***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background To reduce the duration of sick leave and loss of productivity due to common mental disorders ( CMDs ) , we developed a return-to-work programme to be provided by occupational physicians ( OPs ) based on the principles of exposure in vivo ( RTW-E programme ) . This study evaluates this programme 's effectiveness and cost-effectiveness by comparing it with care as usual ( CAU ) . The three research questions we have are : 1 ) Is an RTW-E programme more effective in reducing the sick leave of employees with common mental disorders , compared with care as usual ? 2 ) Is an RTW-E programme more effective in reducing sick leave for employees with anxiety disorders compared with employees with other common mental disorders ? 3 ) From a societal perspective , is an RTW-E programme cost-effective compared with care as usual ? Methods / design This study was design ed as a pragmatic cluster-r and omized controlled trial with a one-year follow-up and r and omization on the level of OPs . We aim ed for 60 OPs in order to include 200 patients . Patients in the intervention group received the RTW-E programme .  Patients in the control group received care as usual .  Eligible patients had been on sick leave due to common mental disorders for at least two weeks and no longer than eight weeks . As primary outcome measures , we calculated the time until full return to work and the duration of sick leave . Secondary outcome measures were time until partial return to work , prevalence rate of sick leave at 3 , 6 , 9 , and 12 months ' follow-up , and scores of symptoms of distress , anxiety , depression , somatization , and fatigue ; work capacity ; perceived working conditions ; self-efficacy for return to work ; coping behaviour ; avoidance behaviour ; patient satisfaction ; and work adaptations . As process measures , we used indices of compliance with the intervention in the intervention group and employee-supervisor communication in both groups . Economic costs were calculated from a societal perspective . The total costs consisted of the costs of consuming health care , costs of production loss due to sick leave and reduced productivity , and out-of-pocket costs of patients for travelling to their OP . Discussion The results will be published in 2009 . The strengths and weaknesses of the study protocol are discussed . Trial registration IS RCT Background Considering the high costs of sick leave and the consequences of sick leave for employees , an early return-to-work of employees with mental disorders is very important . Therefore , a workplace intervention is developed based on a successful return-to-work intervention for employees with low back pain . The objective of this paper is to present the design of a r and omized controlled trial evaluating the cost-effectiveness of the workplace intervention compared with usual care for sick-listed employees with common mental disorders . Methods The study is design ed as a r and omized controlled trial with a follow-up of one year . Employees eligible for this study are on sick leave for 2 to 8 weeks with common mental disorders . The workplace intervention will be compared with usual care . The workplace intervention is a stepwise approach that aims to reach consensus about a return-to-work plan by active participation and strong commitment of both the sick-listed employee and the supervisor . Outcomes will be assessed at baseline , 3 , 6 , 9 and 12 months . The primary outcome of this study is lasting return-to-work , which will be acquired from continuous registration systems of the companies after the follow-up . Secondary outcomes are total number of days of sick leave during the follow-up , severity of common mental disorders , coping style , job content , and attitude , social influence , and self-efficacy determinants . Cost-effectiveness will be evaluated from the societal perspective . A process evaluation will also be conducted . Discussion Return-to-work is difficult to discuss in the workplace for sick-listed employees with mental disorders and their supervisors . Therefore , this intervention offers a unique opportunity for the sick-listed employee and the supervisor to discuss barriers for return-to-work . Results of this study will possibly contribute to improvement of disability management for sick-listed employees with common mental disorders . Results will become available in 2009.Trial registration IS RCT Background Musculoskeletal disorders ( MSDs ) are a major reason for impaired work productivity and sick leave . In 2009 , a national rehabilitation program was introduced in Sweden to promote work ability , and patients with MSDs were offered multimodal rehabilitation . The aim of this study was to analyse the effect of this program on health related quality of life , function , sick leave and work ability . Methods We conducted a prospect i ve , observational cohort study including 406 patients with MSDs attending multimodal rehabilitation .  