Table 2 Assessment criteria and judgements for RtW coordination in Finland

Priority of the problem

Long-term sick leave has an important impact on the worker and the society in terms of productivity. RtW is a recognized priority by policy-makers in Finland

Benefits and harms

RtW coordination compared to usual care neither increases nor decreases the length of sick leave, and does not increase the number of workers returning to work

Certainty of the evidence^a

Moderate quality evidence for the outcomes:

  Cumulative sickness absence in workdays for follow-up of 6 months and more than 12 months

  Proportion who had ever returned to work—long-term follow-up: 12 months

Low quality evidence for the outcomes:

  Time to return to work: for follow-up of 6 months, 12 months and more than 12 months

  Cumulative sickness absence in workdays—long-term follow-up: 12 months

  Proportion who had ever returned to work—very long-term follow-up: more than 12 months

  Proportion at work at end of the follow-up—follow-up: 6 months, 12 months, more than 12 months

Very low-quality evidence for the outcomes:

  Proportion who had ever returned to work—short-term follow-up: 6 months

Outcome importance

The included evidence does not provide information on stakeholders’ values of a possibly small decrease in the duration of sick leave. Duration of long-term sick leave in Finland lasts on average 106 days. A small decrease of sick leave by 5 days might not be that relevant to the individual worker but might be relevant for the employer, especially of small companies and blue-collar workers

Balance between desirable and undesirable effects

Coordination of RtW did not have a desirable or undesirable effect on RtW

Resource use

 Resource requirements

The analysis of the costs showed that the saving from the reduction of 5 days of sick leave outweighed by 1.6-fold the cost of RtW coordination

 Certainty of the evidence

The analysis of the costs was done as a brief calculation that may not include all important items of the costs and benefits of RtW coordination, such as the costs of implementing the plan

 Impact on health equity

Interventions that increase RtW improve the access to the labour market and decrease inequity between healthy and disabled workers. The effect of usual care and RtW coordination on sick leave might be similar

 Acceptability

The intervention is already a common intervention by occupational health service providers in Finland [24]. We did not evaluate the attitudes of workers, employers and health service providers towards the intervention

 Feasibility

Our survey showed that the intervention might not be implemented according to the recommendations. We did not evaluate important barriers that would prevent the implementation of RtW coordination in Finland