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Cochrane Database of Systematic Reviews

Intervenciones para mejorar el retorno al trabajo de los pacientes con cáncer

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Información

DOI:
https://doi.org/10.1002/14651858.CD007569.pub3Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 25 septiembre 2015see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Salud laboral

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Angela GEM de Boer

    Correspondencia a: Coronel Institute of Occupational Health, Academic Medical Centre, Amsterdam, Netherlands

    [email protected]

  • Tyna K Taskila

    Centre for Workforce Effectiveness, The Work Foundation, London, UK

  • Sietske J Tamminga

    Coronel Institute of Occupational Health, Academic Medical Centre, Amsterdam, Netherlands

  • Michael Feuerstein

    Departments of Medical and Clinical Psychology and Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, USA

  • Monique HW Frings‐Dresen

    Coronel Institute of Occupational Health and Research Center for Insurance Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands

  • Jos H Verbeek

    Cochrane Work Review Group, Finnish Institute of Occupational Health, Kuopio, Finland

Contributions of authors

AdB is the main review author and has been involved with all aspects of the protocol. She wrote the protocol and the review. She designed and conducted the search strategy. TT, ST, MF‐D, MF and JV contributed to the draft version of the protocol and review and will contribute to subsequent versions and revisions of the review. AdB and TT screened eligible studies, conducted the quality assessment of eligible studies and extracted data from the included studies. JV and AdB conducted the data synthesis. JV performed GRADE data synthesis.

Sources of support

Internal sources

  • Coronel Institute of Occupational Health, Netherlands.

  • Cochrane Occupational Safety and Health Review Group, Finland.

  • University of Birmingham, UK.

  • Uniformed Services University of the Health Sciences, USA.

  • Centre for Workforce Effectiveness, The Work Foundation, London, UK.

External sources

  • SIG Pathways to Work. University Research Programme, Netherlands.

  • Finnish Work Environment Fund, Finland.

  • COST Action CANWON IS1211, Not specified.

Declarations of interest

Angela de Boer: I am an author of Tamminga 2013.

Tyna Taskila: None known.

Sietske Tamminga: I am an author of Tamminga 2013.

Michael Feuerstein: I have received consultancy fees from Paradigm Health Corp and travel support and royalties from Springer but these are not related to the topic of this Cochrane review. Neither the grant I currently have nor the retirement investments I have (managed by TIAA‐CREF) are also not related to the topic of this Cochrane review.

Monique Frings‐Dresen: I am an author of Tamminga 2013.

Jos Verbeek: I am an author of Tamminga 2013 and I am employed by the Finnish Institute of Occupational Health to coordinate the Cochrane Work Review Group.

Acknowledgements

We thank Emma Sydenham and the Cochrane Injuries Group peer referees for their valuable comments. We also thank the Cochrane Work Group Trials Search Coordinator Leena Isotalo and Consumer Editor Wim van Veelen for their feedback on the systematic searches and the trade unions' point of views respectively. We are grateful to Charlotte Archibald from Wiley Blackwell and Jani Ruotsalainen from Cochrane Work for their copy edit support. We thank Christina Mischke from Cochrane Work for her help on recalculating all ORs into RRs.

Version history

Published

Title

Stage

Authors

Version

2024 Mar 05

Non‐medical interventions to enhance return to work for people with cancer

Review

Angela GEM Boer, Sietske J Tamminga, Julitta S Boschman, Jan L Hoving

https://doi.org/10.1002/14651858.CD007569.pub4

2015 Sep 25

Interventions to enhance return‐to‐work for cancer patients

Review

Angela GEM de Boer, Tyna K Taskila, Sietske J Tamminga, Michael Feuerstein, Monique HW Frings‐Dresen, Jos H Verbeek

https://doi.org/10.1002/14651858.CD007569.pub3

2011 Feb 16

Interventions to enhance return‐to‐work for cancer patients

Review

Angela GEM de Boer, Taina K Taskila, Sietske J Tamminga, Monique HW Frings‐Dresen, Michael Feuerstein, Jos H Verbeek

https://doi.org/10.1002/14651858.CD007569.pub2

2009 Jan 21

Interventions to enhance return‐to‐work for cancer patients

Protocol

Angela GM de Boer, Taina Taskila, Sietske J Tamminga, Monique HW Frings‐Dresen, Michael Feuerstein, Jos H Verbeek

https://doi.org/10.1002/14651858.CD007569

Differences between protocol and review

For this 2015 Cochrane review update we excluded non‐randomised studies because it was clear that randomised studies are feasible and have been conducted. This proved that our earlier understanding was mistaken in that it would be difficult to randomise in this context. This had been the main reason for including non‐randomised studies.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

PRISMA flow diagram of reference selection and study inclusion.
Figuras y tablas -
Figure 1

PRISMA flow diagram of reference selection and study inclusion.