Changes over time and differences between groups were analysed concerning function , health related quality of life , work ability and sick leave . Regression analyses were used to study the outcome variables health related quality of life ( measured with EQ-5D ) , and sick leave . Results Functional ability and health related quality of life improved after rehabilitation . Patients with no sick leave/disability pension the year before rehabilitation , improved health related quality of life more than patients with sick leave/disability pension the year before rehabilitation ( p = 0.044 ) . During a period of −/+ four months from rehabilitation start , patients with EQ-5D ≥ 0.5 at rehabilitation start , reduced their net sick leave days with 0.5 days and patients with EQ-5D < 0.5 at rehabilitation start , increased net sick leave days with 1.5 days ( p = 0.019 ) . Factors negatively associated with sick leave at follow-up were earlier episodes of sick leave/disability pension , problems with exercise tolerance functions and mobility after rehabilitation . Higher age was associated with not being on sick leave at follow-up and reaching an EQ-5D ≥ 0.5 at follow-up . Severe pain after rehabilitation , problems with exercise tolerance functions , born outside of Sweden and full-time sick leave/disability pension the year before rehabilitation were all associated with an EQ-5D level < 0.5 at follow-up . Conclusions Patients with MSDs participating in a national work promoting rehabilitation program  significantly improved their health related quality of life and functional ability , especially those with no sick leave . This shows that vocational rehabilitation programs in a primary health care setting are effective . The findings of this study can also be valuable for more appropriate patient selection for rehabilitation programs for MSDs Background Major depressive disorder is among the medical conditions with the highest negative impact on work outcome . However , little is known regarding evidence -based interventions targeting the improvement of work outcomes in depressed employees . In this paper , the design of a r and omized controlled trial is presented in order to evaluate the effectiveness of adjuvant occupational therapy in employees with depression . This occupational intervention is based on an earlier intervention , which was design ed and proven effective by our research group , and is the only intervention to date that specifically targets work outcome in depressed employees . Methods / Design In a two-arm r and omized controlled trial , a total of 117 participants are r and omized to either ' care as usual ' or ' care as usual ' with the addition of occupational therapy . Patients included in the study are employees who are absent from work due to depression for at least 25 % of their contract hours , and who have a possibility of returning to their own or a new job .  The occupational intervention consists of six individual sessions , eight group sessions and a work-place visit over a 16-week period . By increasing exposure to the working environment , and by stimulating communication between employer and employee , the occupational intervention aims to enhance self-efficacy and the acquisition of more adaptive coping strategies . Assessment s take place at baseline , and at 6 , 12 , and 18-month follow-ups . Primary outcome measure is work participation ( hours of absenteeism and time until work resumption ) . Secondary outcome measures are work functioning , symptomatology , health-related quality of life , and neurocognitive functioning . In addition , cost-effectiveness is evaluated from a societal perspective . Finally , mechanisms of change ( intermediate outcomes ) and potential patient-treatment matching variables are investigated . Discussion This study hopes to provide valuable knowledge regarding an intervention to treat depression , one of the most common and debilitating diseases of our time . If our intervention is proven ( cost- ) effective , the personal , economic , and health benefits for both patients and employers are far-reaching . Trial registration R and omised controlled trial to evaluate the effectiveness of collaborative care in a Dutch occupational healthcare setting : 126 workers on sick leave with major depressive disorder were r and omised to usual care ( n = 61 ) or collaborative care ( n = 65 ) . After 3 months , collaborative care was more effective on the primary outcome measure of treatment response ( i.e. reduction in symptoms of ≥50 % ) on the Patient Health Question naire-9 ( PHQ-9 ) . However , the groups did not differ on the PHQ-9 as a continuous outcome measure . Implication s of these results are discussed Background There is a paucity of method ologically robust vocational rehabilitation ( VR ) intervention trials . This study assessed the feasibility and acceptability of a VR trial of women with breast cancer to inform the development of a larger interventional study . Methods Women were recruited in Scotl and and r and omised to either a  case management VR service or to usual care .  