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eHealth interventions to facilitate work participation

a scoping review protocol

Øyeflaten, Irene1,2; Johansen, Thomas1; Nielsen, Claus Vinther3,4; Johnsen, Tone Langjordet2,5; Tveito, Torill Helene2,6; Momsen, Anne-Mette Hedeager3,4

JBI Database of Systematic Reviews and Implementation Reports: June 2019 - Volume 17 - Issue 6 - p 1026–1033
doi: 10.11124/JBISRIR-2017-003953

Review question: The objective of this scoping review is to identify and synthesize existing literature on the different types of eHealth interventions used in workplaces and healthcare settings to facilitate work participation. The following questions will be examined: For which user groups, in which settings and by which stakeholders are eHealth interventions provided? Are eHealth interventions that are aimed at work participation theory-driven or based on empirical evidence?

1National Advisory Unit on Occupational Rehabilitation, Rauland, Norway

2Norwegian Research Centre, Bergen, Norway

3Department of Public Health, Section of Clinical Social Medicine and Rehabilitation, Aarhus University, Denmark

4DEFACTUM - Social & Health Services and Labour Market, Corporate Quality, Central Denmark Region, Denmark

5Division of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Tønsberg, Norway

6Department of Health, Social and Welfare Studies, University South-Eastern Norway, Horten, Norway

Correspondence: Anne-Mette Hedeager Momsen,

There is no conflicts of interest in this project.

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Worldwide, there is an increased demand for better healthcare services, technologies and medicines.1 Healthcare expenditures continue to rise, and governments face pressure to restrain costs.1 The World Health Organization (WHO) recommends looking at ways to improve efficiency, and the use of information and communication technology is proposed as a useful tool.1 In 2001, Eysenbach claimed that eHealth was an emerging field in the intersection of medical informatics, public health and business.2 eHealth may also be a promising solution to better manage the process of return to work (RTW) among sick-listed employees.3-5

The use of information and communication technology in health care (eHealth) is one of the most rapidly growing areas in the delivery of healthcare services.6,7 The WHO is actively working to improve health by providing member states with strategic information and guidance on effective practices and standards in eHealth.6 At present, more than half of all member states have an eHealth strategy.6 Similarly, the European Union (EU) has an eHealth Network, which aims to increase the potential and use of information and communication technology to improve the prevention, diagnosis, treatment, monitoring and management of health.8

There is growing research literature on eHealth for various patient groups and healthcare settings.9-13 eHealth has shown positive impacts on health-related outcomes, such as behavior changes among persons with anxiety disorder14 and more person-centered care for patients with cancer.15-19 The evidence for cost-effectiveness of eHealth interventions is promising in some specialities (e.g. teleophthalmology and telecardiology), although reviews conclude there are still several limitations, such as a lack of randomized controlled trials (RCTs).20,21 An overview concluded that 23% of reviews found eHealth to be effective to reduce healthcare costs, and 42% found promising evidence.21 When it comes to eHealth and measures of sick leave and work-related outcomes, there seems to be a significant gap in the literature on cost-effectiveness.

Currently, there are still a number of barriers to the implementation of eHealth in routine healthcare practices, including skepticism among stakeholders, such as nurses, physicians, nutritionists and other groups of healthcare providers.21,22 There is also debate about whether the introduction of eHealth in modern healthcare may influence trust in the patient-doctor relationship in various ways,23 but the current practice seems to indicate that eHealth is supplementing rather than replacing other health services.24

Barriers to the implementation of eHealth may build on policy-related, technical, organizational and process-related factors.25-27 Healthcare providers’ personal beliefs in the eHealth tool, both for themselves and their patients, are important factors for successful implementation.26 Furthermore, dropouts among patients may hinder full implementation of eHealth.28 An overall reason for dropouts seems to be loss of motivation, often related to frustrations with the technology or irrelevant and incomprehensible content.28 Many patients prefer other types of communication and face-to-face encounters.28,29

