The Effectiveness of Cognitive-Behavioral Therapy in Helping People on Sick Leave to Return to Work: A Systematic Review and Meta-analysis

Effectiveness of clinical healthcare interventions for enhancing the work participation of patients with various health conditions: a synthesis of systematic reviews

OBJECTIVES

This objectives of this study were to determine the effectiveness of clinical healthcare interventions designed for improving the work participation of patients with various health conditions and identify promising elements within these interventions.

DESIGN

A systematic literature search was conducted, and a synthesis of systematic reviews (SRs) was performed.

DATA SOURCES

MEDLINE, Embase, Cochrane Library and CINAHL were searched for articles published from January 2012 to December 2023.

ELIGIBILITY CRITERIA

SRs of randomised controlled trials evaluating the effectiveness of interventions that aimed at improving work participation initiated within clinical healthcare in patients being treated for various health conditions were included.

DATA EXTRACTION AND SYNTHESIS

Two authors independently used standardised methods to search and select SRs, and extract data. Our primary outcome was work participation, which could include return-to-work rate or sick leave duration. We were interested in both short-, medium-, as well as long-term outcomes. Risk of bias was assessed using the AMSTAR-2 tool. We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to evaluate the certainty of the evidence and findings were summarised in GRADE evidence profiles. We used a deductive synthesis to identify promising intervention elements.

RESULTS

The health conditions included in the selected SRs were cancer, chronic low back and musculoskeletal pain, coronary heart disease, inflammatory arthritis, complaints of the lumbopelvic region during pregnancy, stroke and traumatic brain injury. Across health conditions, many interventions trended towards small, favourable effects. Moderately certain evidence showed that multidisciplinary and physical interventions enhance work participation at 12 months for people with cancer (risk ratio (RR) 1.23, 95% CI 1.09 to 1.33 and RR 1.23, 95% CI 1.08 to 1.39, respectively), and that multidisciplinary interventions reduce the days of return to work compared with usual care for people with coronary heart disease (40.77 days lower than control, 95% CI -67.19 to -14.35). Low-certainty evidence suggested that multidisciplinary interventions may enhance work participation at 12 months for people with coronary heart disease (RR 1.56, 95% CI 1.23 to 1.98) and reduce the number of sick leave days at 12 months for people with chronic low back pain (82, IQR 51 to 164 vs 175, IQR 91 to 365; p=0.003). Promising elements included (psycho)education, cognitive-behavioural therapy, psychosocial support, group and vocational counselling and physical training.

CONCLUSIONS

There is considerable overlap in clinical healthcare interventions that aim to enhance work participation for patients across health conditions. Although their effects on work participation vary, some conditions show favourable response to multidisciplinary interventions. More evidence is needed on developing tailored interventions and evaluating their cost-effectiveness.

PROSPERO REGISTRATION NUMBER

CRD42022346552.

Effectiveness of cognitive behavioral therapy vs conservative pain management for occupational performance in patients with low back pain: a systematic review protocol

OBJECTIVE

This review aims to evaluate the effectiveness of cognitive behavioral therapy (CBT) compared with conservative pain management for improving the occupational performance of individuals with low back pain.

INTRODUCTION

Low back pain is a condition that describes pain between the lower edge of ribs and the buttocks. It is projected to affect 843 million people by 2050, with significant economic and occupational consequences. CBT is a growing treatment for chronic pain that aims to change maladaptive thoughts and behaviors. This review will examine the effectiveness of CBT for improving occupational performance.

INCLUSION CRITERIA

The review will focus on the effect of CBT on adults with musculoskeletal low back pain, whether acute, subacute, or chronic. It will analyze randomized controlled trials, cohort studies, case-control studies, and quasi-experimental studies to assess CBT's impact on occupational performance, including activities of daily living, work, and sleep.

METHODS

Two independent reviewers will screen titles, abstracts, and full-text manuscripts from PubMed, CINAHL (EBSCOhost), Web of Science Core Collection, Cochrane Library, OTSeeker, and ScienceDirect. Unpublished studies and gray literature will also be searched in ClinicalTrials.gov, Google Scholar, World Health Organization, and ProQuest Dissertations and Theses. A subgroup analysis will explore the effects of CBT on post-treatment outcomes, identifying sources of heterogeneity in its impact on activities of daily living, work, and sleep. Factors such as CBT type, delivery method, participant age, and low back pain chronicity will be considered. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach will assess evidence certainty, and a Summary of Findings will be provided.

REGISTRATION NUMBER

PROSPERO CRD42023472522.

Functional assertiveness with acceptance and commitment therapy for employees returning to work: a preliminary investigation

Owing to the ongoing global mental health crisis, providing support for employees returning to work after a mental health leave has become a crucial issue. This study aimed to preliminarily examine the efficacy of a functional assertiveness training program incorporating acceptance and commitment therapy (ACT) in a pilot study involving individuals who had taken a leave of absence due to mental health problems. As part of the program, eight group sessions were offered to these individuals in a group format while they attended an outpatient psychiatric clinic. The effectiveness of the program was assessed in terms of mindfulness, psychological flexibility, functional assertiveness, and difficulty in returning to work. A total of 29 participants took part in the program, and 28 participants completed it. A paired t-test and effect size analysis (Cohen's d) were conducted using data from 26 participants; two participants were excluded from the analysis due to post-test data was not collected. The results showed an increase in participants' mindfulness (observing, non-reactivity and non-judging), psychological flexibility, and functional assertiveness increased and their sense of difficulty in returning to work (especially difficulties arising from workplace relationships) decreased after the intervention. Although the lack of a control group makes it difficult to draw definitive conclusions, the results suggest that a functional assertiveness training program incorporating ACT may be beneficial for employees on leave due to mental health issues in returning to work.

