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Intervenciones no farmacológicas para la prevención de la pérdida de puestos de trabajo en trabajadores con artritis inflamatoria

Appendices

Appendix 1. Cochrane Library search strategy (including CENTRAL and DARE)

#1 MeSH descriptor: [Arthritis] explode all trees )

#2 MeSH descriptor: [Rheumatic Diseases] explode all trees

#3 arthritis or ankylosing next spondyl* or rheumatic next disease* or rheumatic next disorder* or rheumatic next condition* or bechterew*:ti,ab,kw (Word variations have been searched)

#4 #1 OR #2 OR #3

#5 MeSH descriptor: [Rehabilitation, Vocational] explode all trees

#6 MeSH descriptor: [Occupational Health] explode all trees

#7 MeSH descriptor: [Occupational Health Services] explode all trees

#8 MeSH descriptor: [Occupational Health Nursing] explode all trees

#9 MeSH descriptor: [Workers’ Compensation] explode all trees

#10 MeSH descriptor: [Social Participation] explode all trees

#11 MeSH descriptor: [Occupational Medicine] explode all trees

#12 MeSH descriptor: [Employment] explode all trees

#13 MeSH descriptor: [Disability Evaluation] explode all trees

#14 #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13

#15 work* or “sick leave” or absenteeism or presenteeism or retirement or employment or “sickness absence” or “disabled persons” or “social participation” or job or ergonomic or vocational or occupation* or employee or employer or unemployment or “disability evaluation”:ti,ab,kw (Word variations have been searched)

#16 #14 OR #15

#17 #4 AND #16

Appendix 2. MEDLINE (PubMed) search strategy

#1 “rheumatic diseases”[MeSH Terms] OR “Arthritis”[Mesh]

#2 arthritis[tw] OR ankylosing spondyl*[tw] OR rheumatic disease*[tw] OR rheumatic disorder*[tw] OR rheumatic condition*[tw] OR bechterew*[tw]

#3 #1 OR #2

#4 “Rehabilitation, Vocational”[Mesh] OR “Occupational Health”[Mesh] OR “Occupational Health Services”[Mesh] OR “workers' compensation”[MeSH] OR “Social Participation”[Mesh] OR “Occupational medicine” [MESH] OR employment[MESH] OR unemployment[MESH] OR “disability evaluation”[MeSH]

#5 “return to work”[tw] OR “sick leave”[tw] OR absenteeism[tw] OR presenteeism[tw] OR retirement[tw] OR employment[tw] OR “sickness absence”[tw] OR “disabled persons”[tw] OR “social participation”[tw] OR job[tw] OR work[tw] OR works*[tw] OR worka*[tw] OR worke*[tw] OR workg*[tw] OR worki*[tw] OR workl*[tw] OR workp*[tw] OR ergonomic[tw] OR vocational[tw] OR occupation*[tw] OR employee[tw] OR employer[tw] OR unemployment[tw] OR “disability evaluation”[tw]

#6 #4 OR #5

#7 randomized controlled trial[pt] OR controlled clinical trial[pt] OR randomized[tiab] OR placebo[tiab] OR clinical trials as topic[mesh:noexp] OR randomly[tiab] OR trial[ti] NOT (animals[mh] NOT humans [mh])

#8 #3 AND #6 AND #7

Appendix 3. EMBASE (embase.com) search strategy

(((arthritis:de,ab,ti OR 'ankylosing spondylitis':de,ab,ti OR (rheumatic NEXT/1 disease*):de,ab,ti OR (rheumatic NEXT/1 disorder*):de,ab,ti OR (rheumatic NEXT/1 condition*):ab,ti OR bechterew*:de,ab,ti) OR ('arthritis'/exp OR 'rheumatic disease'/exp)) AND (('return to work':ab,ti OR employment:ab,ti OR unemployment:ab,ti OR unemployed:ab,ti OR retirement:ab,ti OR 'sick leave':ab,ti OR 'sickness absence':ab,ti OR absenteeism:ab,ti OR presenteeism:ab,ti OR vocational*:ab,ti OR 'work ability':ab,ti OR 'work capacity':ab,ti OR 'work activity':ab,ti OR 'work disability':ab,ti OR 'work rehabilitation':ab,ti OR 'work status':ab,ti OR workability:ab,ti OR employability:ab,ti OR employable:ab,ti OR employee*:ab,ti OR occupation*:ab,ti OR 'job satisfaction':ab,ti OR 'job performance':ab,ti OR 'disability evaluation':ab,ti OR 'disability management':ab,ti OR disabled:ab,ti OR ergonomic:ab,ti OR worker*:ab,ti OR (loss OR remain* OR return* OR retention OR participation*) NEAR/2 (work OR job)) OR ('occupational health'/exp OR 'occupational medicine'/exp OR 'employment'/exp OR 'disability'/exp OR 'work'/exp OR 'vocational rehabilitation':de OR 'workman compensation':de OR 'social participation':de OR unemployment:de OR 'medical leave':de OR retirement:de)) AND (('crossover procedure':de OR 'double‐blind procedure':de OR 'randomized controlled trial':de OR 'single‐blind procedure':de) OR (random*:de,ab,ti OR factorial*:de,ab,ti OR crossover*:de,ab,ti OR (cross NEXT/1 over*):de,ab,ti OR placebo*:de,ab,ti OR (doubl* NEAR/1 blind*):de,ab,ti OR (singl* NEAR/1 blind*):de,ab,ti OR assign*:de,ab,ti OR allocat*:de,ab,ti OR volunteer*:de,ab,ti))) AND [embase]/lim