Web-based follow-up interventions have shown promising results in terms of faster RTW for sick-listed employees3 (e.g. women after gynecological surgery30 and employees with common mental disorders).5 An ongoing study is seeking new insights into the feasibility and effectiveness of eHealth interventions on RTW for patients with cancer.4,31 However, the literature on eHealth interventions to facilitate RTW has not yet been comprehensively reviewed, and little is known about specific areas (e.g. to whom, by which stakeholders, and in which settings eHealth is provided). Furthermore, assessment of work outcomes is needed to evaluate the effectiveness of health services.32 Long-term sick leave and work disability are costly not only for society and workplaces, but also for the individual.33 There is, however, no consensus among researchers about how to measure sick leave and successful RTW.34,35 Thus, a broad approach is needed to capture different work-related outcomes available in the literature.

A preliminary search for existing reviews on the topic was conducted in the JBI Database of Systematic Reviews and Implementation Reports, the Cochrane Database of Systematic Reviews, PubMed and Trip Database. Only one systematic review focusing on clinical outcomes was found in which RTW was a secondary outcome in two of the included studies.36 However, the search in this review was performed only until February 2007, and there is a need for a more current search.

A search in PROSPERO revealed approximately 30 systematic reviews on eHealth interventions, of which only one ongoing systematic review included a work-related outcome. In this review, the objective was to examine the effectiveness through RCTs, with RTW as the only outcome.37 In contrast, this planned scoping review will include eHealth interventions aiming to facilitate RTW among sick-listed employees, as well as stakeholders’ (e.g. healthcare professionals and managers) follow-up of sick-listed employees.

The search will also include all types of quantitative and qualitative studies, and populations across diagnoses and settings. Therefore, this scoping review will map and increase knowledge on the topic beyond only effectiveness and may identify gaps in evidence. This scoping review may inform current practice by presenting examples of how stakeholders in different settings use eHealth in their follow-up of sick-listed workers (e.g. in occupational health services).

Furthermore, information about the theoretical basis for the interventions will be extracted. It is important to inform practice on why and how interventions might work.38 Therefore, more theory-driven research is sought (e.g. in complex clinical processes).38,39

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Inclusion criteria


The current scoping review will consider studies that include working-age employees/patients (18–65 years) on sick leave (full or partial) due to any type of diagnoses/disabilities.

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Two core concepts, eHealth and work participation, will be combined in this scoping review. In light of the rising profile of eHealth in the policy agenda, the term has become an accepted neologism, despite the lack of an agreed-upon definition.42 The review will consider studies that evaluate eHealth interventions42 or telehealth interventions.21 That means the intervention must be accessible via the Internet, mobile devices/telephones and/or computer programs/software. The definitions of eHealth may vary between stakeholders and settings, and no clear definition is provided, although there is an implicit understanding of its meaning across stakeholder groups.42,43 eHealth contains three key elements: data obtained from the patient, electronic transfer of data over distance and patient-tailored feedback from a healthcare professional. Furthermore, eHealth communication is personalized and interactive in contrast to patient information websites.44,45 The communicative functions of eHealth are often emphasized and the use of networked digital technologies is specified, thus differentiating eHealth from the field of medical informatics.43

Work participation in this study is operationalized by measures of work-related outcomes. Terminology and measurements of work-related outcomes (e.g. reduced work participation, sick leave duration, time to RTW and work productivity) vary between studies,35 depending on the purpose of the study and available data.46,47 Return to work is not an isolated event, but rather an evolving process with several phases before and after work re-entry.34,47-49 Moreover, the complexity in RTW outcomes may be influenced by differences in the legal system, labor market and work environment in different countries.35,50

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The current scoping review will consider studies on eHealth interventions aimed to facilitate work participation for the specified target group, and conducted in all countries and settings. The context may, for example, be in primary health care or specialist health care, workplaces or within occupational health services. Exclusion criteria will be studies on eHealth interventions offered to the unemployed (with or without any health problems) and to health professionals aimed at their own work participation. Furthermore, studies focusing on presenteeism (reflecting people working with an injury or illness that impacts their work productivity) will be excluded.

