Scolaris Content Display Scolaris Content Display

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 2

'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.
Figuras y tablas -
Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 CBT versus no treatment, Outcome 1 Partial RTW, follow‐up one year.
Figuras y tablas -
Analysis 1.1

Comparison 1 CBT versus no treatment, Outcome 1 Partial RTW, follow‐up one year.

Comparison 1 CBT versus no treatment, Outcome 2 Full RTW, follow‐up one year.
Figuras y tablas -
Analysis 1.2

Comparison 1 CBT versus no treatment, Outcome 2 Full RTW, follow‐up one year.

Comparison 1 CBT versus no treatment, Outcome 3 DASS distress score, follow‐up one year.
Figuras y tablas -
Analysis 1.3

Comparison 1 CBT versus no treatment, Outcome 3 DASS distress score, follow‐up one year.

Comparison 2 CBT versus non‐guideline based care, Outcome 1 Full RTW, follow‐up one year.
Figuras y tablas -
Analysis 2.1

Comparison 2 CBT versus non‐guideline based care, Outcome 1 Full RTW, follow‐up one year.

Comparison 2 CBT versus non‐guideline based care, Outcome 2 DASS distress score, follow‐up three months.
Figuras y tablas -
Analysis 2.2

Comparison 2 CBT versus non‐guideline based care, Outcome 2 DASS distress score, follow‐up three months.

Comparison 2 CBT versus non‐guideline based care, Outcome 3 DASS distress score, follow‐up four to 12 months.
Figuras y tablas -
Analysis 2.3

Comparison 2 CBT versus non‐guideline based care, Outcome 3 DASS distress score, follow‐up four to 12 months.

Comparison 3 PST versus non‐guideline based care, Outcome 1 Partial RTW, follow‐up one year.
Figuras y tablas -
Analysis 3.1

Comparison 3 PST versus non‐guideline based care, Outcome 1 Partial RTW, follow‐up one year.

Comparison 3 PST versus non‐guideline based care, Outcome 2 Full RTW, follow‐up one year.
Figuras y tablas -
Analysis 3.2

Comparison 3 PST versus non‐guideline based care, Outcome 2 Full RTW, follow‐up one year.

Comparison 3 PST versus non‐guideline based care, Outcome 3 Full RTW, follow‐up one to two years.
Figuras y tablas -
Analysis 3.3

Comparison 3 PST versus non‐guideline based care, Outcome 3 Full RTW, follow‐up one to two years.

Comparison 3 PST versus non‐guideline based care, Outcome 4 4DSQ distress score, follow‐up three months.
Figuras y tablas -
Analysis 3.4

Comparison 3 PST versus non‐guideline based care, Outcome 4 4DSQ distress score, follow‐up three months.

Comparison 3 PST versus non‐guideline based care, Outcome 5 4DSQ distress score, follow‐up four to 12 months.
Figuras y tablas -
Analysis 3.5

Comparison 3 PST versus non‐guideline based care, Outcome 5 4DSQ distress score, follow‐up four to 12 months.

Comparison 3 PST versus non‐guideline based care, Outcome 6 4DSQ distress score, follow‐up one to two years.
Figuras y tablas -
Analysis 3.6

Comparison 3 PST versus non‐guideline based care, Outcome 6 4DSQ distress score, follow‐up one to two years.

Comparison 4 PST versus CBT, Outcome 1 Partial RTW, follow‐up one year.
Figuras y tablas -
Analysis 4.1

Comparison 4 PST versus CBT, Outcome 1 Partial RTW, follow‐up one year.

Comparison 4 PST versus CBT, Outcome 2 Full RTW , follow‐up one year.
Figuras y tablas -
Analysis 4.2

Comparison 4 PST versus CBT, Outcome 2 Full RTW , follow‐up one year.

Comparison 5 Participatory PST versus PST, Outcome 1 Full RTW, follow‐up one year.
Figuras y tablas -
Analysis 5.1

Comparison 5 Participatory PST versus PST, Outcome 1 Full RTW, follow‐up one year.