Effect of cognitive-behavioral therapy on fatigue in cancer patients: a systematic review and meta-analysis

Background

Fatigue is a prevalent issue among cancer patients. Cognitive behavioral therapy (CBT) is an individualized intervention that empowers patients and caregivers to actively participate in the treatment process. A recent systematic review and meta-analysis examined the impact of CBT on fatigue in cancer patients.

Methods

Articles published up to April 2023 were systematically searched in Scopus, PubMed, and the Web of Science using relevant keywords. All randomized clinical trials (RCTs) investigating the effects of CBT on fatigue in cancer patients were included. Statistical analyses were conducted using Stata version 14, with a significance level set at a p-value of <0.05.

Results

The current systematic review and meta-analysis encompasses 10 RCTs. CBT demonstrated a significant reduction in fatigue scores among cancer patients [standardized mean difference (WMD): -2.50; 95%CI: -3.43, -1.56; I2 = 95.8%, p < 0.001]. This effect was consistent across all subgroup analyses.

Conclusion

This study underscores the significant impact of CBT on fatigue in cancer patients. Further randomized clinical trials focusing on various cancer types are warranted to validate and build upon these findings.

Being Cynical Is Bad for Your Wellbeing: A Structural Equation Model of the Relationship Between Cynicism and Mental Health in First Responders in South Africa

Cynicism has been associated with adverse mental and physical health outcomes. This study investigated the role of cynicism in relation to indices of mental health among South African first responders. Research has highlighted that first responders are at increased risk of adverse mental health outcomes owing to the nature of their work. The sample consisted of 429 participants who completed a brief demographic questionnaire and several research instruments: Turner Cynicism Scale, Chalder Fatigue Scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder Scale-7. Structural equation modeling was used to explore the relationship between cynicism and mental health indicators. It included a measurement model, which identified four latent variables-cynicism, fatigue, depression, and anxiety-and their respective indicators, and a structural model, which defined the relationships among these latent variables. Path analysis was used to explore the potential mediating role of fatigue in the relationship between cynicism and indices of mental health. The results demonstrated significant associations between cynicism and anxiety, depression, and fatigue. Fatigue also mediated the relationship between cynicism and indices of mental health. The results underscore the importance of recognizing and addressing cynicism as a critical factor in the mental health of individuals working in high-stress occupations.

Interventions to Support the Return to Work for Individuals with Stroke: A Systematic Review and Meta-analysis

PURPOSE

An increasing number of individuals with stroke are having difficulties in returning to work, having a significant impact on both individuals and society. The aims of this meta-analysis were to summarize the interventions to support the return to work (RTW) for individuals with stroke and to quantitatively evaluate the efficacy of each type of intervention.

METHODS

A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Embase, Cochrane Library, CINAHL, and PsycINFO were searched until 26 June 2023, and the list of references of the initially included articles was also searched. Two researchers independently performed the search, screening, selection, and data extraction. The primary outcome was RTW rate (the RTW rate was defined as the proportion of individuals who returned to work in each group (intervention and control) at the endpoint). Pooled risk ratio (RR) was estimated using a random-effects model with 95% confidence intervals (CIs).

RESULTS

A total of 13 studies representing 4,282 individuals with stroke were included in our study. Results showed that physiological interventions could improve the RTW rate of individuals with stroke (RR: 1.19, 95% CI: 1.01 to 1.42, I2 = 72%). And receiving intravenous thrombolytic therapy was beneficial in promoting the RTW in individuals with stroke. Subgroup analysis and meta-regression analysis showed that the individuals' functional status during hospitalization was the only source of heterogeneity. Psychological interventions had little or no effect on the RTW rate of individuals with stroke (RR: 1.20, 95% CI: 0.58 to 2.51, I2 = 30%). Work-related interventions had little or no effect on the RTW rate of the individuals with stroke (RR:1.36,95%CI: 0.99 to 1.88, I2 = 73%). The subgroup analysis showed that country, age, and follow-up method were the sources of heterogeneity.

CONCLUSION

Physiological intervention promoted the RTW of individuals with stroke. But, the effect of psychological and work-related interventions in promoting the RTW of individuals with stroke was not significant. We anticipate that these findings may inform the design of future interventions. For future research, we recommend that more high-quality randomized controlled trials be conducted to further promote the RTW of individuals with stroke.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO Registration Number, CRD42023443668.

Impact of fatigue on work productivity and health-related job loss

BACKGROUND

Fatigue is commonly reported in population surveys and has been identified in patients with health conditions as a key co-morbidity which makes remaining in work challenging. Such patients, however, rarely have access to programmes to help them manage their fatigue.

AIMS

To quantify the relationship between fatigue, work impairment and health-related job loss.

METHODS

We use data from the Health and Employment After Fifty study, a longitudinal study of people aged 50-64 years when recruited through general practices in England in 2013-14. During follow-up, fatigue was measured using the Fatigue Assessment Scale, work impairment was assessed using the Work Productivity and Activity Impairment scale, and changes in employment status were recorded.

RESULTS

A total of 2743 participants were eligible for the current analysis; 23% satisfied criteria for being fatigued. People who were fatigued were less likely to have a partner, university degree, be physically active and were more likely to be obese. Their job was more likely to involve shifts, be perceived as insecure, have reported difficulties coping with job demands, and be unsatisfying. After adjustment for socio-economic, lifestyle and work-related factors, they were almost twice as likely to report both work impairment (relative risk 1.8; 95% confidence interval [CI] 1.6, 2.1) and future health-related job loss, although the latter effect was only in those with other morbidities (incidence rate ratio 1.96; 95% CI 1.03-3.72).

CONCLUSIONS

Providing evidence-based support for workers with health conditions who experience fatigue may have an important impact at a population level in terms of extending working lives.