Abstract:
Background: Earlier research have revealed risk factors for sick leave in the workplace, and thus the workplace
has become an important arena for sick leave prevention and return to work (RTW). Despite that, some of these
aspects have received little attention in exploratory studies. Simultaneously, there is a need to translate and
implement the growing knowledge base in this field in order to develop evidence-based practice (EBP).
Aim: The aim of the present research was to explore some aspects of workplace-based sick leave prevention and
RTW, such as workplace interventions (studies III, IV, and the appendix), leadership qualities (study I), and
work demands (study II), and also to reveal challenges to translating scientific knowledge into intervention
decisions in the RTW process, and possible solutions to these challenges (study III).
Methods: Content analysis methods were applied on data from interview transcripts and documents. In
addition, a Cochrane systematic review of the literature was conducted.
Results: Study I identified 78 distinct leadership qualities and seven leadership types (n = 345 meaning units)
perceived by 30 employees on long-term sick leave and their immediate supervisors. The three most valued
leadership qualities were “ability to make contact”, “being considerate”, and “being understanding”. The three
most valued leadership types were the Protector, the Problem-Solver, and the Contact-Maker. The subordinates
gave more descriptions of the Encourager and the Recognizer, whereas the supervisors most often described the
Responsibility-Maker and the Problem-Solver. The combination of leadership types reported most frequently
was the Protector together with the Problem-Solver. In study II, eight employees on long-term sick leave due to
musculoskeletal diseases and disorders described 51 work demands they had experienced. The demands were
perceived in some cases as having only a negative or a positive impact on work performance, but in others as
both. Only seven of the demands were physical in nature, and most involved emotional and cognitive challenges
in mastering the work tasks. It was also experienced that most demands came from the employee (n = 36) and
only a few from the employer/work environment (n = 7) or both those sources (n = 8). Study III was a
hypothetical case study aimed at revealing the challenges associated with translating scientific evidence into
intervention decisions in the RTW process. This investigation was performed according to EBP frameworks.
The evidence seemed to differ depending on whether it came from preventive, curative, or rehabilitative
interventions. Moreover, it appeared that evidence in some cases originated from “good-for-all” interventions
but in others from “tailored-type” interventions. Thus, a need to differentiate the roles of evidence was revealed
in terms of whether it inspired, challenged, enlightened, informed, or determined the intervention decision. In
general, the evidence-based framework seemed to construct a confined decision process. Possible solutions, and
revised EBP steps were suggested. In study IV, 15 workplace interventions were identified (n = 306 meaning
units), which were intended to reduce sick leave rates in 12 municipalities. The interventions were divided into
two groups according to their targets in the organizations: nine organizational-workplace interventions targeted
structures, processes, and culture (n = 220 descriptions, 72%); six employee-workplace interventions targeted
persons (n = 86 descriptions, 28%). Examples of organizational-workplace interventions were developing
routines/systems, establishing cooperation/ collaboration, providing information/education, building
culture/anchoring, and recruiting/staffing. Employee-workplace interventions involved well-being/lifestyle
interventions, physical activity/exercise, redeployment, adaptation, follow-up of employees on sick leave, and
RTW programmes. The intervention profiles varied considerably between the municipalities. In the appendix
(study V), a Cochrane systematic review of the literature was conducted to reveal the content and effectiveness
of workplace interventions for employees with neck pain. Of 1,995 references found, 10 randomized controlled
trials (RCTs) were included. Two of the RCTs had low risk of bias, and eight of them examined office workers.
Few were on sick leave. Only three of the ten studies assessed the outcome of sick leave. The workplace
interventions varied considerably regarding complexity and content. Overall, evidence was of low quality and
showed no significant impact of workplace interventions on pain reduction (seven RCTs, 2,368 workers).
Furthermore, one RCT, with 415 workers revealed that workplace interventions were significantly more
effective in reducing sick leave in the intermediate term (OR 0.56, 95% CI 0.33–0.95), but not in the short or the
long term.
Conclusions: The results reported in this thesis revealed a variety of terminology related to workplace
interventions, leadership qualities, and work demands, which might contribute to more in-depth understanding
of sick leave prevention and RTW at workplaces. It was a challenge to trying to use evidence from randomized
controlled trials in the RTW process, and the results call for new EBP approaches to translate evidence into
decisions concerning complex workplace interventions. The current research also revealed that knowledge about
the effectiveness of workplace interventions is still limited.