Comparison 5 Participatory PST versus PST, Outcome 2 4DSQ distress score, follow‐up three months.
Figuras y tablas -
Analysis 5.2

Comparison 5 Participatory PST versus PST, Outcome 2 4DSQ distress score, follow‐up three months.

Comparison 5 Participatory PST versus PST, Outcome 3 4DSQ distress score, follow‐up four to 12 months.
Figuras y tablas -
Analysis 5.3

Comparison 5 Participatory PST versus PST, Outcome 3 4DSQ distress score, follow‐up four to 12 months.

Comparison 6 CBT and physical relaxation versus physical relaxation, Outcome 1 Rate of partial RTW, follow‐up one year.
Figuras y tablas -
Analysis 6.1

Comparison 6 CBT and physical relaxation versus physical relaxation, Outcome 1 Rate of partial RTW, follow‐up one year.

Comparison 6 CBT and physical relaxation versus physical relaxation, Outcome 2 Rate of partial RTW, follow‐up one to two years.
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Analysis 6.2

Comparison 6 CBT and physical relaxation versus physical relaxation, Outcome 2 Rate of partial RTW, follow‐up one to two years.

Comparison 6 CBT and physical relaxation versus physical relaxation, Outcome 3 Rate of full RTW, follow‐up one year.
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Analysis 6.3

Comparison 6 CBT and physical relaxation versus physical relaxation, Outcome 3 Rate of full RTW, follow‐up one year.

Comparison 6 CBT and physical relaxation versus physical relaxation, Outcome 4 Rate of full RTW, follow‐up one to two years.
Figuras y tablas -
Analysis 6.4

Comparison 6 CBT and physical relaxation versus physical relaxation, Outcome 4 Rate of full RTW, follow‐up one to two years.

Comparison 6 CBT and physical relaxation versus physical relaxation, Outcome 5 SMBQ score, follow‐up one year.
Figuras y tablas -
Analysis 6.5

Comparison 6 CBT and physical relaxation versus physical relaxation, Outcome 5 SMBQ score, follow‐up one year.

Comparison 6 CBT and physical relaxation versus physical relaxation, Outcome 6 SMBQ score, follow‐up one to two years.
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Analysis 6.6

Comparison 6 CBT and physical relaxation versus physical relaxation, Outcome 6 SMBQ score, follow‐up one to two years.

Comparison 7 Individual CBT versus group CBT, Outcome 1 Full RTW, follow‐up one year.
Figuras y tablas -
Analysis 7.1

Comparison 7 Individual CBT versus group CBT, Outcome 1 Full RTW, follow‐up one year.

Comparison 7 Individual CBT versus group CBT, Outcome 2 DASS distress score, follow‐up three months.
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Analysis 7.2

Comparison 7 Individual CBT versus group CBT, Outcome 2 DASS distress score, follow‐up three months.

Comparison 7 Individual CBT versus group CBT, Outcome 3 DASS distress score, follow‐up four to 12 months.
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Analysis 7.3

Comparison 7 Individual CBT versus group CBT, Outcome 3 DASS distress score, follow‐up four to 12 months.

Comparison 8 CBT versus no treatment, full adjustment disorder diagnosis, Outcome 1 Partial RTW, follow‐up one year.
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Analysis 8.1

Comparison 8 CBT versus no treatment, full adjustment disorder diagnosis, Outcome 1 Partial RTW, follow‐up one year.

Comparison 9 PST versus non‐guideline based care full adjustment disorder diagnosis, Outcome 1 Full RTW, follow‐up one year.
Figuras y tablas -
Analysis 9.1

Comparison 9 PST versus non‐guideline based care full adjustment disorder diagnosis, Outcome 1 Full RTW, follow‐up one year.

Comparison 9 PST versus non‐guideline based care full adjustment disorder diagnosis, Outcome 2 4DSQ distress score, follow‐up three months.
Figuras y tablas -
Analysis 9.2

Comparison 9 PST versus non‐guideline based care full adjustment disorder diagnosis, Outcome 2 4DSQ distress score, follow‐up three months.

