Guidance for Primary Care Services and Employers on the Management of Long-term Sickness and Incapacity: Mapping Review

Transcription

1 Document 2 Guidance for Primary Care Services and Employers on the Management of Long-term Sickness and Incapacity: Mapping Review Report January 2008

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3 Document 2 Guidance for Primary Care Services and Employers on the Management of Long-term Sickness and Incapacity: Mapping Review Sue Hayday Jo Rick Chris Carroll Nick Jagger School Of Health And Related Research

4 Published by: INSTITUTE FOR EMPLOYMENT STUDIES Mantell Building University of Sussex Falmer Brighton BN1 9RF UK Tel (0) Fax + 44 (0) studies.co.uk Copyright 2007 Institute for Employment Studies No part of this publication may be reproduced or used in any form by any means graphic, electronic or mechanical including photocopying, recording, taping or information storage or retrieval systems without prior permission in writing from the Institute for Employment Studies. ID No:

5 The Institute for Employment Studies The Institute for Employment Studies is an independent, apolitical, international centre of research and consultancy in public employment policy and organisational human resource issues. For over 35 years the Institute has been a focus of knowledge and practical experience in employment and training policy, the operation of labour markets and human resource planning and development. IES is a not for profit organisation which has over 60 multidisciplinary staff and international associates. IES aims to help bring about sustainable improvements in employment policy and human resource management. IES achieves this by increasing the understanding and improving the practice of key decision makers in policy bodies and employing organisations. Institute of Work Psychology, Sheffield University The Institute of Work Psychology is dedicated to conducting applied research in work settings, in both the public and private sectors. The aims of the Institute are to: advance knowledge about the causes of individual, team and organisational effectiveness at work increase understanding of the well being of people at work advance knowledge about innovation and creativity at work disseminate this knowledge in the scientific community, in the workplace and in the wider public domain design, implement and evaluate methods of promoting effectiveness, innovation and well being at work. The School of Health and Related Research, Sheffield University ScHARR is a large multi disciplinary School within the Faculty of Medicine at the University of Sheffield. It employs around 200 staff, primarily behavioural and social scientists, epidemiologists, statisticians, public health specialists and health economists. Its research infrastructure and its multi disciplinarily approach offer huge potential for collaboration with leading researchers in other fields, whilst its Information Resources Section is able to provide first class support with systematic literature searches. ScHARR staff have considerable expertise in systematic review methodology and have contributed to the development of the latest techniques for v

6 identifying, assessing and synthesising non RCT evidence in systematic review methodology. vi

7 Contents Executive Summary Methodology Summary of mapping results 1 Introduction Background Research objectives Structure of report 3 2 Methodology Effectiveness and economic literature searches for Questions 1 to Effectiveness and economic literature searches for Question Inclusion and exclusion criteria Study selection and allocation to research areas Next stages in the research 11 3 Mapping Review Results Effectiveness primary study abstracts for Questions 1to Effectiveness primary study abstracts for Question Economic abstracts (primary studies and reviews) Questions 1 to Economic abstracts (primary studies and review) Question Review abstracts Questions 1 to Review abstracts Question Summary of mapping 24 Appendix 1: Scoping Document 25 Appendix 2: Bibliography 39 Appendix 3: Example search strategy used for research questions 1 to 3 and 4 40 Appendix 4: Sifting Criteria Used 45 ix x xi vii

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9 Executive Summary The National Institute for Health and Clinical Excellence (NICE) has been asked by the Department of Health to develop guidance for primary care services and employers on the management of long term sickness and incapacity. The guidance will provide recommendations for good practice based on the best available evidence of effectiveness and cost effectiveness. The scope of this guidance has been defined by NICE in consultation with a stakeholder group composed of health professionals, research organisations and academic institutions, national organisations representing patients, carers or the public and providers of health services and statutory organisations. The development of the guidance will be achieved through a series of specified rapid effectiveness reviews, economic reviews and economic analyses for the Programme Development Group (PDG). The specific research objectives are to conduct effectiveness and economics reviews to answer the following four questions: 1. What work or primary care based interventions, programmes, policies or strategies are effective and cost effective in preventing or reducing the number of employees moving from short (less than 20 working days) to long term sickness absence (20 working days or longer)? This includes activities to prevent or reduce the reoccurrence of short term sickness absence episodes. 2. What work or primary care based interventions, programmes, policies or strategies are effective and cost effective in helping employees who have been on long term sickness absence to return to work? 3. What work or primary care based interventions, programmes, policies or strategies are effective and cost effective in helping to reduce the re occurrence of long term sickness absence? 4. What UK primary care based interventions, programmes, policies or strategies are effective and cost effective in helping those in receipt of incapacity benefit to return to full or part time employment? These could be delivered by a number of sectors ix

