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Early Workplace Intervention for Employees With Musculoskeletal-Related Absenteeism: A Prospective Controlled Intervention Study

Arnetz, Bengt B. MD, PhD; Sjögren, Berit; Rydéhn, Berit; Meisel, Roland BA

Journal of Occupational and Environmental Medicine: May 2003 - Volume 45 - Issue 5 - p 499-506
doi: 10.1097/01.jom.0000063628.37065.45

Sickness absenteeism caused by musculoskeletal disorders (MSDs) is a persistent and costly occupational health challenge. In a prospective controlled trial, we compared the effects on sickness absenteeism of a more proactive role for insurance case managers as well as workplace ergonomic interventions with that of traditional case management. Patients with physician-diagnosed MSDs were randomized either to the intervention group or the reference group offered the traditional case management routines. Participants filled out a comprehensive questionnaire at the initiation of the study and after 6 months. In addition, administrative data were collected at 0, 6, and 12 months after the initiation of the project. For the entire 12-month period, the total mean number of sick days for the intervention group was 144.9 (SEM 11.8) days/person as compared to 197.9 (14.0) days in the reference group (P < 0.01). Compared with the reference group, employees in the intervention group significantly more often received a complete rehabilitation investigation (84% versus 27%). The time for doing this was reduced by half (59.4 (5.2) days versus 126.8 (19.2), P < .01). The odds ratio for returning to work in the intervention group was 2.5 (95% confidence interval 1.2–5.1) as compared with the reference group. The direct cost savings were USD 1195 per case, yielding a direct benefit-to-cost ratio of 6.8. It is suggested that the management of MSDs should to a greater degree focus on early return to work and building on functional capacity and employee ability. Allowing the case managers a more active role as well as involving an ergonomist in workplace adaptation meetings might also be beneficial.

From the Department of Public Health and Caring Sciences, Section for Social Medicine and CEOS, Center for Environmental Illness and Stress, Uppsala University, Uppsala, Sweden (Dr. Arnetz); Älgdalsvägen 14, 134 63 Ingarö, Sweden (Mr Sjögren); Skogås Försäkringskassa, 142 81 Skogås, Sweden (Rydéhn); and A-rehab, Inc., Brännerigatan 1, 116 38 Stockholm, Sweden(Mr Meisel).

Address correspondence to: Bengt B. Arnetz, MD, Section for Social Medicine, Department of Public Health and Caring Sciences, Uppsala University, 751 85 Uppsala, Sweden; E-mail address:

Supported by a grant from the Research Unit of the Stockholm branch of the Swedish National Health Insurance Plan.

Bengt Arnetz has no commercial interest related to this article.

©2003The American College of Occupational and Environmental Medicine