Comparison 9 PST versus non‐guideline based care full adjustment disorder diagnosis, Outcome 3 4DSQ distress score, follow‐up four to 12 months.
Figuras y tablas -
Analysis 9.3

Comparison 9 PST versus non‐guideline based care full adjustment disorder diagnosis, Outcome 3 4DSQ distress score, follow‐up four to 12 months.

Summary of findings for the main comparison. CBT compared to no treatment for adjustment disorders

CBT compared to no treatment for adjustment disorders

Patient or population: patients with adjustment disorders
Settings: occupational health care
Intervention: CBT
Comparison: no treatment

Outcomes3

Illustrative comparative risks* (95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

No treatment

CBT

Partial return to work

Follow‐up: mean 1 year

The mean time to partial return to work in the control groups was
88 days

The mean time to partial return to work in the intervention groups was
8.78 days less
(95% CI is ‐23.26 lower to 5.71 higher)

201
(2 studies; 1 study with 2 treatment arms)

⊕⊕⊕⊝
moderate1

Full return to work
Scale from: ‐180 to +180 days
Follow‐up: 1 year (mean)

The mean time to full return to work in the control groups was
252 days

The mean time to full return to work in the intervention groups was
35.73 days less
(95% CI is 113.15 lower to 41.69 higher)

105
(1 study; 2 treatment arms)

⊕⊕⊝⊝
low1,2

Distress score
DASS distress scale from: 0 to 42 points (worse)
Follow‐up: 1 year (mean)

The mean distress score in the control groups was
14.1 points

The mean distress score in the intervention groups was
0.06 points higher
(95% CI is 3.91 lower to 4.02 higher)

89
(1 study; 2 treatment arms)

⊕⊕⊕⊝
moderate1

*The basis for the assumed risk when there was more than one study was the mean partial RTW in the control group across studies. The corresponding risk (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).
CI: confidence interval

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Fewer than 400 participants.

2Heterogeneity I² = 58% (moderate heterogeneity).

3CBT = cognitive behavioural therapy, DASS = Distress, Anxiety and Stress Scales.

Figuras y tablas -
Summary of findings for the main comparison. CBT compared to no treatment for adjustment disorders
Table 1. Study characteristics

Study

Number

Follow‐up 

Diagnosis

Treatment type

CBT or PST

Treatment provider

Treatment frequency

Comparison type

Work outcome

Bakker 2007; the Netherlands

227 versus 206

12 months

Stress‐related mental disorders measured by means of self reported levels of distress with a validated questionnaire

Individual sessions on: information on the importance of the patient's active role with regard to successful RTW; advice on the content of functional rehabilitation; monitoring of the patient's efforts to translate the (work) situation into a problem that could be solved; referral to specialised care in case of no progressions

PST: translate the (work) situation into a problem that could be solved

Work: information on successful RTW; the work situation is translated into a problem that could be solved

24 primary care physicians trained in the intervention (2 session of 3.5 hours and 2 follow‐up sessions of 2 hours)

3 consultations within 3 months

Care as usual by primary care physician

Duration of sick leave in calendar days from the first day of sick leave until full RTW, lasting for a period of at least 4 weeks without partial or full relapse into sick leave (self report)

Blonk 2006; the Netherlands

40 versus 21

12 months

Adjustment disorders diagnosed with the CIDI

Individual sessions on cognitive restructuring; registration of symptoms and situations; sessions on time‐management, work resumption, workplace interventions, conflict handling and fatigue; assignments related to the work situation

CBT: sessions on cognitive restructuring

Work: sessions on work resumption and workplace interventions

Psychologists who followed a highly structured protocol

11 sessions of 45 minutes (2 sessions a week)

No treatment

The length of time until partial RTW and the length of time until full RTW (register‐based)