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Type of studies

The current scoping review will include empirical studies with either qualitative or quantitative data published in English, Norwegian, Swedish or Danish. The review will exclude all types of reviews, protocols, book chapters, editorial letters, guidelines and websites.

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To guide the review and synthesis process, the Joanna Briggs Institute (JBI) approach will be employed, using the framework by Arksey and O’Malley, enhanced to eight stages proposed by Peters et al.40 and recommended in the Joanna Briggs Institute Reviewer's Manual.40,41

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Search strategy

The search strategy will aim to locate both published and unpublished studies. The main databases searched will be PubMed, Scopus, Embase, PsycINFO, the WHO clinical registry and

The JBI three-phase search process will be followed.40,41 Initially, a limited search of PubMed and the Trip Database will be performed, followed by an analysis of the index terms and text words contained in the title and abstract. A second search across all included databases will use the identified index terms and keywords. Thirdly, the reference lists of all identified reports and articles that have been included will be searched for additional studies.

The search will be limited to studies published after 2008, as eHealth technology is changing constantly and rapidly. Since reporting of eHealth interventions is determined by what is technologically possible, earlier studies will be less relevant for the current practice of eHealth technologies.51 The search strategy developed for PubMed will be refined for use in the other electronic databases, with assistance from a research librarian. A full search strategy for PubMed is detailed in Appendix I.

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Study selection

The study selection process will be conducted in three stages. In stage one, all the titles and available abstracts of the identified citations revealed in the literature search will be screened. This will be done to select full-text papers and will be performed based on inclusion criteria, which means that the abstract should include both the terms eHealth interventions and work-related outcomes. To decrease the likelihood of bias or errors, two authors will screen the citations independently. The full text will be accessed if at least one of the authors deems the study potentially eligible. Studies are eligible regardless of the quality.

In stage two, the full texts of eligible studies will be assessed. This will be done by pairs of two independent authors comparing the results within the couple. To reduce bias, the pairs of authors will change through the selection process. The selection of full-text papers will be performed based on inclusion and exclusion criteria. Disagreement will be discussed, and if a consensus cannot be reached, it will be resolved through a third author.

In the third stage, the reference lists of all identified reports and articles will be searched for additional studies. The reviewers will contact authors of primary studies or reviews for further information, if required.

The selection process will be recorded in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.52 Reasons for excluding studies following full-text reading will be provided in the PRISMA flow diagram. The search records will be collated and managed by use of RefWorks (ProQuest LLC, Ann Arbor, USA).

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Data extraction

Data will be extracted from the papers included by two independent authors using a structured data extraction form, designed by using the participant, concept and context (PCC) strategy and based on the research questions (Appendix II). Charting the results will be an iterative process whereby the extraction form may be updated. The review team will trial the data extraction form on 10 studies to ensure consistency, so as to gain familiarity with the source results and to ensure that all relevant results are extracted. Any disagreements that arise between the authors will be resolved through discussion, or with a third author. Authors of papers will be contacted to request missing or additional data, where required.

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Data mapping

The extracted data will be presented in diagrammatic or tabular form in a manner that aligns with the objectives and scope of this scoping review. Results will be classified under main conceptual categories, such as study population, setting, eHealth intervention and key findings. The charts and tables will report on distribution of studies by period of publication, countries of origin, settings and research methods.

A draft charting form will be developed including detailed key information on authors, year of publication, country (where the study was conducted), aims, methods, study population/sample size, setting (e.g. primary healthcare, occupational health service, workplace), stakeholders, eHealth intervention type, comparator intervention (in RCTs), duration, if the intervention is theory or evidence-base, outcomes and results.

A narrative summary will accompany the charted results and describe how the results relate to the review objective and type of questions.

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We acknowledge the contribution of Research librarian Karen Sigaard, Aarhus University Library, Denmark; and Cecilie Varsi, PhD, RN, Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Norway.

