Extensive variability of work participation outcomes measured in randomized controlled trials: a systematic review

Objective: To investigate how work participation outcomes in randomized controlled trials are measured internationally and across
Study Design and Setting: We identified trials that reported on work participation in Medline, Embase, PsycINFO and Cochrane
Central published between 2014 and 2019. Screening, selection, and data extraction were done by two authors independently. We
grouped outcomes into four categories (“employment status”, “absence from work”, “at-work productivity loss,” and “employability”)
and created subcategories according to how the outcome was measured.
Results: From 10,022 database hits we selected 269 trials reporting on 435 work participation outcomes. Authors used inconsistent
outcome terminology to describe the measured constructs. Grouped in four main categories we identified 70 outcomes that reported on
“employment status”, 196 on “absence from work” and return-to-work, 132 on “at-work productivity loss,” and 37 on “employability”
outcomes. Variability in measurement methods existed across all categories. Employment status and absenteeism measures consisted
mostly of clinimetrically unvalidated tools. “At-work productivity loss” and “employability” were measured by at least 41 different
Conclusion: Extensive variability exists among trials in the measurement of outcomes, measurement methods and measurement
instruments that focus on work participation. This study is a first step towards the development of a Core Outcome Set for work
participation. © 2021 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http:


This review is the first part of an initiative aiming to develop a COS for work participation and shows how work participation outcomes are measured in vocational and nonvocational RCTs for people with health problems.


Margarita Ravinskaya, Jos H. Verbeeka, Miranda Langendam, Joost G. Daams, Carel T.J. Hulshof, Ira Madan, Suzanne M.M. Verstappene, Marije Hagendijk, Regina Kunz, Jan L. Hoving


Journal: Journal of Clinical Epidemiology
Volume: 142
Pages: 60 - 99
Year: 2022
DOI: 10.1016/j.jclinepi.2021.10.013

Further Study Information

Current Stage: Completed
Funding source(s): SV is supported by Versus Arthritis (grant numbers 20385, 20380) and the NIHR Manchester Biomedical Research Centre.

Health Area

Disease Category: Other

Disease Name: N/A

Target Population

Age Range: 18 - 65

Sex: Either

Nature of Intervention: Other

Stakeholders Involved

Study Type

- Systematic review of outcomes measured in trials


- Systematic review

We retrieved data from trials that were identified in Medline, Embase, PsycINFO and Cochrane Central. The publishing timeframe was restricted to between January 01, 2014 and May 21, 2019