Blonk work 2006; the Netherlands

40 versus 21

12 months

Adjustment disorders diagnosed with the CIDI

Individual sessions on: psycho education on work stress; registration of symptoms and situations; relaxation; self help books on rational emotive behaviour therapy; time‐management; writing assignments; advice on work processes (setting priorities, planning, conflict management, reducing work demands, delegating tasks, organisation of work); stimulating work resumption

CBT: self help books on rational emotive behaviour therapy

Work: advice on work processes; stimulating work resumption

6 labour experts trained in brief CBT‐based stress management

5 to 6 1‐hour sessions (2 sessions a week)

No treatment

The length of time until partial RTW and the length of time until full RTW (register‐based)

Brouwers 2006; the Netherlands

98 versus 96

18 months

Emotional distress or minor mental disorders according to GPs and self report

Individual sessions on: acknowledging the problem and accepting responsibility for its resolution; developing and implementing
problem solving strategies, with a special focus on solving work‐related problems and promoting early work resumption; making a daily activity schedule

PST: developing and implementing problem solving strategies

Work: focus on work‐related problems and promoting early work resumption

11 social workers trained in the intervention (3‐day training course with 2 follow‐up sessions)

5 individual 50‐minute sessions over 10 weeks

Care as usual by the GP

Sick leave duration
(in days), defined as the period between the first
day of absenteeism and the first day of partial and full work resumption (self report)

de Vente group 2008; the Netherlands

28 versus 13

10 months

Symptoms of neurasthenia based on a screening interview

Group sessions and homework assignments on: psycho education; self assessment of stressors and complaints; life style; relaxation techniques; cognitive restructuring; time‐management; goal setting; assertiveness skills; evaluation and relapse prevention

CBT: cognitive restructuring

12 clinical psychologists trained in the intervention (4 x 1‐hour sessions)

12 x 1‐hour sessions

Care as usual by the occupational physician and GP

Number of days absent

and number of weeks until complete work resumption (self report)

de Vente individual 2008; the Netherlands

28 versus 13

10 months

Symptoms of neurasthenia based on a screening interview

Individual sessions and homework assignments on: psycho education; self assessment of stressors and complaints; life style; relaxation techniques; cognitive restructuring; time‐management; goal setting; assertiveness skills; evaluation and relapse prevention

CBT: cognitive restructuring

12 clinical psychologists trained in the intervention (4 x 1‐hour sessions)

12 x 2‐hour sessions

Care as usual by the occupational physician and GP

Number of days absent

and number of weeks until complete work resumption (self report)

Rebergen 2009; the Netherlands

125 versus 115

12 months

Symptoms of adjustment disorders based on the DASS (based on unpublished data from author)

Individuals sessions on: information about the origin and cause of loss of control; structuring daily activities developing and implementing problem solving skills and strategies for the causes of stress; gradual RTW

PST: developing and implementing problem solving skills

Work: gradual RTW

5 OPs trained in the intervention (3‐day training course)

Mean number of consultations with OP was 3.4

Minimal involvement of the

OP (same OPs as intervention group) and access to treatment by a psychologist

Duration of sick leave due to mental health problems in calendar days from the moment of inclusion to first (partial or full) and full RTW, respectively, in own or equal earnings; duration of sick leave days until full RTW added with number of days of recurrences on sick leave in the 1‐year follow‐up

Stenlund 2009; Sweden

67 versus 69

2 years

Burnout based on psychological examinations at the Stress Clinic

Group session on: education on stress reactions, medication and rest; awareness of reactions and self talk; development of cognitive/behavioural/emotional skills; spiritual issues and life values; preparation for RTW; physical relaxation and mindfulness meditation

CBT: awareness of reactions and self talk

Work: preparation for RTW

1 group leader trained in CBR; 1 physiotherapist

CBR: 30 x 3‐hour sessions over 1 year with short follow‐up meetings 3, 6 and 12 months after the treatment year; Qigong: a 1‐hour session every week during 1 year

Physical relaxation and mindfulness meditation

Sick leave rate: 100, 75, 50, 25 or 0% (register‐based)

van der Klink 2003; the Netherlands

109 versus 83

12 months

Adjustment disorders diagnosed with a checklist based on the DSM‐IV criteria for adjustment disorder

