were sick-listed. Thus, workplace interventions (WIs) were seldom designed to improve return-to-work. Overall, there was low quality evidence that showed no significant differences between WIs and no intervention for pain prevalence or severity. If present, significant results in favour of WIs were not sustained across follow-up times. There was moderate quality evidence (1 study, 415 workers) that a four-component WI was significantly more effective in reducing sick leave in the intermediate-term (OR 0.56 95% CI 0.33 to 0.95), but not in the short- (OR 0.83  95% CI 0.52 to 1.34) or long-term (OR 1.28  95% CI 0.73 to 2.26). These findings might be because only a small proportion of the workers were sick-listed.","Overall, this review found low quality evidence that neither supported nor refuted the benefits of any specific WI for pain relief and moderate quality evidence that a multiple-component intervention reduced sickness absence in the intermediate-term, which was not sustained over time. Further research is very likely to have an important impact on the review authors confidence in the estimate of effect and is likely to change the estimate. There is an urgent need for high quality RCTs with well designed WIs"]
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[null,"ANHWYLDER ADDASU"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Arends I, Bruinvels DJ, Rebergen DS, Nieuwenhuijsen K, Madan I, Neumeyer-Gromen A, Bültmann U, Verbeek JH. Interventions to facilitate return to work in adults with adjustment disorders.\nCochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD006389.DOI:10.1002/14651858.CD006389.pub2. Available here ","All interventions that aimed at facilitating RTW of workers on sick leave because of adjustment disorders, using individual or group approaches were included. These included pharmacological interventions, psychological interventions, relaxation techniques, exercise programmes, employee assistance programmes and any combination of these","The evidence suggests that problem solving therapies may be effective in reducing time to partial return to work in people with adjustment disorder\n\nThe evidence suggests that CBT may not be effective in reducing time to return to work in people with adjustment disorder","Workers (18 to 65 years of age) with work disability related to an adjustment disorder causing sick leave","The review objective was to assess the effects of interventions facilitating return to work for workers with acute or chronic adjustment disorders ","Primary\nTime until partial return to work (RTW); time until full RTW\n\nSecondary\nSymptoms related to adjustment disorder, work functioning, generic functional status","Included nine studies reporting on 10 psychological interventions and one combined intervention, 1546 participants. \nNo RCTs were found of pharmacological interventions, exercise programmes or employee assistance programmes. \nAssessed seven studies as having low risk of bias and the studies that were pooled together were comparable. \n\nFor those who received no treatment, compared with CBT, the assumed time to partial and full RTW was 88 and 252 days respectively. Based on two studies with a total of 159 participants, moderate-quality evidence showed that CBT had similar results for time (measured in days) until partial RTW compared to no treatment at one-year follow-up (mean difference (MD) -8.78, 95% confidence interval (CI) -23.26 to 5.71). \n\nReview authors found low-quality evidence of similar results for CBT and no treatment on the reduction of days until full RTW at one year follow-up (MD -35.73, 95% CI -113.15 to 41.69) (one study with 105 participants included in the analysis). \n\nBased on moderate quality evidence, problem solving therapy (PST) significantly reduced time until partial RTW at one-year follow-up compared to non guideline based care (MD -17.00, 95% CI -26.48 to -7.52) (one study with 192 participants clustered among 33 treatment providers included in the analysis), but reviewers found moderate-quality evidence of no significant effect on reducing days until full RTW at one-year follow-up (MD -17.73, 95% CI -37.35 to 1.90) (two studies with 342 participants included in the analysis).","The review authors found moderate-quality evidence that CBT did not significantly reduce time until partial RTW and low-quality evidence that it did not significantly reduce time to full RTW compared with no treatment. Moderate-quality evidence showed that PST significantly enhanced partial RTW at one-year follow-up compared to non-guideline based care but did not significantly enhance time to full RTW at one-year follow-up. An important limitation was the small number of studies included in the meta-analyses and the small number of participants, which lowered the power of the analyses."]
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[null,"CANSER"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"de Boer AGEM, Taskila TK, Tamminga SJ, Feuerstein M, Frings-Dresen MHW, Verbeek JH. Interventions to enhance\nreturn-to-work for cancer patients. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD007569. DOI:\n10.1002/14651858.CD007569.pub3.  Available here","Interventions aiming to enhance return to work. Including psycho-educational, vocational, physical, medical or pharmacological, or any combination of these ","The evidence suggests that multidisciplinary physical, psycho-educational and/or vocational interventions may be effective in supporting people with cancer to return to work","Adults (>= 18 years old) who had been diagnosed with cancer (any type) and were in paid employment (employee or self employed) at the time of diagnosis","Review objective was to evaluate the effectiveness of interventions aimed at enhancing return to work (RTW) in cancer patients compared to alternative programmes including usual care or no intervention","Primary\nRTW measured as event data such as RTW rates or (change in) disability pension rates. RTW measured as time-to-event data, such as number of days between reporting sick and any work resumption or the number of days on sick leave during the follow-up period\n\nSecondary\nQoL which included overall QoL, physical QoL and emotional QoL measured with validated and unvalidated questionnaires","Fifteen RCTs including 1835 cancer patients met the inclusion criteria and because of multiple arms studies 19 evaluations were included. Reviewers judged six studies to have a high risk of bias and nine to have a low risk of bias. All included studies were conducted in high income countries and most studies were aimed at breast cancer patients (seven trials) or prostate cancer patients (two trials).\n\nTwo studies involved psycho-educational interventions including patient education and teaching self-care behaviours. Results indicated low quality evidence of similar RTW rates for psycho-educational interventions compared to care as usual (RR 1.09, 95% CI 0.88 to 1.35, n = 260 patients) and low quality evidence that there is no difference in the effect of psycho-educational interventions compared to care as usual on quality of life (standardised mean difference (SMD) 0.05, 95% CI -0.2 to 0.3, n = 260 patients). No studies were found on vocational interventions. In one study breast cancer patients were offered a physical training programme. Low quality evidence suggested that physical training was not more effective than care as usual in improving RTW (RR 1.20, 95% CI 0.32 to 4.54, n = 28 patients) or quality of life (SMD -0.37, 95% CI -0.99 to 0.25, n = 41 patients).\n\nSeven RCTs assessed the effects of a medical intervention on RTW. In all studies a less radical or functioning conserving medical intervention was compared with a more radical treatment. Low quality evidence was found that less radical, functioning conserving approaches had similar RTW rates as more radical treatments (RR 1.04, 95% CI 0.96 to 1.09, n = 1097 patients) and moderate quality evidence of no differences in quality of life outcomes (SMD 0.10, 95% CI -0.04 to 0.23, n = 1028 patients).\n\nFive RCTs involved multidisciplinary interventions in which vocational counselling, patient education, patient counselling, biofeedback- assisted behavioral training and/or physical exercises were combined. Moderate quality evidence showed that multidisciplinary interventions involving physical, psycho-educational and/or vocational components led to higher RTW rates than care as usual (RR 1.11, 95% CI 1.03 to 1.16, n = 450 patients). No differences were found in the effect of multidisciplinary interventions compared to care as usual on quality of life outcomes (SMD 0.03, 95% CI -0.20 to 0.25, n = 316 patients).","Review authors found moderate quality evidence that multidisciplinary interventions enhance the RTW of patients with cancer."]
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[null,"RHAGLENNI RHEOLI ANABLEDD YN Y GWEITHLE"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Gensby U, Lund T, Kowalski K, Saidj M, Jørgensen AMK, Filges T, Irvin E, Amick BC III, Labriola M. Workplace Disability Management Programs Promoting Return-to-Work: A Systematic Review. Campbell Systematic Reviews 2012:17\nDOI: 10.4073/csr.2012.17 Available here","This review focused on workplace disability management (WPDM) programmes that were:\n• Characterised as an ‘onsite’ WPDM or RTW programme\n• Provided by the employer or initiated by the employer in collaboration with key players in the workplace\n• Addressed the duration or extent of an inability to work due to physical injury or mental illness\n• Implemented within the workplace setting","Evidence is lacking (identified studies were of a design inappropriate to assess interventions) so it is not possible to tell whether workplace disability management programmes help to reduce sickness absence","Employees (from the public or private sector) on sick-leave with an inability to work due to physical injury, illness or mental health disorders","The objective of this review was to assess the effectiveness of Workplace Disability Management Programmes (WPDM) promoting RTW\n• Compare WPDM programmes to no treatment, treatment as usual or alternative intervention\n• Examine components of WPDM programmes which appear more highly related to positive outcome\n","Primary\n• Return to work \n• Duration of sickness absence \n• Reduction in lost days from work \nSecondary\n• The functional health consequences \n• Return to fulltime or part-time work (yes/no)\n• Whether RTW was completed at the current employer\nSustainability of return to work:\n• Relapse to sickness absence in the follow-up period ","Thirteen studies (two non-randomised studies (NRS) and eleven single group ‘before and after’ studies (B & A)), including data from eleven different WPDM programmes, met the inclusion criteria. There were insufficient data on the characteristics of the sample and the effect sizes were uncertain. However, narrative descriptions of the included programme characteristics were rich, and provide valuable insights into programme scope, components, procedures and human resources involved.\n\nThere is a lack of evidence to draw unambiguous conclusions on the effectiveness of employer provided WPDM programmes promoting RTW. It was not possible to determine if specific programme components or specific sets of components are driving effectiveness.\n\nThe review adds to the existing knowledge base on WPDM programme development, characteristics and evaluation. At an organisational level intervention, employer provided WPDM programmes are multi-component constructs, offering a suite of policies and practices for injured or ill employees. The review identified 15 constituent programme components, covering individual, organisational, and system level policies and practices, depicting key human resources involved in workplace programme procedures and administration.\n\nFuture programme evaluations ought to broaden their focus beyond the first phases of the RTW process and incorporate sustainable outcomes (e.g. job retention, satisfactory and productive job performance, work role functioning, and maintenance of job function).\n\nGiven the lack of WPDM programmes evaluated in peer-reviewed publications, more attention needs to be given to locate and rigorously evaluate efforts from company studies that may still exist outside the peer reviewed published literature.\n\nWhile many employers recognise the importance of WPDM and are adopting policies and practices to promote RTW, judging from this review, the existing evidence leaves room for more rigorous methodological studies to develop the present WPDM knowledge base. Prospectively, WPDM evaluation research also needs to enlarge its perspective and refine its analytic tools to examine information that is meaningful and cost effective to those who will benefit from it, to further advance the field.","The review findings might help explicate WPDM programmes and their potential impact on RTW outcomes, and provide a more complete understanding of the research in the field of WPDM. This may inspire researchers, employers, and policy makers, who are interested not only in questions regarding the impact of programmes, but also their nature, to promote future design and evaluation of DM in organisations."]
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[null,"CLEFYD CORONAIDD Y GALON"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Hegewald J, Wegewitz UE, Euler U, van Dijk JL, Adams J, Fishta A, Heinrich P, Seidler A. Interventions to support return to work for people with coronary heart disease. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD010748.\nDOI: 10.1002/14651858.CD010748.pub2. Available here","Interventions  that aim to support the return-to-work process with individual or group approaches.\n• Work-directed interventions: these can include changes in the work environment, work tasks or working methods\n• Person-directed interventions:\ni) psychological interventions \nii) physical conditioning interventions\n• Any combination of the above","The evidence suggests that psychological interventions (including health education) for people with coronary heart disease may not be effective in reducing sickness absence (days until return to work) \n\nThe evidence suggests that work directed counselling may not be effective for people with coronary heart disease in reducing sickness absence (days to return to work)\n\nThe evidence suggests exercise programmes and combined cardiac rehabilitation programmes for people with coronary heart disease may not be effective  reducing time needed to return to work. \n\n","Adults (18 years or older) who had been diagnosed with CHD, who experienced a MI, or a coronary revascularisation procedure like CABG or PCI, as well as people with angina pectoris or angiographically-defined CHD. Within each study, at least 80% of participants had to fulfil these criteria.\nParticipants should also have been employed (either in paid employment\nor self-employed) at the time of diagnosis and on sick leave or otherwise not working at the time of the study because of the CHD ","Review objective was to assess the effects of person- and work-directed interventions aimed at enhancing return to work in patients with coronary heart disease compared to usual care or no intervention","Primary\nReturn to work, including return to\neither full- or part-time employment, to the previous job, and to the same role or with changes in work status (change of duties,\nworking location, function). Return to work included number of days on sick leave during the follow-up period\n\nSecondary\n• Health-related quality of life within the return-to-work process, either measured with generic instruments or with disease-specific instruments\n•  Number of participants who returned to work and were still working after an extended period of at least one year\n• Number of participants who were still working after five years ","Included 39 RCTs (including one cluster- and four three-armed RCTs). Return-to-work results of 34 studies were included in the meta-analyses.\n\nPerson-directed, psychological counselling versus usual care\nIncluded 11 studies considering return to work following psychological interventions among a subgroup of 615 participants in the meta-analysis. Most interventions used some form of counselling to address participants’ disease-related anxieties and provided information on the causes and course of CHD to dispel misconceptions. Cannot tell whether these interventions increase return to work up to six months (risk ratio (RR) 1.08, 95% confidence interval (CI) 0.84 to 1.40; six studies; very low-certainty evidence) or at six to 12 months (RR 1.24, 95% CI 0.95 to 1.63; seven studies; very low-certainty evidence). Cannot tell whether psychological interventions shorten the time until return to work. Psychological interventions may have little or no effect on the proportion of participants working between one and five years (RR 1.09, 95% CI 0.88 to 1.34; three studies; low-certainty evidence).\n\nPerson-directed, work-directed counselling versus usual care\nFour studies examined work-directed counselling. These counselling interventions included advising patients when to return to work based on treadmill testing or extended counselling to include co-workers’ fears and misconceptions regarding CHD. Work-directed counselling may result in little to no difference in the mean difference (MD) in days until return to work (MD −7.52 days, 95% CI −20.07 to 5.03 days; four studies; low-certainty evidence). Work-directed counselling probably results in little to no difference in cardiac deaths (RR 1.00, 95% CI 0.19 to 5.39; two studies; moderate-certainty evidence).\n\nPerson-directed, physical conditioning interventions versus usual care\nNine studies examined the impact of exercise programmes. Compared to usual care, cannot tell if physical interventions increase return to work up to six months (RR 1.17, 95% CI 0.97 to 1.41; four studies; very low-certainty evidence). Physical conditioning interventions may result in little to no difference in return-to-work rates at six to 12 months (RR 1.09, 95% CI 0.99 to 1.20; five studies; low-certainty evidence), and may also result in little to no difference on the rates of patients working after one year (RR 1.04, 95% CI 0.82 to 1.30; two studies; low-certainty evidence). Physical conditioning interventions may result in little to no difference in the time needed to return to work (MD −7.86 days, 95% CI −29.46 to 13.74 days; four studies; low-certainty evidence). Physical conditioning interventions probably do not increase cardiac death rates (RR 1.00, 95%CI 0.35 to 2.80; two studies; moderate-certainty evidence).\n\nPerson-directed, combined interventions versus usual care\nIncluded 13 studies considering return to work following combined interventions in the meta-analysis. Combined cardiac rehabilitation programmes may have increased return to work up to six months (RR 1.56, 95% CI 1.23 to 1.98; number needed to treat for an additional beneficial outcome (NNTB) 5; four studies; low-certainty evidence), and may have little to no difference on return to- work rates at six to 12 months’ follow-up (RR 1.06, 95% CI 1.00 to 1.13; 10 studies; low-certainty evidence). Reviewers could not tell if combined interventions increased the proportions of participants working between one and five years (RR 1.14, 95% CI 0.96 to 1.37; six studies; very low-certainty evidence) or at five years (RR 1.09, 95% CI 0.86 to 1.38; four studies; very low-certainty evidence). Combined interventions probably shortened the time needed until return to work (MD −40.77, 95% CI −67.19 to −14.35; two studies; moderate-certainty evidence). Combining interventions probably results in little to no difference in reinfarctions (RR 0.56, 95% CI 0.23 to 1.40; three studies; moderate-certainty evidence).\n\nWork-directed, interventions\nNo studies exclusively examining strictly work-directed interventions at the workplace were found","Combined interventions may increase return to work up to six months and probably reduce the time away from work. Otherwise, no evidence was found of either a beneficial or harmful effect of person-directed interventions. The certainty of the evidence for the various interventions and outcomes ranged from very low to moderate. Return to work was typically a secondary outcome of the studies, and as such, the results pertaining to return to work were often poorly reported. Adhering to RCT reporting guidelines could greatly improve the evidence of future research. A research gap exists regarding controlled trials of work-directed interventions, health-related quality of life within the return-to-work process, and adverse effects."]
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[null,"ARTHRITIS LLIDIOL"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Hoving JL, Lacaille D, Urquhart DM, Hannu TJ, Sluiter JK, Frings-Dresen MHW. Non-pharmacological interventions for preventing job loss in workers with inflammatory arthritis. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD010208. DOI: 10.1002/14651858.CD010208.pub2. Available here","Included interventions where the focus was on job loss prevention or improving work function. Interventions that fulfilled at least two of the following components:\na) An evaluation of the work challenges or work adaptations as a step in the main intervention of the study\nb) Interventions directed at the person, meaning job coaching, job or vocational training, vocational\ncounselling; or empowerment for work; or self-management, including support or information regarding work or both\nc) Interventions directed at the work environment, meaning work adaptations, ergonomic measures, job accommodations; or interventions targeted directly at the employer, supervisor\nor co-workers","Evidence is lacking so it is not possible to tell if non- pharmacological interventions reduce sickness absence for people with inflammatory arthritis","Included trials in which the population was limited to adults of working age (18 to 65 years) of which at least half of all workers\n(>50%) had been diagnosed with inflammatory arthritis (IA), including rheumatoid arthritis (RA), ankylosing spondylitis (AS),  psoriatic arthritis (PsA) or\nundifferentiated spondyloarthritis (SpA), or IA associated with connective tissue diseases such as Systemic\nLupus Erythematosus (SLE)","The review objective was to assess the effects of non-pharmacological interventions that aim to prevent job loss, work absenteeism or improve work functioning for employees with IA","Primary outcomes\n• Job loss measured as: the number of people that become unemployed at some stage following diagnosis, regardless of disability pension status; or the time to job loss\n• Sickness absenteeism measured as: time lost from work (number of work days or hours missed at work due to sick leave, or absenteeism); or time to return to work; or the proportion of workers on sick leave at a certain moment of follow-up\n\nSecondary outcomes\nWork functioning measured using any at-work productivity, work functioning or presenteeism questionnaire","Included three RCTs with a total of 414 participants at risk of job loss. The majority of participants had IA, most with RA and to a lesser degree AS. The interventions aimed to prevent job loss and improve work functioning in several ways: firstly by evaluating work changes or adaptations and secondly by providing any person-directed interventions including vocational counselling, advice or education. Interventions directly targeted at the work environment were minimal and included workplace visits (one trial) or any actions by an occupational physician (one trial). The duration or dose of the interventions varied from two 1.5-hour sessions (one RCT) over five months, two consultation and multidisciplinary treatments during three months (one RCT), to six to eight individual or group sessions over six months (also one RCT). All participants were recruited through rheumatology clinics, both in or outside hospitals. Included trials investigated job loss (n = two RCTs; 382 participants), work absenteeism and work functioning (n = one RCT; 32 participants). The two smaller trials were assessed as having a high risk of bias and the large trial as having a low risk of bias. Trials showed marked differences in how they performed on risk of bias items, particularly on performance bias.\n\nUsing the GRADE there was judged to be to be very low quality evidence across the three reported outcomes. Of the two RCTs investigating job loss, the larger one (n = 242 participants) reported a large statistically significant reduction in job loss (relative risk (RR) = 0.35, 95% confidence interval (CI) 0.18 to 0.68) and the other RCT (n = 140) reported similar effects in both groups, although the CI was very wide (RR = 1.05, 95% CI 0.53 to 2.06). The latter one probably suffered from performance bias and reviewers judged it to have a high risk of bias. The one small trial investigating sickness absenteeism found uncertain results at six months’ follow-up (MD = -2.42 days, 95% CI -5.03 to 0.19). Finally, in the same small trial investigating work functioning using the Rheumatoid Arthritis-Work Instability Scale (RA-WIS), there was a moderate improvement of intermediate term work functioning (six months; scale range 0 to 23; mean improvement -4.67 points, 95% CI -8.43 to -0.91). No adverse effects were identified in the publications of the three trials.","This Cochrane review of three RCTs found very low quality evidence overall for job loss prevention interventions having an effect on job loss, work absenteeism and work functioning in workers with inflammatory arthritis. While this review highlights that further high quality RCTs are required, the results suggest that these strategies have potential to be effective."]