10 (such as voluntary or education sectors) in collaboration with, and/or funded by, employers and primary care services. The first stage in the development of the effectiveness and economic rapid reviews is this mapping report to the PDG. It discusses the methodology and results from a systematic sifting of abstracts to identify material that may address the above research questions. Methodology It was decided at an early stage in consultation with NICE that it would be best to conduct a single search strategy for Questions 1 to 3, which all deal with the long term sickness of employees, as it was likely that the literature would be applicable to one or more of the research questions. Question 4, covering those on incapacity benefit, involved a different population and required a separate searching strategy. Searches were made of 19 relevant databases and six websites for Questions 1 to 3 and Question 4 using agreed search strategies. Abstract screening checklists were used to assess the relevance of each item identified by the search strategies to each of the research questions. This process took into account the following included and excluded population groups. Population that were covered: All adults over age 16 in full or part time employment, both paid and unpaid. All adults over age 16 who have experienced long term sickness (for 20 working days or longer) or re occurring short term sickness (less than 20 working days) and/or are in receipt of incapacity benefit. All employers in the public, private and not for profit sectors. Population groups that were not covered: Self employed individuals. Pregnant women who have taken sickness absence related to their pregnancy, during the course of their pregnancy. Unemployed individuals who are not sick or in receipt of incapacity benefit. The following interventions, programmes, policies and strategies were also excluded, those which: Aim to prevent the first occurrence of sickness absence (primary prevention) or aim to prevent sickness absence episodes of less than 20 working days. Target pregnant women exclusively and/or which focus on illnesses associated with pregnancy, during the course of a pregnancy. x

11 Tackle workplace absences which are not reported and/or recorded as sickness absence (for example, maternity leave). Are delivered outside the workplace or primary care settings. Involve the clinical diagnosis, treatment (including pharmacological treatment) and management of conditions associated with short and/or long term sickness or incapacity (for example, low back pain). Look at the effectiveness of private health insurance schemes, the incapacity benefit system and/or the claiming of statutory sick pay to reduce sickness absence. Summary of mapping results The search strategies resulted in 24,776 references being identified as potentially relevant to the research. The title and abstract for each of these references were screened for relevance. The summary findings from the abstract assessment are presented in the table below. The effectiveness papers can only be allocated to each of the Questions 1 to 3, and are shown in the column entitled Relevant papers. These add to more than the number of actual papers as some are applicable to more than one question. Without seeing the full papers, it was impossible to assign the economic, review and websites papers to the specific questions 1 to 3, so these are shown in total. The table shows that from all the searches there are 488 papers thought to be appropriate for Questions 1 to 3 and 35 for Question 4. A further 814 separate papers have been identified in the searches for Questions 1 3 and 176 for Question 4 for which, although they appeared to meet the inclusion criteria, it was impossible to tell from the abstract how to categorise the data presented. The full papers will also be obtained for these abstracts. Table: Summary of mapping review Question 1: Preventing movement from short to longterm sickness Question 2: Helping return to work after long-term sickness Question 3: Preventing reoccurrence of long-term sickness Question 4: Helping those in receipt of incapacity benefit to return to work Relevant papers Total number of actual papers Effectiveness Effectiveness Economic Reviews Total Source: IES, 2007 xi

12 These findings from the mapping review are presented to the PDG to inform their decisions on the parameters and sequencing of the rapid effectiveness and economic reviews to be presented in December 2007, February 2008 and April xii

13 Institute for Employment Studies 1 1 Introduction The National Institute for Health and Clinical Excellence (NICE) has been asked by the Department of Health to develop guidance for primary care services and employers on the management of long term sickness and incapacity. The guidance will provide recommendations for good practice based on the best available evidence of effectiveness and cost effectiveness. The scope of this guidance has been defined by NICE in consultation with a stakeholder group composed of health professionals, research organisations and academic institutions, national organisations representing patients, carers or the public and providers of health services and statutory organisations. The scoping document for the guidance can be seen at Appendix Background The impact of long term absence is significant on both individuals, employers and the economy as it is estimated that long term absences of 20 days or more accounted for 43 per cent of working time lost in the UK in 2006 and cost the economy 5.8 billion (CBI/AXA, 2007). Absences of over four weeks or more represented 17 per cent of all absences from work due to sickness in 2006 (CIPD, 2007). In addition, extensive studies of work and unemployment support the concept that work is beneficial for health and well being and that prolonged absence from work can have negative health consequences (Waddell and Burton, 2006, Hill et al. 2007). Prolonged absence can also result in job loss and the longer a person is on incapacity benefit; the less likely they are to return to work (Cabinet Office, 2004). It has been estimated that for a person claiming incapacity benefit for a year, the average duration of their claim will be for eight years and after two years they are more likely to die or retire than return to work (DWP/DH/HSE, 2005). It is against this background the Department of Health is seeking to provide guidance for professionals and managers with public health as part of their remit working in the NHS, local authorities and the wider public, private, voluntary and community sectors.