'Risk of bias' graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies.
Figuras y tablas -
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.

Funnel plot of comparison: 4 Medical function conserving versus Medical more radical‐RCTs, outcome: 4.1 RTW.
Figuras y tablas -
Figure 4

Funnel plot of comparison: 4 Medical function conserving versus Medical more radical‐RCTs, outcome: 4.1 RTW.

Comparison 1 Psycho‐educational versus Care as usual, Outcome 1 RTW.
Figuras y tablas -
Analysis 1.1

Comparison 1 Psycho‐educational versus Care as usual, Outcome 1 RTW.

Comparison 1 Psycho‐educational versus Care as usual, Outcome 2 QoL.
Figuras y tablas -
Analysis 1.2

Comparison 1 Psycho‐educational versus Care as usual, Outcome 2 QoL.

Comparison 2 Physical versus Care as usual, Outcome 1 RTW.
Figuras y tablas -
Analysis 2.1

Comparison 2 Physical versus Care as usual, Outcome 1 RTW.

Comparison 2 Physical versus Care as usual, Outcome 2 QoL.
Figuras y tablas -
Analysis 2.2

Comparison 2 Physical versus Care as usual, Outcome 2 QoL.

Comparison 3 Medical function conserving versus Medical more radical, Outcome 1 RTW.
Figuras y tablas -
Analysis 3.1

Comparison 3 Medical function conserving versus Medical more radical, Outcome 1 RTW.

Comparison 3 Medical function conserving versus Medical more radical, Outcome 2 QoL.
Figuras y tablas -
Analysis 3.2

Comparison 3 Medical function conserving versus Medical more radical, Outcome 2 QoL.

Comparison 4 Multidisciplinary physical, psycho‐educational and/or vocational interventions versus Care as usual, Outcome 1 RTW.
Figuras y tablas -
Analysis 4.1

Comparison 4 Multidisciplinary physical, psycho‐educational and/or vocational interventions versus Care as usual, Outcome 1 RTW.

Comparison 4 Multidisciplinary physical, psycho‐educational and/or vocational interventions versus Care as usual, Outcome 2 QoL.
Figuras y tablas -
Analysis 4.2

Comparison 4 Multidisciplinary physical, psycho‐educational and/or vocational interventions versus Care as usual, Outcome 2 QoL.

Summary of findings for the main comparison. Multidisciplinary physical, psycho‐educational and/or vocational interventions versus Care as usual for cancer

Multidisciplinary physical, psycho‐educational and/or vocational interventions versus Care as usual for cancer

Patient or population: Patients with cancer
Settings: Hospital
Intervention: Multidisciplinary physical, psycho‐educational and/or vocational interventions versus Care as usual

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Control

Multidisciplinary physical, psycho‐educationaland/or vocational interventions versus Care as usual

RTW
Follow‐up: median 12 months

786 per 10001

872 per 1000
(810 to 912)

RR 1.11
(1.03 to 1.16)

450
(5 studies)

⊕⊕⊕⊝
moderate2

QoL
Follow‐up: mean 12 months

The mean QoL in the intervention groups was
0.03 standard deviations higher
(0.20 lower to 0.25 higher)

316
(2 studies)

⊕⊕⊝⊝
low3,4

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio;RTW: return‐to‐work; QoL: quality of life.

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.

1Median RTW rate in control groups.
2Three out of five trials with high risk of bias, downgraded one level.
3Wide CIs, downgraded one level.
4One study with high and one with low risk of bias, downgraded one level.