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[null,"SGLEROSIS YMLEDOL"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Khan F, Ng L, Turner-Stokes L. Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis.\nCochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007256.\nDOI: 10.1002/14651858.CD007256.pub2. Available here","All categories of  vocational rehabilitation (VR) programmes which incorporate a clearly defined vocational rehabilitation or work therapy element. These included\nstructured multi-disciplinary / multi-agency interventions to preserve employment such as clinic or community based counselling, planning for disclosure and accommodation and work place accommodations. All three types of VR programmes were included, such as those offered by ‘general rehabilitation programmes’, ‘MS specialised VR programmes’ and ‘pan -disability VR programmes’ ","Evidence is lacking so it is not possible to tell whether vocational rehabilitation improves employment outcomes in people with multiple sclerosis","Trials were included if the study population was working age (i.e. mean age between 18-65 years) and had the diagnosis of MS (sub types of MS were included- relapsing remitting, secondary progressive and primary progressive MS), irrespective of MS severity","The primary objective of this review is to evaluate the effectiveness of vocational rehabilitation (VR) programmes compared to alternative programmes or care as usual on return to work, employment and work ability in persons with multiple sclerosis. A secondary objective is to evaluate the cost effectiveness of these VR programmes","Primary outcomes\n• The change in proportion of pwMS in competitive employment (full time or part time employment position held by a person in an ordinary work setting, for which they were receiving payment at the market rate \n• The change in proportions of persons in supported employment (employment in an ’open work’ setting but with ongoing support such as government funded programmes)\nSecondary outcomes\n• The rate of return to work in days of pwMS\n• The change in proportion of pwMS on disability pension\n• The improvement of work ability in pwMS (such as the proportion of persons with MS who are engaged in attending a sheltered workshop and earn a modest living)\n• Costs of programmes and cost effectiveness of return to work or employment","Two trials (one RCT and one CCT) (total 80 participants) met the review criteria. Both trials scored poorly on the methodological quality assessment. There was ’insufficient evidence’ for VR programmess for (a)‘competitive employment’, in altering rates of job retention, changes in employment, improvement in rates of re-entry into the labour force; (b) for altering ‘work ability’ by improving participants’ confidence in the accommodation request process, or employability maturity or job seeking activity. No evidence could be assimilated for changes in proportions of persons in supported employment or on disability pensions, nor for cost-effectiveness.","There was inconclusive evidence to support VR for pwMS. However, the review highlights some of the challenges in providing VR for pwMS. Clinicians need to be aware of vocational issues, and to understand and manage barriers for maintaining employment. Proactive and timely VR programmes should incorporate practical solutions to deal with work disability, workplace accommodation and educate employers, and the wider community. Liaison with policy makers is imperative for government initiatives that encourage work focused VR programmes. Future research in VR should focus on improving methodological and scientific rigour of clinical trials; on the development of appropriate and valid outcome measures; and on cost effectiveness of VR programmes."]
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[null,"ISELDER"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Nieuwenhuijsen K, Faber B, Verbeek JH, Neumeyer-Gromen A, Hees HL, Verhoeven AC, van der Feltz-Cornelis CM, Bültmann U. Interventions to improve return to work in depressed people. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD006237. DOI: 10.1002/14651858.CD006237.pub3. Available here","1. work-directed interventions, i.e. addressing the work or the work-worker interface as part of the clinical treatment or as a\nstand-alone intervention; and\n2. clinical interventions, i.e. treatment of depressive disorder without a focus on work","The evidence suggests that work directed interventions added to clinical intervention may reduce sickness absence in people with depression","Adult (that is over 17 years old) workers (employees or self-employed) from occupational health settings, primary care, or outpatient care settings","The review objective was to evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders","Primary outcomes\nDays of sickness absence during the follow-up period\n\nSecondary outcomes\n• Depression (either dichotomously or continuously measured)\n• Work functioning \n• Employment status after a period of time \n\nOther outcomes such as employee satisfaction, general social functioning (not work specific), or quality of life scales were excluded","Included 23 studies with 26 study arms, involving 5996 participants with either a major depressive disorder or a high level of depressive symptoms. Fourteen studies were judged to have a high risk of bias and nine to have a low risk of bias.\n\nWork-directed interventions\nFive work-directed interventions. There was moderate quality evidence that a work-directed intervention added to a clinical intervention reduced sickness absence (SMD -0.40; 95% CI -0.66 to -0.14; 3 studies) compared to a clinical intervention alone. There was moderate quality evidence based on a single study that enhancing the clinical care in addition to regular work-directed care was not more effective than work-directed care alone (SMD -0.14; 95% CI -0.49 to 0.21). There was very low quality evidence based on one study that regular care by occupational physicians that was enhanced with an exposure-based return to work programme did not reduce sickness absence compared to regular care by occupational physicians (nonsignificant finding: SMD 0.45; 95% CI -0.00 to 0.91).\n\nClinical interventions, antidepressant medication\nThree studies compared the effectiveness of selective serotonin reuptake inhibitor (SSRI) to selective norepinephrine reuptake inhibitor (SNRI) medication on reducing sickness absence and yielded highly inconsistent results.\n\nClinical interventions, psychological\nModerate quality evidence based on three studies that telephone or online cognitive behavioural therapy was more effective in reducing sick leave than usual primary or occupational care (SMD -0.23; 95% CI -0.45 to -0.01).\n\nClinical interventions, psychological combined with antidepressant medication\nLow quality evidence based on two studies that enhanced primary care did not substantially decrease sickness absence in the medium term (4 to 12 months) (SMD -0.02; 95% CI -0.15 to 0.12). A third study found no substantial effect on sickness absence in favour of this intervention in the long term (24 months). Reviewers found high quality evidence, based on one study, that a structured telephone outreach and care management program was more effective in reducing sickness absence than usual care (SMD - 0.21; 95% CI -0.37 to -0.05).\n\nClinical interventions, exercise\nLow quality evidence based on one study that supervised strength exercise reduced sickness absence compared to relaxation (SMD -1.11; 95% CI -1.68 to -0.54). Moderate quality evidence based on two studies that aerobic exercise was no more effective in reducing sickness absence than relaxation or stretching (SMD -0.06; 95% CI -0.36 to 0.24","Review authors found moderate quality evidence that adding a work-directed intervention to a clinical intervention reduced the number of days on sick leave compared to a clinical intervention alone. They also found moderate quality evidence that enhancing primary or occupational care with cognitive behavioural therapy reduced sick leave compared to the usual care. A structured telephone outreach and care management programme that included medication reduced sickness absence compared to usual care. However, enhancing primary care with a quality improvement programme did not have a considerable effect on sickness absence. There was no evidence of a difference in effect on sickness absence of one antidepressant medication compared to another. More studies are needed on work-directed interventions. Clinical intervention studies should also include work outcomes to increase our knowledge on reducing sickness absence in depressed workers."]
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[null,"POEN CEFN"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Schaafsma FG, Whelan K, van der Beek AJ, van der Es-Lambeek LC, Ojajärvi A, Verbeek JH. Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain.\nCochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD001822.\nDOI: 10.1002/14651858.CD001822.pub Available here","Included studies on physical conditioning programmes when they included the following three key elements:\n• (advice about) exercises specifically designed to restore an individual’s systemic, neurological, musculoskeletal (strength,\nendurance, movement, flexibility and motor control) or cardiopulmonary function, or a combination\n• explicitly stated to have an intended improvement of work\nstatus\n• a stated relationship between the intervention and\nfunctional job demands","The evidence is inconsistent so it is not possible to tell if physical conditioning is effective in improving employment outcomes in people on sick leave because of back pain","Male and female adults (> 16 years) with work disability related to back pain","Objective to assess the effectiveness of physical conditioning as part of a return to work strategy in reducing time lost from work and improving work status for workers with back pain","• Time between intervention and return-to-work\n• Return-to-work status in terms of ’at work’ or ‘off work’\n• Time on light or modified duties","Included 41 articles reporting on 25 RCTs with 4404 participants. Risk of bias was low in 16 studies. \n\nThree studies involved workers with acute back pain, eight studies workers with subacute back pain, and 14 studies workers with chronic back pain.\n\nIn 14 studies, physical conditioning as part of a return to work strategy was compared to usual care. The physical conditioning mostly consisted of graded activity with work-related exercises aimed at increasing back strength and flexibility, together with a set date for return to work. The programmes were divided into a light version with a maximum of five sessions, or an intense version with more than five sessions up to full time or as inpatient treatment. \n\nFor acute back pain, there was low quality evidence that both light and intense physical conditioning programmes made little or no difference in sickness absence duration compared with care as usual at three to 12 months follow-up (3 studies with 340 workers). \n\nFor subacute back pain, the evidence on the effectiveness of intense physical conditioning combined with care as usual compared to usual care alone was conflicting (four studies with 395 workers). However, subgroup analysis showed low quality evidence that if the intervention was executed at the workplace, or included a workplace visit, it may have reduced sickness absence duration at 12 months follow-up (3 studies with 283 workers; SMD -0.42, 95% CI -0.65 to -0.18). \n\nFor chronic back pain, there was low quality evidence that physical conditioning as part of integrated care management in addition to usual care may have reduced sickness absence days compared to usual care at 12 months follow-up (1 study, 134 workers; SMD - 4.42, 95% CI -5.06 to -3.79). What part of the integrated care management was most effective remained unclear. There was moderate quality evidence that intense physical conditioning probably reduced sickness absence duration only slightly compared with usual care at 12 months follow-up (5 studies, 1093 workers; SMD -0.23, 95% CI -0.42 to -0.03). \n\nPhysical conditioning compared to exercise therapy showed conflicting results for workers with subacute and chronic back pain. Cognitive behavioural therapy was probably not superior to physical conditioning as an alternative or in addition to physical conditioning.","The effectiveness of physical conditioning as part of a return to work strategy in reducing sick leave for workers with back pain, compared to usual care or exercise therapy, remains uncertain. For workers with acute back pain, physical conditioning may have no effect on sickness absence duration. There is conflicting evidence regarding the reduction of sickness absence duration with intense physical conditioning versus usual care for workers with subacute back pain. It may be that including workplace visits or execution of the intervention at the workplace is the component that renders a physical conditioning programme effective. For workers with chronic back pain physical conditioning has a small effect on reducing sick leave compared to care as usual after 12 months follow-up. To what extent physical conditioning as part of integrated care management may alter the effect on sick leave for workers with chronic back pain needs further research."]
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[null,"CYMORTH I GADW'R RHEINY AG ANGHENION YCHWANEGOL MEWN CYFLOGAETH"]
[null,"POBL Â CHANSER"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"de Boer AGEM, Taskila TK, Tamminga SJ, Feuerstein M, Frings-Dresen MHW, Verbeek JH. Interventions to enhance\nreturn-to-work for cancer patients. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD007569. DOI:\n10.1002/14651858.CD007569.pub3. Available here","Interventions aiming to enhance return to work. Including psychoeducational, vocational, physical, medical or pharmacological, or any combination of these ","The evidence suggests that multidisciplinary physical, psycho-educational and/or vocational interventions may be effective in supporting people with cancer to return to work","Adults (>= 18 years old) who had been diagnosed with cancer (any type) and were in paid employment (employee or self employed) at the time of diagnosis","Review objective was to evaluate the effectiveness of interventions aimed at enhancing return to work (RTW) in cancer patients compared to alternative programmes including usual care or no intervention","Primary\n• RTW measured as event data such as RTW rates or (change in) disability pension rates\n• RTW measured as time-to-event data, such as number of days between reporting sick and any work resumption or the number of days on sick leave during the follow-up period\n\nSecondary\nQoL which included overall QoL, physical QoL and emotional QoL measured with validated and unvalidated questionnaires","Fifteen RCTs including 1835 cancer patients met the inclusion criteria and because of multiple arms studies 19 evaluations were included. Review authors judged six studies to have a high risk of bias and nine to have a low risk of bias. All included studies were conducted in high income countries and most studies were aimed at breast cancer patients (seven trials) or prostate cancer patients (two trials).\n\nTwo studies involved psycho-educational interventions including patient education and teaching self-care behaviours. Results indicated low quality evidence of similar RTW rates for psycho-educational interventions compared to care as usual (RR 1.09, 95% CI 0.88 to 1.35, n = 260 patients) and low quality evidence that there is no difference in the effect of psycho-educational interventions compared to care as usual on quality of life (standardised mean difference (SMD) 0.05, 95% CI -0.2 to 0.3, n = 260 patients). No studies were found on vocational interventions. In one study breast cancer patients were offered a physical training programme. Low quality evidence suggested that physical training was not more effective than care as usual in improving RTW (RR 1.20, 95% CI 0.32 to 4.54, n = 28 patients) or quality of life (SMD -0.37, 95% CI -0.99 to 0.25, n = 41 patients).\n\nSeven RCTs assessed the effects of a medical intervention on RTW. In all studies a less radical or functioning conserving medical intervention was compared with a more radical treatment. Low quality evidence was found that less radical, functioning conserving approaches had similar RTW rates as more radical treatments (RR 1.04, 95% CI 0.96 to 1.09, n = 1097 patients) and moderate quality evidence of no differences in quality of life outcomes (SMD 0.10, 95% CI -0.04 to 0.23, n = 1028 patients).\n\nFive RCTs involved multidisciplinary interventions in which vocational counselling, patient education, patient counselling, biofeedback- assisted behavioral training and/or physical exercises were combined. Moderate quality evidence showed that multidisciplinary interventions involving physical, psycho-educational and/or vocational components led to higher RTW rates than care as usual (RR 1.11, 95% CI 1.03 to 1.16, n = 450 patients). No differences were found in the effect of multidisciplinary interventions compared to care as usual on quality of life outcomes (SMD 0.03, 95% CI -0.20 to 0.25, n = 316 patients).","Review authors found moderate quality evidence that multidisciplinary interventions enhance the RTW of patients with cancer."]
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[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Fong CJ, Murphy KM, Westbrook JD, Markle MM. Behavioral, Psychological, Educational, and Vocational Interventions to Facilitate Employment Outcomes\nfor Cancer Survivors: A Systematic Review Campbell Systematic Reviews 2015:5\nDOI: 10.4073/csr.2015.5. Available here","Included studies addressed the effectiveness on employment outcomes of behavioral, psychological,\neducational, or vocational interventions or component of an intervention for cancer\nsurvivors","The evidence suggests that employment interventions for cancer survivors may help them to maintain employment","Adults aged 18 or older who had a past or present cancer diagnosis which occurred whilst they were aged 18 or older. Particpants with an employment history and those without were included","Not clearly specified","Employment initiation, return-to-work, or decreasing absenteeism and use of work disability or sick leave","Included 12 studies evaluating the effects of psychosocially-related interventions on the employment of cancer survivors (n = 2151). The results suggest that the included interventions may improve employment status (OR = 1.71, 95% confidence interval (CI) 1.26 to 2.32) for cancer survivors. For RCTs (n = 6), the weighted mean effect size for employment status was OR = 1.44 (95% CI 0.99 to 2.09), favouring the intervention groups. The mean odds ratio of 1.44 translates to an employment rate of about 68% for intervention participants compared to a baseline 60% for comparison group participants. For QEDs (n = 6), the weighted mean effect size for employment status was OR = 2.18 95% CI 1.32 to 3.60), also favoring the intervention groups. The mean odds ratio of 2.18 for the quasi-experimental studies translates to an employment rate of about 77% for intervention participants, compared to the baseline rate of 60% for the comparison group participants. Although the mean effect size from QEDs was larger than that from the RCTs, there is no significant difference between the two types of experimental designs (p = 0.19).\n\nThere was no evidence of an effect on the number of hours worked (OR = 0.89, 95% CI 0.22 to 1.52) or number of sick leave days (OR = 1.18, 95% CI 0.81 to 1.71). Overall, the assessment of the risk of bias was high, and conclusions about the effectiveness of the included interventions should be interpreted with caution.","This review highlights the positive effect psychosocial interventions may have on\nemployment outcomes for cancer survivors. However, the methodological\nshortcomings of the included studies overall makes it likely that there is bias in the results and too few studies to provide sufficiently strong evidence to recommend particular practices. This review brings attention to the need for additional rigorous studies in this area, in particular, randomised controlled trials with more detailed reporting of data and study design and methodology."]
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[null,"RHAGLENNI RHEOLI ANABLEDD YN Y GWEITHLE"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Gensby U, Lund T, Kowalski K, Saidj M, Jørgensen AMK, Filges T, Irvin E, Amick BC III, Labriola M. Workplace Disability Management Programs Promoting Return-to-Work: A Systematic Review. Campbell Systematic Reviews 2012:17\nDOI: 10.4073/csr.2012.17. Available here","This review focused on workplace disability management (WPDM) programmes that were:\n• Characterised as an ‘onsite’ WPDM or RTW programme\n• Provided by the employer or initiated by the employer in collaboration with key players in the workplace\n• Addressed the duration or extent of an inability to work due to physical injury or mental illness\n• Implemented within the workplace setting","Evidence is lacking so it is not possible to tell whether workplace disability management programmes support people to maintain employment","Employees (from the public or private sector) on sick-leave with an inability to work due to physical injury, illness or mental health disorders","The objective of this review was to assess the effectiveness of Workplace Disability Management Programmes (WPDM) promoting RTW \n• Compare WPDM programmes to no treatment, treatment as usual or alternative intervention\n• Examine components of WPDM programmes which appear more highly related to positive outcome\n","Primary\n• Return to work \n• Duration of sickness absence \n• Reduction in lost days from work \n\nSecondary\n• The functional health consequences \n• Return to fulltime or part-time work (yes/no)\n• Whether RTW was completed at the current employer\nSustainability of return to work:\n• Relapse to sickness absence in the follow-up period ","Thirteen studies (two non-randomized studies (NRS) and eleven single group ‘before and after’ studies (B & A), including data from eleven different WPDM programmes, met the inclusion criteria. There were insufficient data on the characteristics of the sample and the effect sizes were uncertain. However, narrative descriptions of the included programme characteristics were rich, and provide valuable insights into programme scope, components, procedures and human resources involved.\n\nThere is a lack of evidence to draw unambiguous conclusions on the effectiveness of employer provided WPDM programmes promoting RTW. It was not possible to determine if specific program components or specific sets of components are driving effectiveness.\n\nThe review adds to the existing knowledge base on WPDM programme development, characteristics and evaluation. At an organisational level intervention, employer provided WPDM programmes are multi-component constructs, offering a suite of policies and practices for injured or ill employees. The review identified 15 constituent programme components, covering individual, organisational, and system level policies and practices, depicting key human resources involved in workplace program procedures and administration.\n\nFuture programme evaluations ought to broaden their focus beyond the first phases of the RTW process and incorporate sustainable outcomes (e.g. job retention, satisfactory and productive job performance, work role functioning, and maintenance of job function).\n\nGiven the lack of WPDM programmes evaluated in peer-reviewed publications, more attention needs to be given to locate and rigorously evaluate efforts from company studies that may still exist outside the peer reviewed published literature.\n\nWhile many employers recognize the importance of WPDM and are adopting policies and practices to promote RTW, judging from this review, the existing evidence leaves room for more rigorous methodological studies to develop the present WPDM knowledge base. Prospectively,WPDM evaluation research also needs to enlarge its perspective and refine its analytic tools to examine information that is meaningful and cost effective to those who will benefit from it, to further advance the field.","The review findings might help explicate WPDM programmes and their potential impact on RTW outcomes, and provide a more complete understanding of the research in the field of WPDM. This may inspire researchers, employers, and policy makers, who are interested not only in questions regarding the impact of programmes, but also their nature, to promote future design and evaluation of DM in organisations."]
