Interventions to improve return to work in depressed people
Information
- DOI:
- https://doi.org/10.1002/14651858.CD006237.pub4Copy DOI
- Database:
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- Cochrane Database of Systematic Reviews
- Version published:
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- 14 October 2020see what's new
- Type:
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- Intervention
- Stage:
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- Review
- Cochrane Editorial Group:
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Cochrane Work Group
- Copyright:
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- Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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Authors
Contributions of authors
Original review
KN wrote the initial draft of the protocol and will write subsequent drafts of the protocol and review. She and AN designed and conducted the search strategy. AV, UB, CF, AN, and JV contributed to the draft version of the protocol and contributed to subsequent versions and revisions of the protocol and review. KN, AV, and UB included eligible studies. UB and CF conducted the quality assessment of eligible studies. KN and AN extracted the data from the original studies. KN, CF, and JV conducted the data synthesis.
Update 2014
BF adapted the search strategy and conducted the searches. BF, KN, CF, UB, and AV checked resulting studies for eligibility. BF, KN, AN, AV CF, HH, and UB conducted data extraction. BF, KN, AN, AV, CH, HH, UB, and JV assessed included studies for risk of bias. BF, KN, and JV ran the analyses. KN wrote the draft of the updated review and all others commented on this draft. JV acted as an advisor on the whole review process and several specific topics such as meaningful comparisons, GRADE, and meta‐analysis.
Update 2020
JV conducted the searches. KN and JV checked resulting studies for eligibility. JV, BF, KN, AN, AV, and UB conducted data extraction and KN and JV assessed included studies for risk of bias. KN, and JV ran the analyses. KN wrote the draft of the updated review and all others commented on this draft.
Sources of support
Internal sources
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Coronel Institute of Occupational Health, Netherlands
Salary for Karen Nieuwenhuijsen (on going) and Babs Faber (update 2014)
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Trimbos Instituut ‐ Netherlands Institute of Mental Health and Addiction, Netherlands
Salary for Christina van der Feltz‐Cornelis
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Federal Institute for Occupational Safety and Health, Germany
Salary for Angela Neumeyer‐Gromen
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Finnish Institute of Occupational Health, Finland
Salary for Jos Verbeek
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University Medical Center Groningen, Netherlands
Salary for Ute Bültmann
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Dutch Research Center for Insurance Medicine, Netherlands
Support and training for authors
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Radboud University Medical Centre Nijmegen, Netherlands
Salary of Arco Verhoeven
External sources
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KIS programme, Ministry of Social Affairs and Employment, Netherlands
A small grant to Karen Nieuwenhuijsen to help her finish the first version of this review
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Cochrane Review Support Programme , UK
£5,000 payment upon publication of the update (2020) review
Declarations of interest
Karen Nieuwenhuijsen was an author of one of the included studies: Noordik 2013.
Babs Faber: none known.
Jos Verbeek: none known.
Angela Neumeyer‐Gromen: none known.
Hiske Hees (author on the 2014 update) was an author of one of the included studies: Hees 2013.
Arco Verhoeven: none known.
Christina van der Feltz‐Cornelis (author on the 2008 and 2014 versions) was an author of one of the included studies: Vlasveld 2013. Her employer received an unrestricted grant from Eli Lilly for an investigator‐initiated trial on depression and pain. She also received payment from Benecke for speaking at a symposium on chronic pain. She has received royalties from various publishers on her books on psychiatry.
Ute Bültmann: none known.
None of the authors assessed studies they were authors of for eligibility or risk of bias.
Acknowledgements
We are grateful to José Luis Fernandez, Martin Keller, Tony Kendrick, Paul Knekt, Paul McCrone, Judith Proudfoot, Renee Romeo, Kathryn Rost, Aart Schene, Gregory Simon, Alan Wade, Penny Bee, Clément Francois, Nicholas Moore, and Ken Wells for kindly providing further information about their studies. We thank the CCDAN group for their support with the first version of this review. We thank Melissa Raven and Berend Terluin for their peer review of the updated 2020 review. We thank Janet Wale for copy editing the text of the updated 2014 review and Hacsi Horvath for copy editing the text of the updated 2020 review. In the 2020 update Joost Daams kindly conducted the search update. To conclude, we are very grateful for the help of the Cochrane Work Review Group.