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Appendix I: Search strategy for PubMed

#1 (patients [MeSH] OR beneficiaries OR “sickness beneficiaries” OR “benefit

recipients” OR “sick listed” OR sicklisted OR worker OR employee)

#2 (telemedicine [MeSH] OR telerehabilitation [MeSH] OR “tele medicine” OR “tele

rehabilitation” OR telecare OR “tele care” OR teleconsultation OR “tele

consultation” OR telehealth OR “tele health” OR “electronic health” OR

“e health” OR ehealth OR etherapy OR “e therapy” OR mhealth OR “m

health” OR internetbased OR “internet based” OR webbased OR


#3 (workplace [MeSH] OR occupational health [MeSH] OR rehabilitation, vocational [MeSH] OR

occupational health services [MeSH] OR rehabilitation centers [MeSH] OR ambulatory

care facilities [MeSH] OR outpatient clinics, hospital [MeSH] OR secondary care

centers [MeSH] OR “work place” OR “vocational rehabilitation” OR

occupational rehabilitation” OR “work rehabilitation” OR hospital units [MeSH]

#4 (return to work [MeSH] OR sick leave [MeSH] OR absenteeism OR “returning to work” OR

“back to work” OR sick OR sickness OR sicklist* OR sick list* OR “work participation”

OR “work disability”)

#5 #1 AND #2 AND #3 AND #4

Limited to: 01-01-2008-2018, English

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Appendix II: Draft study details, characteristics and results extraction instrument