14 2 Long-term Sickness and Incapacity Guidance: Mapping review 1.2 Research objectives The broad aim for this research is to support the work of the National Institute for Health and Clinical Excellence (NICE) in the development of guidance on the management of long term sickness and incapacity. This will be achieved through a series of specified rapid effectiveness reviews, economic reviews and economic analysis for the Programme Development Group (PDG). The specific research objectives are to conduct effectiveness and economics reviews to answer the following four questions: 1. What work or primary care based interventions, programmes, policies or strategies are effective and cost effective in preventing or reducing the number of employees moving from short (less than 20 working days) to long term (20 working days or longer) sickness absence? This includes activities to prevent or reduce the reoccurrence of short term sickness absence episodes. 2. What work or primary care based interventions, programmes, policies or strategies are effective and cost effective in helping employees who have been on long term sickness absence to return to work? 3. What work or primary care based interventions, programmes, policies or strategies are effective and cost effective in helping to reduce the re occurrence of long term sickness absence? 4. What UK work or primary care based interventions, programmes, policies or strategies are effective and cost effective in helping those in receipt of incapacity benefit to return to full or part time employment? These could be delivered by a number of sectors (such as the voluntary or education sectors) in collaboration with, and/or funded by, employers and primary care services. The first stage in the development of the effectiveness and economic rapid reviews is this mapping report to the PDG. It discusses the results of a systematic sifting of all abstracts produced by searches of relevant databases and websites to identify material that may address the four research questions above. The report also outlines the next stages of the project involving reference and citation checking for the papers obtained and the contacting of experts to ask if they are aware of any additional research relevant to the four research questions. The rapid effectiveness and economic reviews will be presented at the next three PDG meetings in December 2007, February 2008 and April An economic analysis, including economic modelling, will be presented at the PDG meeting in May This will cover a selection of the topics identified by the effectiveness and economics reviews which have been chosen by the PDG and where there is sufficient information to make modelling possible.

15 Institute for Employment Studies Structure of report The structure of this mapping report is as follows: Chapter 2 discusses how the literature search was conducted, the criteria used to identify studies and how the abstracts were selected and allocated to the research question areas. Chapter 3 presents the mapping results from the abstract appraisal for research questions 1 to 3 and Question 4. There are four appendices to the report which contain the scoping document for the research, the bibliography, the database and website search terms used and the abstract screening checklists.

16 4 Long-term Sickness and Incapacity Guidance: Mapping review 2 Methodology The research questions fall into two groups, Questions 1 to 3 look at interventions to manage the long term sickness of employees while Question 4 is about interventions to help those in receipt of incapacity benefit to return to work. It was unlikely that the literature would deal separately with Questions 1 to 3 and it is anticipated that titles and abstracts would be identified that were applicable to one or more of these areas. In consultation with NICE it was decided, therefore, to conduct two main searches, one combining search terms to cover Questions 1 to 3 and the other with search terms specific for Question 4. Each of the two main search strategies contained three components search results for primary studies, review level search results and economic search results. The approaches to the two main search strategies will be outlined in the sections that follow. 2.1 Effectiveness and economic literature searches for Questions 1 to 3 The search strategy for Questions 1 to 3 involved combining a number of key terms and limiters. Key terms were defined as long term sickness absence or other synonym. The search strategy used for the Medline search for primary studies can be seen in Appendix 3 and this was adapted as appropriate for other databases and websites. The search strategy was limited to the study designs below: Primary level study designs: randomised controlled trials (RCTs) longitudinal intervention studies The searches were limited to these study designs for several reasons. Firstly, the aim of the searches is to identify studies that demonstrate causality, ie that an intervention does have an impact on the outcome of choice, in this case return to work or prevention of re occurrence of long term sickness absence, rather than simply

17 Institute for Employment Studies 5 demonstrating an association. Such causality can only be demonstrated by longitudinal study design, ie studies that collect data over time, such as randomised controlled trials or prospective cohort studies. Therefore the search strategies aimed to limit the retrieved studies to longitudinal studies, and to achieve this randomised controlled trials and longitudinal study design search filters were used (see Appendix 3). A search was also performed to identify relevant reviews so that these articles could be scanned for further potentially relevant references. No study design search strategies were used to identify economic studies; specific economic searches were simply performed on specialist economic databases. Other than study design, the following limits were also placed on the search strategy: Location: developed/organisation for Economic Co operation and Development (OECD) countries only Published from 1990 onwards Published in English language only. The location limiter was applied to enhance the generalisation of any findings from the reviews for the intended audience (primary care services and employers). The limitations of date and language were applied to make more manageable the number of items retrieved for selection and synthesis, given the timescale and resources available for these reviews. The following 15 core databases were searched to identify primary studies and review level studies for the effectiveness reviews: Databases Cochrane Database of Systematic Reviews (CDSR) Database of Abstracts of Reviews of Effectiveness (DARE) Cochrane Central Register of Controlled Trials MEDLINE EMBASE PsycINFO CINAHL (Cumulative Index of Nursing and Allied Health Literature) AMED (Allied and Complementary Medicine) Business Source Premier British Nursing Index NHS HTA