We would like to acknowledge the contribution of Hiske Hees and Christina van der Feltz‐Cornelis as authors of the previous version of this review
Version history
| Published | Title | Stage | Authors | Version |
| 2020 Oct 14 | Interventions to improve return to work in depressed people | Review | Karen Nieuwenhuijsen, Jos H Verbeek, Angela Neumeyer-Gromen, Arco C Verhoeven, Ute Bültmann, Babs Faber | |
| 2014 Dec 03 | Interventions to improve return to work in depressed people | Review | Karen Nieuwenhuijsen, Babs Faber, Jos H Verbeek, Angela Neumeyer‐Gromen, Hiske L Hees, Arco C Verhoeven, Christina M van der Feltz‐Cornelis, Ute Bültmann | |
| 2008 Apr 23 | Interventions to improve occupational health in depressed people | Review | Karen Nieuwenhuijsen, Ute Bültmann, Angela Neumeyer‐Gromen, Arco C Verhoeven, Jos H Verbeek, Christina M. Feltz‐Cornelis | |
| 2006 Oct 18 | Interventions to improve occupational health in depressed people | Protocol | Karen Nieuwenhuijsen, Arco C Verhoeven, Ute Bültmann, Angela Neumeyer‐Gromen, C M van der Feltz‐Cornelis, Christina M. Feltz‐Cornelis | |
Differences between protocol and review
In order to reflect the latest guidance available in the Cochrane Handbook for Systematic Reviews of Interventions, we used the GRADE approach. In the first version of the protocol and the published review, we used the Downs and Black checklist to assess quality, while in this update we used Cochrane’s 'Risk of bias' tool. Also, we no longer formally tested heterogeneity but rather assessed the I² statistic. Furthermore, our search strategy was simplified and we no longer handsearched journals as these were indexed in MEDLINE and did not yield additional studies. Instead of searching the CCDAN registers, we now directly searched CENTRAL.
In the 2020 update, we have re‐organised the comparisons. One change was that we now distinguish between care as usual (a study arm where patients are treated without a specific intervention protocol) and an alternative intervention (an intervention that was protocolised, regardless of whether that intervention constitutes the regular care in that setting). We also made a small change in the classification of the interventions where we no longer divided the work‐directed interventions into subgroups. We divided the psychological interventions into a subgroup with and a group without guidance or face to face contact with a therapist.
In the 2020 update we renamed the outcome 'employment status' as being off work and treated this as a second operationalisation of sickness absence (next to days of sickness absence).
In the previous version, we had not specified the assessment of clinical heterogeneity. We added this now.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- *Absenteeism;
- Antidepressive Agents [therapeutic use];
- Bias;
- Cognitive Behavioral Therapy;
- Depression [*therapy];
- Depressive Disorder, Major [*therapy];
- Muscle Stretching Exercises;
- *Occupational Health;
- Randomized Controlled Trials as Topic;
- Return to Work [*psychology];
- Sick Leave;
- Work Performance;
Medical Subject Headings Check Words
Adult; Humans;
PICOs
PRISMA Study flow diagram of the study selection process until 2014.
PRISMA Study flow diagram of the study selection process 2014‐2020.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1: Work‐directed plus clinical versus CAU (medium‐term), Outcome 1: Days of sickness absence
Comparison 1: Work‐directed plus clinical versus CAU (medium‐term), Outcome 2: Off work
Comparison 1: Work‐directed plus clinical versus CAU (medium‐term), Outcome 3: Depressive symptoms
Comparison 1: Work‐directed plus clinical versus CAU (medium‐term), Outcome 4: Work functioning
Comparison 2: Work‐directed plus clinical versus CAU (long‐term), Outcome 1: Days of sickness absence
Comparison 2: Work‐directed plus clinical versus CAU (long‐term), Outcome 2: Depressive symptoms
Comparison 2: Work‐directed plus clinical versus CAU (long‐term), Outcome 3: Work functioning
Comparison 3: Work‐directed plus clinical versus psychological (medium‐term), Outcome 1: Days of sickness absence
Comparison 3: Work‐directed plus clinical versus psychological (medium‐term), Outcome 2: Depressive symptoms
Comparison 3: Work‐directed plus clinical versus psychological (medium‐term), Outcome 3: Work functioning
Comparison 4: Work‐directed plus clinical versus work‐directed (medium‐term), Outcome 1: Days of sickness absence
Comparison 4: Work‐directed plus clinical versus work‐directed (medium‐term), Outcome 2: Depressive symptoms
Comparison 4: Work‐directed plus clinical versus work‐directed (medium‐term), Outcome 3: Work functioning
Comparison 5: Work‐directed versus CAU (medium‐term), Outcome 1: Days of sickness absence
Comparison 5: Work‐directed versus CAU (medium‐term), Outcome 2: Off work
Comparison 5: Work‐directed versus CAU (medium‐term), Outcome 3: Depressive symptoms
Comparison 5: Work‐directed versus CAU (medium‐term), Outcome 4: Work functioning
Comparison 6: Work‐directed versus CAU (long‐term), Outcome 1: Off work