Figuras y tablas -
Summary of findings for the main comparison. Multidisciplinary physical, psycho‐educational and/or vocational interventions versus Care as usual for cancer
Summary of findings 2. Psycho‐educational care versus Care as usual for return to work in cancer patients

Psycho‐educational care versus Care as usual for return to work in cancer patients

Patient or population: Patients with cancer
Settings: Hospital
Intervention: Psycho‐educational care
Comparison: Care as usual

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Care as usual

Psycho‐educationalcare

Return to work (RTW)
Follow‐up: 1.5 to 12 months

491 per 10001

535 per 1000
(432 to 663)

RR 1.09
(0.88 to 1.35)

260
(2 studies)

⊕⊕⊝⊝
low2,3

Quality of life (QoL)
Various scales
Follow‐up: 1.5 to 12 months

The mean QoL in the intervention groups was
0.05 standard deviations higher
(0.2 lower to 0.3 higher)

260
(2 studies)

⊕⊕⊝⊝
low2,4

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio; RTW: return‐to‐work; QoL: quality of life.

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.

1Average of control groups' RTW rates.
2One study with high and one with low risk of bias, downgraded one level.
3Wide CIs overlapping with 1, downgraded one level.
4Wide CI including 0 and small effect size, downgraded one level.

Figuras y tablas -
Summary of findings 2. Psycho‐educational care versus Care as usual for return to work in cancer patients
Summary of findings 3. Physical exercise versus Care as usual for RTW in cancer

Physical exercise versus Care as usual for return to work in cancer

Patient or population: Patients with cancer
Settings: Community
Intervention: Physical exercise
Comparison: Care as usual

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Care as usual

Physical exercise

RTW

357 per 10001

429 per 1000
(114 to 1000)

RR 1.2
(0.32 to 4.54)

28
(1 study)

⊕⊕⊝⊝

low2

QoL
Various scales
Follow‐up: 12 months

The mean QoL in the intervention groups was
0.37 standard deviations lower
(0.99 lower to 0.25 higher)

41
(1 study)

⊕⊕⊝⊝
low2

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio; RTW: return‐to‐work; QoL: quality of life.

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.

1RTW rate in the control group.
2Wide CIs, only one included study, downgraded with two levels.

Figuras y tablas -
Summary of findings 3. Physical exercise versus Care as usual for RTW in cancer
Summary of findings 4. Medical function conserving treatment versus Medical more radical treatment for cancer

Medical function conserving treatment versus Medical more radical treatment for cancer

Patient or population: Patients with cancer
Settings: Hospital
Intervention: Medical function conserving treatment
Comparison: Medical more radical treatment

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Medical more radical treatment

Medical function conserving treatment

RTW
Follow‐up: median 18 months

850 per 10001

884 per 1000
(816 to 926)

RR 1.04
(0.96 to 1.09)

1097
(7 studies)

⊕⊕⊝⊝
low2,3

QoL
Various instruments
Follow‐up: mean 9 months

The mean QoL in the intervention groups was
0.10 standard deviations higher
(0.04 lower to 0.23 higher)

1028
(2 studies)

⊕⊕⊕⊝
moderate3

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio; RTW: return‐to‐work; QoL: quality of life.

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.

1 Median RTW rate in control groups of this comparison.
2 I² statistic = 51%, downgraded one level.
3 CIs overlap with one, downgraded one level.

Figuras y tablas -
Summary of findings 4. Medical function conserving treatment versus Medical more radical treatment for cancer
Table 1. Characteristics of included studies

Study

Country

Diagnosis

Design

Number

Intervention(s)