18 6 Long-term Sickness and Incapacity Guidance: Mapping review ASSIA (Applied Social Science Index and Abstracts) Social Science Citation Index Science Citation Index Sociological Abstracts. Four databases of grey literature were also searched: HMIC (Health Management Information Consortium. Comprises King s Fund Database and DH Data database) SIGLE (International System for grey literature) National Research Register Current Contents. Websites A series of websites were also searched to identify any relevant grey literature. Department for Work & Pensions: Institute for Public Policy & Research: Employment studies research unit: Centre for Longitudinal Studies: Health & safety Executive: Department for Business, Enterprise and Regulatory Reform: Department for Work & Pensions: The search for primary studies and review level material for the economic searches was performed separately using the same restrictions as for the effectiveness searches. The following specific economic databases were searched: Health Economics Evaluation Database (HEED) NHS EED (NHS Economics Evaluation Database) Econlit.

19 Institute for Employment Studies Effectiveness and economic literature searches for Question 4 The following key terms and limiters were used in the Question 4 search. Key search terms were defined as benefit recipients, return to work, work readiness or other synonyms. With the exception of study design the limiters were the same as for Questions 1 to 3. The search strategy used for the Medline search can be seen in Appendix 3 and this was adapted for each of the databases and websites searched. The references retrieved by the search for Question 4 were checked for duplication against the database of references for questions 1 to 3 and any duplicates removed. Any abstracts identified as relevant to Question 4 were coded as such when screening those abstracts retrieved for Questions 1 to Inclusion and exclusion criteria The titles and abstracts for each primary study and review level references retrieved by the searches were screened to determine if they satisfied the following inclusion/exclusion criteria Criteria for Questions 1 to 3 Locations included covered: Developed/OECD countries Setting had to be work / employer based or primary care based d locations : Developing or non OECD countries Populations included covered: all adults over age 16 in full or part time employment, both paid and unpaid all adults over age 16 who have experienced long term sickness (for 20 working days or longer, or re occurring short term sickness which may be defined as long term absence or sickness absence in the research) all employers in the public, private and not for profit sectors. d population groups: self employed individuals

20 8 Long-term Sickness and Incapacity Guidance: Mapping review pregnant women who have taken sickness absence related to their pregnancy, during the course of their pregnancy unemployed individuals Interventions, programmes, policies and strategies included were any that: aimed to prevent or reduce the number of employees moving from short term to long term sickness absence (including activities to prevent or reduce the reoccurrence of short term sickness absence episodes) aimed to help employees on long term sickness to return to work aimed to help to reduce re occurrence of long term sickness absences. Interventions, programmes, policies and strategies that were excluded were any that: aimed to prevent the first occurrence of sickness absence (primary prevention) or aimed to prevent sickness absence episodes of less than 20 working days targeted pregnant women exclusively and/or which focus on illnesses associated with pregnancy, during the course of a pregnancy tackled workplace absences which are not reported and/or recorded as sickness absence (for example, maternity leave) were delivered in a workplace and/or primary care settings and/or planned, designed, delivered, managed or funded in collaboration with primary care providers and/or employers? These interventions etc. can be delivered by a number of providers (such as voluntary, private, statutory sector) and/or in various settings not just workplace or primary care setting (such as job centres, community centres) as long as they are fully or co planned, designed, delivered, managed and/or funded in collaboration with employers and primary care service). involved the clinical diagnosis or treatment (including pharmacological treatment) of conditions associated with short and/or long term sickness or incapacity (for example, low back pain) looked at the effectiveness of private health insurance schemes, the incapacity benefit system and/or the claiming of statutory or occupational sick pay to reduce sickness absence. Deals solely with preventing ill health retirement (ie where recipient has no intention of returning to work) Outcomes that were included:

21 Institute for Employment Studies 9 long term sickness absence return to work after long term sickness absence re occurrence of long term sickness absence other work related outcomes. Other exclusions: studies which describe the relationship between health/ill health and incapacity benefit (ie correlates studies or non evaluative studies of an intervention/policy/programme or strategy) Criteria for Question 4 Inclusion and exclusion criteria for Question 4 were as follows: Location included covered: UK only because incapacity benefit designates a specific population that only exists in the UK Population covered: All adults over the age of 16 living in the community who are: unemployed because of long term incapacity and in receipt of incapacity benefit/disability benefits. Interventions, programmes, policies and strategies to be included were any that: aimed to help adults in receipt of incapacity benefit to return to work or prepare for work. Outcomes that were included: return to work after being in receipt of incapacity benefit job related activity (eg job seeking) other work related outcome. 2.4 Study selection and allocation to research areas The purpose of abstract appraisal is to identify articles that help to answer the questions being addressed by the review (NHS CRD, 2001). Study selection should be systematic, replicable and free from bias. Sifting is informed by criteria reflecting the population, intervention, outcome, study design, language and other criteria defined