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[null,"CLEFYD CORONAIDD Y GALON"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Hegewald J, Wegewitz UE, Euler U, van Dijk JL, Adams J, Fishta A, Heinrich P, Seidler A. Interventions to support return to work for people with coronary heart disease. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD010748.\nDOI: 10.1002/14651858.CD010748.pub2. Available here","Interventions  that aim to support the return-to-work process with individual or group approaches.\n1. Work-directed interventions: these can include changes in the work environment, work tasks or working methods\n2. Person-directed interventions:\ni) psychological interventions \nii) physical conditioning interventions\n3. Any combination of the above","The evidence suggests that psychological interventions (including health education) may not be effective for keeping people with coronary heart disease in employment\n\nThe evidence suggests that physical conditioning and combined interventions for people with coronary heart disease may have no effect on the proportion of participants working after one year.","Adults (18 years or older) who had been diagnosed with CHD, who experienced a MI, or a coronary revascularisation procedure like CABG or PCI, as well as people with angina pectoris or angiographically-defined CHD. Within each study, at least 80% of participants had to fulfil these criteria.\nParticipants should also have been employed (either in paid employment\nor self-employed) at the time of diagnosis and on sick leave or otherwise not working at the time of the study because of the CHD ","Review objective was to assess the effects of person- and work-directed interventions aimed at enhancing return to work in patients with coronary heart disease compared to usual care or no intervention","Primary\nReturn to work, including return to\neither full- or part-time employment, to the previous job, and to the same role or with changes in work status (change of duties,\nworking location, function). Return to work included number of days on sick leave during the follow-up period\n\nSecondary\n• Health-related quality of life within the return-to-work process, either measured with generic instruments or with disease-specific instruments\n• Number of participants who returned to work and were still working after an extended period of at least one year\n• Number of participants who were still working after five years ","Included 39 RCTs (including one cluster- and four three-armed RCTs). Reviewers included the return-to-work results of 34 studies in the meta-analyses.\n\nPerson-directed, psychological counselling versus usual care\nIncluded 11 studies considering return to work following psychological interventions among a subgroup of 615 participants in the meta-analysis. Most interventions used some form of counselling to address participants’ disease-related anxieties and provided information on the causes and course of CHD to dispel misconceptions. Cannot tell whether these interventions increase return to work up to six months (risk ratio (RR) 1.08, 95% confidence interval (CI) 0.84 to 1.40; six studies; very low-certainty evidence) or at six to 12 months (RR 1.24, 95% CI 0.95 to 1.63; seven studies; very low-certainty evidence). Cannot tell whether psychological interventions shorten the time until return to work. Psychological interventions may have little or no effect on the proportion of participants working between one and five years (RR 1.09, 95% CI 0.88 to 1.34; three studies; low-certainty evidence).\n\nPerson-directed, work-directed counselling versus usual care\nFour studies examined work-directed counselling. These counselling interventions included advising patients when to return to work based on treadmill testing or extended counselling to include co-workers’ fears and misconceptions regarding CHD. Work-directed counselling may result in little to no difference in the mean difference (MD) in days until return to work (MD −7.52 days, 95% CI −20.07 to 5.03 days; four studies; low-certainty evidence). Work-directed counselling probably results in little to no difference in cardiac deaths (RR 1.00, 95% CI 0.19 to 5.39; two studies; moderate-certainty evidence).\n\nPerson-directed, physical conditioning interventions versus usual care\nNine studies examined the impact of exercise programmes. Compared to usual care, cannot tell if physical interventions increase return to work up to six months (RR 1.17, 95% CI 0.97 to 1.41; four studies; very low-certainty evidence). Physical conditioning interventions may result in little to no difference in return-to-work rates at six to 12 months (RR 1.09, 95% CI 0.99 to 1.20; five studies; low-certainty evidence), and may also result in little to no difference on the rates of patients working after one year (RR 1.04, 95% CI 0.82 to 1.30; two studies; low-certainty evidence). Physical conditioning interventions may result in little to no difference in the time needed to return to work (MD −7.86 days, 95% CI −29.46 to 13.74 days; four studies; low-certainty evidence). Physical conditioning interventions probably do not increase cardiac death rates (RR 1.00, 95%CI 0.35 to 2.80; two studies; moderate-certainty evidence).\n\nPerson-directed, combined interventions versus usual care\nIncluded 13 studies considering return to work following combined interventions in the meta-analysis. Combined cardiac rehabilitation programmes may have increased return to work up to six months (RR 1.56, 95% CI 1.23 to 1.98; number needed to treat for an additional beneficial outcome (NNTB) 5; four studies; low-certainty evidence), and may have little to no difference on return to- work rates at six to 12 months’ follow-up (RR 1.06, 95% CI 1.00 to 1.13; 10 studies; low-certainty evidence). Cannot tell if combined interventions increased the proportions of participants working between one and five years (RR 1.14, 95% CI 0.96 to 1.37; six studies; very low-certainty evidence) or at five years (RR 1.09, 95% CI 0.86 to 1.38; four studies; very low-certainty evidence). Combined interventions probably shortened the time needed until return to work (MD −40.77, 95% CI −67.19 to −14.35; two studies; moderate-certainty evidence). Combining interventions probably results in little to no difference in reinfarctions (RR 0.56, 95% CI 0.23 to 1.40; three studies; moderate-certainty evidence).\n\nWork-directed, interventions\nNo studies exclusively examining strictly work-directed interventions at the workplace were found","Combined interventions may increase return to work up to six months and probably reduce the time away from work. Otherwise, no evidence was found of either a beneficial or harmful effect of person-directed interventions. The certainty of the evidence for the various interventions and outcomes ranged from very low to moderate. Return to work was typically a secondary outcome of the studies, and as such, the results pertaining to return to work were often poorly reported. Adhering to RCT reporting guidelines could greatly improve the evidence of future research. A research gap exists regarding controlled trials of work-directed interventions, health-related quality of life within the return-to-work process, and adverse effects."]
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[null,"ARTHRITIS LLIDIOL"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Hoving JL, Lacaille D, Urquhart DM, Hannu TJ, Sluiter JK, Frings-Dresen MHW. Non-pharmacological interventions for preventing job loss in workers with inflammatory arthritis. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD010208. DOI: 10.1002/14651858.CD010208.pub2. Available here","Included intervention where the focus was on job loss prevention or improving work function. Interventions that fulfilled at least two of the following components:\n• An evaluation of the work challenges or work adaptations as a step in the main intervention of the study\n• Interventions directed at the person, meaning job coaching, job or vocational training, vocational\ncounselling; or empowerment for work; or self-management, including support or information regarding work or both\n• Interventions directed at the work environment, meaning work adaptations, ergonomic measures, job accommodations; or interventions targeted directly at the employer, supervisor\nor co-workers","Evidence is lacking so it is not possible to tell whether non-pharmacological interventions for people with inflammatory arthritis reduce job loss","Included trials in which the population was limited to adults of working age (18 to 65 years) of which at least half of all workers\n(>50%) had been diagnosed with inflammatory arthritis (IA), including rheumatoid arthritis (RA), ankylosing spondylitis (AS),  psoriatic arthritis (PsA) or\nundifferentiated spondyloarthritis (SpA), or IA associated with connective tissue diseases such as Systemic Lupus Erythematosus (SLE)","The review objective was to assess the effects of non-pharmacological interventions that aim to prevent job loss, work absenteeism or improve work functioning for employees with IA","Primary outcomes\n• Job loss measured as: the number of people that become unemployed at some stage following diagnosis, regardless of disability pension status; or the time to job loss\n• Sickness absenteeism measured as: time lost from work (number of work days or hours missed at work due to sick leave, or absenteeism); or time to return to work; or the proportion of workers on sick leave at a certain moment of follow-up\n\nSecondary outcomes\nWork functioning measured using any at-work productivity, work functioning or presenteeism questionnaire","Included three RCTs with a total of 414 participants at risk of job loss. The majority of participants had IA, most with RA and to a lesser degree AS. The interventions aimed to prevent job loss and improve work functioning in several ways: firstly by evaluating work changes or adaptations and secondly by providing any person-directed interventions including vocational counselling, advice or education. Interventions directly targeted at the work environment were minimal and included workplace visits (one trial) or any actions by an occupational physician (one trial). The duration or dose of the interventions varied from two 1.5-hour sessions (one RCT) over five months, two consultation and multidisciplinary treatments during three months (one RCT), to six to eight individual or group sessions over six months (also one RCT). All participants were recruited through rheumatology clinics, both in or outside hospitals. Included trials investigated job loss (n = two RCTs; 382 participants), work absenteeism and work functioning (n = one RCT; 32 participants). The two smaller trials were assessed as having a high risk of bias and the large trial as having a low risk of bias. Trials showed marked differences in how they performed on risk of bias items, particularly on performance bias.\n\nUsing the GRADE there was judged to be to be very low quality evidence across the three reported outcomes. Of the two RCTs investigating job loss, the larger one (n = 242 participants) reported a large statistically significant reduction in job loss (relative risk (RR) = 0.35, 95% confidence interval (CI) 0.18 to 0.68) and the other RCT (n = 140) reported similar effects in both groups, although the CI was very wide (RR = 1.05, 95% CI 0.53 to 2.06). The latter one probably suffered from performance bias and we judged it to have a high risk of bias. The one small trial investigating sickness absenteeism found uncertain results at six months’ follow-up (MD = -2.42 days, 95% CI -5.03 to 0.19). Finally, in the same small trial investigating work functioning using the Rheumatoid Arthritis-Work Instability Scale (RA-WIS), there was a moderate improvement of intermediate term work functioning (six months; scale range 0 to 23; mean improvement -4.67 points, 95% CI -8.43 to -0.91). No adverse effects were identified in the publications of the three trials.","This Cochrane review of three RCTs found very low quality evidence overall for job loss prevention interventions having an effect on job loss, work absenteeism and work functioning in workers with inflammatory arthritis. While this review highlights that further high quality RCTs are required, the results suggest that these strategies have potential to be effective."]
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[null,"SGLEROSIS YMLEDOL"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Khan F, Ng L, Turner-Stokes L. Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis.\nCochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007256.\nDOI: 10.1002/14651858.CD007256.pub2. Available here","All categories of  vocational rehabilitation (VR) programmes which incorporate a clearly defined vocational rehabilitation or work therapy element. These included\nstructured multi-disciplinary / multi-agency interventions to preserve employment such as clinic or community based counselling, planning for disclosure and accommodation, and work place accommodations.\nAll three types of VR programmes were included, such as those offered by ‘general rehabilitation programmes’, ‘MS\nspecialised VR programmes’ and ‘pan -disability VR programmes’ ","Evidence is lacking so it is not possible to tell whether vocational rehabilitation programmes for people with multiple sclerosis helps them to maintain employment","Trials were included if the study population was working age (i.e. mean age between 18-65 years) and had the diagnosis of MS (sub types of MS were included-relapsing remitting, secondary progressive and primary progressive MS), irrespective of MS severity","The primary objective of this review is to evaluate the effectiveness of vocational rehabilitation (VR) programmes compared to alternative programmes or care as usual on return to work, employment and work ability in persons with multiple sclerosis. A secondary objective was to evaluate the cost effectiveness of these VR programmes","Primary outcomes\n• The change in proportion of pwMS in competitive employment (full time or part time employment position held by a person in an ordinary work setting, for which they were receiving payment at the market rate \n• The change in proportions of persons in supported employment (employment in an ’open work’ setting but with ongoing support such as government funded programmes)\nSecondary outcomes\n• The rate of return to work in days of pwMS\n• The change in proportion of pwMS on disability pension\n• The improvement of work ability in pwMS (such as the proportion of persons with MS who are engaged in attending a sheltered workshop and earn a modest living)\n• Costs of programmes and cost effectiveness of return to work or employment","Two trials (one RCT and one CCT) (total 80 participants) met the review criteria. Both trials scored poorly on the methodological quality assessment. There was insufficient evidence for VR programmes for (a)competitive employment, in altering rates of job retention, changes in employment, improvement in rates of re-entry into the labour force; (b) for altering work ability by improving participants’ confidence in the accommodation request process, or employability maturity or job seeking activity. No evidence could be assimilated for changes in proportions of persons in supported employment or on disability pensions, nor for cost-effectiveness.","There was inconclusive evidence to support VR for pwMS. However, the review highlights some of the challenges in providing VR for pwMS. Clinicians need to be aware of vocational issues, and to understand and manage barriers for maintaining employment. Proactive and timely VR programmes should incorporate practical solutions to deal with work disability, workplace accommodation and educate employers, and the wider community. Liaison with policy makers is imperative for government initiatives that encourage work focused VR programmes. Future research in VR should focus on improving methodological and scientific rigour of clinical trials; on the development of appropriate and valid outcome measures; and on cost effectiveness of VR programmes"]
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[null,"ANHWYLDER AR Y SBECTRWM AWTISTIG"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Westbrook J, Nye C, Fong C, Wan J, Cortopassi T, Martin F. Adult employment assistance for persons with autism spectrum disorders: Effects on employment outcomes. Campbell Systematic Reviews 2012:5 DOI: 10.4073/csr.2012.5. Available here","Interventions to assist in gaining competitive, supported, or integrated employment","Evidence is lacking so it is not possible to tell whether employment assistance is effective in helping adults with autistic spectrum disorder maintain employment","Adults 18 years or older with a diagnosis of ASD, who were no longer enrolled in a school-to-work programme or secondary-level education programme","To determine the effectiveness of adult employment assistance in securing and maintaining employment for adults (18 years and older) with autism spectrum disorders (ASD)","Attainment and duration and/or retention gainful employment. Gainful employment included competitive, integrated, or supported employment. Sheltered work or non-integrated work was not considered as an outcome measure for this review","This review was not able to identify definitive interventions that predictably and positively supported the development of employment outcomes for individuals with ASD.\n\nThere were two included studies. One described outcomes directly related to employment by comparing an experimental group (n = 30) who received guidance from a support worker in the form of job finding, work preparation, and communication with the employers with a control group (n = 20) that did not receive any support. At the end of the two-year study period, the authors found that the experimental group demonstrated significantly higher rates of having found paid employment (d = 1.067, 95% CI = 0.123 to 2.010), significantly longer periods of working time (d = 0.684, 95% CI = 0.111 to 1.257), and significantly higher wages (d = 1.177, 95% CI = 0.169 to 0.819). The experimental group also worked more hours per work week (d = 0.328, 95% CI = -0.628 to 1.284), but this effect was not significant.\n\nThe second included study described differential effects of supported employment and sheltered employment for persons with autism. The experimental group received supported employment, i.e., jobs working between 15 and 30 hours per week in their communities and received job coach support services. The control group received sheltered employment, i.e. jobs that were not in their communities and with no job coaching services. Using measures of the Childhood Autism Rating Scale (CARS), the supported employment group was not significantly different from the sheltered employment group after treatment (d = -0.229, 95% CI = -0.764 to 0.306). The study did not report any differences in employment acquisition or maintenance between the two groups.\n\nIn an analysis of risk bias of the included studies, it was found that there was a high level of substantial potential for bias across three of the five sources of bias analysed including unit of assignment, unit of analysis, attrition, fidelity of implementation, and blinding. The methodological quality of both included studies was low. Therefore, these review results should not be interpreted as indicating definitive results related to the development of employment outcomes for persons with ASD.","Qualitative and other relevant research studies connected to the employment of persons with ASD were also reviewed and suggest that the following may be elements of successful employment placement for persons with ASD: (1) identification of the most appropriate work settings and placements, (2) provision of effective supports on the job, (3) need for long-term support services for the employer and the consumer, (4) costs for support, and (5) positive effects of employment on persons with ASD. While qualitative studies point to a number of promising issues for future research, they do not provide a definitive statement about what works.\n\nIn addition, the authors noted that costs for community-based employment interventions such as those included in this review are more expensive than other employment alternatives such as sheltered non-integrated workshops. However, the review authors were aware of other studies showing that supported employment service interventions, such as those identified in their included studies, are becoming less expensive to deliver. It seems important to note that community-based integrated employment interventions, while expensive, do expand options for mainstream social integration, competitive wages, and community involvement."]
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[null,"GWEITHWYR HŶN"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Cox A et al. Factors facilitating or constraining interventions to protect and promote health of older workers and to help plan and prepare for retirement.   Brighton. Institute for Employment Studies. 2015. Available here","Interventions to enhance the well-being of older workers and support them in continuing to work beyond state pensionable age","Evidence is lacking so it is not possible to tell whether interventions support older workers to remain in employment","All adults aged at least 50 in full or part-time employment, both paid and unpaid, self-employed people working in micro, small, medium and large organisations with an appointed line manager, and volunteers\n\nAll employers in the public, private and ‘not for profit’ sectors who employ at least one employee","What factors facilitate or constrain workplaces to enhance the well-being of older workers, to support them in continuing to work up to and beyond state pensionable age and affect the quality and outcomes of pre-retirement planning?","Organisation: employee health and well-being and engagement; levels of employee recruitment and retention for the relevant age group; days lost to sickness absence  health related behaviours/diseases\nEmployee: individual levels of health and well-being","Flexible impacts for older workers: There is moderate evidence from five studies, that offering flexible working to older employees is associated with positive attitudinal outcomes, and in one study reportedly affects staff retention. The studies are mostly directly applicable to the UK.\n\nManagement initiatives: training and rewards: There is weak evidence from one qualitative study that providing training and small informal rewards positively influences older workers intention to stay with the current employer. The findings are partially applicable to the UK.\n\nGradual retirement: There is weak and mixed evidence on the benefits of gradual retirement from one study. The evidence is partially applicable to the UK\n\n","The limitations of the evidence base reviewed here reflect wider challenges also associated with earlier reviews on this topic concerning the effectiveness and cost-effectiveness of interventions to promote and support the health and well-being of older workers and in the area of pre-retirement planning and training. There is a dearth of evidence on the outcomes and impact of management-initiated interventions in this field, and the overall quality of research in this area was both disappointing and surprising, consistent with the evidence of large scale literature reviews on related topics.\n\nDespite some prominent examples of reportedly good practice in managing older workers available via case studies in grey literature and the trade press, little documented process or impact evaluation was located, and many of the studies on employer practices included in this review are up to a decade old. Since then, both the labour market context and the employment policy context has changed significantly, and indeed recession and consequent more abundant labour supply for some occupations may have reduced employer need and appetite to consider the management of older employees. Moreover, the studies from an employer perspective considered for this review may reflect a degree of employer passivity in taking action in this area, albeit with evidence of emerging awareness of the need to manage older workers and to consider the impact of the abolition of the default retirement age. For some employers this appears to be coupled with a degree of ignorance in the growth and potential issues presented by an ageing workforce and a ‘mainstreaming’ approach to the management of diversity. This is of concern on at least two grounds. First, the abolition of the default retirement age in 2011 means that employers will have to start considering how to manage workers whose transition to retirement can no longer be assumed. Second, government reforms to increase the age at which people are eligible for the state pension will lead to those lacking adequate alternative pension provision in particular seeking to remain in work for longer.\n\nThere are also clear methodological considerations arising from this review for research in this field. There is an urgent need for research which uses mixed methods and deploys both employer and worker perspectives to examine employer practices with regard to recruitment, retirement planning and transitions. Those commissioning, designing and undertaking research also need to confront the challenge that to examine long-term impacts of working in later life, it will be essential to conduct longitudinal studies. This review urges research commissioners to prioritise funding of high quality studies into the impact of workplace level interventions on health and well-being outcomes which will seek to track the health and well-being of individuals during the lifespan of the intervention and onwards beyond the end of their working lives."]