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1. World Health Organization. Health systems financing. The path to universal coverage. The World Health Report 2010. Geneva: World Health Organization; 2010.
2. Eysenbach G. What is e-health? J Med Internet Res 2001; 3 2:E20.
3. Lokman S, Volker D, Zijlstra-Vlasveld MC, Brouwers EP, Boon B, Beekman AT, et al. Return-to-work intervention versus usual care for sick-listed employees: health-economic investment appraisal alongside a cluster randomised trial. BMJ Open 2017; 7 10: e016348-2017-016348.
4. Tamminga SJ, van Hezel S, de Boer AG, Frings-Dresen MH. Enhancing the Return to Work of Cancer Survivors: Development and Feasibility of the Nurse-Led eHealth Intervention Cancer@Work. JMIR Res Protoc 2016; 5 2:e118.
5. Volker D, Zijlstra-Vlasveld MC, Anema JR, Beekman AT, Brouwers EP, Emons WH, et al. Effectiveness of a blended web-based intervention on return to work for sick-listed employees with common mental disorders: results of a cluster randomized controlled trial. J Med Internet Res 2015; 17 5:e116.
6. World Health Organization. Global diffusion of eHealth: Making universal health coverage achievable. Report of the third global survey on eHealth. Geneva: World Health Organization; 2016.
7. World Health Organization. Atlas of eHealth country profiles 2015: The use of eHealth in support of universal health coverage. Based on the findings of the 2015 global survey on eHealth. Geneva: World Health Organization; 2016.
8. “EU Commision”. EU network on eHealth. [cited 21 March 2018] Available from:
9. Eccleston C, Palermo TM, Williams AC, Lewandowski Holley A, Morley S, Fisher E, et al. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev 2014; 5:CD003968.
10. Cuijpers P, van Straten A, Andersson G. Internet-administered cognitive behavior therapy for health problems: a systematic review. J Behav Med 2008; 31 2:169–177.
11. Wantland DJ, Portillo CJ, Holzemer WL, Slaughter R, McGhee EM. The effectiveness of Web-based vs. non-Web-based interventions: a meta-analysis of behavioral change outcomes. J Med Internet Res 2004; 6 4:e40.
12. Samoocha D, Bruinvels DJ, Elbers NA, Anema JR, van der Beek AJ. Effectiveness of web-based interventions on patient empowerment: a systematic review and meta-analysis. J Med Internet Res 2010; 12 2:e23.
13. Murray E, Burns J, See TS, Lai R, Nazareth I. Interactive Health Communication Applications for people with chronic disease. Cochrane Database Syst Rev 2005; 4:CD004274.
14. Olthuis JV, Watt MC, Bailey K, Hayden JA, Stewart SH. Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database Syst Rev 2016; 3:CD011565.
15. Grimsbo GH, Finset A, Ruland CM. Left hanging in the air: experiences of living with cancer as expressed through E-mail communications with oncology nurses. Cancer Nurs 2011; 34 2:107–116.
16. Borosund E, Cvancarova M, Moore SM, Ekstedt M, Ruland CM. Comparing effects in regular practice of e-communication and Web-based self-management support among breast cancer patients: preliminary results from a randomized controlled trial. J Med Internet Res 2014; 16 12:e295.
17. Kruse CS, Argueta DA, Lopez L, Nair A. Patient and provider attitudes toward the use of patient portals for the management of chronic disease: a systematic review. J Med Internet Res 2015; 17 2:e40.
18. Ruland CM, Maffei RM, Borosund E, Krahn A, Andersen T, Grimsbo GH. Evaluation of different features of an eHealth application for personalized illness management support: cancer patients’ use and appraisal of usefulness. Int J Med Inform 2013; 82 7:593–603.
19. Wibe T, Helleso R, Varsi C, Ruland C, Ekstedt M. How does an online patient-nurse communication service meet the information needs of men with recently diagnosed testicular cancer? ISRN Nurs 2012; 2012:260975.
20. de la Torre-Diez I, Lopez-Coronado M, Vaca C, Aguado JS, de Castro C. Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review. Telemed J E Health 2015; 21 2:81–85.
21. Elbert NJ, van Os-Medendorp H, van Renselaar W, Ekeland AG, Hakkaart-van Roijen L, Raat H, et al. Effectiveness and cost-effectiveness of ehealth interventions in somatic diseases: a systematic review of systematic reviews and meta-analyses. J Med Internet Res 2014; 16 4:e110.
22. Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the Consolidated Framework for Implementation Research to Identify Barriers and Facilitators for the Implementation of an Internet-Based Patient-Provider Communication Service in Five Settings: A Qualitative Study. J Med Internet Res 2015; 17 11:e262.
23. Andreassen HK, Trondsen M, Kummervold PE, Gammon D, Hjortdahl P. Patients who use e-mediated communication with their doctor: new constructions of trust in the patient-doctor relationship. Qual Health Res 2006; 16 2:238–248.
24. Andreassen HK, Bujnowska-Fedak MM, Chronaki CE, Dumitru RC, Pudule I, Santana S, et al. European citizens’ use of E-health services: a study of seven countries. BMC Public Health 2007; 7 1:53.