22 10 Long-term Sickness and Incapacity Guidance: Mapping review in the protocol. Sift criteria were developed and refined by the project team in consultation with NICE by piloting forms and criteria on a sample of titles and abstracts. Reviewers were all trained on using the criteria and forms. Two reviewers sifted a random ten per cent sample of titles and abstracts and an acceptable interrater reliability score was achieved. Thereafter, titles and abstracts of retrieved articles were sifted by single reviewers with ten per cent of all abstracts being independently sifted by a second reviewer as a quality check (NHS CRD, 2001). Where a question existed over whether or not to include a study it was referred to a second or third reviewer (or consensus was reached by two reviewers) Development of abstract sifting criteria Based on the protocol and the inclusion and exclusion criteria specified in section 2.2 detailed sifting criteria in the form of abstract screening checklists were developed. The inclusion/exclusion criteria outlined in the scope (see Appendix 1) and above Section 2.3 guided the sift process and helped to ensure consistency in screening across the abstract sifting team. The sifting criteria were tailored to the specific search results, research questions and study types. In total, five abstract screening checklists were developed as follows: 1. Effectiveness: Questions 1, 2 & 3 primary studies: RCT s and longitudinal intervention studies 2. Economics: Questions 1, 2 & 3 primary studies and review level 3. Effectiveness: Question 4 primary studies: RCTs and longitudinal intervention studies 4. Economics: Question 4 primary studies and review level literature 5. Effectiveness: Questions 1 to 4 Review level literature and meta analyses. The five different abstract screening checklists are given in Appendix 4. When an abstract is unclear it is coded as get full paper. For the economic results, abstracts that could provide potentially relevant background modelling data but were not a comparative evaluative study were tagged and coded appropriately for inclusion. As noted above, review level literature was sifted to identify relevant reviews, the reference lists of which may contain further relevant primary studies. These primary studies will then be appraised in line with above process and if accepted/included then will be added to the references requested for full paper retrieval.

23 Institute for Employment Studies Next stages in the research For all studies that do meet the inclusion criteria, the reference lists will be examined to identify any additional relevant references and the corresponding abstract appraised. Citation searching of included papers will also be performed (ie papers will be identified using appropriate search engines, such as ISI Web of Science and Google Scholar, that have cited the included paper). Once again, any new primary studies will then be appraised in line with above process and if accepted/included then will be added to the references requested for full paper retrieval. In addition, once full papers are gathered, the research team will identify particular authors or research groups who have published a number of relevant studies. These researchers will then be contacted to check: whether they have any additional published data relevant to the research questions, or whether they have any on going (currently un published) work relevant to the research questions. These contacts will also be asked to indicate if they are aware of any other researchers/groups working in areas relevant to the research questions. In this way current and past research that can contribute to answering the four research questions will be identified and included in the subsequent reviews.

24 12 Long-term Sickness and Incapacity Guidance: Mapping review 3 Mapping Review Results This chapter presents the mapping review results covering the four research questions. The database and website searches resulted in a total of 24,776 abstracts being identified as potentially relevant to the research questions. Table 3.1 below provides an overview of the number of search results for the different components of the search strategy: Table 3.1: Number of abstracts and titles identified by each search Questions 1-3 Question 4 Effectiveness -primary studies 15,299 5,471 Effectiveness review level material Economics primary studies and reviews 2, Websites-primary studies Total 18,161 6,615 It should be noted that, although the research questions define short term absence as less than 20 working days and long term absence as 20 working days or longer, at the abstract stage it was not clear whether a study fell within the 20 day parameter. It is also probable that this will be the case when the full paper has been obtained. The results for the effectiveness abstracts will be given first, followed by the economic and finally the review abstracts. It should be noted that the final number of references identified for full paper retrieval will be subject to change due to the citation searches, reference tracking and as a result of approaching experts as outlined in Section Effectiveness primary study abstracts for Questions 1 to 3 Figure 3.1 shows the mapping of the effectiveness primary studies abstracts and titles for Questions 1 to 3. This search produced the largest number of references and, of the

