Assessing fitness for work and writing a "fit note".

Findings have been mainly observational and thus may be influenced in part by health related selection for work. Nevertheless, a “best evidence synthesis” based largely on a review of systematic reviews concluded that the overall weight of evidence pointed strongly to health benefits from employment. When treating patients of working age, doctors should therefore always consider the impact of their illness or injury on their capacity to work, and whether optimal t iming of a return to work is an important element of their rehabilitation. Direct evidence that earlier return to work can accelerate recovery from illness or prevent long term incapacity is lim‐ ited. One systematic review of experimental and observational studies found strong evidence that duration of “work disabil‐ ity” (encompassing a range of related outcomes such as self reported time to return to work, time in receipt of benefits) was reduced when the job was modified, but no consistent evidence for impact on quality of life. A systematic review of workplace rehabilitation for low back pain found only one study that assessed early return to work, and this suggested a reduction in pain and disability at six months. Against this, a systematic review of randomised controlled trials concluded that workplace interventions assisting return to work were not effective in improving health outcomes among workers with musculoskeletal disorders. And although a cohort study of employees absent from work with mental health problems found that earlier return to work was associated with a more favourable course of symptoms, this may have been because clinical improvement enabled a more rapid return to work. Nevertheless, the possibility that optimal timing of a return to work might lead to quicker recovery seems plausible, especially for disorders such as low back pain and acute limb injuries, which systematic reviews of randomised controlled trials have found to benefit from maintained activity or early mobilisation.