Individual sessions on: information on the origin and cause of loss of control; structuring daily activities; development and implementation of problem solving strategies for the causes of stress; gradual RTW

PST: development and implementation of problem solving strategies

Work: gradual RTW

17 occupational physicians trained in the intervention (3‐day training course)

4 to 5 sessions (with a total length over all sessions of at least 90 minutes) in the first 6 weeks of sickness leave and 1 session after work resumption

Care as usual by occupational physicians

Time (days) to partial and full RTW; duration (days) of sick leave; partial and full RTW rate at 3 and 12 months follow‐up; incidence of recurrent sick leave in the year following full RTW; time to first recurrent sick leave in the year following full RTW (register‐based)

van Oostrom 2010; the Netherlands

73 versus 72

12 months

Distress based on a validated screening questionnaire

Consultations with the worker and supervisor to (1) identify obstacles and solutions for RTW, (2) formulate a plan for implementation of the solutions and (3) to evaluate the actual implementation of solutions

PST: identifying obstacles (problems) for RTW and finding/implementing solutions

Work: problems related to RTW

9 RTW co‐ordinators (company social worker or a labour expert) trained in the intervention

3 sessions at 1 day and a follow‐up meeting after 1 month

 

Care as usual by occupational physicians

Days until full and lasting RTW; total number of days of sick leave in the 12‐month follow‐up (register‐based)

Willert 2011; Denmark

51 versus 51

48 weeks

Persistent symptoms of work‐related stress based on a semi‐structured assessment interview

Group sessions and homework on: introduction to CBT; psycho education on stress; identifying dysfunctional thinking; modifying dysfunctional thinking; communication and stress; communication skills training; implementing strategies at work (e.g. cope with stressful situations at work); review of techniques

CBT: identifying and modifying dysfunctional thinking

Work: implementing strategies at work (e.g. cope with stressful situations at work)

2 licensed clinical psychologists, with > 5 years of clinical experience and a 1‐year advanced training course in CBT

8 x 3‐hour sessions over a period of 3 months

Waiting list control group; after 3 months on the waiting list, the participants also received the intervention

Sick leave days 3‐month in retrospect (self report); weeks registered with part‐ or full‐time sick leave (register‐based)

CBR: Cognitively oriented Behavioural Rehabilitation
CBT: cognitive behavioural therapy
CIDI: Composite International Diagnostic Interview
DASS: Depression, Anxiety and Stress Scales
GP: general practitioner
OP: occupational physician
PST: problem solving therapy
RTW: return to work

Figuras y tablas -
Table 1. Study characteristics
Table 2. Quality of the evidence (GRADE)

Comparison/outcome

Studies in comparison

Risk of bias in studies

Inconsistency

Indirectness

Imprecision

Publication bias

Overall quality of evidence

CBT versus no treatment/partial RTW follow‐up 1 year

Blonk psychologist 2006; Willert 2011

No: the majority of studies have low risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Moderate quality

CBT versus no treatment/full RTW follow‐up 1 year

Blonk psychologist 2006

No: the study has low risk of bias

Inconsistent:

I2 > 50%

Direct

Imprecise: < 400 participants

Undetected

Low quality

CBT versus no treatment/distress follow‐up 1 year

Blonk psychologist 2006

No: the study has low risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Moderate quality

CBT versus non‐guideline based care/full RTW follow‐up 1 year

de Vente individual 2008

Yes: the study has high risk of attrition bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Low quality

CBT versus non‐guideline based care/distress follow‐up 3 months

de Vente individual 2008

Yes: the study has high risk of attrition bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Low quality

CBT versus non‐guideline based care/distress follow‐up 1 year

de Vente individual 2008

Yes: the study has high risk of attrition bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Moderate quality

PST versus non‐guideline based care/partial RTW follow‐up 1 year

van der Klink 2003

No: the study has low risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Moderate quality