25 Institute for Employment Studies 13 15,347 identified, 427 separate abstracts were assessed to be relevant to research questions 1 to 3. Full papers for each of these will be obtained for appraisal and, if relevant, their quality will be assessed and data extracted for presentation in the subsequent reviews. Eighty nine per cent (13,615) of the abstracts were excluded, predominantly because they did not describe an evaluative study of an intervention, policy, strategy or programme seeking to influence long term sickness absence. Frequently these excluded studies described correlation studies that examined the factors and characteristics associated with sickness absence. A further 696 abstracts were identified as possibly relevant but the details presented in the titles and abstracts were unclear on some or all of the criteria. The full papers will also be obtained for these and checked for relevance. The effectiveness searches for Questions 1 to 3 identified 328 abstracts that referred to reviews and 235 that contained economic data, these will be sifted using the appropriate criteria. Twelve abstracts were identified as relevant to research Question 4. A further 34 abstracts from books/or book titles were identified and marked for consideration at a later stage, if insufficient papers have been found. Books do not usually contain details of primary studies. Eighty per cent of the included abstracts appear to be relevant to Question 2 about helping employees return to work after long term sickness, 19 per cent to Question 1 concerning the prevention of movement from short to long term absence and 11 per cent to Question 3 on the prevention of the re occurrence of long term absence. There is some overlap between the questions, which in most cases involves Question 2 and one or more of the other questions.

26 14 Long-term Sickness and Incapacity Guidance: Mapping review Figure 3.1: Mapping of effectiveness primary study abstracts for Questions 1 to 3 All effectiveness abstracts for Questions 1 to 3 15,347 Include 427 Question 1 83 Question Question ,615 Get full paper/ unclear 696 Book/book chapter 34 Effectiveness Question 4 12 Reviews 328 Economics 235 Source: IES, 2007

27 Institute for Employment Studies Effectiveness primary study abstracts for Question 4 The results of the abstract screening for Question 4 are shown in Figure 3.2. Of the 5,546 abstracts found, 28 were found to specifically address the research question with a further 146 being identified as potentially relevant (ie the abstract was unclear for some of screening criteria). Most of the 5,071 abstracts excluded were on the grounds that they did not describe an evaluative study of an intervention, programme, strategy or policy to assist the return to work of incapacity benefit recipients. There were also 166 papers with economic information and 118 review papers. Figure 3.2: Mapping of effectiveness primary study abstracts for Question 4 All effectiveness abstracts for Question 4 5,546 Include 28 5,071 Get full paper 146 Book/book chapter 17 Economics 166 Reviews 118

28 16 Long-term Sickness and Incapacity Guidance: Mapping review Source: IES, 2007 Seventeen additional abstracts of books or book chapters were identified as relevant to Question Economic abstracts (primary studies and reviews) Questions 1 to 3 The economic mapping for Questions 1 to 3 is given in Figure 3.3. The search strategy for economic abstracts identified 2,495 titles and abstracts. Of these, a total of 47 abstracts appear relevant to Questions 1 to 3, although from the abstracts alone it is not possible to allocate them to a specific research question. Additionally, 23 abstracts were thought to be potentially relevant for modelling work but the details presented in the abstracts were unclear on some or all of the criteria and the full papers for these will also be requested. Eighty one other papers were seen as possibly appropriate for Questions 1 to 3 and these will be obtained and assessed. Seven abstracts were also found to be relevant to the economics results for Question 4. No abstracts were identified as relevant to the effectiveness reviews or tagged as books or book chapters.

29 Institute for Employment Studies 17 Figure 3.3: Mapping of economic abstracts (primary studies and reviews) for Questions 1 to 3 All economics abstracts for Questions 1 to 3 2,495 Include 47 2,337 Modelling 23 Get full paper 81 Economics Question 4 7 Effectiveness 0 Books/book chapter 0 Source: IES, 2007

30 18 Long-term Sickness and Incapacity Guidance: Mapping review 3.4 Economic abstracts (primary studies and review) Question 4 The search strategy for economic abstracts for Question 4 identified 353 abstracts and titles as shown in Figure 3.4. None of these were found to address the specific research question but there were eight possibly useful titles where the full paper will be retrieved for further appraisal. Twelve abstracts appear to be suitable for the economic modelling. A further 14 papers were identified as appropriate for the economics review for Questions 1 to 3 and one for the Question 4 effectiveness review. No books or suitable book chapters were found.

31 Institute for Employment Studies 19 Figure 3.4: Mapping of economic abstracts (primary studies and reviews) for Question 4 All economics abstracts for Question Include Modelling 12 Get full paper 8 Effectiveness Question 4 1 Economics Questions 1 to 3 14 Book/book chapter 0

32 20 Long-term Sickness and Incapacity Guidance: Mapping review Source: IES, Review abstracts Questions 1 to 3 There were 309 review level abstracts found for Questions 1 to 3, of these 14 were judged to be suitable for inclusion with a further 37 possibly useful abstracts. The full papers for these 51 abstracts will be retrieved for screening of the reference lists to identify any additional potentially relevant tiles which in turn will be abstract appraised. One abstract was identified as possibly relevant to the review level material for Question 4. The remainder were excluded, usually on the basis of not being concerned with an evaluative study of an intervention, programme, strategy or policy to manage long term sickness absence. No primary studies, economic papers or books were identified in the search.