Comparison 6: Work‐directed versus CAU (long‐term), Outcome 2: Depressive symptoms
Comparison 7: Psychological intervention versus CAU (short‐term), Outcome 1: Days of sickness absence
Comparison 8: Psychological intervention versus CAU (medium‐term), Outcome 1: Days of sickness absence
Comparison 8: Psychological intervention versus CAU (medium‐term), Outcome 2: Depressive symptoms
Comparison 8: Psychological intervention versus CAU (medium‐term), Outcome 3: Work functioning
Comparison 9: Psychological intervention other psychological (medium‐term), Outcome 1: Days of sickness absence
Comparison 9: Psychological intervention other psychological (medium‐term), Outcome 2: Off work
Comparison 9: Psychological intervention other psychological (medium‐term), Outcome 3: Work functioning
Comparison 9: Psychological intervention other psychological (medium‐term), Outcome 4: Depressive symptoms
Comparison 10: Psychological intervention versus other psychological (long‐term), Outcome 1: Days of sickness absence
Comparison 10: Psychological intervention versus other psychological (long‐term), Outcome 2: Off work
Comparison 10: Psychological intervention versus other psychological (long‐term), Outcome 3: Depressive symptoms
Comparison 10: Psychological intervention versus other psychological (long‐term), Outcome 4: Work functioning
Comparison 11: Psychological with antidepressant versus antidepressant (medium‐term), Outcome 1: Days of sickness absence
Comparison 11: Psychological with antidepressant versus antidepressant (medium‐term), Outcome 2: Depressive symptoms
Comparison 11: Psychological with antidepressant versus antidepressant (medium‐term), Outcome 3: Work functioning
Comparison 12: Antidepressant medication versus placebo (medium‐term), Outcome 1: Days of sickness absence
Comparison 12: Antidepressant medication versus placebo (medium‐term), Outcome 2: Work functioning
Comparison 13: Antidepressant versus other antidepressant (medium‐term), Outcome 1: Days of sickness absence
Comparison 13: Antidepressant versus other antidepressant (medium‐term), Outcome 2: Depressive symptoms
Comparison 13: Antidepressant versus other antidepressant (medium‐term), Outcome 3: Work functioning
Comparison 14: Improved care versus CAU (medium‐term), Outcome 1: Days of Sickness absence
Comparison 14: Improved care versus CAU (medium‐term), Outcome 2: Off work
Comparison 14: Improved care versus CAU (medium‐term), Outcome 3: Depressive symptoms
Comparison 14: Improved care versus CAU (medium‐term), Outcome 4: Work functioning
Comparison 15: Improved care versus CAU (long‐term), Outcome 1: Off work
Comparison 15: Improved care versus CAU (long‐term), Outcome 2: Depressed yes/no
Comparison 16: Exercise intervention versus CAU or relaxation (medium‐term), Outcome 1: Days of sickness absence
Comparison 16: Exercise intervention versus CAU or relaxation (medium‐term), Outcome 2: Off work
Comparison 16: Exercise intervention versus CAU or relaxation (medium‐term), Outcome 3: Depressive symptoms
Comparison 16: Exercise intervention versus CAU or relaxation (medium‐term), Outcome 4: Work functioning
Comparison 17: Art therapy versus CAU (medium‐term), Outcome 1: Off work
Comparison 17: Art therapy versus CAU (medium‐term), Outcome 2: Depressive symptoms
Comparison 18: Adjunctive diet versus adjunctive social support (medium‐term), Outcome 1: Days of sickness absence
Comparison 18: Adjunctive diet versus adjunctive social support (medium‐term), Outcome 2: Depressive symptoms
Comparison 19: Sensitivity analysis: Work directed plus clinical versus CAU (medium‐term), Outcome 1: Days of sickness absence
Comparison 20: Sensitivity analysis: Psychotherapy versus CAU (medium‐term), Outcome 1: Days of sickness absence
Comparison 21: Sensitivity analysis: Improved care versus CAU, Outcome 1: Days of sickness absence
Comparison 22: Sensitivity analysis: Improved care versus CAU cluster, Outcome 1: Days of Sickness absence
| Work‐directed plus clinical intervention compared to care as usual (medium‐term) in depressed people | ||||||
| Patients: Depressed persons | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with care as usual | Risk with work‐directed intervention plus clinical intervention | |||||
| Sickness absence days | ‐ | SMD 0.25 SD lower | ‐ | 1292 | ⊕⊕⊕⊝ | The SMD translates back to ‐0.5 days per 2 weeks (CI ‐0.7 to ‐0.2) or ‐24.7 days in 12 months (‐37.5 to ‐11.8). |
| On sick leave | 417 per 1.000 | 451 per 1.000 | RR 1.08 | 1025 | ⊕⊕⊕⊕ | |
| Depressive symptoms‐ | ‐ | SMD 0.25 SD lower | ‐ | 1091 | ⊕⊕⊝⊝ | |
| Work functioning | ‐ | SMD 0.19 SD lower | ‐ | 926 | ⊕⊕⊝⊝ | |