PST versus non‐guideline based care/full RTW follow‐up 1 year

Bakker 2007; van der Klink 2003

No: the studies have low risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Moderate quality

PST versus non‐guideline based care/full RTW follow‐up 1 to 2 years

Brouwers 2006

Serious limitation: the study has high risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Low quality

PST versus non‐guideline based care/distress follow‐up 3 months

Bakker 2007; Brouwers 2006; van der Klink 2003

No: the majority of studies have low risk of bias

Consistent:

I2 < 50%

Direct

Precise: > 400 participants

Undetected

High quality

PST versus non‐guideline based care/distress follow‐up 3 to 12 months

Bakker 2007; Brouwers 2006; van der Klink 2003

No: the majority of studies have low risk of bias

Consistent:

I2 < 50%

Direct

Precise: > 400 participants

Undetected

High quality

PST versus non‐guideline based care/distress follow‐up 1 to 2 years

Brouwers 2006

Serious limitation: the study has high risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Low quality

PST work versus CBT work/partial RTW follow‐up 1 year

Rebergen 2009

No: the study has low risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Moderate quality

PST work versus CBT work/full RTW follow‐up 1 year

Rebergen 2009

No: the study has low risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Moderate quality

Participatory PST work versus PST work/full RTW follow‐up 1 year

van Oostrom 2010

No: the study has low risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Moderate quality

Participatory PST work versus PST work/distress follow‐up 3 months

van Oostrom 2010

No: the study has low risk of bias

No:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Moderate quality

Participatory PST work versus PST work/distress follow‐up 3 to 12 months

van Oostrom 2010

No: the study has low risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Moderate quality

CBT and physical relaxation versus Physical relaxation/rate of partial RTW follow‐up 1 year

Stenlund 2009

Serious limitation: the study has high risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Low quality

CBT and physical relaxation versus physical relaxation/rate of partial RTW follow‐up 1 to 2 years

Stenlund 2009

Serious limitation: the study has high risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Low quality

CBT and physical relaxation versus physical relaxation/rate of full RTW follow‐up 1 year

Stenlund 2009

Serious limitation: the study has high risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Low quality

CBT and physical relaxation versus physical relaxation/rate of full RTW follow‐up 1 to 2 years

Stenlund 2009

Serious limitation: the study has high risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Low quality

CBT and physical relaxation versus physical relaxation/SMBQ score follow‐up 1 year

Stenlund 2009

Serious limitation: the study has high risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Low quality

CBT and physical relaxation versus physical relaxation/SMBQ score follow‐up 1 to 2 years

Stenlund 2009

Serious limitation: the study has high risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Low quality

Individual CBT versus group CBT/full RTW follow‐up 1 year

de Vente individual 2008

Yes: the study has high risk of attrition bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Low quality

Individual CBT versus group CBT/distress follow‐up 3 months

de Vente individual 2008

Yes: the study has high risk of attrition bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Low quality

Individual CBT versus group CBT/distress follow‐up 3 to 12 months

de Vente group 2008

Yes: the study has high risk of attrition bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Low quality

CBT versus no treatment full AD/partial RTW follow‐up 1 year

Blonk psychologist 2006

No: the study has low risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Moderate quality

PST versus Non‐guideline based care full AD/full RTW follow‐up 1 year

van der Klink 2003

No: the study has low risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Moderate quality

PST versus non‐guideline based care full AD/distress follow‐up 3 months

van der Klink 2003

No: the study has low risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Moderate quality

PST versus non‐guideline based care full AD/distress follow‐up 4 to 12 months

van der Klink 2003

No: the study has low risk of bias

Consistent:

I2 < 50%

Direct

Imprecise: < 400 participants

Undetected

Moderate quality

AD: adjustment disorder
CBT: cognitive behavioural therapy
PST: problem solving therapy
RTW: return to work
SMBQ: Shirom–Melamed Burnout Questionnaire

Figuras y tablas -
Table 2. Quality of the evidence (GRADE)
Comparison 1. CBT versus no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Partial RTW, follow‐up one year Show forest plot