33 Institute for Employment Studies 21 Figure 3.5: Mapping of review abstracts for Questions 1 to 3 All review abstracts for Questions 1 to Include Get full paper/ unclear 37 Question 4 reviews 1 Book/book chapter 0 Economic data 0 Primary data 0 Source: IES, 2007

34 22 Long-term Sickness and Incapacity Guidance: Mapping review 3.6 Review abstracts Question 4 Figure 3.6 shows the search results for the review level abstracts for Question 4 which produced 716 potentially relevant titles and abstracts. It was not possible to identify if any of the reviews were specifically relevant to question 4 from the abstracts as it was not clear if the reviews were of UK papers alone.

35 Institute for Employment Studies 23 Figure 3.6: Mapping of review abstracts for Question 4 All review abstracts for Question Include Get full paper/ unclear 22 Question 1 reviews 5 Question 2 reviews 28 Book/book chapter 2 Economics 4 Effectiveness 7 Source: IES, 2007 Twenty two reviews were identified as being possibly suitable and the full papers for these will be obtained. Twenty eight of the reviews were about helping employees on long term sickness return to work and were appropriate for Question 2 and a further five were relevant to Question 1 about moving from short to long term absence. Two abstracts of books were identified and tagged for later use, if necessary. The search

36 24 Long-term Sickness and Incapacity Guidance: Mapping review also provided seven effectiveness studies and four economic reviews which could be potentially relevant. 3.7 Summary of mapping This mapping report is the first step in understanding the type and amount of data available from electronic searches which may contain relevant evidence to address the four research questions. The summary findings from the abstract assessment are presented in Table 3.2. The effectiveness papers only can be allocated to each of the Questions 1 to 3, and are shown in the column entitled Relevant papers. These add to more than the number of actual papers as some are applicable to more than one question. Without seeing the full papers, it is impossible to assign the economic, review and websites papers to the specific questions 1 to 3, so these are shown in total. The table shows that from all the searches there are 488 papers thought to be appropriate for Questions 1 to 3 and 35 for Question 4. A further 814 separate papers have been identified in the searches for Questions 1 3 and 176 for Question 4 for which, although they appear to meet the inclusion criteria, it is impossible to tell from the abstract how to categorise the data presented. The full papers will also be obtained for these abstracts. Table 3.2: Summary of mapping review Question 1: Preventing movement from short to long-term sickness Question 2: Helping return to work after long-term sickness Question 3: Preventing reoccurrence of long-term sickness Question 4: Helping those in receipt of incapacity benefit to return to work Relevant papers Total number of actual papers Effectiveness Effectiveness Economic Reviews Total Source: IES, 2007 These findings from the mapping review are presented to the PDG to inform their decisions on the parameters and sequencing of the rapid effectiveness and economic reviews to be presented in December 2007, February 2008 and April 2008.

37 Institute for Employment Studies 25 Appendix 1: Scoping Document NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE PUBLIC HEALTH PROGRAMME GUIDANCE SCOPE 1 Guidance title Guidance for primary care services and employers on the management of longterm sickness and incapacity 1.1 Short title Guidance on the management of long-term sickness and incapacity for work 2 Background (a) (b) The National Institute for Health and Clinical Excellence ( NICE or the Institute ) has been asked by the Department of Health to develop guidance on a public health programme aimed at managing long-term sickness and incapacity. NICE public health programme guidance supports implementation of the preventive aspects of national service frameworks (NSFs) where a framework has been published. The statements in each NSF reflect

38 26 Long-term Sickness and Incapacity Guidance: Mapping review the evidence that was used at the time the framework was prepared. The public health guidance published by the Institute after an NSF has been issued will have the effect of updating the framework. (c) This guidance will support a number of related government policy documents and legislation including: A new deal for welfare: empowering people to work (DWP 2006a) Incapacity benefits and pathways to work (House of Commons Work and Pensions Committee 2006) Welfare reform bill (DWP 2006b) Employment Equality (Age) Regulation (2006) Department for Work and Pensions five year strategy. Opportunity and security throughout life (DWP 2005a) Disability Discrimination Act (2005) Health, work and wellbeing caring for our future. A strategy for the health and wellbeing of working age people (HMG 2005) 2004 spending review. Public service agreements (HM Treasury 2004) Choosing health making healthy choices easier (DH 2004) Building capacity for work. A UK framework for vocational rehabilitation (DWP 2004) Jobs and enterprise in deprived areas (ODPM 2004) Pathways to work: helping people into employment. The government s response and action plan (DWP 2003) A strategy for workplace health and safety in Great Britain to 2010 and beyond (HSC 2003). (d) This guidance will provide recommendations for good practice, based on the best available evidence of effectiveness, including cost effectiveness. It is aimed at professionals and managers with public health as part of their remit working within the NHS, local authorities and the wider public, private, voluntary and community sectors. This

