Impact of medical guidelines on employees' sickness absences and physicians' operations in cases of musculoskeletal pain

The occupational health physicians of the City of Helsinki were provided with instructions concerning the treatment of musculoskeletal pain and the need for and duration of sickness absence. The study examines the impact of the guidelines on sickness absences.




According to studies, many physicians find it difficult to assess the need for sickness absence and the duration and extent of incapacity for work. The practice of issuing a sickness absence also varies considerably between physicians.

In 2007, the Swedish National Board of Health and Welfare published national guidelines aimed at harmonizing practices in issuing sickness absences and improving the quality of care. The guidelines apply to more than 90 diagnoses that have most frequently led to granting sickness allowance in Sweden. The majority of physicians have benefited from the guidelines and feel that they have improved the quality of care and co-operation with the Försäkringskassan, other health care personnel and workplaces. The effects of the guidelines on sickness absences have not been studied.

In August 2019, a general recommendation related to the assessment of the need for sickness absence for physicians was published in Finland in the form of Current Care Guidelines. Previous studies have shown that the adoption of new practices in health care can take time. When staff are guided to change their activities through brief training sessions or new guidelines, changes in knowledge, skills and attitudes are often achieved, but practical operations may not change as expected. We need more research data on the factors that promote and hinder change in operations.

In January 2016, the City of Helsinki occupational health services (Occupational Health Helsinki) introduced medical guidelines related to the treatment of lower back pain (ICD-10 M54.5), shoulder pain (ICD-10 M75) and elbow pain (ICD-10 M77.1) as well as the assessment of the need for and duration of sickness absence.

The aim of the study is to examine the effects of these guidelines designed for physicians. Key research questions:

  1. Quantitative (register and survey data) analysis 
  • How the medical guidelines affected the sickness absences of the employees of the City of Helsinki in these diagnostic groups
  1. Qualitative (interview data) analysis
  • How and why have the medical guidelines affected the work of occupational physicians?
  • In the opinion of occupational health physicians, what factors other than the medical guidelines have affected the development of the City of Helsinki's employees' sickness absences, especially in these diagnostic groups?

Data and methods

Register study: The data of the project will be processed in accordance with the Personal Data Act, the University of Helsinki and the Helsinki Health Study study group's internal guidelines on the use of research data. 

Scientists analyse the data in anonymized form.

Interview study: Interviewees are asked for informed consent for the interview. The ethical working group of the Finnish Institute of Occupational Health has approved the interview study.

Our experts

Johanna Kausto

Johanna Kausto

Johanna.Kausto [at]
+358 30 474 2509


Kela, The Finnish Work Environment Fund and Finnish Institute of Occupational Health