PT  - JOURNAL ARTICLE
AU  - Mark Gabbay
AU  - Lorraine Taylor
AU  - Linda Sheppard
AU  - Jim Hillage
AU  - Clare Bambra
AU  - Fiona Ford
AU  - Richard Preece
AU  - Nichole Taske
AU  - Michael P Kelly
TI  - NICE guidance on long-term sickness and incapacity
AID  - 10.3399/bjgp11X561221
DP  - 2011 Mar 01
TA  - British Journal of General Practice
PG  - e118--e124
VI  - 61
IP  - 584
4099  - http://bjgp.org/content/61/584/e118.short
4100  - http://bjgp.org/content/61/584/e118.full
SO  - Br J Gen Pract2011 Mar 01; 61
AB  - Long-term sickness absence and incapacity benefits (disability pension) rates have increased across industrialised countries. Effective measures are needed to support return to work. The recommendations of this guidance were informed by the most appropriate available evidence of effectiveness and cost-effectiveness. Public health evidence was provided by research using a variety of study designs that attempted to determine the outcome of a particular intervention by evaluating status before and after the intervention had been effected, and was not limited to randomised control trials. Where the evidence base was depleted or underdeveloped, expert witnesses were called to give their opinion on the best available evidence and emerging interventions. The process enabled challenge and contestability from stakeholder groups at different points as the guidance was developed. Forty-five heterogeneous studies were included in the review of interventions to reduce long-term sickness absence and transitions from short-term to long-term absence (mainly covering the former and also mainly examining musculoskeletal conditions). The analysis of evidence was restricted to descriptive synthesis. Three general themes emerged from an analysis of the studies that were more likely to report positive results: early interventions; multidisciplinary approaches; and interventions with a workplace component. Two further reviews were undertaken, one on interventions to reduce the re-occurrence of sickness absence, which identified seven studies on lower back pain, and concluded that early intervention and direct workplace input are important factors. The final evidence review focused on six studies of interventions for those in receipt of incapacity benefit. The evidence was that work-focused interviews coupled with access to tailored support are effective and cost-effective interventions. Practitioners should consider the impact of interventions and management options on work ability for patients of working age. Work ability should be considered a key outcome for future intervention studies.