5 Recommendations for research

The PDG has made the following recommendations to fill the most important gaps in the evidence.

These recommendations are aimed at:

  • Research councils.

  • Government departments including the Department for Work and Pensions.

  • Local and regional authorities and primary care trusts.

  • National and other research commissioners and funders such as the National Institute for Health Research.

Recommendation 1: prevention

What action should they take?

Commission or undertake research to identify activities which can prevent the first occurrence of sickness absence or reduce further occurrences of sickness absence. These may include:

  • pre-employment health assessments to identify existing health problems

  • workplace adjustments

  • application of the Disability Discrimination Act (HM Government 1995/2005)

  • health, safety and wellbeing interventions for example: risk assessment and control strategies covering chemical, physical, biological and psychological hazards; health promotion; and health and safety training

  • occupational health services, for example, physiotherapy, counselling, health assessments, health surveillance and biological monitoring (such as biological assessments for musculoskeletal disorder or mental health assessments) and the use of screening tools

  • human resource strategies such as flexible working practices, the provision of parental or carers' leave and dignity at work policies and practices.

Recommendation 2: evaluation

What action should they take?

Commission evaluations to establish the effectiveness of interventions to help people return to work (paid or unpaid) after experiencing long-term sickness absence or recurring short- or long-term sickness absence. This includes interventions aimed at those in receipt of incapacity benefit or employment and support allowance (ESA). It also includes treatment-related interventions. Evaluations should:

  • Use combined quantitative and qualitative methods to consider the context, process, content and experience of those involved and the impact (including the costs and health effects) of the intervention. Barriers and facilitators should also be investigated. For complex interventions, use the approach recommended in the Medical Research Council guidelines (2008).

  • Consider using a bio-psychosocial model of health to develop any research questions.

  • Where possible, use longitudinal designs and comparison/well-matched control groups to measure impact. Evaluations should be sufficiently powered to assess a sustained return to work (rather than other end points). They should also avoid selection bias. Drop-out and follow-up numbers should be measured.

  • Describe the theoretical links between the context, process, structure and impact of the interventions.

  • Describe the primary reasons or conditions causing the sickness absence or incapacity and the duration of the absence. Use definitions of health conditions that encapsulate symptom patterns as well as diagnostic paradigms.

  • Describe in detail the content of the intervention, when it was delivered, by whom, in what setting and at what point during the individual's absence or incapacity. Describe how health and safety or other policies were applied.

  • Define and collect appropriate process and outcome measures for baseline and follow-up (across a series of time points) of intended and unintended, short, intermediate and long-term impacts (positive and negative). Ensure follow-up periods are long enough for any improvements in work-related outcomes to be evaluated – in particular, to cover a sustained return to paid or unpaid work in a temporary or permanent new job or in the same job (albeit with modifications). Use validated outcome measures, where possible.

  • Use 'presenteeism' (in addition to absenteeism) as an outcome measure along with quality of working life measures and other work-related outcomes.

  • Where multi-component interventions are used, identify whether the outcome is due to one or a combination of components.

  • Determine if interventions are more effective for particular groups (groups could be defined by sex/gender, age, race/ethnicity, socioeconomic status, disability, sexual orientation, religion/belief or any other characteristic). Ensure there is a wide representation of population groups and health conditions.

  • Consider the perceived advantages and disadvantages of any compulsory versus voluntary components of the intervention, taking into account both the views of those delivering it and recipients.

  • Ideally publish in peer-reviewed scientific literature and not just as evaluation reports.

Recommendation 3: return-to-work programmes and interventions

What action should they take?

Determine if the following help those experiencing long-term or recurring short- or long-term sickness absence or recipients of incapacity benefit (or ESA) return to work. Commission independent evaluations to achieve this.The evaluations should take into account the content of research recommendation 2.

  • Expert Patients' Programme.

  • Conditions Management Programme.

  • Regional NHS Employability schemes.

  • Job retention schemes.

  • Fit for work schemes.

  • Pathways to Work and any other similar programmes or interventions, such as rehabilitation or psychosocial interventions which aim to promote a return to work.

  • Clinical combined with return-to-work interventions for low back pain, musculoskeletal disorders and mental health problems.

  • Multi-disciplinary interventions which aim to prevent the occurrence of long-term or recurring short-term sickness absence or the move from short- to long-term sickness absence.

Recommendation 4: cost effectiveness

What action should they take?

Gather evidence on the costs and benefits of interventions to help those experiencing long-term sickness absence or recurring short- or long-term sickness absence return to work (paid or unpaid). This should include interventions aimed at those in receipt of incapacity benefit and ESA. In particular:

  • Where appropriate, include economic evaluation as an integral part of funded evaluation studies.

  • Where possible, use validated long-term outcome measures to assess the impact on health and a sustained return to work, alongside any other benefits.

  • Consider the time that should elapse before outcomes are measured (public health outcomes often require long follow-up periods).

  • Take careful account of the costs of delivering (or not delivering) the intervention or, in the absence of cost information, identify the level of resources used.

  • Ensure evaluations are not limited to the costs to, and benefits for, the NHS.

More detail on the gaps in the evidence identified during development of this guidance is provided in appendix D.

  • National Institute for Health and Care Excellence (NICE)