The quality of evidence is downgraded by inconsistency (heterogeneity in co-interventions) and imprecise results (few studies for each comparison).
A Cochrane review included 9 randomized trials with a total of 1546 participants in examining the effects of psychological interventions to return to work. The patients were adults on sick leave because of adjustment disorders (defined by DSM-IV or ICD-10 diagnostic criteria) or similar distress conditions defined by screening instruments excluding other mental disorders. Four studies were performed in occupational health, 2 in primary care practice, and 3 studies in specific Stress Clinics. Patients were on sick leave at the start of the study: the duration varied from approximately 2 months in 4 studies, to 1 year in one study, and the rest were not reported. The psychological therapies examined were either cognitive behavior therapy (CBT) or problem solving therapy (PST), provided individually for the most.
Patients receiving PST or CBT had shorter period to return to work; for CBT the difference was however not statistically significant. There was no difference between PST and CBT (based on 1 study).
| Outcome | Number of trials (participants) | Control: Non-guideline based care | Intervention: PST | Effect size (95 % CI) |
|---|---|---|---|---|
| Full return to work | 2 (342) | 156 and 91 days | 153 and 67 days | MD -17.73 (-37.35 to 1.90) |
| Partial return to work | 1 (192) | 53 days | 36 days | MD -17.00 (-26.48 to -7.52) |
| Outcome | Number of trials (participants) | Control: No intervention | Intervention: CBT | Effect size (95 % CI) |
| Full return to work | 1 (105) | 252 days | 216 days | MD -35.73 (-113.15 to 41.69) |
| Partial return to work | 2 (159) | 88 days | 80 days | MD -8.78 (-23.26 to 5.71) |