| The risk in the intervention group (and the 95% CI) is based on the risk in the control group and the relative effect of the intervention (and the 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1A majority of the studies in the meta‐analysis (in terms of weights) showed high or unclear risk on the randomisation items (sequence and concealment), blinded outcome assessment or attrition. We therefore rated down one level due to a high risk of bias. 2Depression is self‐reported and participants were not blinded. We rated down one level due to a high risk of bias. 3Study effects varied with some clearly indicating beneficial results and some not. We rated down one level due to imprecision. 4Rated down one level due to inconsistency (I2 61%). 5Pooled effect size includes small harmful effec. Rated down one level due to wide CI (imprecision) | ||||||
| Work‐directed intervention compared to care as usual in depressed people | ||||||
| Patient or population: Depressed persons | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with care as usual | Risk with work‐directed intervention | |||||
| Sickness absence days, medium‐term follow‐up | ‐ | SMD 0.39 higher | ‐ | 130 | ⊕⊕⊝⊝ | The SMD translates back to + 0.7 days in two weeks (95% CI 0.1 to 1.3) or + 38 days in 12 months (95% CI 3.9 to 73). |
| Off work, medium‐term follow‐up | 708 per 1.000 | 658 per 1.000 | RR 0.93 | 226 | ⊕⊕⊕⊝ | |
| Depressive symptoms, medium‐term follow‐up | ‐ | SMD 0.1 lower | ‐ | 390 | ⊕⊕⊕⊝ | |
| Work functioning, medium‐term follow‐up | ‐ | SMD 0.32 lower | ‐ | 48 | ⊕⊕⊝⊝ | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1One study with unclear risk and one with serious risk of bias. Rated down one level due to high risk of bias. 2Two studies with 130 participants. CI includes harms and benefits. Rated down one level due to imprecision. 3Based on one study with small number of participants, rated down one level due to to imprecision. 4Includes studies with high risk of bias. Rated down one level due to high risk of bias. 5One study with unclear risk of bias. Rated down with one level due to high risk of bias. | ||||||
| Psychological intervention compared to care as usual in depressed people | ||||
| Patient or population: Depressed persons | ||||
| Outcomes | Anticipated absolute effects* (95% CI) | № of participants | Certainty of the evidence | Comments |
|---|---|---|---|---|
| Risk with psychological intervention | ||||
| Sickness absence days, medium‐term follow‐up | SMD 0.15 lower | 1649 | ⊕⊕⊝⊝ | The SMD translates back to ‐0.3 days per 2 weeks (95% CI ‐0.5 to ‐0.1) or ‐14.7 days in 12 months (95% CI ‐27.6 to ‐3.0). |
| Depressive symptoms, medium‐term follow‐up | SMD 0.3 lower | 1255 | ⊕⊕⊝⊝ | |
| Work ability, medium‐term follow‐up | SMD 0.05 higher | 58 | ⊕⊝⊝⊝ | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||
| GRADE Working Group grades of evidence | ||||
| 1In most studies, the outcome was self‐reported, leading to risk of bias in outcome assessment. There was also large attrition. Rated down one level due to high risk of bias. 2Funnel plot shows missing small studies with no effect or harmful effect. Rated down one level due to risk of publication bias. 3Outcomes self‐reported in unblinded studies. Rated down one level due to high risk of bias 4CI includes appreciable harms and benefits. Sole study. Rated down two levels due to imprecision. 5One study with unclear risk of bias. Rated down one level due to high risk of bias. | ||||
| Improved care compared to care as usual in depressed persons | ||||||
| Patient or population: Depressed persons | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with care as usual | Risk with improved care | |||||
| Sickness absence days, medium‐term follow‐up | ‐ | SMD 0.06 lower | ‐ | 1912 | ⊕⊕⊕⊝ | The SMD translates back to ‐0.1 days per 2 weeks (95% CI ‐0.3 to 0.1) or ‐5.9 days in 12 months (95% CI ‐14.8 to 3.9). The SMD of the sensitivity analysis1 translates back to ‐0.4 days per 2 weeks (95% CI ‐0.6 to ‐0.1) or ‐19.7 days in 12 months (95% CI ‐34.5 to ‐4.9). |
| Off work, medium‐term follow up | 496 per 1.000 | 516 per 1.000 | RR 0.97 | 362 | ⊕⊕⊝⊝ | |
| Depressive symptoms, medium‐term follow‐up | ‐ | SMD 0.21 SD lower | ‐ | 1808 | ⊕⊕⊕⊝ | |
| Work functioning, medium‐term follow‐up | ‐ | SMD 0.5 higher | ‐ | 604 | ⊕⊕⊕⊝ | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 A sensitivity analysis revealed that two RCTs with a lower risk of bias found a SMD of 0.20 lower (0.35 lower to 0.05 lower); moderate‐certainty evidence). 2 Majority of studies at high risk; downgraded with one level due to high risk of bias. 3 One study at high risk of bias, downgraded with one level due to high risk of bias. 4 One study with less than 400 participants, downgraded with one level due to imprecision 5 Study with unblinded outcome assessment, rated down one level due to high risk of bias. | ||||||
| Study | Blinding of outcome assessment (detection bias) | Incomplete outcome data: attrition bias |
| Agosti 1991 | Low risk (blinded clinician) | High risk |
| Burnand 2002 | High risk (self‐report) | High risk |
| Finnes 2017 | High risk (self‐report) | Low risk |
| Hees 2013 | High risk (self‐report) | Low risk |
| Kaldo 2018 | High risk (self‐report) | High risk |
| Knekt 2013 | High risk (self‐report) | Low risk |
| Lerner 2012 | High risk (self‐report) | Low risk |
| Miller 1998 | High risk (self‐report) | Unclear risk |