Data were collected on eligibility , recruitment and attrition rates to assess trial feasibility , and interviews conducted to determine trial acceptability . Sick leave days ( primary outcome ) were self-reported via postal question naire every 4 weeks during the first 6 months post-surgery and at 12 months . Secondary outcome measures were change in employment pattern , quality of life and fatigue . Results Of the 1,114 women assessed for eligibility , 163 ( 15 % ) were eligible . The main reason for in eligibility was age ( > 65 years , n = 637 , 67 % ) . Of those eligible , 111 ( 68 % ) received study information , of which 23 ( 21 % ) consented to participate in the study . Data for 18 ( 78 % ) women were analysed ( intervention : n = 7 ; control : n = 11 ) . Participants in the intervention group reported , on average , 53 fewer days of sick leave over the first 6 months post-surgery than those in the control group ; however , this difference was not statistically significant ( p = 0.122 ; 95 % confidence interval −15.8 , 122.0 ) . No statistically significant differences were found for secondary outcomes . Interviews with trial participants indicated that trial procedures , including recruitment , r and omisation and research instruments , were acceptable . Conclusions Conducting a pragmatic trial of effectiveness of a VR intervention among cancer survivors is both feasible and acceptable , but more research about the exact components of a VR intervention and choice of outcomes to measure effectiveness is required . VR to assist breast cancer patients in the return to work process is an important component of cancer survivorship plans . Trial registration IS RCT Purpose . Test the feasibility and impact of an automated workplace mental health assessment and intervention . Design . Efficacy was evaluated in a r and omized control trial comparing employees who received screening and intervention with those who received only screening .  Setting . Workplace . Subjects . 463 volunteers from Boston Medical Center , Boston University , and EMC and other employed adults , among whom 164 were r and omized to the intervention ( N = 87 ) and control ( N = 77 ) groups . Intervention . The system administers a panel of telephonic assessment instruments followed by tailored information , education , and referrals . Measures . The Work Limitation Question naire , the Medical Outcomes Question naire Short Form-12 , the Patient Health Question naire-9 , question 10 from the Patient Health Question naire to measure functional impairment , and the Perceived Stress Scale-4 and questions written by study psychiatrists to measure emotional distress and social support respectively . The WHO-Five Well-being Index was administered to measure overall well-being . Analysis . Independent sample t-tests and χ2 tests as well as mean change were used to compare the data . Results . No significant differences on 16 of the 20 comparisons at 3- and 6-month time points . The intervention group showed a significant improvement in depression ( p ≤ .05 ) at 3 months and on two Work Limitation Question naire subscales , the Mental-Interpersonal Scale ( p ≤ .05 ) and the Time and Scheduling Scale ( p ≤ .05 ) , at 3 and 6 months respectively with a suggestive improvement in mental health at 6 months ( p ≤ .10 ) . Conclusions . This is a potentially fruitful area for research with important implication s for workplace behavioral interventions . ( Am J Health Promot 2011;25[3]:207–216 . Background To describe the design of a population based r and omized controlled trial ( RCT ) , including a cost-effectiveness analysis , comparing participative ergonomics interventions between 2–8 weeks of sick leave and Grade d Activity after 8 weeks of sick leave with usual care , in occupational back pain management . Methods Design : An RCT and cost-effectiveness evaluation in employees sick-listed for a period of 2 to 6 weeks due to low back pain . Interventions used are 1 . Communication between general practitioner and occupational physician plus Participative Ergonomics protocol performed by an ergonomist . 2 . Grade d Activity based on cognitive behavioural principles by a physiotherapist . 3 . Usual care , provided by an occupational physician according to the Dutch guidelines for the occupational health management of workers with low back pain . The primary outcome measure is return to work . Secondary outcome measures are pain intensity , functional status and general improvement . Intermediate variables are kinesiophobia and pain coping . The cost-effectiveness analysis includes the direct and indirect costs due to low back pain . The outcome measures are assessed before r and omization ( after 2–6 weeks on sick leave ) and 12 weeks , 26 weeks and 52 weeks after first day of sick leave . Discussion The combination of these interventions has been subject of earlier research in Canada . The results of the current RCT will : 
    Output:
    
We found moderate- quality evidence that workplace interventions reduce time to first RTW , high- quality evidence that workplace interventions reduce cumulative duration of sickness absence , very low- quality evidence that workplace interventions reduce time to lasting RTW , and moderate- quality evidence that workplace interventions increase recurrences of sick leave .
Overall , the effectiveness of workplace interventions on work disability showed varying results .
Workplace interventions reduce time to RTW and improve pain and functional status in workers with musculoskeletal disorders .
We found no evidence of a considerable effect of workplace interventions on time to RTW in workers with mental health problems or cancer .
We found moderate- quality evidence to support workplace interventions for workers with musculoskeletal disorders .
The quality of the evidence on the effectiveness of workplace interventions for workers with mental health problems and cancer is low , and results do not show an effect of workplace interventions for these workers .