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[null,"CADW POBL MEWN GWAITH"]
[null,"RHEOLI ABSENOLDEB SALWCH"]
[null,"YMYRIADAU CYFFREDINOL"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Agymhellion pwyllgor canllaw:"]
[null,"National Institute for Health and Care Excellence. Workplace health: long-term sickness absence and capability to work. [A] Evidence review for reducing recurrent short-term sickness absence. London, NICE. 2019. Available here\n\n\n\n","Interventions to reduce recurrent short term sickness absence","Evidence is lacking and it is not possible to tell whether interventions to reduce short term sickness absence are effective","Adult employess aged 16 years or over, full or part time, paid or unpaid who have experienced four or more episodes of short term sickness absence in a 12 month period (each episode lasting less than four weeks) or are currently absent from work for less than four weeks because of sickness (with a minimum study follow up of 12 months to enabale patterns of recurrent absence to be identified)\n\nOrganisational level -  all employers in the public, private and not-for-profit sectors","What interventions, programmes, policies or strategies are effective and cost-effective in preventing or reducing recurrence of short-term sickness absence among employees?\n\nAre the interventions, programmes, policies or strategies acceptable to employees, employers and other key stakeholders, and what are the barriers and facilitators to their successful delivery?","Primary\n• Short-term sickness absence, as measured and reported by the authors \nSecondary \n• Health-related quality of life - using validated patient-report measures, for example EQ-5D \n• Psychological and/or social functioning - using any patient-report measure \n• Adverse / unintended effects: - Self-reported presenteeism or work performance (individual-level studies); - Job satisfaction (individual or organisational-level) - Rate of staff turnover (organisational-level studies) - Number of grievances (organisational-level studies)\n\nQualitative studies (second question) Participant views on: \n• Intervention acceptability (including preferences for content, frequency, location, etc.) \n• Barriers and facilitators to successful intervention delivery","There were two studies included, a cluster RCT and an RCT. These were not pooled by outcome into a meta-analysis, they included different interventions and had reported outcomes in different ways. The short-term sickness absence data from one of the studies have been presented in a forest plot to enable discussion. Evidence statements have been presented on an individual study basis.\n\nShort-term sickness absence rate over 29 weeks\nThere was low quality evidence from one cluster RCT, conducted in Denmark with a total of 3,039 employees of 78 pre-school organisations with relatively high rates of short-term sickness absence of 14 or more days per episode. The intervention consisted of focusing on the core task at work, based on the theory that illegitimate tasks (those regarded by employees as unreasonable or unnecessary) lead to higher levels of stress, poor self-esteem and employee resentment, resulting in higher rates of short-term sickness absence. No difference was found in the rates of short term sickness absence over 29 months follow-up, compared with pre-schools with no intervention (8.7 vs. 9.2 STSA days per person-year; RR: 0.93; 95%CI 0.86 to 1.01), the proportion returning to work within 3 months (61% vs. 80%; RR 0.76; 95%CI 0.49 to 1.49). However, when adjusted for age, sex, type of workplace, workplace size, a reduction was found in the workplace average level of short-term sickness absence in the previous 12 months; RR 0.89 (95%CI 0.83 to 0.95). \n\nProportion with frequent short-term sickness absence at 12 month follow-up\nThere was low quality evidence from one RCT, conducted in the Netherlands, with a total of 82 employees at 21 different organisations with a history of frequent sickness absence (three or more episodes in the past 12 months). The intervention consisted of access to e-health advice and support, with or without an additional preventive consultation with an occupational physician. No difference was found in the reduced frequency and duration of sickness absence, or in the number of sickness absence episodes, or in the total duration of all sickness absence in days.","Due to the lack of evidence relating to recurrent short-term sickness absence the overall recommendations relating to return to work would be applicable for this group. Following the completion of the evidence reviews for review questions B and C it was discussed and agreed by the committee that in practice the interventions that may be effective in supporting return to work after long-term absence may also help with recurrent short-term absences and to prevent the movement from short to long-term absence. \nRecommendations were therefore not made that distinguished between the types of absence. Though the committee did also note that evidence specifically relating to short term sickness absence, in a UK context, could contribute substantially to supporting those who have recurrent sickness absence in employment and so developed a research recommendation in this area."]
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[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Agymhellion pwyllgor canllaw:"]
[null,"National Institute for Health and Care Excellence. Workplace health: long-term sickness absence and capability to work. [B] Evidence review for reducing movement from short-term to long-term sickness absence. London, NICE. 2019. Available here\n\n\n","To reduce movement from short to long term sickness absence","Evidence is lacking and it is not possible to tell whether interventions reduce movement from short to long term sickness absence","Individual level \n• Adult employees (≥16 years, full- or part-time, paid or unpaid) who are currently absent from work for less than 4 consecutive weeks due to sickness. \n\nOrganisation level \n• All employers in the public, private and ‘not-for-profit’ sectors","What interventions, programmes, policies or strategies are effective and cost effective in reducing the number of employees who move from short- to long-term sickness absence?\n\nAre the interventions, programmes, policies or strategies acceptable to employees,  employers and other key stakeholders, and what are the barriers and facilitators to their  successful delivery?","Primary  \n• Return to work. Measured as any of: -     \n      -Proportion returning to work within four weeks of start of absence\n      -Time taken to return to work\nor\n• Sickness absence, as reported by the authors, including:\n      - Proportion with any long-term sickness absence (≥4 consecutive weeks duration)\n     - Total number of sickness absence days\n\nSecondary\n• Health-related quality of life - using validated patient-report measures, for example EQ-5D\n • Psychological and/or social functioning - using any patient-report measure \n• Adverse / unintended effects:\n     - Self-reported 'presenteeism' or work performance (individual-level studies) \n    - Job satisfaction (individual or organisational-level)\n    - Rate of staff turnover (organisational-level studies)\n    - Number of grievances (organisational-level studies)\n\nQualitative studies (second question) Participant views on: \n• Sickness absence recurrence following RTW (individual-level studies) \n• Intervention acceptability (including preferences for content, frequency, location, etc.) \n• Barriers and facilitators to successful intervention delivery","There were six studies included for these review questions. Three RCT studies, two non-randomised control studies and one observational study with no control group. It was not considered reasonable to pool the studies by outcome into a meta-analysis. The studies included very different interventions and had reported outcomes in different ways.\n\nEarly multidisciplinary assesssment: There is low quality evidence from 1 RCT conducted in Sweden, in a total of 33 patients with musculoskeletal or mental health disorders. The intervention consisted of early multidisciplinary assessment in the primary care centre compared with usual GP care. No difference was found in the proportion returning to work within 3 months (61% vs. 80%; RR 0.76; 95%CI 0.49 to 1.49), the proportion returning to work within 12 months (78% vs. 93%; RR 0.83; 95%CI 0.63 to 1.10), or in the total number of sickness absence (full) days over 12 months (MD: 40.0; 95%CI -19.33 to 99.33).\n\nStress counselling and case management: There was very low quality evidence from 1 non-randomised controlled study, conducted in Denmark with a total of 161 patients with emotional distress. The intervention consisted of an outpatient stress counselling and case management compared to usual care. This found a reduction in the proportion of patients returning to the labour market within 4 weeks (7% vs. 19%; RR 0.36; 95%CI 0.14 to 0.94). No difference was found in the proportion returning to the labour market by 3 months (28% vs. 43%; RR 0.65; 95%CI 0.42 to 1.01), or by 12 months (75% vs. 76%; RR 0.98; 95%CI 0.82 to 1.17). Nor was there any difference in those not resuming labour market activity in over 68 weeks (unadjusted HR 0.84; 95%CI 0.60 to 1.18).\n\nOccupational health programme: There was very low quality evidence from 1 case series, conducted in the USA with a total of 190 people with work-related injury events. The intervention consisted of before and after implementation of an internal occupational health programme with early access to treatment or workplace rehabilitation, compared with usual care. This found an increase post-intervention, in the proportion returning to work within 4 weeks (55% vs. 36%; RR 1.54; 95%CI 1.06 to 2.23) and a reduction in the total number of lost work days per injury event (44.6 lost work days from 128 injuries) compared with before the intervention (100.3 lost work days from 62 injuries; MD -55.7; 95%CI -87.8 to -23.8).\n\nParticipatory workplace intervention: There was low quality evidence from 1 RCT conducted in the Netherlands, with a total of 145 employees with emotional distress. The intervention consisted of early access to treatment or workplace rehabilitation, compared with usual care and usual occupational physician care. No difference was found in the proportion returning to work by 12 months (90% vs. 92%; RR 0.99; 95%CI: 0.89 to 1.09), or time to return to work over 12 months (unadjusted HR: 0.99; 95%CI: 0.70 to 1.40). Nor was any difference found in total sickness absence over 12 months (MD -0.1; 95%CI -36.24 to 36.04), or in the proportion of those with one or more recurrence episodes of sickness (8% vs. 8%; RR 0.99; 95%CI 0.33 to 2.92).\n\nEarly part time sick leave: There was moderate quality evidence from 1 RCT conducted in Finland, with a total of 62 employees with musculoskeletal disorders. The intervention consisted of early part time sick leave compared to usual full-time sick leave. This found a difference in self-reported health-related quality of life over 12 weeks (MD: -0.60; 95%CI -0.91 to -0.29). No difference was found in the proportion returning to work by 4 weeks (12% vs. 64%; RR 1.10; 95%CI 0.78 to 1.55), or by 3 months (100% vs. 87%; RR 1.15; 95%CI 0.99 to 1.33). Nor was any difference found in the time to return to the labour market over 12 months (HR adjusted for age:1.60; 95%CI 0.98 to 2.61), or in number of recurrent sick leave episodes per person-year (MD: -2.1; 95%CI -4.54 to 0.44).\n\nEducational intervention delivered to occupational health physicians: There was very low quality evidence from 1 non-randomised controlled study  conducted in Finland, with a total of 30 employees with musculoskeletal pain or depressive symptoms. The intervention consisted of an educational intervention delivered to occupational health physicians and a case management intervention, compared to usual care. No difference was found in the proportion returning to regular work by 4 weeks (42% vs. 72%; RR 0.58; 95%CI 0.28 to 1.19), or by 3 months (84% vs. 83%; RR 1.00; 95%CI 0.72 to 1.39), or by 12 months (92% vs. 100%; RR 0.91; 95%CI 0.74 to 1.12).","Following the completion of the evidence reviews for review questions A and C it was discussed and agreed by the committee that in practice the interventions that may be effective in supporting return to work after long-term absence may also help with recurrent short-term absences and to prevent the movement from short- to long-term absence. Recommendations were therefore not made that distinguished between the types of absence."]
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[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Agymhellion pwyllgor canllaw:"]
[null,"National Institute for Health and Care Excellence. Workplace health: long-term sickness absence and capability to work. [C] Evidence review for facilitating the return to work of employees on long-term sickness absence and reducing risk of recurrence.  London, NICE. 2019. Available here\n\n","Any interventions, programmes, policies or strategies that aim to increase the return to work of employees who experience an episode of long-term sickness absence (≥4 consecutive weeks) and / or prevent the recurrence of long-term absence Where interventions are not delivered in a workplace or primary care setting, there should be some element of employer or primary care involvement in the design, content, implementation or funding of the intervention.","SHORT TERM OUTCOMES\nThe evidence suggests that individual employee focused interventions for those with musculoskeletal conditions may be effective in supporting return to work in the short term\n\nEvidence is lacking so it is not possible to tell whether individual employee focused interventions for those with musculoskeletal  or mental health problems are effective in reducing days of sickness absence in the short term\n\nThe evidence suggests combined interventions (workplace and individual employee focused) for those with mental health problems may not be effective in increasing return to work in the short term\n\nMEDIUM TERM OUTCOMES\nThe evidence suggests that individual employee focused interventions for people with musculoskeletal conditions may not be effective in increasing the proportion returning to work in the medium term\n\nEvidence is lacking so it is not possible to tell whether individual employee focused interventions  for people with mental health problems increase the proportion returning to work in the medium term\n\nEvidence is lacking so it is not possible to tell whether individual employee focused interventions  for people with musculoskeletal problems reduce days of sickness absence in the medium term \n\nThe evidence suggests that individual employee focused interventions for people with mental health problems may not be effective in reducing days of sickness absence in the medium term\n\nThe evidence suggests that individual employee focused interventions for people with musculoskeletal disorders and people with mental health problems may not be  effective in reducing the time to return to work in the medium term\n\nThe evidence suggests that workplace focussed interventions for people with musculoskeletal conditions may be effective in reducing the time to return to work in the medium term\n\nEvidence is lacking so it is not possible to tell whether workplace focussed interventions for mixed populations reduce time to return to work in the medium term\n\nThe evidence suggests combined interventions (workplace and individual employee focused) for those with musculoskeletal conditions and for those with mental health problems may not be effective in increasing the proportion returning to work in the medium term\n\nThe evidence suggests combined interventions (workplace and individual employee focused) for those with mental health problems may not be effective in reducing the number of days of sickness absence in the medium term\n\nThe evidence suggests combined interventions (workplace and individual employee focused) for those with musculoskeletal conditions and for those with mental health problems may not be effective in reducing the time to return to work in the medium term\n\n\n","Adult employees (≥16 years; full- or part-time; paid or unpaid) who \n• are currently absent from work for 4 or more consecutive weeks due to sickness or \n• have returned to work in the past 6 months after an episode of long-term sickness absence (lasting 4 or more consecutive weeks) \n\nOrganisation level All employers in the public, private and ‘not-for-profit’ sectors","What interventions, programmes, policies or strategies are effective and cost-effective in:\n• Helping employees on long-term sickness absence to return to work?\n• Reducing the recurrence of long-term sickness absence following a return to work?\n\nAre the interventions, programmes, policies or strategies acceptable to employees, employers and other key stakeholders, and what are the barriers and facilitators to their successful delivery?","Primary  \n• Return to work. Measured as any of: -     \n      -Proportion returning to work within four weeks of start of absence\n      -Time taken to return to work\nor\n• Sickness absence, as reported by the authors, including:\n      - Proportion with any long-term sickness absence (≥4 consecutive weeks duration)\n     - Total number of sickness absence days\n\nSecondary\n• Health-related quality of life - using validated patient-report measures, for example EQ-5D\n • Psychological and/or social functioning - using any patient-report measure \n• Adverse / unintended effects:\n     - Self-reported 'presenteeism' or work performance (individual-level studies) \n    - Job satisfaction (individual or organisational-level)\n    - Rate of staff turnover (organisational-level studies)\n    - Number of grievances (organisational-level studies)\n\nQualitative studies (second question) Participant views on: \n• Sickness absence recurrence following RTW (individual-level studies) \n• Intervention acceptability (including preferences for content, frequency, location, etc.) \n• Barriers and facilitators to successful intervention delivery","Individual focused interventions: \nLong term sickness absence due to musculoskeletal conditions \nFull RTW in short-term: Moderate quality evidence from 2 RCTs. Graded activity, and multidisciplinary outpatient treatment with a biopsychosocial focus. Increase in full RTW favouring the intervention compared with controls. Full RTW in medium term: Moderate quality evidence from 4 RCTs. Graded activity, problem-solving therapy, and multidisciplinary outpatient treatment with a biopsychosocial focus. No difference was found in full return to work compared with controls. Sickness absence short-term: Very low quality evidence from 1 RCT. Outpatient CBT-based RTW programme conducted as group sessions. No difference was found in sickness absence over 3 months compared with controls for short and long-term absent groups. Sickness absence over medium term: Low quality evidence from 1 RCT. Group-based problem-solving therapy plus graded activity and group education. A decrease was found in sickness absence over the medium-term favouring the  intervention compared with controls. Time to return to work over the medium term: Very low quality evidence from 3 RCTs. Graded activity / work hardening, and education. No difference in time to RTW compared with controls. Recurrence of sickness absence over medium term: Low quality evidence from 1 RCT. Graded activity and education. No difference was found in the incidence of recurrent sickness absence per person-year compared with controls\n\nLong term sickness absence due to mental health disorders:\nFull RTW in the medium term: Low quality evidence from 1 RCT. Guided e-health RTW intervention, (which included problem-solving, cognitive restructuring, pain and fatigue management), and occupational physician collaborative care. No difference was found in full RTW compared with controls. Sickness absence over short term: Low quality evidence from 1 RCT. Acceptance and commitment therapy. No difference was found in sickness absence over 3 months compared with controls. Sickness absence over medium term: Very low quality evidence from 2 RCTs. Activating and problem-solving intervention delivered by social workers in primary care, a guided e-health RTW intervention (which included problem-solving, cognitive restructuring, pain and fatigue management) and occupational physician collaborative care. No difference was found in sickness absence over 12 months compared with controls. Recurrence of sickness absence - 12 months: Low quality evidence from 1 RCT. (1) a passive awareness-raising intervention to promote GPs use of ‘active sick leave’ (that is, a return to modified duties in the workplace) as an option for sickness certification among employees and (2) a proactive intervention to promote use of active sick leave. No difference was found associated with either intervention in recurrence of sickness absence for back pain over follow-up.\n\nLong term sickness absence due to mental health conditions:\nFull RTW in medium term: Moderate quality evidence from 1 RCT. Return to work intervention (which included basic CBT and graded exposure to the workplace) and a return to work intervention plus CBT. No difference was found in full RTW compared with controls. Sickness absence over short term: Low quality evidence from 1 RCT. Workplace dialogue  intervention to agree a return-to-work plan including any facilitating modifications. No difference was found in the number of sickness absence days compared with controls. Sickness absence over medium term: Moderate quality evidence from 1 RCT. Return to work intervention (which included basic CBT and graded exposure to the workplace) and a return to work intervention plus CBT. No difference was found in the number of days sickness absence days compared with controls.