| Sarfati 2016 | High risk (self‐report) | High risk |
| Wang 2007 | High risk (self‐report) | Low risk |
| Lerner 2020 | High risk (self‐report) | Low risk |
| Work‐directed plus clinical compared to care as usual in depressed people, long‐term follow‐up | ||||
| Patient or population: Depressed persons | ||||
| Outcomes | Anticipated absolute effects* (95% CI) | № of participants | Certainty of the evidence | Comments |
|---|---|---|---|---|
| Risk with work‐directed intervention plus clinical intervention | ||||
| Days of sickness absence, long‐term follow‐up | SMD 0.19 lower | 179 | ⊕⊕⊝⊝ | The SMD translates back to ‐0.3 days per 2 weeks (CI ‐0.9 to 0.2) and ‐18.7 days in 12 months (‐48.3 to 11.8). |
| Depressive symptoms, long‐term follow‐up | SMD 0.63 lower | 117 | ⊕⊕⊝⊝ | |
| Work functioning, long‐term follow‐up | SMD 0.25 lower | 117 | ⊕⊕⊝⊝ | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||
| GRADE Working Group grades of evidence | ||||
| 1Both studies at high risk because of unblinded outcome assessment. Rated down one level due to high risk of bias. 2Pooled effect size includes small harms and appreciable benefits; sample size small; rated down one level due to imprecision. 3One study only, with small number of participants; downgraded two levels due to imprecision. | ||||
| Work‐directed compared to care as usual in depressed people, long‐term follow‐up | ||||||
| Patient or population: Depressed persons | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with care as usual | Risk with work‐directed intervention | |||||
| Off work | 606 per 1.000 | 606 per 1.000 | RR 1.00 | 363 | ⊕⊕⊕⊝ | |
| Depressive symptoms | ‐ | SMD 0.18 higher | ‐ | 160 | ⊕⊕⊝⊝ | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1CI includes appreciable harm and benefit. Rated down one level due to imprecision. 2CI include appreciable harm and benefit; one study only; rated down two levels due to imprecision. | ||||||
| Psychological intervention compared to care as usual in depressed people (short‐term follow‐up) | ||||
| Patient or population: Depressed persons | ||||
| Outcomes | Anticipated absolute effects* (95% CI) | № of participants | Certainty of the evidence | Comments |
|---|---|---|---|---|
| Risk with psychological intervention | ||||
| Days of sickness absence; follow‐up short term | SMD 0.05 lower | 300 | ⊕⊕⊝⊝ | The SMD translates back to ‐0.1 days per 2 weeks (CI ‐0.5 to 0.3) or ‐4.9 days in 12 months (‐27.6 to 16.8). |
| Depressive symptoms | No data available | |||
| Work functioning | No data available | |||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||
| GRADE Working Group grades of evidence | ||||
| 1One study with high risk of bias; rated down one level. 2One study only with 300 participants; rated down one level. | ||||
| Improved care compared to care as usual in depressed people | ||||||
| Patient or population: Depressed persons | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with care as usual | Risk with improved care | |||||
| Off work, long‐term follow‐up | 607 per 1.000 | 656 per 1.000 | RR 1.08 | 1356 | ⊕⊕⊕⊝ | |
| Depressed yes/no, long‐term follow‐up | 614 per 1.000 | 546 per 1.000 | RR 0.89 | 1356 | ⊕⊕⊕⊝ | |
| Work functioning | No data available | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1At risk of bias because of lack of allocation concealment. Rated down one level due to high risk of bias. | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Days of sickness absence Show forest plot | 9 | 1292 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.25 [‐0.38, ‐0.12] |
| 1.1.1 Work‐directed plus clinical vs. CAU‐psych | 2 | 179 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.30 [‐0.61, 0.01] |
| 1.1.2 Work‐directed plus clinical vs. CAU‐PC | 4 | 718 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.32 [‐0.56, ‐0.07] |
| 1.1.3 Work‐directed plus clinical vs CAU‐WD | 2 | 270 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.20 [‐0.44, 0.04] |
| 1.1.4 Work‐directed plus clinical vs CAU‐no int | 1 | 125 | Std. Mean Difference (IV, Random, 95% CI) | 0.02 [‐0.33, 0.37] |
| 1.2 Off work Show forest plot | 2 | 1025 | Risk Ratio (M‐H, Random, 95% CI) | 1.08 [0.64, 1.83] |
| 1.2.1 Work‐directed plus clinical vs. CAU‐PC | 1 | 392 | Risk Ratio (M‐H, Random, 95% CI) | 1.73 [0.70, 4.24] |
| 1.2.2 Work‐directed plus clinical vs CAU‐WD | 1 | 633 | Risk Ratio (M‐H, Random, 95% CI) | 0.94 [0.83, 1.06] |
| 1.3 Depressive symptoms Show forest plot | 8 | 1091 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.25 [‐0.49, ‐0.01] |
| 1.3.1 work‐directed plus clinical vs. CAU‐psych | 2 | 179 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.08 [‐0.66, 0.50] |
| 1.3.2 Work‐directed plus clinical vs. CAU‐PC | 4 | 713 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.44 [‐0.73, ‐0.15] |
| 1.3.3 Work‐directed plus clinical vs. CAU‐WD | 1 | 74 | Std. Mean Difference (IV, Random, 95% CI) | 0.26 [‐0.20, 0.72] |
| 1.3.4 Work‐directed plus clinical vs. CAU‐no int | 1 | 125 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.23 [‐0.59, 0.12] |