Appendix 4. CINAHL (EbSCOhost) search strategy

S28 S25 AND S26 AND S27

S27 S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR S13 OR S14 OR S15 OR S16 OR S17 OR S18 OR S19

S26 (TX allocat* random*) OR (MH "Quantitative Studies") OR (MH "Placebos") OR (TX placebo* ) OR (TX random* allocat*) OR (MH "Random Assignment") OR (TX randomi* control* trial*) OR ( (singl* n1 blind*) or (singl* n1 mask*) ) OR TX ( (doubl* n1 blind*) or (doubl* n1 mask*) ) OR TX ( (tripl* n1 blind*) or (tripl* n1 mask*) ) OR TX ( (trebl* n1 blind*) or (trebl* n1 mask*) ) OR (TX clinic* n1 trial*) OR (PT Clinical trial) OR (MH "Clinical Trials+")

S25 S20 OR S21 OR S22 OR S23 OR S24

S24 (MH "Spondylitis, Ankylosing") OR "ankylosing spondylitis"

S23 "rheumatic conditions"

S22 "rheumatic disorders"

S21 (MH "Rheumatic Diseases+") OR "rheumatic diseases"

S20 (MH "Arthritis+") OR "arthritis" OR (MH "Spondylarthritis+") OR (MH "Arthritis, Rheumatoid+")

S19 "employer"

S18 "Occupational"

S17 "occupation"

S16 "work*"

S15 (MH "Ergonomics+") OR "ergonomic"

S14 (MH "Employee, Disabled+") OR "Employee"

S13 (MH "Job Accommodation") OR "job"

S12 (MH "Work") OR "work"

S11 "disabled persons"

S10 "sickness absence"

S9 "presenteeism"

S8 (MH "Absenteeism") OR "Absenteeism"

S7 (MH "Sick Leave") OR "sick leave"

S6 (MH "Job Re‐Entry") OR "Return to work"

S5 (MH "Unemployment") OR "Unemployment"

S4 (MH "Disability Evaluation+") OR "disability evaluation" OR (MH "Employee, Disabled+") OR (MH "Employment of Disabled+") OR (MM "Disability Management") OR (MM "Sick Leave")

S3 (MH "Employment+") OR "employment" OR (MM "Employment Status") OR (MH "Employment of Disabled+")

S2 (MH "Occupational Health+") OR (MH "Occupational Health Services+")

S1 (MH "Rehabilitation, Vocational+") OR "Vocational rehabilitation" OR (MM "Vocational Guidance") OR (MM "Job Change")