39 Institute for Employment Studies 27 includes occupational health professionals, employers, workplace representatives and trades unions, as well as employees themselves. 3 The need for guidance a) It is widely recognised that being employed can help improve an individual s health and wellbeing and reduce health inequalities (DH 2004; DWP 2005b). Conversely, unemployment is linked to higher levels of mortality and psychological and psychiatric morbidity (Mclean C et al. 2005). Since 1997 the UK has seen rising employment (DWP 2006b). The Department of Health estimates that 7.5% of the working age population is out of work due to a health condition or disability (DH 2004). b) The quality and accuracy of available data on absence and sickness absence is variable (Barham and Leonard 2002; Barham and Begum 2005). In 2006, UK employees were absent for an average 3.5% of the time they were due to spend working. Sixty per cent of absences are short term (up to 7 days), 20% are medium term (8 days to 4 weeks) and 20% are long term (4 weeks/20 working days or longer) (CIPD 2006). An estimated 40 million working days are lost each year in Britain due to ill health and injury. Sickness absence costs the British economy an estimated 12 billion each year (HMG 2005). c) On average, in 2006, 1% of the UK workforce was absent from work due to long-term sickness. It is estimated that 12% of employees on longterm leave are covered by the Disability discrimination act (CIPD 2006). Back pain, musculo-skeletal injuries, acute medical conditions, mental ill health and stress are the most common causes. In the public sector, mental ill health and stress were identified as the main causes of longterm sickness absence for non-manual workers; musculo-skeletal injuries and back pain most affected manual workers (CIPD 2006).

40 28 Long-term Sickness and Incapacity Guidance: Mapping review d) Sickness absence rates, including long-term sickness absence rates, vary by gender, age, occupation, sector, region and size of workplace (Barhum and Begum 2005, CIPD 2006). e) It is widely recognised that prolonged sickness absence can lead to job losses. A wide range of benefits are available when a worker falls ill, including incapacity benefit. Although the number of people in receipt of incapacity benefit has fallen by a third since the 1990s, 2.7 million people still receive it (DWP 2005a; 2006a). The longer someone is signed off, the less likely they are to return to work (DH 2004; Ministerial task force for health, safety and productivity and the Cabinet Office 2004). If someone has been claiming incapacity benefit for 12 months, the average duration of their claim will be 8 years. After 2 years they are more likely to die or retire than return to work (HM Government 2005). f) Many national strategies, targets and initiatives focus on how employers and primary care services can help adults over 16 remain in or return to work. Examples include those listed in section 2, page 1 of this document. 4 The guidance a) Public health guidance will be developed according to NICE processes and methods. For details see section 5. b) This document is the scope. It defines exactly what this guidance will (and will not) examine, and what the guidance developers will consider. The scope is based on a referral from the Department of Health (see appendix A).

41 Institute for Employment Studies Populations Groups that will be covered All adults over age 16 in full or part-time employment, both paid and unpaid. All adults over age 16 who have experienced long-term sickness (for 20 working days or longer) or re-occurring short-term sickness (less than 20 working days) and/or are in receipt of incapacity benefit. All employers in the public, private and not for profit sectors Groups that will not be covered Self-employed individuals. Pregnant women who have taken sickness absence related to their pregnancy, during the course of their pregnancy. Unemployed individuals who are not sick or in receipt of incapacity benefit. 4.2 Areas Areas that will be covered The activities to be considered by this guidance are: a) Work or primary care-based interventions, programmes, policies or strategies to prevent or reduce the number of employees moving from short to long-term sickness absence. This includes activities to prevent or reduce the re-occurrence of short-term sickness absence episodes. Examples may include: trigger mechanisms to identify frequent short-term sickness absence risk assessments, modifications and reasonable adjustments to the physical and organisational work environment

42 30 Long-term Sickness and Incapacity Guidance: Mapping review training for line managers in handling and monitoring sickness absence. b) Work or primary care-based interventions, programmes, policies or strategies to help employees who have been on long-term sickness absence to return to work. Examples may include: return to work interviews following a period of sickness absence rehabilitation and retention programmes provision of information, training and support networks training, advice and support for GPs and other primary care staff. c) Work or primary care-based interventions, programmes, policies or strategies that help reduce the re-occurrence of long-term sickness absence. Examples include: linking management performance to the way they deal with long-term sickness absence where appropriate, early referral of employees on long-term sickness absence to occupational health professionals, general practitioners or organisations offering Employee Assistance Programmes flexible working/work-life balance policies for employees (including carers and special leave for family problems) stress counselling. d) UK work or primary care-based interventions, programmes, policies or strategies which help those in receipt of incapacity benefit to return to full or part-time employment. These could be delivered by a number of sectors (such as the voluntary or education sectors) in collaboration with, and/or funded by, employers and primary care services. Examples may include Pathways to Work, New Deal and Access to Work schemes.