The Cochrane occupational unit or Cochrane Work is a part of the Cochrane Collaboration.   Based at the Finnish Institute for Occupational Health, the unit aims to gather evidence on the effectiveness of occupational health interventions and stimulate systematic reviews on these interventions. From Melbourne, Australia to Kuopio, Finland, RTW Matters spoke with Coordinator Jos Verbeek.

“The idea of the Cochrane Occupational Health Field is that we cover the whole range of interventions that would be beneficial for workers or to improve occupational health outcomes,” said Jos. “We define occupational health outcomes as occupational diseases, occupational injuries but also disability and sickness absence.” The Occupational Health Field has published specific systematic reviews for return to work (RTW) for people with depression, stress-related problems, and for cancer survivors. (Keep your eyes peeled for links to these reviews coming up.)

When asked about the difficulty of doing systematic reviews of RTW interventions, Jos said that gathering the data is easier than many people think. “Because most RTW interventions are directed at individuals, or at least at individual cases, from the methodological point of view you can make quite good quality studies by randomising the intervention.”

“There are two different approaches,” he said. “One is from the point of view of interested clinicians who see that they can cure their patients, but that there is still something missing, then they get interested in RTW and trying to improve the RTW or employment rates. And then there are many studies that are from the company's point of view, or the worker's or the employer's point of view.

Medical practitioners must be snapping up all this great research, right?

Wrong. Getting the research into practice can be tricky business,

“The problem is that many people who may be able to get the evidence into practice have set beliefs.  They may have built up expertise over many years and convey strong authoritative positions.  Not all experts are convinced that using evidence instead of their own expertise is most helpful. It's a challenge.”

"For example, a review of research on training employees how to lift has shown it doesn't reduce injuries or problems.  But training on stress management for nurses makes a substantial difference and helps.  Yet these results have met with disbelief and disquiet from health and safety agencies; it is hard to see change based on the evidence coming soon." 

So how do we overcome this challenge?

“I think if we knew that it would be the golden bullet and we would be very happy and rich. Because I think that's the major problem; how to get knowledge transferred from the ivory tower to a real practice.”

But Jos doesn't consider it an impossible situation. He believes there are two ways in which the Field's specific RTW knowledge can get into everyday use.  “One way is a more traditional, clinical way where you make guidelines for physicians which would be considered the professional standard or the best professional way of doing it,” said Jos, hopeful that things are moving in the right direction.

“There's a lot of knowledge and ideas about how to implement these clinical guidelines so I think the occupational physicians wouldn't be the problem, or the occupational health practitioners could be reached by making more and better guidelines.”

“Of course we also need the involvement of employers and the involvement of workers and unions and I think this is much more difficult. They're not used to evidence-based policy-making and usually there are very strong political opinions about what is best to help or enhance worker health and safety. I think that would be a part of it. There are such strong beliefs or such strong opinions about it.”

Jos worked in the Netherlands creating practice guidelines for and with occupational physicians. There, he said, the local culture and habits of the medical community were very important to the guidelines being accepted. “The guidelines project in the Netherlands was very successful,” he said. “I think all occupational physicians in the Netherlands saw that these guidelines had been developed by their professional association, and they regarded these guidelines as something valuable and something that is really owned by their professional, which has increased their status and also increased it in the view of other medical professions. So they are very keen on showing or at least telling other people that the guidelines are important and should be followed.”

A sense of ownership over the guidelines, it seems, makes practitioners more likely to promulgate them.

When the Cochrane Work unit began scepticism was rife. “Many people in the occupational health field were very sceptical about the Cochrane reviews because they didn't think that there would be enough evidence to show if an intervention was working or not working. I think that in the past five years we have shown that at least the evidence is available and the methods are available, and that you can make a fairly strong statement about the effectiveness or non-effectiveness of a range of occupational health interventions – and I think that's very good, that's an achievement.”