Appendix 5. PsychINFO (ProQuest) search strategy

((SU(Arthritis) OR (ab(arthritis) OR ti(arthritis) OR all("rheumatic disease*") OR all("rheumatic disorder*") OR all("rheumatic condition*") OR all(bechterew*) OR all(ankylosing spondyl*))) AND ((SU.EXACT.EXPLODE("Vocational Rehabilitation") OR SU("occupational health") OR SU("occupational therapy") OR SU("Employability") OR SU("Human Factors Engineering") OR SU("Workers' Compensation Insurance") OR SU.EXACT.EXPLODE("Interpersonal Interaction") OR SU("Occupational Adjustment") OR SU("Occupational Aspirations") OR SU.EXACT.EXPLODE("Employment Status") OR SU("Disabled Personnel") OR SU("Disability Evaluation") OR SU("Occupational Attitudes") OR SU("Work (Attitudes Toward)") OR SU("Occupational Choice") OR SU("Job Involvement") OR SU("Job Satisfaction") OR SU("Employee Absenteeism") OR SU("Reemployment") OR SU("Employee Leave Benefits") OR SU.EXACT("rehabilitation") OR SU.EXACT.EXPLODE("retirement") OR SU.EXACT("Working Conditions")) OR (ab("return to work") OR ab("sick leave") OR ab(absenteeism) OR ab(presenteeism) OR ab(retirement) OR ab(employment) OR ab("sickness absence") OR ab("disabled persons") OR ab("social participation") OR ab(job) OR ab(work*) OR ab(ergonomic) OR ab(vocational) OR ab(occupation*) OR ab(employee) OR ab(employer) OR ab(unemployment) OR ab("disability evaluation") OR ab(employability) OR ab(employable) OR ti("return to work") OR ti("sick leave") OR ti(absenteeism) OR ti(presenteeism) OR ti(retirement) OR ti(employment) OR ti("sickness absence") OR ti("disabled persons") OR ti("social participation") OR ti(job) OR ti(work*) OR ti(ergonomic) OR ti(vocational) OR ti(occupation*) OR ti(employee) OR ti(employer) OR ti(unemployment) OR ti("disability evaluation") OR ti(employability) OR ti(employable)))) AND ((all(random*) OR all(control*) OR SU.EXACT.EXPLODE(treatment) OR SU.EXACT("Treatment Effectiveness Evaluation") OR SU.EXACT.EXPLODE("Treatment Outcomes")) OR (SU.EXACT.EXPLODE(Intervention) OR SU(intervention)))

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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

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Risk of bias summary: review authors' judgements about each risk of bias item for each included trial.
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Figure 3

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

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Comparison 1 job loss prevention vs control intervention, Outcome 1 Job loss counts (workers) cumulative 12, 24, 30, 48 months.
Figuras y tablas -
Analysis 1.1

Comparison 1 job loss prevention vs control intervention, Outcome 1 Job loss counts (workers) cumulative 12, 24, 30, 48 months.

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Comparison 1 job loss prevention vs control intervention, Outcome 2 Sickness absenteeism ‐ work days missed per month ‐ six months.
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Analysis 1.2

Comparison 1 job loss prevention vs control intervention, Outcome 2 Sickness absenteeism ‐ work days missed per month ‐ six months.

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Comparison 1 job loss prevention vs control intervention, Outcome 3 Work functioning ‐ RA WIS ‐ six months.
Figuras y tablas -
Analysis 1.3

Comparison 1 job loss prevention vs control intervention, Outcome 3 Work functioning ‐ RA WIS ‐ six months.

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Comparison 1 job loss prevention vs control intervention, Outcome 4 Extra: Job loss or increase in disability pension: counts (participants) ‐ 24 months.
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Analysis 1.4

Comparison 1 job loss prevention vs control intervention, Outcome 4 Extra: Job loss or increase in disability pension: counts (participants) ‐ 24 months.

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Comparison 1 job loss prevention vs control intervention, Outcome 5 Extra: Job loss events ‐ permanent and temporary ‐ 48 months.
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Analysis 1.5

Comparison 1 job loss prevention vs control intervention, Outcome 5 Extra: Job loss events ‐ permanent and temporary ‐ 48 months.

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Comparison 1 job loss prevention vs control intervention, Outcome 6 Extra: Sickness absenteeism ‐ Workdays missed as proportion of days worked over the past month ‐ six months.
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Analysis 1.6

Comparison 1 job loss prevention vs control intervention, Outcome 6 Extra: Sickness absenteeism ‐ Workdays missed as proportion of days worked over the past month ‐ six months.

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Summary of findings for the main comparison. Job loss prevention compared to control intervention in people with inflammatory arthritis

Job loss prevention compared to control intervention in people with IA

Patient or population: people with IA
Settings:
Intervention: job loss prevention
Comparison: control intervention consisting of usual care or information

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(trials)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control intervention 7

Job loss prevention

Job loss
Self report by questionnaire
Follow‐up: mean 24 months

See comment

See comment

Not estimable

340
(2 trials)

⊕⊝⊝⊝
very low1,2,3,4

Due to inconsistency in the trials we did not pool these two trials

Sickness absenteeism
Self reported no workdays missed in past month. Scale from: 0 to 22.
Follow‐up: mean 6 months

