Article Text

Interventions to facilitate return to work in adults with chronic non-malignant pain: a protocol for a systematic review and network meta-analysis
  1. Mathilda Björk1,
  2. Björn Gerdle1,
  3. Gunilla Liedberg1,
  4. Frida Svanholm1,
  5. Marco Solmi2,
  6. Trevor Thompson3,
  7. Anna Chaimani4,
  8. Elena Dragioti1
  1. 1Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
  2. 2Neurosciences Department, University of Padua, Padua, Italy
  3. 3School of Human Sciences, University of Greenwich, London, UK
  4. 4Research Center of Epidemiology and Statistics Sorbonne Paris Cité (CRESS UMR1153), INSERM, INRA, Université de Paris, Paris, France
  1. Correspondence to Dr Elena Dragioti; elena.dragioti{at}


Introduction Work absenteeism due to chronic non-malignant pain (CNMP) is a major societal and individual cause of concern that requires effective treatments.

Objective We present a protocol for a systematic review and network meta-analysis (NMA) aiming to compare available interventions for return to work (RTW) in adults with CNMP.

Methods and analysis PubMed, Embase, PsycINFO, Web of Knowledge and Cochrane Central Register of Controlled Trials databases will be searched till 31 August 2020 for randomised controlled trials (RCTs) examining interventions for RTW outcomes among patients with CNMP. Two independent investigators will search the databases, perform data extraction and assess the methodological quality of the selected RCTs. The primary outcome will be RTW, if possible, full-time or part-time after work absence due to chronic pain from baseline to the last available follow-up. Secondary outcomes will include self-reported workability or work capacity, or self-reported physical functioning and quality of life as measured by any validated scale. Pairwise meta-analysis and NMA will be conducted for each outcome using a random-effects model. For the primary outcomes, we will also obtain the ranking of all competing interventions within each NMA using surface under the cumulative ranking curve. The assumption of coherence (ie, that direct and indirect evidence are in statistical agreement) will be examined using both a local and a global approach. We will also conduct subgroup and meta-regression analyses, whenever feasible, to investigate the unexplained variation in effect size. The comparison-adjusted funnel plot will be used to evaluate small-study effects. The overall quality of evidence will be rated with the Confidence in Network Meta-Analysis tool. Data analysis will be conducted using Stata V.16.0.

Ethics and dissemination This systematic review does not require ethical approval since it will not disseminate any private patient data. The results of this study will be disseminated through peer-reviewed publication.

PROSPERO registration number CRD42020171429.

  • rehabilitation medicine
  • pain management
  • occupational & industrial medicine

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  • Contributors ED conceived the idea and designed the review. ED, MB and AC wrote the first draft of this protocol, and MB, BG, GL, FS, MS, TT, AC and ED were responsible for the revision of the draft. All authors contributed to developing the search strategy and registering the protocol. ED and AC were the guarantors. All authors scrutinised and approved the final manuscript. AC and ED are joint last authors.

  • Funding This research was supported by a grant to ED by Sinnescentrum, Region Östergötland, Sweden (No. SC-2019-00155-41). The funding body did not take part in the collection, analysis and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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