\n\nLong term sickness absence - mixed health conditions\nFull RTW in the medium term: Very low quality evidence from 1 RCT in UK. Addressing issues in the workplace, typically through ergonomic assessment and employer liaison or mediation. Return to full work (lasting ≥13 weeks) 246/545 (45.1%) vs 205/458 (44.7%). Sickness absence over medium term: very low quality evidence from 1 RCT. Minimal awareness-raising postal intervention. No difference was found between the intervention and control groups in number of sickness absence days over 12 months follow-up. Low quality evidence from 1 RCT. 1-day training workshop for GPs in undertaking structured functional assessments with patients on long-term sick leave. No difference was found in total sickness absence days between sick-listed patients consulting GPs during the study period who had received the training, compared with those who consulted control group GPs who were not trained in structured functional assessments. Time to return to work over medium term: Very low quality evidence from 1 RCT. Minimal awareness-raising postal intervention. No difference was found between intervention and control groups in time to RTW over 12 months. Quality of life: Low quality evidence from 1 RCT in the UK. Addressing issues in the workplace, typically through ergonomic assessment and employer  liaison or mediation. At 42 weeks follow-up, no differences were found on any SF36 subscale scores between intervention group and controls. Time to RTW over medium term: Very low quality evidence from 3 RCTs. Stress treatment with gradual work exposure, coping skills plus workplace contact to agree a return to work plan and any facilitating modifications, occupational physician-delivered CBT-based stress inoculation and gradual return to work with facilitating modifications, an occupational physician-delivered activating and problem-solving intervention plus contacts with workplace, and a psychologist-delivered work-focused CBT  for stress, plus the offer of participation in meeting with workplace. No difference was found in time to RTW compared with controls. Low quality evidence from 1 RCT. Psychologist-delivered individual CBT and the offer of attendance by the psychologist at a meeting with employers. No difference was found in time to RTW compared with controls. Time to RTW over long term: Low quality evidence from 1 RCT.  Occupational therapist-delivered work reintegration programme, plus CBT treatment. No difference was found in time to RTW compared with controls. Recurrence of sickness absence: Moderate quality evidence from 1 RCT. Occupational physician-delivered CBT-based stress inoculation and gradual return-to-work with facilitating modifications. No difference was found between intervention and control groups in the mean number of recurrences of sickness absence episodes following return-to-work, nor in the average duration of recurrent absence episodes\n\nLong term sickness absence - mixed health conditions:\nFull RTW over medium term: Very low quality evidence from 1 RCT in UK. Tailored health treatment intervention plus an intervention addressing issues in the workplace, typically through ergonomic assessment and employer liaison or mediation. No difference in RTW. Long term sickness absence: Very low quality evidence from 1 observational before and after study with a control group in the UK. Multidisciplinary case management return to work service for employees on long-term sickness absence, delivered jointly by the Human Resource and Occupational Health services. A reduction was found (from baseline to one year following the implementation of the intervention) in the percentage of 4-week absences continuing beyond 8 weeks, compared  with the control site. However no  difference was found in the overall reduction of mean days lost beyond 4  weeks, for all long-term sickness absence. Full RTW in medium term: Very low quality evidence from 1 RCT in UK. Tailored treatment intervention for health problems. A reduction was found in return to work for at least a 13 week spell of full time work, with health only interventions 255/587  (43.5%) in the intervention group returning versus 205/458 (44.7%) in the control group. Quality of life: Very low quality evidence from 1 RCT conducted in  UK. Tailored  treatment intervention for health problems. At 42 weeks follow-up, differences were found favouring the intervention group in SF36 scores on the  energy/fatigue subscale on the mental health subscale and on general health. No differences were found between the intervention and  control participants on any other SF36 domains.\n\nWork- focused interventions\nLong term sickness absence due to musculo skeletal conditions\nFull RTW short term: Moderate quality evidence from 1 RCT. Multidisciplinary assessment and tailored work rehabilitation coordinated by a caseworker. No difference was found compared with controls. Full RTW medium term: Moderate quality evidence from 1 RCT. Multidisciplinary assessment and tailored work rehabilitation coordinated by a caseworker and early guideline-based occupational physician management of employees. This included identifying barriers to returning to work, implementing adaptions (to work or hours) and advising supervisors. No difference was found in full RTW compared with controls. Low quality evidence from 1 RCT. (1) a passive awareness-raising intervention to promote GPs use of ‘active sick leave’ (that is, a return to modified duties in the workplace) as an option for sickness certification among employees and (2) a proactive intervention to promote use of ‘active sick leave’. No difference was found compared with a ‘no intervention’ control group in full return to work within 12 months, associated with either intervention. Sickness absence medium term: Low quality evidence from 1 RCT, participants absent from work with back pain.(1) a passive awareness-raising intervention to promote GPs use of ‘active sick leave’ (that is, a return to modified duties in the workplace) as an option for sickness certification among employees and (2) a proactive intervention to promote the use of active sick leave. No difference was found at population level associated with either intervention compared with a ‘no intervention’ control group. This applied to total days of absence due to the index condition (back pain), or for any reason over the 12 months follow-up. Time to RTW over medium term: Moderate quality evidence from 2 RCTs. Participatory worksite assessment, and agreement and implementation of a participatory ergonomics intervention or other job modifications. A reduction was found in the time to RTW favouring the intervention compared with controls.\n\nCombined (individual and work-focused interventions): \nLong-term sickness absence due to muculoskeletal conditions:\nFull RTW in the medium-term: Moderate quality evidence from 3 RCTs. Outpatient multidisciplinary rehabilitation with workplace contact and vocational support of a caseworker. No difference was found in full RTW compared with controls. Time to RTW over medium term: Moderate quality evidence from 5 RCTs. Participatory worksite assessment, agreement and implementation of a participatory ergonomics intervention or other job modifications plus graded activity, an outpatient multidisciplinary rehabilitation within a biopsychosocial framework plus workplace contact, and vocational support of caseworker. No difference was found between the intervention and control groups in time to RTW.\n\nLong term sickness absence due to mental health conditions:\nFull RTW over short-term: Low quality evidence from 4 RCTs, 1  UK. Case management with low intensity psychological interventions, a self-help handbook and workplace facilitation, a  multidisciplinary stress treatment with gradual work exposure plus workplace dialogue, a return to work consultation with a psychiatrist plus occupational physician-delivered CBT and workplace modifications, and occupational physician delivered activating and problem-solving intervention, plus contacts with workplace. No difference was found in full RTW compared with controls. Low quality evidence from 1 RCT. Occupational therapist-delivered work reintegration programme plus CBT treatment. RTW in what was reported to be good health between 1-6 months 5/78 (6%) vs 4/39 (10%). Full RTW over medium-term: Very low quality evidence from 3 RCTs. Occupational physician-delivered CBT-based stress inoculation and gradual return to work with facilitating modifications; an occupational physician-delivered activating and problem-solving intervention plus contacts with the workplace; collaborative stepped-care (including problem-solving therapy and guided self-help) plus a workplace dialogue intervention to agree a return-to-work plan coordinated by an occupational physician-care manager. No difference was found in full RTW compared with controls. Low quality evidence from 1 RCT. Occupational therapist-delivered work reintegration programme plus CBT treatment. RTW in what was reported to be good health between 7-12 months 27/78 (34%) vs 9/39 (23%). Sickness absence over short term: Low quality evidence from 1 RCT. Acceptance and  commitment therapy, plus a workplace convergence dialogue intervention to agree a return-to-work plan including any facilitating modifications. No difference was found in the number of sickness absence days compared with controls. Sickness absence over medium term: Moderate quality evidence from 3 RCTs. CBT-based return to work interventions delivered by psychologists (including gradual exposure, psychoeducation, problem-solving and agreement of return to work plans with the employer, plus CBT treatment), a return to work consultation with a psychiatrist plus occupational physician-delivered CBT and workplace modifications, and a collaborative stepped-plus workplace dialogue intervention to agree a return-to-work plan coordinated by an occupational physician care manager. No difference was found in the number of sickness absence days compared with controls.\n\nQualitative evidence not included here. ","Overall the committee discussed that there was greater variation in terms of content, intensity and mode of delivery in the studies involving those with mental health conditions than was observed in the individual-focused RTW interventions evaluated in populations with musculoskeletal conditions. This can be seen in that most mental health studies included in the review consisted of combined interventions. There was a large amount of heterogeneity in terms of both interventions and comparators studied and no significant effects were found on any outcome. The committee discussed the low-quality assessment of most of the included studies, the lack of evidence of effectiveness and the variety in the interventions included. Nonetheless the committee considered it important to provide guidance for returning to work after long-term absence relating to mental health conditions. Specifically, the committee discussed the overall importance of facilitating the most effective return to work for those who have been on long-term sickness absence. They noted that continuing long-term absence from the workplace can have a serious detrimental impact on individuals’ long-term health, financial security and social inclusion.\n\nMental health issues increasingly account for a significant proportion of long-term sickness absence from work. This is reflected by the availability of more new evidence from studies in mental health populations since the original guideline was published in 2009. The committee discussed the lack of any clear evidence of effectiveness of any RTW interventions in these studies. They discussed the possibility that to some degree this could be due to greater heterogeneity both in interventions and comparators than was the case for studies in musculoskeletal populations. Recruitment difficulties are frequently experienced in mental health research. Lack of target numbers of participants combined with wider variability in the outcomes of interest may differentially impact on the precision of effect estimates generated in mental health compared with musculoskeletal studies in this area.\n\nThe committee considered one large UK based study that had considered before and after a joint working initiative between OH and HR departments. This study was of a mixed population of employees of two NHS hospital trusts. It identified a reduction in baseline of 4-week absences but no overall reduction in days beyond 4 weeks for all long-term sickness absence. The committee noted that this UK based observational study was the only non RCT evidence included and that it had additional limitations, such as that there were differences between sites in the workforces, proportions of full and part time employees and rates of long term sickness attributable to mental health disorders. Nonetheless they considered that it provided support for importance of wider management support to enable the facilitation of return to work initiatives and the need to evaluate implemented programmes.\n\nConsidering the low quality of the evidence identified and presented in the evidence reviews and the committee concern that most of the evidence reported on settings that are very different from the UK workplace context, it was agreed to seek further views from UK expert organisations.\n\n"]
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[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"van Vilsteren M, van Oostrom SH, de Vet HCW, Franche RL, Boot CRL, Anema JR. Workplace interventions to prevent work disability in workers on sick leave. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD006955. DOI:\n10.1002/14651858.CD006955.pub3. Available here\n\n\n","Workplace interventions focusing on changes in the workplace or equipment, work design and organisation (including working relationships), working conditions or work environment, and occupational (case) management with active stakeholder involvement of (at least) the worker and the employer","The evidence is inconsistent so it is not possible to tell whether workplace interventions for people on sick leave are effective in reducing sickness absence","Studies in working-age adults (18 to 65 years) who were on sick leave, full-and part-time workers","No question specified, the objective was to determine the effectiveness of workplace interventions in preventing work disability among sick-listed workers, when compared to usual care or clinical interventions","Primary\n• Time until first RTW: a period of absence from work because of sickness both preceded and followed by a period of at least one day at work \n• Time until lasting RTW: a period of absence from the first day of sick leave to full RTW in previous or equal work for at least four weeks without dropping out\n• Cumulative duration of sickness absence: total days of sick leave during the follow-up period (resulting from one or more periods of sickness absence)\n• Recurrences of sickness absence: the number of days until a recurrence; or the frequency and duration of recurrent episodes of sick leave\n\nSecondary\n• functional status\n• quality of life\n• general health\n• depression\n• pain levels\n• direct and indirect costs of work disability","Included 14 RCTs with 1897 workers. Eight studies included workers with musculoskeletal disorders, five workers with mental health problems, and one workers with cancer. Six studies were judged to have low risk of bias for the outcome sickness absence.\n\nWorkplace interventions significantly improved time until first RTW compared to usual care, moderate-quality evidence (hazard ratio (HR) 1.55, 95% confidence interval (CI) 1.20 to 2.01). Workplace interventions did not considerably reduce time to lasting RTW compared to usual care, very low-quality evidence (HR 1.07, 95% CI 0.72 to 1.57). The effect on cumulative duration of sickness absence showed a mean difference of -33.33 (95% CI -49.54 to -17.12), favouring the workplace intervention, high-quality evidence. One study assessed recurrences of sick leave, and favoured usual care, moderate-quality evidence (HR 0.42, 95% CI 0.21 to 0.82). Overall, the effectiveness of workplace interventions on work disability showed varying results.\n\nIn subgroup analyses workplace interventions reduced time to first and lasting RTW among workers with musculoskeletal disorders more than usual care (HR 1.44, 95% CI 1.15 to 1.82 and HR 1.77, 95% CI 1.37 to 2.29, respectively; both moderate quality evidence). In studies of workers with musculoskeletal disorders, pain also improved (standardised mean difference (SMD) - 0.26, 95% CI -0.47 to -0.06), as well as functional status (SMD -0.33, 95% CI -0.58 to -0.08). In studies of workers with mental health problems, there was a significant improvement in time until first RTW (HR 2.64, 95% CI 1.41 to 4.95), but no considerable reduction in lasting RTW (HR 0.79, 95% CI 0.54 to 1.17). One study of workers with cancer did not find a considerable reduction in lasting RTW (HR 0.88, 95% CI 0.53 to 1.47).\n\nIn another subgroup analysis there was no evidence that offering a workplace intervention in combination with a cognitive behavioural intervention (HR 1.93, 95% CI 1.27 to 2.93) is considerably more effective than offering a workplace intervention alone (HR 1.35, 95% CI 1.01 to 1.82, test for subgroup differences P = 0.17).\n\nWorkplace interventions did not considerably reduce time until first RTW compared with a clinical intervention in workers with mental health problems in one study (HR 2.65, 95% CI 1.42 to 4.95, very low-quality evidence).","The review authors found moderate-quality evidence that workplace interventions reduce time to first RTW, high-quality evidence that workplace interventions reduce cumulative duration of sickness absence, very low-quality evidence that workplace interventions reduce time to lasting RTW, and moderate-quality evidence that workplace interventions increase recurrences of sick leave. Overall, the effectiveness of workplace interventions on work disability showed varying results. Workplace interventions reduce time to RTW and improve pain and functional status in workers with musculoskeletal disorders. We found no evidence of a considerable effect of workplace interventions on time to RTW in workers with mental health problems or cancer.\n\nReview authors found moderate-quality evidence to support workplace interventions for workers with musculoskeletal disorders. The quality of the evidence on the effectiveness of workplace interventions for workers with mental health problems and cancer is low, and results do not show an effect of workplace interventions for these workers. Future research should expand the range of health conditions evaluated with high-quality studies."]
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[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Vogel N, Schandelmaier S, Zumbrunn T, Ebrahim S, de Boer WEL, Busse JW, Kunz R. Return-to-work coordination programmes for improving return to work in workers on sick leave. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD011618. DOI:10.1002/14651858.CD011618.pub2.  Available here","Return-to-work coordination programmes. No uniform definition of return to-\nwork coordination programmes exists. Review authors defined such programmes as \n• The objective is to promote return to work\n• The return-to-work coordinator(s) and the affected worker have at least one face-to-face contact\n• The process starts with an assessment of the worker’s needs and leads to an individually tailored return-to-work plan\n• The implementation of the return-to-work plan is managed by the return-to-work coordinator(s)","The evidence suggests that return to work (RTW) coordination programmes may not be effective in reducing time to return to work at 6, 12 and more than 12 months\n\nEvidence is lacking so it is not possible to tell whether RTW coordination programmes reduce cumulative sickness absence days in the short term (6 months) and very long term (beyond 12 months)\n\nThe evidence suggests that RTW coordination programmes may not be effective in reducing cumulative sickness absence at 12 months\n\n","Studies in adults of working age (16 to 65 years) who:\n• were on full- or part-time sick leave continuously for at least four weeks or were receiving long-term disability benefits; and\n• were employed at the time of sick-listing\n\nAt least 80% of the participants in a study had to fulfil both criteria. Studies were included  irrespective of the cause of sick leave or disability, the setting or the benefit scheme (e.g. private or government provider)","Not specified the review objective was to assess the effects of return-to-work coordination programmes versus usual practice for workers on sick leave or disability","Primary\n• Time to return to work\n• Cumulative sickness absence\n• Proportion at work at end of the follow-up\n• Proportion ever returned to work\n\nSecondary\nPhysical, mental, social or overall functioning\n• Pain, depression and anxiety\n• Quality of life\n• Satisfaction of patients, employers, and social insurance organisations","Included 14 studies from nine countries that enrolled 12,568 workers. Eleven studies focused on musculoskeletal problems, two on mental health and one on both. Most studies (11 of 14) followed workers 12 months or longer. Risk of bias was low in 10 and high in 4 studies, but findings were not sensitive to their exclusion.\n\nNo benefits were found for return-to-work coordination programmes on return-to-work outcomes.\n\nFor short-term follow-up of six months, no effect was found on time to return to work (hazard ratio (HR) 1.32, 95% confidence interval (CI) 0.93 to 1.88, low-quality evidence), cumulative sickness absence (mean difference (MD) −16.18 work days per year, 95% CI −32.42 to 0.06, moderate-quality evidence), the proportion of participants at work at end of the follow-up (risk ratio (RR) 1.06, 95% CI 0.86 to 1.30, low-quality evidence) or on the proportion of participants who had ever returned to work, that is, regardless of whether they had remained at work until last follow-up (RR 0.87, 95% CI 0.63 to 1.19, very low-quality evidence).\n\nFor long-term follow-up of 12 months, no effect was found on time to return to work (HR 1.25, 95% CI 0.95 to 1.66, low-quality evidence), cumulative sickness absence (MD −14.84 work days per year, 95% CI −38.56 to 8.88, low-quality evidence), the proportion of participants at work at end of the follow-up (RR 1.06, 95% CI 0.99 to 1.15, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 1.03, 95% CI 0.97 to 1.09, moderate-quality evidence).\n\nFor very long-term follow-up of longer than 12 months, no effect was found on time to return to work (HR 0.93, 95% CI 0.74 to 1.17, low-quality evidence), cumulative sickness absence (MD 7.00 work days per year, 95% CI −15.17 to 29.17, moderate-quality evidence), the proportion of participants at work at end of the follow-up (RR 0.94, 95% CI 0.82 to 1.07, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 0.95, 95% CI 0.88 to 1.02, low-quality evidence).\n\nOnly small benefits were found for return-to-work coordination programmes on patient-reported outcomes. All differences were below the minimal clinically important difference (MID).","Offering return-to-work coordination programmes for workers on sick leave for at least four weeks results in no benefits when compared to usual practice. The review authors found no significant differences for the outcomes time to return to work, cumulative sickness absence, the proportion of participants at work at end of the follow-up or the proportion of participants who had ever returned to work at short-term, long-term or very long-term follow-up. For patient-reported outcomes, they found only marginal effects below the MID. The quality of the evidence ranged from very low to moderate across all outcomes."]
