Musculoskeletal disorders are a common problem that may lead to func-Ational limitations and (work) disability. It is not clear yet how improvement in Apain or functional limitations is related to return to work after an episode of sick Aleave. Furthermore, several physicians are involved in the treatment and man-Aagement of a patient is on sick leave. In the Netherlands a strict separation be-Atween treating physicians and occupational physicians exists, whereby the treating Aphysician treats the disorder and the occupational physician manages return to Awork. Will a better collaboration between occupational health and curative care Aresult in a quicker return to work? A Chapter 2 presents a systematic review of 19 articles of the effects of treat-Ament of impingement syndrome on the associated functional limitations and re-Aturn to work. For functional limitations, there is strong evidence that extracorpo-Areal shock-wave therapy is not effective, and moderate evidence that exercise Acombined with manual therapy is more effective than exercise alone, that ultra-Asound is not effective, and that open and arthroscopic acromioplasty are equally Aeffective on the long term. For all other interventions there is only limited evi-Adence. We found many studies using range of motion and pain as outcome meas-Aures but functional limitations were less often used as an outcome measure in this Atype of research. Duration of sick leave was seldom included as an outcome meas-Aure. Although recovery on functional limitations is not equal to return to work A(RTW), the effectiveness of interventions with regard to ability to work or dura-Ation of sick leave does not seem to differ from the effectiveness on functional limi-Atations. A The controlled trial in chapter 3 evaluated a training for general practitioners Aand occupational physicians for patients on sick leave due to low back pain (LBP). AThe goal of this training was to improve collaboration which might improve a pa-Atient’s recovery and shorten sick leave. In a controlled trial the intervention in one Aregion was compared with usual care in a control region. In each region 56 LBP Apatients on sick leave for 3-12 weeks were included. These patients filled out three Aquestionnaires; at inclusion, three and six months later. Information on sick leave Awas gathered from occupational health services. There was little collaboration be-Atween physicians during the project. Patients in the intervention region returned Ato work significantly later (p=0.005) but were significantly more satisfied with Atheir occupational health physician (p=0.01). No differences were found between Athe intervention and control patients for pain, disability, quality of life, and medi-Acal consumption.

Koes, Prof. Dr. B.W. (promotor), Verhaar, Prof. Dr. J.A.N. (promotor)
B.W. Koes (Bart) , J.A.N. Verhaar (Jan)
Erasmus University Rotterdam
Erasmus MC: University Medical Center Rotterdam

Faber, E. (2007, January 18). Management of Sick Leave due to Musculoskeletal Disorders. Retrieved from