Control

Type

Ackerstaff 2009

Netherlands

Head, neck

RCT

34 versus 28

Intra‐arterial chemoradiation

Intravenous chemoradiation

Medical

Berglund 1994

Sweden

Breast

RCT

81 versus 73

Physical training, patient education and training of coping skills re RTW  

Care as usual

Multidisciplinary

Burgio 2006

USA

Prostate

RCT

28 versus 29

Biofeedback behavioral training

Care as usual

Multidisciplinary

Emmanouilidis 2009

Germany

Thyroid

RCT

7 versus 6

L‐thyroxine  after surgery

Later provision of L‐thyroxine

Medical

Friedrichs 2010

Germany

Leukemia

RCT

163 versus 166

Peripheral blood progenitor cell transplantation

Bone marrow transplantation

Medical

Hillman 1998

USA

Laryngeal

RCT

80 versus 63

Chemotherapy

Laryngectomy

Medical

Hubbard 2013

UK

Breast

RCT

7 versus 11

Physical, occupational, psycho‐educational support services, multi‐disciplinary

Booklet work and cancer

Multidisciplinary

Johnsson 2007

Sweden

Breast

RCT

53 versus 17

55 versus 17

64 versus 17

  1. Tamoxifen

  2. Goserelin

  3. Tamoxifen+Goserelin

No endocrine therapy

Medical

Kornblith 2009

USA

Endometrial

RCT

164 versus 73

Laparoscopy

Laparotomy

Medical

Lee 1992

UK

Breast

RCT

44 versus 47

Breast conservation

Mastectomy

Medical

Lepore 2003

USA

Prostate

RCT

41 versus 20

43 versus 20

  1. Patient education

  2. Patient education + group discussion

Care as usual

Psycho‐educational

Maguire 1983

UK

Breast

RCT

42 versus 46

Physical training, individual counselling and encouragement of RTW.

Care as usual

Multidisciplinary

Purcell 2011

Australia

Radiotherapy patients

RCT

43 versus 48

21 versus 24

  1. Post‐radio fatigue education

  2. Pre‐ and post‐radio fatigue education

Flyer with generic information about fatigue.

Psycho‐educational

Rogers 2009

USA

Breast

RCT

14 versus 14

Physical activity training

Care as usual

Physical

Tamminga 2013

Netherlands

Breast

RCT

65 versus 68

Vocational support, counselling, education, multi‐disciplinary, RTW advice.

Care as usual

Multidisciplinary

Figuras y tablas -
Table 1. Characteristics of included studies
Table 2. Quality of the evidence (GRADE)

Comparison/outcome

Number of studies

Study limitations

Inconsistency

Indirectness

Imprecision

Publication bias

Overall quality of evidence

Psycho‐educational versus Care as usual/

RTW

2 RCTs

Yes: 1 high 1 low risk

1 level down

No inconsistency

No

Wide CI

1 level down

Only two studies

Low

Physical versus Care as usual/

RTW

1 RCT

No: Low risk

No

No

Wide CI

2 levels down

Only one study

Low

Medical function conserving versus Medical more radical/

RTW

7 RCTs

No: 2/7 high risk studies contribute 25%

High: I² statistic = 51%

No

Wide CI

1 level down

Not observed

Low

Multidisciplinary physical, psycho‐educational and/or vocational interventions versus Care as usual/

RTW

5 RCTs

Yes: 3/5 high risk

1 level down

No: I² statistic = 0%

No

Narrow CIs

Not observed

Moderate

Psycho‐educational versus Care as usual/QoL

2 RCTs

Yes: 1 high, 1 low risk

1 level down

No: I² statistic = 0%

No

Wide CI

1 level down

Only two studies

Low

Physical versus Care as usual/

QoL

1 RCT

No: Low risk

Not applicable

No

Wide CI

1 level down

Only one study

Low

Medical function conserving versus Medical more radical/QoL

2 RCTs

No: Low risk studies

No: I² statistic = 0%

No

Wide CI

1 level down

Only two studies

Moderate

Multidisciplinary physical, psycho‐educational and/or vocational interventions versus Care as usual/QoL

2 RCTs

Yes: 1 low, 1 high risk studies

1 level down

No: I² statistic = 17%

No

Wide CI

1 level down

Only two studies

Low

Column headings (with explanations in parentheses): Study design (RCT = randomised controlled trial); study limitations (likelihood of reported results not being an accurate estimate of the truth); inconsistency (lack of similarity of estimates of treatment effects); indirectness (not representing PICO well); imprecision (insufficient number of patients or wide CIs) of results; and publication bias (probability of selective publication of trials and outcomes) across all studies that measured that particular outcome.