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[null,"RHEOLI ABSENOLDEB SALWCH - YMYRIADAU PENODOL"]
[null,"POEN GWDDF"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Aas RW, Tuntland H, Holte KA, Røe C, Lund T, Marklund S, Moller A. Workplace interventions for neck pain in workers. Cochrane Database of Systematic Reviews 2011, Issue 4. Art. No.: CD008160.\nDOI:10.1002/14651858.CD008160.pub2. Available here","Interventions for neck pain aimed at modifying body function, activity performance, participation, environment or personal factors. Interventions could be single or combination","Evidence is lacking so it is not possible to tell whether interventions reduce sickness absence in people on sick leave because of neck pain","Working age male and female adults (18 to 67 years). Workers at work or absent from work (on sick leave, early retirement or disability pension), but still connected to a workplace by employment agreements (permanent or temporary). All sectors, branches and types of jobs. Workers with reported neck pain of acute (less than six weeks), subacute (six to 12 weeks) or chronic (12 weeks or more) duration were included. Studies were included if at least 50% of the baseline population had neck pain","Objective was to determine the effectiveness of workplace interventions in adult workers with neck pain","Primary\n• Pain severity or pain prevalence (self-reported on a VAS or NSR scale, or measured as the proportion of those with pain)\n• Work absenteeism (time on benefits, number of hours/days on sick leave/lost time, proportion of individuals returning to work, employment status, and shift in employment status to working/part-time working/sick listed, disability pension and early retirement)\n\nSecondary\n• Global improvement (proportion of participants recovered or improved, measured by an overall judgment of improvement or treatment effectiveness)\n• Functional status\n• Well-being / Quality of Life","Included 10 RCTs (2745 workers). Two studies were assessed with low risk of bias. Most trials (n = 8) examined office workers. Few workers were sick-listed. Thus, workplace interventions (WIs) were seldom designed to improve return-to-work. Overall, there was low quality evidence that showed no significant differences between WIs and no intervention for pain prevalence or severity. If present, significant results in favour of WIs were not sustained across follow-up times. There was moderate quality evidence (1 study, 415 workers) that a four-component WI was significantly more effective in reducing sick leave in the intermediate-term (OR 0.56 95% CI 0.33 to 0.95), but not in the short- (OR 0.83  95% CI 0.52 to 1.34) or long-term (OR 1.28  95% CI 0.73 to 2.26). These findings might be because only a small proportion of the workers were sick-listed.","Overall, this review found low quality evidence that neither supported nor refuted the benefits of any specific WI for pain relief and moderate quality evidence that a multiple-component intervention reduced sickness absence in the intermediate-term, which was not sustained over time. Further research is very likely to have an important impact on the review authors confidence in the estimate of effect and is likely to change the estimate. There is an urgent need for high quality RCTs with well designed WIs"]
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[null,"ANHWYLDER ADDASU"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Arends I, Bruinvels DJ, Rebergen DS, Nieuwenhuijsen K, Madan I, Neumeyer-Gromen A, Bültmann U, Verbeek JH. Interventions to facilitate return to work in adults with adjustment disorders.\nCochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD006389.DOI:10.1002/14651858.CD006389.pub2. Available here ","All interventions that aimed at facilitating RTW of workers on sick leave because of adjustment disorders, using individual or group approaches were included. These included pharmacological interventions, psychological interventions, relaxation techniques, exercise programmes, employee assistance programmes and any combination of these","The evidence suggests that problem solving therapies may be effective in reducing time to partial return to work in people with adjustment disorder\n\nThe evidence suggests that CBT may not be effective in reducing time to return to work in people with adjustment disorder","Workers (18 to 65 years of age) with work disability related to an adjustment disorder causing sick leave","The review objective was to assess the effects of interventions facilitating return to work for workers with acute or chronic adjustment disorders ","Primary\nTime until partial return to work (RTW); time until full RTW\n\nSecondary\nSymptoms related to adjustment disorder, work functioning, generic functional status","Included nine studies reporting on 10 psychological interventions and one combined intervention, 1546 participants. \nNo RCTs were found of pharmacological interventions, exercise programmes or employee assistance programmes. \nAssessed seven studies as having low risk of bias and the studies that were pooled together were comparable. \n\nFor those who received no treatment, compared with CBT, the assumed time to partial and full RTW was 88 and 252 days respectively. Based on two studies with a total of 159 participants, moderate-quality evidence showed that CBT had similar results for time (measured in days) until partial RTW compared to no treatment at one-year follow-up (mean difference (MD) -8.78, 95% confidence interval (CI) -23.26 to 5.71). \n\nReview authors found low-quality evidence of similar results for CBT and no treatment on the reduction of days until full RTW at one year follow-up (MD -35.73, 95% CI -113.15 to 41.69) (one study with 105 participants included in the analysis). \n\nBased on moderate quality evidence, problem solving therapy (PST) significantly reduced time until partial RTW at one-year follow-up compared to non guideline based care (MD -17.00, 95% CI -26.48 to -7.52) (one study with 192 participants clustered among 33 treatment providers included in the analysis), but reviewers found moderate-quality evidence of no significant effect on reducing days until full RTW at one-year follow-up (MD -17.73, 95% CI -37.35 to 1.90) (two studies with 342 participants included in the analysis).","The review authors found moderate-quality evidence that CBT did not significantly reduce time until partial RTW and low-quality evidence that it did not significantly reduce time to full RTW compared with no treatment. Moderate-quality evidence showed that PST significantly enhanced partial RTW at one-year follow-up compared to non-guideline based care but did not significantly enhance time to full RTW at one-year follow-up. An important limitation was the small number of studies included in the meta-analyses and the small number of participants, which lowered the power of the analyses."]
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[null,"CANSER"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"de Boer AGEM, Taskila TK, Tamminga SJ, Feuerstein M, Frings-Dresen MHW, Verbeek JH. Interventions to enhance\nreturn-to-work for cancer patients. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD007569. DOI:\n10.1002/14651858.CD007569.pub3.  Available here","Interventions aiming to enhance return to work. Including psycho-educational, vocational, physical, medical or pharmacological, or any combination of these ","The evidence suggests that multidisciplinary physical, psycho-educational and/or vocational interventions may be effective in supporting people with cancer to return to work","Adults (>= 18 years old) who had been diagnosed with cancer (any type) and were in paid employment (employee or self employed) at the time of diagnosis","Review objective was to evaluate the effectiveness of interventions aimed at enhancing return to work (RTW) in cancer patients compared to alternative programmes including usual care or no intervention","Primary\nRTW measured as event data such as RTW rates or (change in) disability pension rates. RTW measured as time-to-event data, such as number of days between reporting sick and any work resumption or the number of days on sick leave during the follow-up period\n\nSecondary\nQoL which included overall QoL, physical QoL and emotional QoL measured with validated and unvalidated questionnaires","Fifteen RCTs including 1835 cancer patients met the inclusion criteria and because of multiple arms studies 19 evaluations were included. Reviewers judged six studies to have a high risk of bias and nine to have a low risk of bias. All included studies were conducted in high income countries and most studies were aimed at breast cancer patients (seven trials) or prostate cancer patients (two trials).\n\nTwo studies involved psycho-educational interventions including patient education and teaching self-care behaviours. Results indicated low quality evidence of similar RTW rates for psycho-educational interventions compared to care as usual (RR 1.09, 95% CI 0.88 to 1.35, n = 260 patients) and low quality evidence that there is no difference in the effect of psycho-educational interventions compared to care as usual on quality of life (standardised mean difference (SMD) 0.05, 95% CI -0.2 to 0.3, n = 260 patients). No studies were found on vocational interventions. In one study breast cancer patients were offered a physical training programme. Low quality evidence suggested that physical training was not more effective than care as usual in improving RTW (RR 1.20, 95% CI 0.32 to 4.54, n = 28 patients) or quality of life (SMD -0.37, 95% CI -0.99 to 0.25, n = 41 patients).\n\nSeven RCTs assessed the effects of a medical intervention on RTW. In all studies a less radical or functioning conserving medical intervention was compared with a more radical treatment. Low quality evidence was found that less radical, functioning conserving approaches had similar RTW rates as more radical treatments (RR 1.04, 95% CI 0.96 to 1.09, n = 1097 patients) and moderate quality evidence of no differences in quality of life outcomes (SMD 0.10, 95% CI -0.04 to 0.23, n = 1028 patients).\n\nFive RCTs involved multidisciplinary interventions in which vocational counselling, patient education, patient counselling, biofeedback- assisted behavioral training and/or physical exercises were combined. Moderate quality evidence showed that multidisciplinary interventions involving physical, psycho-educational and/or vocational components led to higher RTW rates than care as usual (RR 1.11, 95% CI 1.03 to 1.16, n = 450 patients). No differences were found in the effect of multidisciplinary interventions compared to care as usual on quality of life outcomes (SMD 0.03, 95% CI -0.20 to 0.25, n = 316 patients).","Review authors found moderate quality evidence that multidisciplinary interventions enhance the RTW of patients with cancer."]
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[null,"RHAGLENNI RHEOLI ANABLEDD YN Y GWEITHLE"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Gensby U, Lund T, Kowalski K, Saidj M, Jørgensen AMK, Filges T, Irvin E, Amick BC III, Labriola M. Workplace Disability Management Programs Promoting Return-to-Work: A Systematic Review. Campbell Systematic Reviews 2012:17\nDOI: 10.4073/csr.2012.17 Available here","This review focused on workplace disability management (WPDM) programmes that were:\n• Characterised as an ‘onsite’ WPDM or RTW programme\n• Provided by the employer or initiated by the employer in collaboration with key players in the workplace\n• Addressed the duration or extent of an inability to work due to physical injury or mental illness\n• Implemented within the workplace setting","Evidence is lacking (identified studies were of a design inappropriate to assess interventions) so it is not possible to tell whether workplace disability management programmes help to reduce sickness absence","Employees (from the public or private sector) on sick-leave with an inability to work due to physical injury, illness or mental health disorders","The objective of this review was to assess the effectiveness of Workplace Disability Management Programmes (WPDM) promoting RTW\n• Compare WPDM programmes to no treatment, treatment as usual or alternative intervention\n• Examine components of WPDM programmes which appear more highly related to positive outcome\n","Primary\n• Return to work \n• Duration of sickness absence \n• Reduction in lost days from work \nSecondary\n• The functional health consequences \n• Return to fulltime or part-time work (yes/no)\n• Whether RTW was completed at the current employer\nSustainability of return to work:\n• Relapse to sickness absence in the follow-up period ","Thirteen studies (two non-randomised studies (NRS) and eleven single group ‘before and after’ studies (B & A)), including data from eleven different WPDM programmes, met the inclusion criteria. There were insufficient data on the characteristics of the sample and the effect sizes were uncertain. However, narrative descriptions of the included programme characteristics were rich, and provide valuable insights into programme scope, components, procedures and human resources involved.\n\nThere is a lack of evidence to draw unambiguous conclusions on the effectiveness of employer provided WPDM programmes promoting RTW. It was not possible to determine if specific programme components or specific sets of components are driving effectiveness.\n\nThe review adds to the existing knowledge base on WPDM programme development, characteristics and evaluation. At an organisational level intervention, employer provided WPDM programmes are multi-component constructs, offering a suite of policies and practices for injured or ill employees. The review identified 15 constituent programme components, covering individual, organisational, and system level policies and practices, depicting key human resources involved in workplace programme procedures and administration.\n\nFuture programme evaluations ought to broaden their focus beyond the first phases of the RTW process and incorporate sustainable outcomes (e.g. job retention, satisfactory and productive job performance, work role functioning, and maintenance of job function).\n\nGiven the lack of WPDM programmes evaluated in peer-reviewed publications, more attention needs to be given to locate and rigorously evaluate efforts from company studies that may still exist outside the peer reviewed published literature.\n\nWhile many employers recognise the importance of WPDM and are adopting policies and practices to promote RTW, judging from this review, the existing evidence leaves room for more rigorous methodological studies to develop the present WPDM knowledge base. Prospectively, WPDM evaluation research also needs to enlarge its perspective and refine its analytic tools to examine information that is meaningful and cost effective to those who will benefit from it, to further advance the field.","The review findings might help explicate WPDM programmes and their potential impact on RTW outcomes, and provide a more complete understanding of the research in the field of WPDM. This may inspire researchers, employers, and policy makers, who are interested not only in questions regarding the impact of programmes, but also their nature, to promote future design and evaluation of DM in organisations."]
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[null,"CLEFYD CORONAIDD Y GALON"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Hegewald J, Wegewitz UE, Euler U, van Dijk JL, Adams J, Fishta A, Heinrich P, Seidler A. Interventions to support return to work for people with coronary heart disease. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD010748.\nDOI: 10.1002/14651858.CD010748.pub2. Available here","Interventions  that aim to support the return-to-work process with individual or group approaches.\n• Work-directed interventions: these can include changes in the work environment, work tasks or working methods\n• Person-directed interventions:\ni) psychological interventions \nii) physical conditioning interventions\n• Any combination of the above","The evidence suggests that psychological interventions (including health education) for people with coronary heart disease may not be effective in reducing sickness absence (days until return to work) \n\nThe evidence suggests that work directed counselling may not be effective for people with coronary heart disease in reducing sickness absence (days to return to work)\n\nThe evidence suggests exercise programmes and combined cardiac rehabilitation programmes for people with coronary heart disease may not be effective  reducing time needed to return to work. \n\n","Adults (18 years or older) who had been diagnosed with CHD, who experienced a MI, or a coronary revascularisation procedure like CABG or PCI, as well as people with angina pectoris or angiographically-defined CHD. Within each study, at least 80% of participants had to fulfil these criteria.\nParticipants should also have been employed (either in paid employment\nor self-employed) at the time of diagnosis and on sick leave or otherwise not working at the time of the study because of the CHD ","Review objective was to assess the effects of person- and work-directed interventions aimed at enhancing return to work in patients with coronary heart disease compared to usual care or no intervention","Primary\nReturn to work, including return to\neither full- or part-time employment, to the previous job, and to the same role or with changes in work status (change of duties,\nworking location, function). Return to work included number of days on sick leave during the follow-up period\n\nSecondary\n• Health-related quality of life within the return-to-work process, either measured with generic instruments or with disease-specific instruments\n•  Number of participants who returned to work and were still working after an extended period of at least one year\n• Number of participants who were still working after five years ","Included 39 RCTs (including one cluster- and four three-armed RCTs). Return-to-work results of 34 studies were included in the meta-analyses.\n\nPerson-directed, psychological counselling versus usual care\nIncluded 11 studies considering return to work following psychological interventions among a subgroup of 615 participants in the meta-analysis. Most interventions used some form of counselling to address participants’ disease-related anxieties and provided information on the causes and course of CHD to dispel misconceptions. Cannot tell whether these interventions increase return to work up to six months (risk ratio (RR) 1.08, 95% confidence interval (CI) 0.84 to 1.40; six studies; very low-certainty evidence) or at six to 12 months (RR 1.24, 95% CI 0.95 to 1.63; seven studies; very low-certainty evidence). Cannot tell whether psychological interventions shorten the time until return to work. Psychological interventions may have little or no effect on the proportion of participants working between one and five years (RR 1.09, 95% CI 0.88 to 1.34; three studies; low-certainty evidence).\n\nPerson-directed, work-directed counselling versus usual care\nFour studies examined work-directed counselling. These counselling interventions included advising patients when to return to work based on treadmill testing or extended counselling to include co-workers’ fears and misconceptions regarding CHD. Work-directed counselling may result in little to no difference in the mean difference (MD) in days until return to work (MD −7.52 days, 95% CI −20.07 to 5.03 days; four studies; low-certainty evidence). Work-directed counselling probably results in little to no difference in cardiac deaths (RR 1.00, 95% CI 0.19 to 5.39; two studies; moderate-certainty evidence).\n\nPerson-directed, physical conditioning interventions versus usual care\nNine studies examined the impact of exercise programmes. Compared to usual care, cannot tell if physical interventions increase return to work up to six months (RR 1.17, 95% CI 0.97 to 1.41; four studies; very low-certainty evidence). Physical conditioning interventions may result in little to no difference in return-to-work rates at six to 12 months (RR 1.09, 95% CI 0.99 to 1.20; five studies; low-certainty evidence), and may also result in little to no difference on the rates of patients working after one year (RR 1.04, 95% CI 0.82 to 1.30; two studies; low-certainty evidence). Physical conditioning interventions may result in little to no difference in the time needed to return to work (MD −7.86 days, 95% CI −29.46 to 13.74 days; four studies; low-certainty evidence). Physical conditioning interventions probably do not increase cardiac death rates (RR 1.00, 95%CI 0.35 to 2.80; two studies; moderate-certainty evidence).\n\nPerson-directed, combined interventions versus usual care\nIncluded 13 studies considering return to work following combined interventions in the meta-analysis. Combined cardiac rehabilitation programmes may have increased return to work up to six months (RR 1.56, 95% CI 1.23 to 1.98; number needed to treat for an additional beneficial outcome (NNTB) 5; four studies; low-certainty evidence), and may have little to no difference on return to- work rates at six to 12 months’ follow-up (RR 1.06, 95% CI 1.00 to 1.13; 10 studies; low-certainty evidence). Reviewers could not tell if combined interventions increased the proportions of participants working between one and five years (RR 1.14, 95% CI 0.96 to 1.37; six studies; very low-certainty evidence) or at five years (RR 1.09, 95% CI 0.86 to 1.38; four studies; very low-certainty evidence). Combined interventions probably shortened the time needed until return to work (MD −40.77, 95% CI −67.19 to −14.35; two studies; moderate-certainty evidence). Combining interventions probably results in little to no difference in reinfarctions (RR 0.56, 95% CI 0.23 to 1.40; three studies; moderate-certainty evidence).\n\nWork-directed, interventions\nNo studies exclusively examining strictly work-directed interventions at the workplace were found","Combined interventions may increase return to work up to six months and probably reduce the time away from work. Otherwise, no evidence was found of either a beneficial or harmful effect of person-directed interventions. The certainty of the evidence for the various interventions and outcomes ranged from very low to moderate. Return to work was typically a secondary outcome of the studies, and as such, the results pertaining to return to work were often poorly reported. Adhering to RCT reporting guidelines could greatly improve the evidence of future research. A research gap exists regarding controlled trials of work-directed interventions, health-related quality of life within the return-to-work process, and adverse effects."]
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[null,"ARTHRITIS LLIDIOL"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Hoving JL, Lacaille D, Urquhart DM, Hannu TJ, Sluiter JK, Frings-Dresen MHW. Non-pharmacological interventions for preventing job loss in workers with inflammatory arthritis. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD010208. DOI: 10.1002/14651858.CD010208.pub2. Available here","Included interventions where the focus was on job loss prevention or improving work function. Interventions that fulfilled at least two of the following components:\na) An evaluation of the work challenges or work adaptations as a step in the main intervention of the study\nb) Interventions directed at the person, meaning job coaching, job or vocational training, vocational\ncounselling; or empowerment for work; or self-management, including support or information regarding work or both\nc) Interventions directed at the work environment, meaning work adaptations, ergonomic measures, job accommodations; or interventions targeted directly at the employer, supervisor\nor co-workers","Evidence is lacking so it is not possible to tell if non- pharmacological interventions reduce sickness absence for people with inflammatory arthritis","Included trials in which the population was limited to adults of working age (18 to 65 years) of which at least half of all workers\n(>50%) had been diagnosed with inflammatory arthritis (IA), including rheumatoid arthritis (RA), ankylosing spondylitis (AS),  psoriatic arthritis (PsA) or\nundifferentiated spondyloarthritis (SpA), or IA associated with connective tissue diseases such as Systemic\nLupus Erythematosus (SLE)","The review objective was to assess the effects of non-pharmacological interventions that aim to prevent job loss, work absenteeism or improve work functioning for employees with IA","Primary outcomes\n• Job loss measured as: the number of people that become unemployed at some stage following diagnosis, regardless of disability pension status; or the time to job loss\n• Sickness absenteeism measured as: time lost from work (number of work days or hours missed at work due to sick leave, or absenteeism); or time to return to work; or the proportion of workers on sick leave at a certain moment of follow-up\n\nSecondary outcomes\nWork functioning measured using any at-work productivity, work functioning or presenteeism questionnaire","Included three RCTs with a total of 414 participants at risk of job loss. The majority of participants had IA, most with RA and to a lesser degree AS. The interventions aimed to prevent job loss and improve work functioning in several ways: firstly by evaluating work changes or adaptations and secondly by providing any person-directed interventions including vocational counselling, advice or education. Interventions directly targeted at the work environment were minimal and included workplace visits (one trial) or any actions by an occupational physician (one trial). The duration or dose of the interventions varied from two 1.5-hour sessions (one RCT) over five months, two consultation and multidisciplinary treatments during three months (one RCT), to six to eight individual or group sessions over six months (also one RCT). All participants were recruited through rheumatology clinics, both in or outside hospitals. Included trials investigated job loss (n = two RCTs; 382 participants), work absenteeism and work functioning (n = one RCT; 32 participants). The two smaller trials were assessed as having a high risk of bias and the large trial as having a low risk of bias. Trials showed marked differences in how they performed on risk of bias items, particularly on performance bias.\n\nUsing the GRADE there was judged to be to be very low quality evidence across the three reported outcomes. Of the two RCTs investigating job loss, the larger one (n = 242 participants) reported a large statistically significant reduction in job loss (relative risk (RR) = 0.35, 95% confidence interval (CI) 0.18 to 0.68) and the other RCT (n = 140) reported similar effects in both groups, although the CI was very wide (RR = 1.05, 95% CI 0.53 to 2.06). The latter one probably suffered from performance bias and reviewers judged it to have a high risk of bias. The one small trial investigating sickness absenteeism found uncertain results at six months’ follow-up (MD = -2.42 days, 95% CI -5.03 to 0.19). Finally, in the same small trial investigating work functioning using the Rheumatoid Arthritis-Work Instability Scale (RA-WIS), there was a moderate improvement of intermediate term work functioning (six months; scale range 0 to 23; mean improvement -4.67 points, 95% CI -8.43 to -0.91). No adverse effects were identified in the publications of the three trials.","This Cochrane review of three RCTs found very low quality evidence overall for job loss prevention interventions having an effect on job loss, work absenteeism and work functioning in workers with inflammatory arthritis. While this review highlights that further high quality RCTs are required, the results suggest that these strategies have potential to be effective."]