3

159

Mean Difference (IV, Random, 95% CI)

‐8.78 [‐23.26, 5.71]

2 Full RTW, follow‐up one year Show forest plot

2

105

Mean Difference (IV, Random, 95% CI)

‐35.73 [‐113.15, 41.69]

3 DASS distress score, follow‐up one year Show forest plot

2

89

Mean Difference (IV, Random, 95% CI)

0.06 [‐3.91, 4.02]

Figuras y tablas -
Comparison 1. CBT versus no treatment
Comparison 2. CBT versus non‐guideline based care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Full RTW, follow‐up one year Show forest plot

2

78

Mean Difference (IV, Random, 95% CI)

19.81 [‐26.17, 65.79]

2 DASS distress score, follow‐up three months Show forest plot

2

75

Mean Difference (IV, Random, 95% CI)

0.66 [‐2.78, 4.11]

3 DASS distress score, follow‐up four to 12 months Show forest plot

2

54

Mean Difference (IV, Random, 95% CI)

‐0.67 [‐6.06, 4.73]

Figuras y tablas -
Comparison 2. CBT versus non‐guideline based care
Comparison 3. PST versus non‐guideline based care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Partial RTW, follow‐up one year Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Full RTW, follow‐up one year Show forest plot

2

342

Mean Difference (IV, Random, 95% CI)

‐17.73 [‐37.35, 1.90]

3 Full RTW, follow‐up one to two years Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4 4DSQ distress score, follow‐up three months Show forest plot

3

559

Mean Difference (IV, Random, 95% CI)

‐1.69 [‐3.11, ‐0.27]

5 4DSQ distress score, follow‐up four to 12 months Show forest plot

3

540

Mean Difference (IV, Random, 95% CI)

‐0.36 [‐1.76, 1.04]

6 4DSQ distress score, follow‐up one to two years Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 3. PST versus non‐guideline based care
Comparison 4. PST versus CBT

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Partial RTW, follow‐up one year Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Full RTW , follow‐up one year Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 4. PST versus CBT
Comparison 5. Participatory PST versus PST

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Full RTW, follow‐up one year Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 4DSQ distress score, follow‐up three months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 4DSQ distress score, follow‐up four to 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 5. Participatory PST versus PST
Comparison 6. CBT and physical relaxation versus physical relaxation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Rate of partial RTW, follow‐up one year Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2 Rate of partial RTW, follow‐up one to two years Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3 Rate of full RTW, follow‐up one year Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4 Rate of full RTW, follow‐up one to two years Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5 SMBQ score, follow‐up one year Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

6 SMBQ score, follow‐up one to two years Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

Figuras y tablas -
Comparison 6. CBT and physical relaxation versus physical relaxation
Comparison 7. Individual CBT versus group CBT

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Full RTW, follow‐up one year Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 DASS distress score, follow‐up three months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 DASS distress score, follow‐up four to 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 7. Individual CBT versus group CBT
Comparison 8. CBT versus no treatment, full adjustment disorder diagnosis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Partial RTW, follow‐up one year Show forest plot

2

99

Mean Difference (IV, Random, 95% CI)

‐24.92 [‐80.58, 30.74]

Figuras y tablas -
Comparison 8. CBT versus no treatment, full adjustment disorder diagnosis
Comparison 9. PST versus non‐guideline based care full adjustment disorder diagnosis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Full RTW, follow‐up one year Show forest plot

1

33

Mean Difference (IV, Fixed, 95% CI)

‐24.0 [‐47.58, ‐0.42]

2 4DSQ distress score, follow‐up three months Show forest plot

1

139

Mean Difference (IV, Fixed, 95% CI)

‐1.90 [‐4.69, 0.89]

3 4DSQ distress score, follow‐up four to 12 months Show forest plot

1

110

Mean Difference (IV, Fixed, 95% CI)

‐1.06 [‐3.86, 1.74]

Figuras y tablas -
Comparison 9. PST versus non‐guideline based care full adjustment disorder diagnosis