| 1.4 Work functioning Show forest plot | 5 | 926 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.19 [‐0.43, 0.06] |
| 1.4.1 Work‐directed plus clinical vs. CAU‐psych | 1 | 117 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.09 [‐0.48, 0.29] |
| 1.4.2 work‐directed plus clinical vs. CAU‐GP | 4 | 809 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.22 [‐0.53, 0.09] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Days of sickness absence Show forest plot | 2 | 179 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.19 [‐0.49, 0.12] |
| 2.1.1 Work‐directed plus clinical vs. CAU‐psych | 2 | 179 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.19 [‐0.49, 0.12] |
| 2.2 Depressive symptoms Show forest plot | 1 | 117 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.63 [‐1.02, ‐0.24] |
| 2.2.1 Work‐directed plus clinical vs. CAU‐psych | 1 | 117 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.63 [‐1.02, ‐0.24] |
| 2.3 Work functioning Show forest plot | 1 | 117 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.25 [‐0.63, 0.14] |
| 2.3.1 Work‐directed plus clinical vs. CAU | 1 | 117 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.25 [‐0.63, 0.14] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Days of sickness absence Show forest plot | 1 | 59 | Std. Mean Difference (IV, Random, 95% CI) | 0.04 [‐0.47, 0.56] |
| 3.2 Depressive symptoms Show forest plot | 1 | 53 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.15 [‐0.69, 0.39] |
| 3.3 Work functioning Show forest plot | 1 | 51 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.08 [‐0.63, 0.48] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Days of sickness absence Show forest plot | 1 | 51 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.10 [‐0.65, 0.45] |
| 4.2 Depressive symptoms Show forest plot | 1 | 43 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.37 [‐0.98, 0.23] |
| 4.3 Work functioning Show forest plot | 1 | 41 | Std. Mean Difference (IV, Random, 95% CI) | 0.32 [‐0.30, 0.94] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 5.1 Days of sickness absence Show forest plot | 2 | 130 | Std. Mean Difference (IV, Random, 95% CI) | 0.39 [0.04, 0.74] |
| 5.1.1 Work‐directed vs. CAU‐PC | 1 | 55 | Std. Mean Difference (IV, Random, 95% CI) | 0.30 [‐0.24, 0.83] |
| 5.1.2 Work‐directed vs. CAU‐WD | 1 | 75 | Std. Mean Difference (IV, Random, 95% CI) | 0.45 [‐0.00, 0.91] |
| 5.2 Off work Show forest plot | 1 | 226 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.77, 1.11] |
| 5.2.1 Work‐directed vs CAU‐WD | 1 | 226 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.77, 1.11] |
| 5.3 Depressive symptoms Show forest plot | 4 | 390 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.10 [‐0.30, 0.10] |
| 5.3.1 Work‐directed vs. CAU‐PC | 1 | 48 | Std. Mean Difference (IV, Random, 95% CI) | 0.23 [‐0.35, 0.81] |
| 5.3.2 Work‐directed vs. CAU‐WD | 3 | 342 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.14 [‐0.36, 0.07] |
| 5.4 Work functioning Show forest plot | 1 | 48 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.32 [‐0.90, 0.26] |
| 5.4.1 Work‐directed vs. CAU‐PC | 1 | 48 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.32 [‐0.90, 0.26] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 6.1 Off work Show forest plot | 2 | 363 | Risk Ratio (M‐H, Random, 95% CI) | 1.00 [0.82, 1.22] |
| 6.1.1 Work‐directed vs CAU‐WD | 2 | 363 | Risk Ratio (M‐H, Random, 95% CI) | 1.00 [0.82, 1.22] |
| 6.2 Depressive symptoms Show forest plot | 1 | 160 | Std. Mean Difference (IV, Random, 95% CI) | 0.18 [‐0.13, 0.49] |
| 6.2.1 Work‐directed vs. CAU‐WD | 1 | 160 | Std. Mean Difference (IV, Random, 95% CI) | 0.18 [‐0.13, 0.49] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 7.1 Days of sickness absence Show forest plot | 1 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 7.1.1 I‐Unguided | 1 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 8.1 Days of sickness absence Show forest plot | 9 | 1649 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.15 [‐0.28, ‐0.03] |
| 8.1.1 Face‐to‐face | 1 | 63 | Std. Mean Difference (IV, Random, 95% CI) | 0.15 [‐0.34, 0.65] |
| 8.1.2 T‐guided | 1 | 12 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.34 [‐1.50, 0.82] |
| 8.1.3 I‐guided | 5 | 639 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.15 [‐0.36, 0.05] |
| 8.1.4 I‐Unguided | 2 | 935 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.19 [‐0.41, 0.03] |
| 8.2 Depressive symptoms Show forest plot | 8 | 1255 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.30 [‐0.45, ‐0.15] |
| 8.2.1 Face to face | 1 | 58 | Std. Mean Difference (IV, Random, 95% CI) | 0.02 [‐0.49, 0.54] |
| 8.2.2 T‐guided | 1 | 12 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.76 [‐1.97, 0.45] |
| 8.2.3 I‐guided | 4 | 666 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.44 [‐0.60, ‐0.27] |
| 8.2.4 Unguided | 2 | 519 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.14 [‐0.31, 0.03] |