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[null,"SGLEROSIS YMLEDOL"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Khan F, Ng L, Turner-Stokes L. Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis.\nCochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007256.\nDOI: 10.1002/14651858.CD007256.pub2. Available here","All categories of  vocational rehabilitation (VR) programmes which incorporate a clearly defined vocational rehabilitation or work therapy element. These included\nstructured multi-disciplinary / multi-agency interventions to preserve employment such as clinic or community based counselling, planning for disclosure and accommodation and work place accommodations. All three types of VR programmes were included, such as those offered by ‘general rehabilitation programmes’, ‘MS specialised VR programmes’ and ‘pan -disability VR programmes’ ","Evidence is lacking so it is not possible to tell whether vocational rehabilitation improves employment outcomes in people with multiple sclerosis","Trials were included if the study population was working age (i.e. mean age between 18-65 years) and had the diagnosis of MS (sub types of MS were included- relapsing remitting, secondary progressive and primary progressive MS), irrespective of MS severity","The primary objective of this review is to evaluate the effectiveness of vocational rehabilitation (VR) programmes compared to alternative programmes or care as usual on return to work, employment and work ability in persons with multiple sclerosis. A secondary objective is to evaluate the cost effectiveness of these VR programmes","Primary outcomes\n• The change in proportion of pwMS in competitive employment (full time or part time employment position held by a person in an ordinary work setting, for which they were receiving payment at the market rate \n• The change in proportions of persons in supported employment (employment in an ’open work’ setting but with ongoing support such as government funded programmes)\nSecondary outcomes\n• The rate of return to work in days of pwMS\n• The change in proportion of pwMS on disability pension\n• The improvement of work ability in pwMS (such as the proportion of persons with MS who are engaged in attending a sheltered workshop and earn a modest living)\n• Costs of programmes and cost effectiveness of return to work or employment","Two trials (one RCT and one CCT) (total 80 participants) met the review criteria. Both trials scored poorly on the methodological quality assessment. There was ’insufficient evidence’ for VR programmess for (a)‘competitive employment’, in altering rates of job retention, changes in employment, improvement in rates of re-entry into the labour force; (b) for altering ‘work ability’ by improving participants’ confidence in the accommodation request process, or employability maturity or job seeking activity. No evidence could be assimilated for changes in proportions of persons in supported employment or on disability pensions, nor for cost-effectiveness.","There was inconclusive evidence to support VR for pwMS. However, the review highlights some of the challenges in providing VR for pwMS. Clinicians need to be aware of vocational issues, and to understand and manage barriers for maintaining employment. Proactive and timely VR programmes should incorporate practical solutions to deal with work disability, workplace accommodation and educate employers, and the wider community. Liaison with policy makers is imperative for government initiatives that encourage work focused VR programmes. Future research in VR should focus on improving methodological and scientific rigour of clinical trials; on the development of appropriate and valid outcome measures; and on cost effectiveness of VR programmes."]
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[null,"ISELDER"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Nieuwenhuijsen K, Faber B, Verbeek JH, Neumeyer-Gromen A, Hees HL, Verhoeven AC, van der Feltz-Cornelis CM, Bültmann U. Interventions to improve return to work in depressed people. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD006237. DOI: 10.1002/14651858.CD006237.pub3. Available here","1. work-directed interventions, i.e. addressing the work or the work-worker interface as part of the clinical treatment or as a\nstand-alone intervention; and\n2. clinical interventions, i.e. treatment of depressive disorder without a focus on work","The evidence suggests that work directed interventions added to clinical intervention may reduce sickness absence in people with depression","Adult (that is over 17 years old) workers (employees or self-employed) from occupational health settings, primary care, or outpatient care settings","The review objective was to evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders","Primary outcomes\nDays of sickness absence during the follow-up period\n\nSecondary outcomes\n• Depression (either dichotomously or continuously measured)\n• Work functioning \n• Employment status after a period of time \n\nOther outcomes such as employee satisfaction, general social functioning (not work specific), or quality of life scales were excluded","Included 23 studies with 26 study arms, involving 5996 participants with either a major depressive disorder or a high level of depressive symptoms. Fourteen studies were judged to have a high risk of bias and nine to have a low risk of bias.\n\nWork-directed interventions\nFive work-directed interventions. There was moderate quality evidence that a work-directed intervention added to a clinical intervention reduced sickness absence (SMD -0.40; 95% CI -0.66 to -0.14; 3 studies) compared to a clinical intervention alone. There was moderate quality evidence based on a single study that enhancing the clinical care in addition to regular work-directed care was not more effective than work-directed care alone (SMD -0.14; 95% CI -0.49 to 0.21). There was very low quality evidence based on one study that regular care by occupational physicians that was enhanced with an exposure-based return to work programme did not reduce sickness absence compared to regular care by occupational physicians (nonsignificant finding: SMD 0.45; 95% CI -0.00 to 0.91).\n\nClinical interventions, antidepressant medication\nThree studies compared the effectiveness of selective serotonin reuptake inhibitor (SSRI) to selective norepinephrine reuptake inhibitor (SNRI) medication on reducing sickness absence and yielded highly inconsistent results.\n\nClinical interventions, psychological\nModerate quality evidence based on three studies that telephone or online cognitive behavioural therapy was more effective in reducing sick leave than usual primary or occupational care (SMD -0.23; 95% CI -0.45 to -0.01).\n\nClinical interventions, psychological combined with antidepressant medication\nLow quality evidence based on two studies that enhanced primary care did not substantially decrease sickness absence in the medium term (4 to 12 months) (SMD -0.02; 95% CI -0.15 to 0.12). A third study found no substantial effect on sickness absence in favour of this intervention in the long term (24 months). Reviewers found high quality evidence, based on one study, that a structured telephone outreach and care management program was more effective in reducing sickness absence than usual care (SMD - 0.21; 95% CI -0.37 to -0.05).\n\nClinical interventions, exercise\nLow quality evidence based on one study that supervised strength exercise reduced sickness absence compared to relaxation (SMD -1.11; 95% CI -1.68 to -0.54). Moderate quality evidence based on two studies that aerobic exercise was no more effective in reducing sickness absence than relaxation or stretching (SMD -0.06; 95% CI -0.36 to 0.24","Review authors found moderate quality evidence that adding a work-directed intervention to a clinical intervention reduced the number of days on sick leave compared to a clinical intervention alone. They also found moderate quality evidence that enhancing primary or occupational care with cognitive behavioural therapy reduced sick leave compared to the usual care. A structured telephone outreach and care management programme that included medication reduced sickness absence compared to usual care. However, enhancing primary care with a quality improvement programme did not have a considerable effect on sickness absence. There was no evidence of a difference in effect on sickness absence of one antidepressant medication compared to another. More studies are needed on work-directed interventions. Clinical intervention studies should also include work outcomes to increase our knowledge on reducing sickness absence in depressed workers."]
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[null,"POEN CEFN"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Schaafsma FG, Whelan K, van der Beek AJ, van der Es-Lambeek LC, Ojajärvi A, Verbeek JH. Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain.\nCochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD001822.\nDOI: 10.1002/14651858.CD001822.pub Available here","Included studies on physical conditioning programmes when they included the following three key elements:\n• (advice about) exercises specifically designed to restore an individual’s systemic, neurological, musculoskeletal (strength,\nendurance, movement, flexibility and motor control) or cardiopulmonary function, or a combination\n• explicitly stated to have an intended improvement of work\nstatus\n• a stated relationship between the intervention and\nfunctional job demands","The evidence is inconsistent so it is not possible to tell if physical conditioning is effective in improving employment outcomes in people on sick leave because of back pain","Male and female adults (> 16 years) with work disability related to back pain","Objective to assess the effectiveness of physical conditioning as part of a return to work strategy in reducing time lost from work and improving work status for workers with back pain","• Time between intervention and return-to-work\n• Return-to-work status in terms of ’at work’ or ‘off work’\n• Time on light or modified duties","Included 41 articles reporting on 25 RCTs with 4404 participants. Risk of bias was low in 16 studies. \n\nThree studies involved workers with acute back pain, eight studies workers with subacute back pain, and 14 studies workers with chronic back pain.\n\nIn 14 studies, physical conditioning as part of a return to work strategy was compared to usual care. The physical conditioning mostly consisted of graded activity with work-related exercises aimed at increasing back strength and flexibility, together with a set date for return to work. The programmes were divided into a light version with a maximum of five sessions, or an intense version with more than five sessions up to full time or as inpatient treatment. \n\nFor acute back pain, there was low quality evidence that both light and intense physical conditioning programmes made little or no difference in sickness absence duration compared with care as usual at three to 12 months follow-up (3 studies with 340 workers). \n\nFor subacute back pain, the evidence on the effectiveness of intense physical conditioning combined with care as usual compared to usual care alone was conflicting (four studies with 395 workers). However, subgroup analysis showed low quality evidence that if the intervention was executed at the workplace, or included a workplace visit, it may have reduced sickness absence duration at 12 months follow-up (3 studies with 283 workers; SMD -0.42, 95% CI -0.65 to -0.18). \n\nFor chronic back pain, there was low quality evidence that physical conditioning as part of integrated care management in addition to usual care may have reduced sickness absence days compared to usual care at 12 months follow-up (1 study, 134 workers; SMD - 4.42, 95% CI -5.06 to -3.79). What part of the integrated care management was most effective remained unclear. There was moderate quality evidence that intense physical conditioning probably reduced sickness absence duration only slightly compared with usual care at 12 months follow-up (5 studies, 1093 workers; SMD -0.23, 95% CI -0.42 to -0.03). \n\nPhysical conditioning compared to exercise therapy showed conflicting results for workers with subacute and chronic back pain. Cognitive behavioural therapy was probably not superior to physical conditioning as an alternative or in addition to physical conditioning.","The effectiveness of physical conditioning as part of a return to work strategy in reducing sick leave for workers with back pain, compared to usual care or exercise therapy, remains uncertain. For workers with acute back pain, physical conditioning may have no effect on sickness absence duration. There is conflicting evidence regarding the reduction of sickness absence duration with intense physical conditioning versus usual care for workers with subacute back pain. It may be that including workplace visits or execution of the intervention at the workplace is the component that renders a physical conditioning programme effective. For workers with chronic back pain physical conditioning has a small effect on reducing sick leave compared to care as usual after 12 months follow-up. To what extent physical conditioning as part of integrated care management may alter the effect on sick leave for workers with chronic back pain needs further research."]

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[null,"CADW POBL MEWN GWAITH"]
[null,"CYMORTH I GADW'R RHEINY AG ANGHENION YCHWANEGOL MEWN CYFLOGAETH"]
[null,"POBL Â CHANSER"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"de Boer AGEM, Taskila TK, Tamminga SJ, Feuerstein M, Frings-Dresen MHW, Verbeek JH. Interventions to enhance\nreturn-to-work for cancer patients. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD007569. DOI:\n10.1002/14651858.CD007569.pub3. Available here","Interventions aiming to enhance return to work. Including psychoeducational, vocational, physical, medical or pharmacological, or any combination of these ","The evidence suggests that multidisciplinary physical, psycho-educational and/or vocational interventions may be effective in supporting people with cancer to return to work","Adults (>= 18 years old) who had been diagnosed with cancer (any type) and were in paid employment (employee or self employed) at the time of diagnosis","Review objective was to evaluate the effectiveness of interventions aimed at enhancing return to work (RTW) in cancer patients compared to alternative programmes including usual care or no intervention","Primary\n• RTW measured as event data such as RTW rates or (change in) disability pension rates\n• RTW measured as time-to-event data, such as number of days between reporting sick and any work resumption or the number of days on sick leave during the follow-up period\n\nSecondary\nQoL which included overall QoL, physical QoL and emotional QoL measured with validated and unvalidated questionnaires","Fifteen RCTs including 1835 cancer patients met the inclusion criteria and because of multiple arms studies 19 evaluations were included. Review authors judged six studies to have a high risk of bias and nine to have a low risk of bias. All included studies were conducted in high income countries and most studies were aimed at breast cancer patients (seven trials) or prostate cancer patients (two trials).\n\nTwo studies involved psycho-educational interventions including patient education and teaching self-care behaviours. Results indicated low quality evidence of similar RTW rates for psycho-educational interventions compared to care as usual (RR 1.09, 95% CI 0.88 to 1.35, n = 260 patients) and low quality evidence that there is no difference in the effect of psycho-educational interventions compared to care as usual on quality of life (standardised mean difference (SMD) 0.05, 95% CI -0.2 to 0.3, n = 260 patients). No studies were found on vocational interventions. In one study breast cancer patients were offered a physical training programme. Low quality evidence suggested that physical training was not more effective than care as usual in improving RTW (RR 1.20, 95% CI 0.32 to 4.54, n = 28 patients) or quality of life (SMD -0.37, 95% CI -0.99 to 0.25, n = 41 patients).\n\nSeven RCTs assessed the effects of a medical intervention on RTW. In all studies a less radical or functioning conserving medical intervention was compared with a more radical treatment. Low quality evidence was found that less radical, functioning conserving approaches had similar RTW rates as more radical treatments (RR 1.04, 95% CI 0.96 to 1.09, n = 1097 patients) and moderate quality evidence of no differences in quality of life outcomes (SMD 0.10, 95% CI -0.04 to 0.23, n = 1028 patients).\n\nFive RCTs involved multidisciplinary interventions in which vocational counselling, patient education, patient counselling, biofeedback- assisted behavioral training and/or physical exercises were combined. Moderate quality evidence showed that multidisciplinary interventions involving physical, psycho-educational and/or vocational components led to higher RTW rates than care as usual (RR 1.11, 95% CI 1.03 to 1.16, n = 450 patients). No differences were found in the effect of multidisciplinary interventions compared to care as usual on quality of life outcomes (SMD 0.03, 95% CI -0.20 to 0.25, n = 316 patients).","Review authors found moderate quality evidence that multidisciplinary interventions enhance the RTW of patients with cancer."]
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[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Fong CJ, Murphy KM, Westbrook JD, Markle MM. Behavioral, Psychological, Educational, and Vocational Interventions to Facilitate Employment Outcomes\nfor Cancer Survivors: A Systematic Review Campbell Systematic Reviews 2015:5\nDOI: 10.4073/csr.2015.5. Available here","Included studies addressed the effectiveness on employment outcomes of behavioral, psychological,\neducational, or vocational interventions or component of an intervention for cancer\nsurvivors","The evidence suggests that employment interventions for cancer survivors may help them to maintain employment","Adults aged 18 or older who had a past or present cancer diagnosis which occurred whilst they were aged 18 or older. Particpants with an employment history and those without were included","Not clearly specified","Employment initiation, return-to-work, or decreasing absenteeism and use of work disability or sick leave","Included 12 studies evaluating the effects of psychosocially-related interventions on the employment of cancer survivors (n = 2151). The results suggest that the included interventions may improve employment status (OR = 1.71, 95% confidence interval (CI) 1.26 to 2.32) for cancer survivors. For RCTs (n = 6), the weighted mean effect size for employment status was OR = 1.44 (95% CI 0.99 to 2.09), favouring the intervention groups. The mean odds ratio of 1.44 translates to an employment rate of about 68% for intervention participants compared to a baseline 60% for comparison group participants. For QEDs (n = 6), the weighted mean effect size for employment status was OR = 2.18 95% CI 1.32 to 3.60), also favoring the intervention groups. The mean odds ratio of 2.18 for the quasi-experimental studies translates to an employment rate of about 77% for intervention participants, compared to the baseline rate of 60% for the comparison group participants. Although the mean effect size from QEDs was larger than that from the RCTs, there is no significant difference between the two types of experimental designs (p = 0.19).\n\nThere was no evidence of an effect on the number of hours worked (OR = 0.89, 95% CI 0.22 to 1.52) or number of sick leave days (OR = 1.18, 95% CI 0.81 to 1.71). Overall, the assessment of the risk of bias was high, and conclusions about the effectiveness of the included interventions should be interpreted with caution.","This review highlights the positive effect psychosocial interventions may have on\nemployment outcomes for cancer survivors. However, the methodological\nshortcomings of the included studies overall makes it likely that there is bias in the results and too few studies to provide sufficiently strong evidence to recommend particular practices. This review brings attention to the need for additional rigorous studies in this area, in particular, randomised controlled trials with more detailed reporting of data and study design and methodology."]
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[null,"RHAGLENNI RHEOLI ANABLEDD YN Y GWEITHLE"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Gensby U, Lund T, Kowalski K, Saidj M, Jørgensen AMK, Filges T, Irvin E, Amick BC III, Labriola M. Workplace Disability Management Programs Promoting Return-to-Work: A Systematic Review. Campbell Systematic Reviews 2012:17\nDOI: 10.4073/csr.2012.17. Available here","This review focused on workplace disability management (WPDM) programmes that were:\n• Characterised as an ‘onsite’ WPDM or RTW programme\n• Provided by the employer or initiated by the employer in collaboration with key players in the workplace\n• Addressed the duration or extent of an inability to work due to physical injury or mental illness\n• Implemented within the workplace setting","Evidence is lacking so it is not possible to tell whether workplace disability management programmes support people to maintain employment","Employees (from the public or private sector) on sick-leave with an inability to work due to physical injury, illness or mental health disorders","The objective of this review was to assess the effectiveness of Workplace Disability Management Programmes (WPDM) promoting RTW \n• Compare WPDM programmes to no treatment, treatment as usual or alternative intervention\n• Examine components of WPDM programmes which appear more highly related to positive outcome\n","Primary\n• Return to work \n• Duration of sickness absence \n• Reduction in lost days from work \n\nSecondary\n• The functional health consequences \n• Return to fulltime or part-time work (yes/no)\n• Whether RTW was completed at the current employer\nSustainability of return to work:\n• Relapse to sickness absence in the follow-up period ","Thirteen studies (two non-randomized studies (NRS) and eleven single group ‘before and after’ studies (B & A), including data from eleven different WPDM programmes, met the inclusion criteria. There were insufficient data on the characteristics of the sample and the effect sizes were uncertain. However, narrative descriptions of the included programme characteristics were rich, and provide valuable insights into programme scope, components, procedures and human resources involved.\n\nThere is a lack of evidence to draw unambiguous conclusions on the effectiveness of employer provided WPDM programmes promoting RTW. It was not possible to determine if specific program components or specific sets of components are driving effectiveness.\n\nThe review adds to the existing knowledge base on WPDM programme development, characteristics and evaluation. At an organisational level intervention, employer provided WPDM programmes are multi-component constructs, offering a suite of policies and practices for injured or ill employees. The review identified 15 constituent programme components, covering individual, organisational, and system level policies and practices, depicting key human resources involved in workplace program procedures and administration.\n\nFuture programme evaluations ought to broaden their focus beyond the first phases of the RTW process and incorporate sustainable outcomes (e.g. job retention, satisfactory and productive job performance, work role functioning, and maintenance of job function).\n\nGiven the lack of WPDM programmes evaluated in peer-reviewed publications, more attention needs to be given to locate and rigorously evaluate efforts from company studies that may still exist outside the peer reviewed published literature.\n\nWhile many employers recognize the importance of WPDM and are adopting policies and practices to promote RTW, judging from this review, the existing evidence leaves room for more rigorous methodological studies to develop the present WPDM knowledge base. Prospectively,WPDM evaluation research also needs to enlarge its perspective and refine its analytic tools to examine information that is meaningful and cost effective to those who will benefit from it, to further advance the field.","The review findings might help explicate WPDM programmes and their potential impact on RTW outcomes, and provide a more complete understanding of the research in the field of WPDM. This may inspire researchers, employers, and policy makers, who are interested not only in questions regarding the impact of programmes, but also their nature, to promote future design and evaluation of DM in organisations."]
