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CMAJ
CMAJ - June 2, 1998JAMC - le 2 juin 1998

Studying workplace health

CMAJ 1998;158:1434

See response from: S. Verma, L. Flynn
The review article "Wellness programs: a review of the evidence" (CMAJ 1998;158[2]:224-30 [full text]), by Denise Watt and colleagues, addresses an important topic but has 2 important limitations. First, limiting the search to the MEDLINE database excluded many high-quality journals that often publish articles on this topic. Second, insisting that the studies for review had to have randomized controlled designs further excluded many high-quality studies.

In 1996 and 1997 the American Journal of Health Promotion published a series of 11 reviews, written by a team of 22 authors, on the health impact of workplace health promotion programs. A total of 365 articles met the review criteria, of which 29% had randomized controlled designs and 26% had comparison groups that were not randomly assigned. The series drew specific conclusions about the impact of programs in each of the intervention areas, such as fitness, nutrition and stress management. It revealed that these programs produce positive short-term changes in knowledge, attitudes, behaviours and health conditions. The long-term impact of the programs was not clear, both because of relapse and because too few studies measured this. The studies with randomized controlled designs had positive effects, although these were not as strong as for the studies as a whole. The quality of research in this area must continue to improve, but it is already comparable to or better than that of research used to support most nondrug medical interventions.

In addition, a recent article covered 40 studies that met the review criteria.1 Overall, 88% of the studies showed cost savings because of reductions in medical care costs or absenteeism, or both. These ratios were similar for the studies that had randomized controlled designs and those that did not. Among the 13 studies that calculated cost­benefit ratios, the returns were all positive and ranged from US$2.50 to US$6.00 for each dollar invested. The studies with randomized controlled designs showed the highest rates of return.

Michael O'Donnell, PhD
Editor-in-Chief
American Journal of Health Promotion
Lawrence, Kans.

Reference

  1. Aldana S. Financial impact of workplace health promotion programs and methodological quality of the evidence. Art Health Promot 1998;2(1):1-8.

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