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Pre‐employment examinations for preventing occupational injury and disease in workers

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Abstract

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Background

Many employers and other stakeholders believe that health examinations of job applicants prevent occupational diseases and sickness absence.

Objectives

To evaluate the effectiveness of pre‐employment examinations of job applicants in preventing occupational injury, disease and sickness absence compared to no intervention or alternative interventions.

Search methods

We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL, PsycINFO and PEDro (to December 2009) not restricted by date, language or publication type.

Selection criteria

We included randomised controlled trials (RCTs), controlled before‐after studies (CBA), and interrupted time‐series (ITS) of health examinations to prevent occupational diseases and injuries in job applicants.

Data collection and analysis

Four review authors (NM, ML, JV, ES) independently selected studies, extracted data, and determined study quality. The studies were too heterogeneous for statistical pooling of results.

Main results

We included two RCTs, five CBA studies and two ITS. Seven studies with 5872 participants evaluated the screening process of pre‐employment examinations and two studies with 2164 participants evaluated the measures to mitigate the risks found following the screening process.

Of those studies that evaluated the screening process, one study found that a general examination did not reduce sick leave (Mean Difference ‐0.1 95% CI ‐0.5 to 0.3) but another study found that a more task focused examination did (MD ‐36 95% CI ‐68.3 to ‐3.8). One study found that incorporation of a bronchial challenge test decreased occupational asthma (trend change ‐2.6 95% CI ‐3.6 to ‐1.5). Three studies that included functional capacity evaluation found contradictory effects on injury rates and number of medical visits. The rates of rejecting job applicants varied from 2% to 35%.

Neither of the two studies that evaluated risk mitigation found an increased injury rate after training or work accommodations had been implemented.

We rated the evidence for all outcomes as very low quality.

Authors' conclusions

There is very low quality evidence that pre‐employment examinations that are specific to certain jobs or health problems could reduce occupational disease, injury, or sickness absence. This supports the current policy to restrict pre‐employment examinations to job‐specific examinations. More studies are needed that take into account the harms of rejecting job applicants.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Plain language summary

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Health examination of workers before employment begins to prevent injuries and disease

The aim of pre‐employment examinations is to screen job applicants who may have an increased risk for occupational disease or injury while on the job. By not employing job applicants with an increased risk, disease or injury will be prevented but it comes at the cost for the applicants of not having a job. Another option is to remedy the problems found at the examination through work accommodation or training of physical fitness. Many employers and other stakeholders believe that health examinations of job applicants thus prevent occupational diseases and sickness absence.

We found seven studies, including 5872 participants that evaluated the whole process of health examinations including rejection of applicants with increased risks of occupational disease, injury or sickness absence. One of these studies found that a general examination did not reduce sick leave significantly among administrative workers compared to no intervention. One study found a decrease in sick leave with a more job focused pre‐employment examination compared to a general health examination. Three studies evaluated the inclusion of functional capacity evaluation in the pre‐employment examination with contradictory effects on injury rates and number of medical visits. One study found a decrease in occupational asthma after incorporating a bronchial challenge test in the pre‐employment examination. Two studies with 2164 participants compared job applicants that passed the health examination without problems to those who got recommendations for addressing the health problems that were found. Neither of the studies found a difference in injury rates between groups. This indicated that the problems identified were effectively mitigated. The rates of rejecting job applicants varied from 2% to 35%.

We rated the evidence from all studies as very low quality.

We concluded that problem focused health examinations could be effective but there is a need for more high quality studies. Future studies should also take into account the costs of rejecting workers.