The mean sickness absenteeism in the control groups was
2.75 days absent

The mean sickness absenteeism in the intervention groups was
2.42 lower
(5.03 lower to 0.19 higher)

‐

32
(1 study)

⊕⊝⊝⊝
very low5,6

‐

Work functioning
Rheumatoid Arthritis Work Instability Scale. Scale from: 0 to 23 (higher score = worse work functioning)
Follow‐up: mean 6 months

The mean work functioning in the control groups was
13.67 score points

The mean work functioning in the intervention groups was
4.67 lower
(8.43 to 0.91 lower)

‐

32
(1 study)

⊕⊝⊝⊝
very low5,6

‐

*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;

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 We judged the RCTs by de Buck 2005 and Macedo 2009 to have an overall high risk of bias and the RCT by Allaire 2003 to have an overall low risk of bias. Overall, we judged serious risk of bias to be present and therefore we downgraded the quality of the evidence by one level (‐1).
2 The magnitude of the effect on job loss for Allaire 2003 and de Buck 2005 show different relative risks. Allaire 2003 cites a highly significant and large beneficial effect (24 months: RR 0.35, 95% CI 0.18 to 0.68) whereas de Buck 2005 shows no effect (RR 1.05, 95% CI 0.53 to 2.06). The CIs hardly overlap. In addition, considerable statistical heterogeneity is present (I2 > 80%). Hence we did not pool the results. As we failed to identify a plausible explanation for the inconsistency, we downgraded the quality of the evidence by two levels (‐2). For the outcomes sickness absenteeism and work functioning, we only had one included RCT. Hence we judged inconsistency as not serious.
3 The number of job loss events was less than 300. The 'threshold rule of thumb value' states that there should be at least 300 events for job loss (dichotomous outcome), and for continuous outcomes there should be at least 400 participants (Higgins 2011). None of the trials fulfilled this criterion, nor did any of the comparisons for any of the outcomes. As the two RCTs reporting on job loss (Allaire 2003; de Buck 2005) were considerably larger than the one very small study (Macedo 2009) we judged the two to have serious imprecision, and so we downgraded the quality of the evidence by just one level (‐1).
4 We included both trials with smaller (N = 32 in Macedo 2009) and larger (N = 140 in de Buck 2005, N = 242 in Allaire 2003) sample sizes and both trials with positive (Allaire 2003 ; Macedo 2009) as well as non‐significant results (de Buck 2005). Given the low number of trials we were unable to further analyse publication bias with funnel plots or with statistical tests. Consequently we did not downgrade the quality of the evidence.
5 Risk of bias in the Macedo 2009 RCT related in particular to an absence of prognostic comparability and blinding of outcome assessment, which we judged to be sources for serious risk of bias. Consequently we downgraded the quality of the evidence by one level (‐1).
6Macedo 2009 included only 32 participants in total. We considered it to have very serious imprecision for the outcomes sickness absenteeism and work functioning. Thus we downgraded the quality of the evidence by two levels (‐2).

7 All control groups received either usual care or a minimal intervention such as written information in Allaire 2003.

Figuras y tablas -
Summary of findings for the main comparison. Job loss prevention compared to control intervention in people with inflammatory arthritis
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Table 1. Other outcome data reported in the RCTs

Outcome measures

Follow‐up times

Trials

Extra analyses

Combined job loss or increase of disability pension

24 months

de Buck 2005

Analysis 1.4

Job loss events

48 months

Allaire 2003

Analysis 1.5

Sickness absenteeism defined as workdays missed in proportion to days worked

Macedo 2009

Analysis 1.6

In this table we present other supporting job loss outcome data reported in the trials for informative purposes only. These data do not contribute to our conclusions.

Figuras y tablas -
Table 1. Other outcome data reported in the RCTs
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Comparison 1. job loss prevention vs control intervention

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Job loss counts (workers) cumulative 12, 24, 30, 48 months Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

1.1 Follow‐up 12 months

2

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Follow‐up 24 months

2

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.3 Follow‐up 30 months

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.4 Follow‐up 48 months

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Sickness absenteeism ‐ work days missed per month ‐ six months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 Work functioning ‐ RA WIS ‐ six months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4 Extra: Job loss or increase in disability pension: counts (participants) ‐ 24 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

5 Extra: Job loss events ‐ permanent and temporary ‐ 48 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

6 Extra: Sickness absenteeism ‐ Workdays missed as proportion of days worked over the past month ‐ six months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 1. job loss prevention vs control intervention
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