Wads of money are spent on pre-employment examinations, yet there is limited evidence that they help.

Employers often undertake pre-employment examinations in the hope that they will prevent people with medical problems aggravating their condition through work.

Researchers from the University of Sydney undertook a systematic review of existing research studies into pre-employment examinations.

The review found seven relevant studies, covering just under 6,000 employees.

The researchers found that a general pre-employment examination did not reduce sick leave.

There was some evidence that a task-focused examination could reduce sick leave.

There was no good evidence that a functional capacity evaluation reduced injury rates or time off work.

Between 2% and 35% of employees who went through the pre-employment process were rejected.

In two research papers there were attempts to reduce the risk of injury, after assessing the person’s condition. For example, if the person had a shoulder problem, they might be put in a job where they weren’t doing overhead work. These studies do not show evidence that trying to reduce the risk actually decreases the injury rate.

Pre-employment examinations have a long history. In some countries such as the Netherlands, employers are not able to do pre-employment examinations unless there is a particular occupational health and safety issue. For example, pilots are required to undergo pre-employment examinations, but an employer may not require it of a machine operator.

It is important for organisations to evaluate the amount of money they spend on pre-employment medical reviews. If one takes into account the cost of the assessment, the administrative costs of setting it up, the costs of reviewing the evaluation and then implementing the findings, the expense is considerable.

Considering that pre-employment examinations are often done on casual and full time staff, the cost to many organisations is significant.

These expenses need to be weighed against the opportunity costs. For example, could these funds be spent on training supervisors in how to work with employees in return to work? Could it be spent on setting up participatory ergonomic programs? There are a number of initiatives that have been shown to be successful in reducing work absence and workers compensation costs. Monies that this review indicates are being wasted because of pre employment examinations may be better directed towards such initiatives.

Authors

Mahmud N. Schonstein E. Schaafsma F. Lehtola MM. Fassier JB. Reneman MF. Verbeek JH. .

Authors Full Name

Mahmud, Norashikin. Schonstein, Eva. Schaafsma, Frederieke. Lehtola, Marika M. Fassier, Jean-Baptiste. Reneman, Michiel F. Verbeek, Jos H. .

Institution

Faculty of Health Sciences, University of Sydney, Cumberland Campus C42, PO Box 170, Lidcombe, NSW, Australia, 1825.

Title

Pre-employment examinations for preventing occupational injury and disease in workers.

Source

Cochrane Database of Systematic Reviews. 12:CD008881, 2010.

Abstract

BACKGROUND: Many employers and other stakeholders believe that health examinations of job applicants prevent occupational diseases and sickness absence.

OBJECTIVES: To evaluate the effectiveness of pre-employment examinations of job applicants in preventing occupational injury, disease and sickness absence compared to no intervention or alternative interventions.SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL, PsycINFO and PEDro (to December 2009) not restricted by date, language or publication type.

SELECTION CRITERIA: We included randomised controlled trials (RCTs), controlled before-after studies (CBA), and interrupted time-series (ITS) of health examinations to prevent occupational diseases and injuries in job applicants.

DATA COLLECTION AND ANALYSIS: Four review authors (NM, ML, JV, ES) independently selected studies, extracted data, and determined study quality. The studies were too heterogeneous for statistical pooling of results.

MAIN RESULTS: We included two RCTs, five CBA studies and two ITS. Seven studies with 5872 participants evaluated the screening process of pre-employment examinations and two studies with 2164 participants evaluated the measures to mitigate the risks found following the screening process.Of those studies that evaluated the screening process, one study found that a general examination did not reduce sick leave (Mean Difference -0.1 95% CI -0.5 to 0.3) but another study found that a more task focused examination did (MD -36 95% CI -68.3 to -3.8). One study found that incorporation of a bronchial challenge test decreased occupational asthma (trend change -2.6 95% CI -3.6 to -1.5). Three studies that included functional capacity evaluation found contradictory effects on injury rates and number of medical visits. The rates of rejecting job applicants varied from 2% to 35%.Neither of the two studies that evaluated risk mitigation found an increased injury rate after training or work accommodations had been implemented.We rated the evidence for all outcomes as very low quality.

AUTHORS' CONCLUSIONS: There is very low quality evidence that pre-employment examinations that are specific to certain jobs or health problems could reduce occupational disease, injury, or sickness absence. This supports the current policy to restrict pre-employment examinations to job-specific examinations. More studies are needed that take into account the harms of rejecting job applicants.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/21154401