Vocational rehabilitation programs for workers with knee osteoarthritis: a systematic review

Introduction
Most people with knee osteoarthritis (OA) and those who have undergone knee arthroplasty who are still in the workforce report that their work capacity is affected. There is a need to identify evidence-based vocational rehabilitation programs to help ensure that this population maintains their capacity to work or return to work safely. The purpose of this review was to draw up an inventory of vocational rehabilitation programs aimed at job retention and/or return to work offered to knee OA patients and identify which programs were the most effective. 

Methods
A systematic review was performed using Medline, Embase, HealthStar, CINAHL, AMED, MANTIS and EBM reviews (up to June 2011). Three sets of keywords (KW) were used for this search: 1) KW relating to knee OA; 2) KW relating to knee arthroplasty; and 3) KW relating to vocational rehabilitation programs or organizational policies/initiatives aimed at job retention or a return to work. No restrictions on study design, publication year or language were applied. Two reviewers independently evaluated the relevance and quality of each article. 

Results
Following a systematic evaluation of the articles, only 1 article was considered relevant among the 144 articles from the combination of sets 1 and 3 and none among the 81 articles from the combination of sets 2 and 3. 

Discussion
These results clearly indicate a paucity of research in the field of vocational rehabilitation for patients with knee OA and those who have undergone knee arthroplasty. While significant efforts have been made over the last 20 years to develop and implement vocational rehabilitation program for workers with other musculoskeletal disorders, an important knowledge gap exists in terms of knee OA. Several research priorities can be suggested to bridge this gap.