Do return to work interventions for workers with disabilities and health conditions achieve employment outcomes and are they cost effective? A systematic narrative review

Purpose: The purpose of this paper is to evaluate existing evidence on whether return to work interventions achieve employment outcomes and are cost effective in order to better inform those needing accommodations at work, as well as their line managers and trade union representatives, occupational health specialists and HR managers. Design/methodology/approach: The paper uses a systematic narrative review to evaluate the evidence on the employment outcomes and cost effectiveness of return to work initiatives. Findings: Evidence on interventions for musculoskeletal conditions such as lower back pain indicates that certain forms of intervention such as vocational rehabilitation and workplace-based rehabilitation facilitate outcomes such as employment, reduced sick leave and effective return to work. However, there is very little evidence on whether these interventions are cost effective. More generally there are glaring gaps in evidence on cardio-respiratory (heart and breathing) and mental health conditions with regard to both employment outcomes and the cost of interventions. Research limitations/implications: This systematic review has critical and timely implications for both knowledge development and practice. While highlighting methodological limitations in the existing research base, it also presents avenues for further research on return work strategies and the factors inhibiting and facilitating their adoption and effective operation. Originality/value: Although there is much existent literature on the return to work process, far less attention has been paid to the employment outcomes and cost effectiveness of interventions. This paper highlights the interventions for musculoskeletal conditions such as lower back conditions that may result in positive employment outcomes, with implications for practice. However, it also highlights gaps in evidence on the employment outcomes and cost effectiveness of interventions for cardio-respiratory (heart and breathing) and mental health conditions.