Figuras y tablas -
Table 2. Quality of the evidence (GRADE)
Comparison 1. Psycho‐educational versus Care as usual

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 RTW Show forest plot

2

260

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.88, 1.35]

1.1 Patient education

1

61

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.77, 1.51]

1.2 Patient education, group discussion

1

63

Risk Ratio (M‐H, Fixed, 95% CI)

1.33 [0.99, 1.79]

1.3 Post‐radiotherapy fatigue education

1

91

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.54, 1.76]

1.4 Pre‐ and post‐radiotherapy fatigue education

1

45

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.41, 1.67]

2 QoL Show forest plot

2

260

Std. Mean Difference (IV, Fixed, 95% CI)

0.05 [‐0.20, 0.30]

2.1 Patient education‐physical QoL

1

61

Std. Mean Difference (IV, Fixed, 95% CI)

0.09 [‐0.44, 0.62]

2.2 Patient education and group discussion‐physical QoL

1

63

Std. Mean Difference (IV, Fixed, 95% CI)

0.22 [‐0.32, 0.75]

2.3 Post‐radiotherapy fatigue education

1

91

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.05 [‐0.46, 0.36]

2.4 Pre‐ and post‐radiotherapy fatigue education

1

45

Std. Mean Difference (IV, Fixed, 95% CI)

0.03 [‐0.56, 0.61]

Figuras y tablas -
Comparison 1. Psycho‐educational versus Care as usual
Comparison 2. Physical versus Care as usual

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 RTW Show forest plot

1

Risk Ratio (Fixed, 95% CI)

Totals not selected

1.1 Physical activity

1

Risk Ratio (Fixed, 95% CI)

0.0 [0.0, 0.0]

2 QoL Show forest plot

1

Std. Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 2. Physical versus Care as usual
Comparison 3. Medical function conserving versus Medical more radical

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 RTW Show forest plot

7

Odds Ratio (Random, 95% CI)

1.32 [0.78, 2.25]

1.1 Chemoradiation

1

Odds Ratio (Random, 95% CI)

0.73 [0.25, 2.14]

1.2 Early thyroid hormones

1

Odds Ratio (Random, 95% CI)

11.36 [1.17, 110.34]

1.3 Minimal surgery

3

Odds Ratio (Random, 95% CI)

1.52 [0.74, 3.14]

1.4 Adjuvant endocrine

1

Odds Ratio (Random, 95% CI)

1.28 [0.24, 6.77]

1.5 Peripheral blood progenitor cell transplantation

1

Odds Ratio (Random, 95% CI)

0.81 [0.38, 1.73]

2 QoL Show forest plot

2

1028

Std. Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.04, 0.23]

2.1 Chemoradiation

1

126

Std. Mean Difference (IV, Fixed, 95% CI)

0.17 [‐0.18, 0.52]

2.2 Minimal surgery

1

902

Std. Mean Difference (IV, Fixed, 95% CI)

0.08 [‐0.06, 0.23]

Figuras y tablas -
Comparison 3. Medical function conserving versus Medical more radical
Comparison 4. Multidisciplinary physical, psycho‐educational and/or vocational interventions versus Care as usual

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 RTW Show forest plot

5

Odds Ratio (Random, 95% CI)

1.86 [1.16, 2.99]

1.1 Physical training, patient education and coping with RTW

1

Odds Ratio (Random, 95% CI)

1.84 [0.78, 4.37]

1.2 Physical exercise, counselling, encouragement of RTW

1

Odds Ratio (Random, 95% CI)

2.69 [1.07, 6.74]

1.3 Physical exercise, patient education and biofeedback

1

Odds Ratio (Random, 95% CI)

0.96 [0.27, 3.42]

1.4 Case management vocational rehabilitation

1

Odds Ratio (Random, 95% CI)

2.97 [0.51, 17.33]

1.5 Enhancing RTW, patient education, counselling

1

Odds Ratio (Random, 95% CI)

1.57 [0.57, 4.34]

2 QoL Show forest plot

2

316

Std. Mean Difference (IV, Fixed, 95% CI)

0.03 [‐0.20, 0.25]

2.1 Physical training, patient education and coping with RTW

1

188

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.08 [‐0.36, 0.21]

2.2 Enhancing RTW, patient education, counselling

1

128

Std. Mean Difference (IV, Fixed, 95% CI)

0.18 [‐0.17, 0.52]

Figuras y tablas -
Comparison 4. Multidisciplinary physical, psycho‐educational and/or vocational interventions versus Care as usual