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[null,"CLEFYD CORONAIDD Y GALON"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Hegewald J, Wegewitz UE, Euler U, van Dijk JL, Adams J, Fishta A, Heinrich P, Seidler A. Interventions to support return to work for people with coronary heart disease. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD010748.\nDOI: 10.1002/14651858.CD010748.pub2. Available here","Interventions  that aim to support the return-to-work process with individual or group approaches.\n1. Work-directed interventions: these can include changes in the work environment, work tasks or working methods\n2. Person-directed interventions:\ni) psychological interventions \nii) physical conditioning interventions\n3. Any combination of the above","The evidence suggests that psychological interventions (including health education) may not be effective for keeping people with coronary heart disease in employment\n\nThe evidence suggests that physical conditioning and combined interventions for people with coronary heart disease may have no effect on the proportion of participants working after one year.","Adults (18 years or older) who had been diagnosed with CHD, who experienced a MI, or a coronary revascularisation procedure like CABG or PCI, as well as people with angina pectoris or angiographically-defined CHD. Within each study, at least 80% of participants had to fulfil these criteria.\nParticipants should also have been employed (either in paid employment\nor self-employed) at the time of diagnosis and on sick leave or otherwise not working at the time of the study because of the CHD ","Review objective was to assess the effects of person- and work-directed interventions aimed at enhancing return to work in patients with coronary heart disease compared to usual care or no intervention","Primary\nReturn to work, including return to\neither full- or part-time employment, to the previous job, and to the same role or with changes in work status (change of duties,\nworking location, function). Return to work included number of days on sick leave during the follow-up period\n\nSecondary\n• Health-related quality of life within the return-to-work process, either measured with generic instruments or with disease-specific instruments\n• Number of participants who returned to work and were still working after an extended period of at least one year\n• Number of participants who were still working after five years ","Included 39 RCTs (including one cluster- and four three-armed RCTs). Reviewers included the return-to-work results of 34 studies in the meta-analyses.\n\nPerson-directed, psychological counselling versus usual care\nIncluded 11 studies considering return to work following psychological interventions among a subgroup of 615 participants in the meta-analysis. Most interventions used some form of counselling to address participants’ disease-related anxieties and provided information on the causes and course of CHD to dispel misconceptions. Cannot tell whether these interventions increase return to work up to six months (risk ratio (RR) 1.08, 95% confidence interval (CI) 0.84 to 1.40; six studies; very low-certainty evidence) or at six to 12 months (RR 1.24, 95% CI 0.95 to 1.63; seven studies; very low-certainty evidence). Cannot tell whether psychological interventions shorten the time until return to work. Psychological interventions may have little or no effect on the proportion of participants working between one and five years (RR 1.09, 95% CI 0.88 to 1.34; three studies; low-certainty evidence).\n\nPerson-directed, work-directed counselling versus usual care\nFour studies examined work-directed counselling. These counselling interventions included advising patients when to return to work based on treadmill testing or extended counselling to include co-workers’ fears and misconceptions regarding CHD. Work-directed counselling may result in little to no difference in the mean difference (MD) in days until return to work (MD −7.52 days, 95% CI −20.07 to 5.03 days; four studies; low-certainty evidence). Work-directed counselling probably results in little to no difference in cardiac deaths (RR 1.00, 95% CI 0.19 to 5.39; two studies; moderate-certainty evidence).\n\nPerson-directed, physical conditioning interventions versus usual care\nNine studies examined the impact of exercise programmes. Compared to usual care, cannot tell if physical interventions increase return to work up to six months (RR 1.17, 95% CI 0.97 to 1.41; four studies; very low-certainty evidence). Physical conditioning interventions may result in little to no difference in return-to-work rates at six to 12 months (RR 1.09, 95% CI 0.99 to 1.20; five studies; low-certainty evidence), and may also result in little to no difference on the rates of patients working after one year (RR 1.04, 95% CI 0.82 to 1.30; two studies; low-certainty evidence). Physical conditioning interventions may result in little to no difference in the time needed to return to work (MD −7.86 days, 95% CI −29.46 to 13.74 days; four studies; low-certainty evidence). Physical conditioning interventions probably do not increase cardiac death rates (RR 1.00, 95%CI 0.35 to 2.80; two studies; moderate-certainty evidence).\n\nPerson-directed, combined interventions versus usual care\nIncluded 13 studies considering return to work following combined interventions in the meta-analysis. Combined cardiac rehabilitation programmes may have increased return to work up to six months (RR 1.56, 95% CI 1.23 to 1.98; number needed to treat for an additional beneficial outcome (NNTB) 5; four studies; low-certainty evidence), and may have little to no difference on return to- work rates at six to 12 months’ follow-up (RR 1.06, 95% CI 1.00 to 1.13; 10 studies; low-certainty evidence). Cannot tell if combined interventions increased the proportions of participants working between one and five years (RR 1.14, 95% CI 0.96 to 1.37; six studies; very low-certainty evidence) or at five years (RR 1.09, 95% CI 0.86 to 1.38; four studies; very low-certainty evidence). Combined interventions probably shortened the time needed until return to work (MD −40.77, 95% CI −67.19 to −14.35; two studies; moderate-certainty evidence). Combining interventions probably results in little to no difference in reinfarctions (RR 0.56, 95% CI 0.23 to 1.40; three studies; moderate-certainty evidence).\n\nWork-directed, interventions\nNo studies exclusively examining strictly work-directed interventions at the workplace were found","Combined interventions may increase return to work up to six months and probably reduce the time away from work. Otherwise, no evidence was found of either a beneficial or harmful effect of person-directed interventions. The certainty of the evidence for the various interventions and outcomes ranged from very low to moderate. Return to work was typically a secondary outcome of the studies, and as such, the results pertaining to return to work were often poorly reported. Adhering to RCT reporting guidelines could greatly improve the evidence of future research. A research gap exists regarding controlled trials of work-directed interventions, health-related quality of life within the return-to-work process, and adverse effects."]
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[null,"ARTHRITIS LLIDIOL"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Hoving JL, Lacaille D, Urquhart DM, Hannu TJ, Sluiter JK, Frings-Dresen MHW. Non-pharmacological interventions for preventing job loss in workers with inflammatory arthritis. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD010208. DOI: 10.1002/14651858.CD010208.pub2. Available here","Included intervention where the focus was on job loss prevention or improving work function. Interventions that fulfilled at least two of the following components:\n• An evaluation of the work challenges or work adaptations as a step in the main intervention of the study\n• Interventions directed at the person, meaning job coaching, job or vocational training, vocational\ncounselling; or empowerment for work; or self-management, including support or information regarding work or both\n• Interventions directed at the work environment, meaning work adaptations, ergonomic measures, job accommodations; or interventions targeted directly at the employer, supervisor\nor co-workers","Evidence is lacking so it is not possible to tell whether non-pharmacological interventions for people with inflammatory arthritis reduce job loss","Included trials in which the population was limited to adults of working age (18 to 65 years) of which at least half of all workers\n(>50%) had been diagnosed with inflammatory arthritis (IA), including rheumatoid arthritis (RA), ankylosing spondylitis (AS),  psoriatic arthritis (PsA) or\nundifferentiated spondyloarthritis (SpA), or IA associated with connective tissue diseases such as Systemic Lupus Erythematosus (SLE)","The review objective was to assess the effects of non-pharmacological interventions that aim to prevent job loss, work absenteeism or improve work functioning for employees with IA","Primary outcomes\n• Job loss measured as: the number of people that become unemployed at some stage following diagnosis, regardless of disability pension status; or the time to job loss\n• Sickness absenteeism measured as: time lost from work (number of work days or hours missed at work due to sick leave, or absenteeism); or time to return to work; or the proportion of workers on sick leave at a certain moment of follow-up\n\nSecondary outcomes\nWork functioning measured using any at-work productivity, work functioning or presenteeism questionnaire","Included three RCTs with a total of 414 participants at risk of job loss. The majority of participants had IA, most with RA and to a lesser degree AS. The interventions aimed to prevent job loss and improve work functioning in several ways: firstly by evaluating work changes or adaptations and secondly by providing any person-directed interventions including vocational counselling, advice or education. Interventions directly targeted at the work environment were minimal and included workplace visits (one trial) or any actions by an occupational physician (one trial). The duration or dose of the interventions varied from two 1.5-hour sessions (one RCT) over five months, two consultation and multidisciplinary treatments during three months (one RCT), to six to eight individual or group sessions over six months (also one RCT). All participants were recruited through rheumatology clinics, both in or outside hospitals. Included trials investigated job loss (n = two RCTs; 382 participants), work absenteeism and work functioning (n = one RCT; 32 participants). The two smaller trials were assessed as having a high risk of bias and the large trial as having a low risk of bias. Trials showed marked differences in how they performed on risk of bias items, particularly on performance bias.\n\nUsing the GRADE there was judged to be to be very low quality evidence across the three reported outcomes. Of the two RCTs investigating job loss, the larger one (n = 242 participants) reported a large statistically significant reduction in job loss (relative risk (RR) = 0.35, 95% confidence interval (CI) 0.18 to 0.68) and the other RCT (n = 140) reported similar effects in both groups, although the CI was very wide (RR = 1.05, 95% CI 0.53 to 2.06). The latter one probably suffered from performance bias and we judged it to have a high risk of bias. The one small trial investigating sickness absenteeism found uncertain results at six months’ follow-up (MD = -2.42 days, 95% CI -5.03 to 0.19). Finally, in the same small trial investigating work functioning using the Rheumatoid Arthritis-Work Instability Scale (RA-WIS), there was a moderate improvement of intermediate term work functioning (six months; scale range 0 to 23; mean improvement -4.67 points, 95% CI -8.43 to -0.91). No adverse effects were identified in the publications of the three trials.","This Cochrane review of three RCTs found very low quality evidence overall for job loss prevention interventions having an effect on job loss, work absenteeism and work functioning in workers with inflammatory arthritis. While this review highlights that further high quality RCTs are required, the results suggest that these strategies have potential to be effective."]
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[null,"SGLEROSIS YMLEDOL"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Khan F, Ng L, Turner-Stokes L. Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis.\nCochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007256.\nDOI: 10.1002/14651858.CD007256.pub2. Available here","All categories of  vocational rehabilitation (VR) programmes which incorporate a clearly defined vocational rehabilitation or work therapy element. These included\nstructured multi-disciplinary / multi-agency interventions to preserve employment such as clinic or community based counselling, planning for disclosure and accommodation, and work place accommodations.\nAll three types of VR programmes were included, such as those offered by ‘general rehabilitation programmes’, ‘MS\nspecialised VR programmes’ and ‘pan -disability VR programmes’ ","Evidence is lacking so it is not possible to tell whether vocational rehabilitation programmes for people with multiple sclerosis helps them to maintain employment","Trials were included if the study population was working age (i.e. mean age between 18-65 years) and had the diagnosis of MS (sub types of MS were included-relapsing remitting, secondary progressive and primary progressive MS), irrespective of MS severity","The primary objective of this review is to evaluate the effectiveness of vocational rehabilitation (VR) programmes compared to alternative programmes or care as usual on return to work, employment and work ability in persons with multiple sclerosis. A secondary objective was to evaluate the cost effectiveness of these VR programmes","Primary outcomes\n• The change in proportion of pwMS in competitive employment (full time or part time employment position held by a person in an ordinary work setting, for which they were receiving payment at the market rate \n• The change in proportions of persons in supported employment (employment in an ’open work’ setting but with ongoing support such as government funded programmes)\nSecondary outcomes\n• The rate of return to work in days of pwMS\n• The change in proportion of pwMS on disability pension\n• The improvement of work ability in pwMS (such as the proportion of persons with MS who are engaged in attending a sheltered workshop and earn a modest living)\n• Costs of programmes and cost effectiveness of return to work or employment","Two trials (one RCT and one CCT) (total 80 participants) met the review criteria. Both trials scored poorly on the methodological quality assessment. There was insufficient evidence for VR programmes for (a)competitive employment, in altering rates of job retention, changes in employment, improvement in rates of re-entry into the labour force; (b) for altering work ability by improving participants’ confidence in the accommodation request process, or employability maturity or job seeking activity. No evidence could be assimilated for changes in proportions of persons in supported employment or on disability pensions, nor for cost-effectiveness.","There was inconclusive evidence to support VR for pwMS. However, the review highlights some of the challenges in providing VR for pwMS. Clinicians need to be aware of vocational issues, and to understand and manage barriers for maintaining employment. Proactive and timely VR programmes should incorporate practical solutions to deal with work disability, workplace accommodation and educate employers, and the wider community. Liaison with policy makers is imperative for government initiatives that encourage work focused VR programmes. Future research in VR should focus on improving methodological and scientific rigour of clinical trials; on the development of appropriate and valid outcome measures; and on cost effectiveness of VR programmes"]
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[null,"ANHWYLDERAU AR Y SBECTRWM AWTISTIG"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Westbrook J, Nye C, Fong C, Wan J, Cortopassi T, Martin F. Adult employment assistance for persons with autism spectrum disorders: Effects on employment outcomes. Campbell Systematic Reviews 2012:5 DOI: 10.4073/csr.2012.5. Available here","Interventions to assist in gaining competitive, supported, or integrated employment","Evidence is lacking so it is not possible to tell whether employment assistance is effective in helping adults with autistic spectrum disorder maintain employment","Adults 18 years or older with a diagnosis of ASD, who were no longer enrolled in a school-to-work programme or secondary-level education programme","To determine the effectiveness of adult employment assistance in securing and maintaining employment for adults (18 years and older) with autism spectrum disorders (ASD)","Attainment and duration and/or retention gainful employment. Gainful employment included competitive, integrated, or supported employment. Sheltered work or non-integrated work was not considered as an outcome measure for this review","This review was not able to identify definitive interventions that predictably and positively supported the development of employment outcomes for individuals with ASD.\n\nThere were two included studies. One described outcomes directly related to employment by comparing an experimental group (n = 30) who received guidance from a support worker in the form of job finding, work preparation, and communication with the employers with a control group (n = 20) that did not receive any support. At the end of the two-year study period, the authors found that the experimental group demonstrated significantly higher rates of having found paid employment (d = 1.067, 95% CI = 0.123 to 2.010), significantly longer periods of working time (d = 0.684, 95% CI = 0.111 to 1.257), and significantly higher wages (d = 1.177, 95% CI = 0.169 to 0.819). The experimental group also worked more hours per work week (d = 0.328, 95% CI = -0.628 to 1.284), but this effect was not significant.\n\nThe second included study described differential effects of supported employment and sheltered employment for persons with autism. The experimental group received supported employment, i.e., jobs working between 15 and 30 hours per week in their communities and received job coach support services. The control group received sheltered employment, i.e. jobs that were not in their communities and with no job coaching services. Using measures of the Childhood Autism Rating Scale (CARS), the supported employment group was not significantly different from the sheltered employment group after treatment (d = -0.229, 95% CI = -0.764 to 0.306). The study did not report any differences in employment acquisition or maintenance between the two groups.\n\nIn an analysis of risk bias of the included studies, it was found that there was a high level of substantial potential for bias across three of the five sources of bias analysed including unit of assignment, unit of analysis, attrition, fidelity of implementation, and blinding. The methodological quality of both included studies was low. Therefore, these review results should not be interpreted as indicating definitive results related to the development of employment outcomes for persons with ASD.","Qualitative and other relevant research studies connected to the employment of persons with ASD were also reviewed and suggest that the following may be elements of successful employment placement for persons with ASD: (1) identification of the most appropriate work settings and placements, (2) provision of effective supports on the job, (3) need for long-term support services for the employer and the consumer, (4) costs for support, and (5) positive effects of employment on persons with ASD. While qualitative studies point to a number of promising issues for future research, they do not provide a definitive statement about what works.\n\nIn addition, the authors noted that costs for community-based employment interventions such as those included in this review are more expensive than other employment alternatives such as sheltered non-integrated workshops. However, the review authors were aware of other studies showing that supported employment service interventions, such as those identified in their included studies, are becoming less expensive to deliver. It seems important to note that community-based integrated employment interventions, while expensive, do expand options for mainstream social integration, competitive wages, and community involvement."]
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[null,"GWEITHWYR HŶN"]
[null,"Ffynhonell:","Ymyrraeth:","Crynodeb tystiolaeth:","Poblogaeth:","Cwestiwn adolygu:","Canlyniadau:","Crynodeb o'r canfyddiadau:","Casgliadau awduron yr adolygiad:"]
[null,"Cox A et al. Factors facilitating or constraining interventions to protect and promote health of older workers and to help plan and prepare for retirement.   Brighton. Institute for Employment Studies. 2015. Available here","Interventions to enhance the well-being of older workers and support them in continuing to work beyond state pensionable age","Evidence is lacking so it is not possible to tell whether interventions support older workers to remain in employment","All adults aged at least 50 in full or part-time employment, both paid and unpaid, self-employed people working in micro, small, medium and large organisations with an appointed line manager, and volunteers\n\nAll employers in the public, private and ‘not for profit’ sectors who employ at least one employee","What factors facilitate or constrain workplaces to enhance the well-being of older workers, to support them in continuing to work up to and beyond state pensionable age and affect the quality and outcomes of pre-retirement planning?","Organisation: employee health and well-being and engagement; levels of employee recruitment and retention for the relevant age group; days lost to sickness absence  health related behaviours/diseases\nEmployee: individual levels of health and well-being","Flexible impacts for older workers: There is moderate evidence from five studies, that offering flexible working to older employees is associated with positive attitudinal outcomes, and in one study reportedly affects staff retention. The studies are mostly directly applicable to the UK.\n\nManagement initiatives: training and rewards: There is weak evidence from one qualitative study that providing training and small informal rewards positively influences older workers intention to stay with the current employer. The findings are partially applicable to the UK.\n\nGradual retirement: There is weak and mixed evidence on the benefits of gradual retirement from one study. The evidence is partially applicable to the UK\n\n","The limitations of the evidence base reviewed here reflect wider challenges also associated with earlier reviews on this topic concerning the effectiveness and cost-effectiveness of interventions to promote and support the health and well-being of older workers and in the area of pre-retirement planning and training. There is a dearth of evidence on the outcomes and impact of management-initiated interventions in this field, and the overall quality of research in this area was both disappointing and surprising, consistent with the evidence of large scale literature reviews on related topics.\n\nDespite some prominent examples of reportedly good practice in managing older workers available via case studies in grey literature and the trade press, little documented process or impact evaluation was located, and many of the studies on employer practices included in this review are up to a decade old. Since then, both the labour market context and the employment policy context has changed significantly, and indeed recession and consequent more abundant labour supply for some occupations may have reduced employer need and appetite to consider the management of older employees. Moreover, the studies from an employer perspective considered for this review may reflect a degree of employer passivity in taking action in this area, albeit with evidence of emerging awareness of the need to manage older workers and to consider the impact of the abolition of the default retirement age. For some employers this appears to be coupled with a degree of ignorance in the growth and potential issues presented by an ageing workforce and a ‘mainstreaming’ approach to the management of diversity. This is of concern on at least two grounds. First, the abolition of the default retirement age in 2011 means that employers will have to start considering how to manage workers whose transition to retirement can no longer be assumed. Second, government reforms to increase the age at which people are eligible for the state pension will lead to those lacking adequate alternative pension provision in particular seeking to remain in work for longer.\n\nThere are also clear methodological considerations arising from this review for research in this field. There is an urgent need for research which uses mixed methods and deploys both employer and worker perspectives to examine employer practices with regard to recruitment, retirement planning and transitions. Those commissioning, designing and undertaking research also need to confront the challenge that to examine long-term impacts of working in later life, it will be essential to conduct longitudinal studies. This review urges research commissioners to prioritise funding of high quality studies into the impact of workplace level interventions on health and well-being outcomes which will seek to track the health and well-being of individuals during the lifespan of the intervention and onwards beyond the end of their working lives."]