25. Lluch M. Healthcare professionals’ organisational barriers to health information technologies-a literature review. Int J Med Inform 2011; 80 12:849–862.
26. Varsi C. Implementation of eHealth patient-provider communication tools into routine practice. University of Oslo: Faculty of Medicine, University of Oslo; 2016.
27. Wallwiener M, Wallwiener CW, Kansy JK, Seeger H, Rajab TK. Impact of electronic messaging on the patient-physician interaction. J Telemed Telecare 2009; 15 5:243–250.
28. Lie SS, Karlsen B, Oord ER, Graue M, Oftedal B. Dropout From an eHealth Intervention for Adults With Type 2 Diabetes: A Qualitative Study. J Med Internet Res 2017; 19 5:e187.
29. Varsi C, Gammon D, Wibe T, Ruland CM. Patients’ reported reasons for non-use of an internet-based patient-provider communication service: qualitative interview study. J Med Internet Res 2013; 15 11:e246.
30. Vonk Noordegraaf A, Anema JR, van Mechelen W, Knol DL, van Baal WM, van Kesteren PJ, et al. A personalised eHealth programme reduces the duration until return to work after gynaecological surgery: results of a multicentre randomised trial. BJOG 2014; 121 9:1127–1135. discussion 1136.
31. Tamminga SJ, Hoving JL, Frings-Dresen MH, de Boer AG. Cancer@Work - a nurse-led, stepped-care, e-health intervention to enhance the return to work of patients with cancer: study protocol for a randomized controlled trial. Trials 2016; 17 1: 453-016-1578-8.
32. Amick BC III, Lerner D, Rogers WH, Rooney T, Katz JN. A review of health-related work outcome measures and their uses, and recommended measures. Spine (Phila a 1976) 2000; 25 24:3152–3160.
33. OECD. Sickness, disability and work: breaking the barriers. A synthesis of findings across OECD countries. Paris: OECD Publishing; 2010.
34. Pransky G, Gatchel R, Linton SJ, Loisel P. Improving return to work research. J Occup Rehabil 2005; 15 4:453–457.
35. Hensing G, Alexanderson K, Allebeck P, Bjurulf P. How to measure sickness absence? Literature review and suggestion of five basic measures. Scand J Soc Med 1998; 26 2:133–144.
36. Kairy D, Lehoux P, Vincent C, Visintin M. A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disabil Rehabil 2009; 31 6:427–447.
37. Schumacher L, Woods P. Effectiveness of e-Health interventions to support return to work: a systematic review. PROSPERO 2016; CRD42016027086:
38. Walshe K. Understanding what works—and why—in quality improvement: the need for theory-driven evaluation. Int J Qual Health Care 2007; 19 2:57–59.
39. Wolf CFS. Strategic planning research: Toward a theory-driven agenda. Journal of Management 2017; 43 6:1754–1788.
40. Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc 2015; 13 3:141–146.
41. Peters MDJ, Godfrey C, McInerney P, Baldini Soares C, Khalil H, Parker D. Chapter 11: Scoping Reviews. In: Aromataris E, Munn Z (Editors). Joanna Briggs Institute Reviewer's Manual [Internet]. The Joanna Briggs Institute, 2017 [cited 21 March 2018]. Available from:
42. Oh H, Rizo C, Enkin M, Jadad A. What is eHealth?: a systematic review of published definitions. World Hosp Health Serv 2005; 41 1:32–40.
43. Pagliari C, Sloan D, Gregor P, Sullivan F, Detmer D, Kahan JP, et al. What is eHealth (4): a scoping exercise to map the field. J Med Internet Res 2005; 7 1:e9.
44. Miller EA. Solving the disjuncture between research and practice: telehealth trends in the 21st century. Health Policy 2007; 82 2:133–141.
45. McLean S, Chandler D, Nurmatov U, Liu J, Pagliari C, Car J, et al. Telehealthcare for asthma. Cochrane Database Syst Rev 2010; 10:CD007717.
46. Biering K, Hjollund NH, Lund T. Methods in measuring return to work: a comparison of measures of return to work following treatment of coronary heart disease. J Occup Rehabil 2013; 23 3:400–405.
47. Wasiak R, Young AE, Roessler RT, McPherson KM, van Poppel MN, Anema JR. Measuring return to work. J Occup Rehabil 2007; 17 4:766–781.
48. Oyeflaten I, Lie SA, Ihlebaek CM, Eriksen HR. Multiple transitions in sick leave, disability benefits, and return to work. A 4-year follow-up of patients participating in a work-related rehabilitation program. BMC Public Health 2012; 12:748.
49. Young AE. An exploration of alternative methods for assessing return-to-work success following occupational injury. Disabil Rehabil 2014; 36 11:914–924.
50. Young AE, Roessler RT, Wasiak R, McPherson KM, van Poppel MN, Anema JR. A developmental conceptualization of return to work. J Occup Rehabil 2005; 15 4:557–568.
51. Eysenbach G. CONSORT-EHEALTH Group. CONSORT-EHEALTH: improving and standardizing evaluation reports of Web-based and mobile health interventions. J Med Internet Res 2011; 13 4:e126.
52. Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009; 62 10:1006–1012.

eHealth; occupational rehabilitation; return to work; sickness absence; work place intervention

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