| 8.3 Work functioning Show forest plot | 1 | 58 | Std. Mean Difference (IV, Random, 95% CI) | 0.05 [‐0.46, 0.57] |
| 8.3.1 Face to face | 1 | 58 | Std. Mean Difference (IV, Random, 95% CI) | 0.05 [‐0.46, 0.57] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 9.1 Days of sickness absence Show forest plot | 1 | 98 | Std. Mean Difference (IV, Random, 95% CI) | 0.70 [‐0.19, 1.59] |
| 9.1.1 Short‐term psychodynamic therapy vs. solution‐focused therapy | 1 | 47 | Std. Mean Difference (IV, Random, 95% CI) | 0.25 [‐0.39, 0.89] |
| 9.1.2 Long‐term psychodynamic therapy vs. solution‐focused therapy | 1 | 51 | Std. Mean Difference (IV, Random, 95% CI) | 1.16 [0.49, 1.83] |
| 9.2 Off work Show forest plot | 1 | 218 | Risk Ratio (IV, Random, 95% CI) | 1.83 [1.00, 3.37] |
| 9.2.1 Short‐term psychotherapy vs. coping focussed therapy | 1 | 218 | Risk Ratio (IV, Random, 95% CI) | 1.83 [1.00, 3.37] |
| 9.3 Work functioning Show forest plot | 1 | Std. Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 9.3.1 Short‐term psychodynamic therapy vs solution‐focused therapy | 1 | 136 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.66 [‐1.03, ‐0.30] |
| 9.3.2 Long‐term psychodynamic therapy vs solution‐focused therapy | 1 | 160 | Std. Mean Difference (IV, Random, 95% CI) | 1.00 [0.63, 1.36] |
| 9.4 Depressive symptoms Show forest plot | 1 | Std. Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 9.4.1 Short‐term psychodynamic therapy vs. solution‐focused therapy | 1 | 136 | Std. Mean Difference (IV, Random, 95% CI) | ‐1.19 [‐1.58, ‐0.81] |
| 9.4.2 Long‐term psychodynamic therapy vs. solution‐focused therapy | 1 | 160 | Std. Mean Difference (IV, Random, 95% CI) | 2.04 [1.62, 2.45] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 10.1 Days of sickness absence Show forest plot | 1 | Std. Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 10.1.1 Short‐term psychodynamic therapy vs. solution‐focused therapy | 1 | 36 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.91 [‐1.62, ‐0.19] |
| 10.1.2 Long‐term psychodynamic therapy vs. solution‐focused therapy | 1 | 42 | Std. Mean Difference (IV, Random, 95% CI) | ‐4.61 [‐5.84, ‐3.39] |
| 10.2 Off work Show forest plot | 1 | 216 | Risk Ratio (IV, Fixed, 95% CI) | 1.14 [0.61, 2.11] |
| 10.2.1 Short‐term psychotherapy vs. coping focussed therapy | 1 | 216 | Risk Ratio (IV, Fixed, 95% CI) | 1.14 [0.61, 2.11] |
| 10.3 Depressive symptoms Show forest plot | 2 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 10.3.1 Short‐term psychodynamic therapy vs. solution‐focused therapy | 1 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 10.3.2 Long‐term psychodynamic therapy vs. solution‐focused therapy | 1 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 10.3.3 Short term solution focused vs brief psychotherapy fu > 1 year | 1 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 10.4 Work functioning Show forest plot | 1 | 263 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.26 [‐0.52, 0.01] |
| 10.4.1 Short‐term psychodynamic therapy vs. solution‐focused therapy | 1 | 118 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.33 [‐0.72, 0.05] |
| 10.4.2 Long‐term psychodynamic therapy vs. solution‐focused therapy | 1 | 145 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.19 [‐0.56, 0.18] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 11.1 Days of sickness absence Show forest plot | 2 | 139 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.38 [‐0.99, 0.24] |
| 11.1.1 Psychodynamic therapy plus TCA vs. TCA | 1 | 57 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.71 [‐1.25, ‐0.17] |
| 11.1.2 I‐CBT plus AD vs AD plus reminder | 1 | 82 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.08 [‐0.52, 0.35] |
| 11.2 Depressive symptoms Show forest plot | 2 | 160 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.19 [‐0.50, 0.12] |
| 11.2.1 Psychodynamic therapy plus TCA vs TCS | 1 | 74 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.11 [‐0.57, 0.35] |
| 11.2.2 I‐CBT plus AD vs AD plus reminder | 1 | 86 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.26 [‐0.69, 0.16] |
| 11.3 Work functioning Show forest plot | 2 | 141 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.24 [‐0.68, 0.20] |
| 11.3.1 Psychodynamic therapy plus TCA vs. TCA | 1 | 57 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.49 [‐1.02, 0.04] |
| 11.3.2 I‐CBT plus AD vs AD plus reminder | 1 | 84 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.04 [‐0.47, 0.39] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 12.1 Days of sickness absence Show forest plot | 1 | 61 | Std. Mean Difference (IV, Random, 95% CI) | 0.48 [‐0.05, 1.00] |
| 12.1.1 TCA or MAO vs. placebo | 1 | 61 | Std. Mean Difference (IV, Random, 95% CI) | 0.48 [‐0.05, 1.00] |
| 12.2 Work functioning Show forest plot | 1 | 61 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.58 [‐1.11, ‐0.05] |
