The effectiveness of vocationally oriented multidisciplinary intervention on sickness absence and early retirement among employees at risk: an observational study.

OBJECTIVE: To study the effect of a preventive vocationally oriented intervention on rates of sickness absence and disability pension in employees considered to be at risk of future work disability.
DESIGN: An observational register-based study of public sector employees.
SUBJECTS: 2236 intervention programme participants and 8944 matched controls were followed up for 8 years.
METHODS: Multidisciplinary intervention was carried out at rehabilitation institutions. Data on demographics and sickness absences were obtained from employers' records and information about health at baseline, participation in the intervention and subsequent disability pension from national registers.
RESULTS: Before the intervention participants had 17% more annual sick leave days and a 23% higher rate of absence spells lasting >21 days than controls. In the intervention year and 3 subsequent years, the sickness absence rate among participants reduced to that observed among controls but thereafter increased to the pre-intervention level (p for curvilinear trend <0.001 for absence days and 0.03 for absence spells). The association between the intervention and future disability pension was non-proportional among participants. Compared to controls, risk among participants was lower in the first 4 years of follow-up but thereafter returned to the previous higher level. The temporary decline in sickness absence attributable to the intervention totalled 6673 absence days per 1000 employees and the cumulative reduction in disability was 56.4 years. These direct health benefits may not fully cover the costs of the intervention.
CONCLUSION: The risk of work disability can be temporarily reduced in employees at risk by means of a vocationally oriented multidisciplinary intervention programme.