| 12.2.1 TCA or MAO vs. placebo | 1 | 61 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.58 [‐1.11, ‐0.05] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 13.1 Days of sickness absence Show forest plot | 5 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 13.1.1 SSRI vs. SNRI | 3 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 13.1.2 SSRI vs. TCA | 1 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 13.1.3 SSRI vs. SSRI | 1 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 13.2 Depressive symptoms Show forest plot | 5 | 1514 | Std. Mean Difference (IV, Random, 95% CI) | 0.07 [‐0.34, 0.48] |
| 13.2.1 SSRI vs. SNRI | 3 | 599 | Std. Mean Difference (IV, Random, 95% CI) | 0.18 [‐0.37, 0.73] |
| 13.2.2 SSRI vs. TCA | 1 | 635 | Std. Mean Difference (IV, Random, 95% CI) | Not estimable |
| 13.2.3 SSRI vs. SSRI | 1 | 280 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.23 [‐0.47, 0.00] |
| 13.3 Work functioning Show forest plot | 1 | 635 | Mean Difference (IV, Random, 95% CI) | ‐0.05 [‐0.16, 0.06] |
| 13.3.1 SSRI vs. TCA | 1 | 635 | Mean Difference (IV, Random, 95% CI) | ‐0.05 [‐0.16, 0.06] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 14.1 Days of Sickness absence Show forest plot | 6 | 1912 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.05 [‐0.16, 0.06] |
| 14.2 Off work Show forest plot | 1 | 362 | Risk Ratio (M‐H, Random, 95% CI) | 0.97 [0.77, 1.21] |
| 14.3 Depressive symptoms Show forest plot | 6 | 1808 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.21 [‐0.35, ‐0.07] |
| 14.4 Work functioning Show forest plot | 1 | 604 | Std. Mean Difference (IV, Random, 95% CI) | 0.50 [0.34, 0.66] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 15.1 Off work Show forest plot | 1 | 1356 | Risk Ratio (M‐H, Random, 95% CI) | 1.06 [0.90, 1.23] |
| 15.2 Depressed yes/no Show forest plot | 1 | 1356 | Risk Ratio (M‐H, Random, 95% CI) | 0.89 [0.81, 0.98] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 16.1 Days of sickness absence Show forest plot | 2 | Std. Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 16.1.1 Supervised strength training vs. relaxation | 1 | 65 | Std. Mean Difference (IV, Random, 95% CI) | ‐1.11 [‐1.68, ‐0.54] |
| 16.1.2 Aerobic exercise vs. relaxation/stretching | 2 | 180 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.06 [‐0.36, 0.24] |
| 16.2 Off work Show forest plot | 1 | 28 | Risk Ratio (M‐H, Random, 95% CI) | 0.38 [0.02, 8.62] |
| 16.2.1 Aerobic exercise versus CAU‐PC | 1 | 28 | Risk Ratio (M‐H, Random, 95% CI) | 0.38 [0.02, 8.62] |
| 16.3 Depressive symptoms Show forest plot | 2 | Std. Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 16.3.1 Supervised strength training vs. relaxation | 1 | 65 | Std. Mean Difference (IV, Random, 95% CI) | 0.15 [‐0.39, 0.68] |
| 16.3.2 Aerobic exercise vs. relaxation/stretching | 2 | 180 | Std. Mean Difference (IV, Random, 95% CI) | 0.18 [‐0.12, 0.48] |
| 16.4 Work functioning Show forest plot | 1 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 16.4.1 Aerobic exercise vs CAU‐GP | 1 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 17.1 Off work Show forest plot | 1 | 79 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.13 [‐0.58, 0.31] |
| 17.2 Depressive symptoms Show forest plot | 1 | 79 | Std. Mean Difference (IV, Fixed, 95% CI) | ‐0.43 [‐0.88, 0.02] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 18.1 Days of sickness absence Show forest plot | 1 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 18.2 Depressive symptoms Show forest plot | 1 | 56 | Std. Mean Difference (IV, Fixed, 95% CI) | ‐4.91 [‐5.99, ‐3.83] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 19.1 Days of sickness absence Show forest plot | 9 | 1292 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.25 [‐0.38, ‐0.12] |
| 19.1.1 Low risk of bias | 8 | 912 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.24 [‐0.41, ‐0.08] |
| 19.1.2 High risk of bias | 1 | 380 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.28 [‐0.48, ‐0.08] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 20.1 Days of sickness absence Show forest plot | 9 | 1649 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.15 [‐0.28, ‐0.03] |
| 20.1.1 Low risk of bias | 3 | 768 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.14 [‐0.41, 0.12] |
| 20.1.2 High risk of bias | 6 | 881 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.14 [‐0.31, 0.02] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 21.1 Days of sickness absence Show forest plot | 6 | 1912 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.05 [‐0.16, 0.06] |
| 21.1.1 Low risk of bias | 2 | 692 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.20 [‐0.35, ‐0.05] |
| 21.1.2 High risk of bias | 4 | 1220 | Std. Mean Difference (IV, Random, 95% CI) | 0.04 [‐0.08, 0.15] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 22.1 Days of Sickness absence Show forest plot | 6 | 1912 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.05 [‐0.16, 0.06] |
| 22.1.1 RCT | 5 | 1724 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.07 [‐0.19, 0.05] |
| 22.1.2 Cluster RCT | 1 | 188 | Std. Mean Difference (IV, Random, 95% CI) | 0.09 [‐0.19, 0.38] |
