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Introduction: In recent years, there has been growing attention given to work participation as a relevant and robust outcome for clinical care that addresses the preferences of working-age individuals with musculoskeletal disorders (MSDs). Several studies indicate that non-operative and operative care-as-usual for workers with MSDs, such as low back pain and knee osteoarthritis, do not appear to improve timely and sustainable return to work. This seems especially true for those performing physically demanding work. This keynote explores what we’ve learned from research and real-world applications to design more effective interventions for keeping these individuals with MSDs engaged in work.

Methods: A systematic literature review for all papers on MSDs published in the Scandinavian Journal of Work, Environment and Health in the past 50 years was used. For this abstract all papers on work participation were used. In addition, references to key publications were searched via google scholar, web of science and/or personal archives.

Results: The review found 1,056 papers and 52 studies reported on prognostic factors for work participation – 28 on personal factors and 24 on work-related factors. Twenty-eight studies reported on intervention studies to support work participation – 21 on workplace interventions and 7 on other types of interventions. Main findings were two fold. First, no specific stepwise conceptual model or framework was found regarding interventions to support work participation among workers with MSDs. Second, an early multifaceted approach addressing both personal and work-related factors as part of the care-as-usual for medically verified MSD seems effective. Thereby clinical care and occupational care is integrated and performed by several professionals including a case manager.

Discussion: Multidisciplinary approaches appear to be essential in promoting work participation among individuals with MSDs. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) framework offers a valuable starting point, as do the models proposed by Loisel, Evanoff, and their respective colleagues. However, these models should ideally be adapted to better address the specific needs of workers and the particular characteristics of MSDs. As a first step, intervention studies focused on work participation should clearly define their underlying conceptual model and explicitly describe how relevant prognostic factors are considered in their design and evaluation.

Conclusion: No stepwise conceptual model was identified for interventions supporting work participation in workers with MSDs. However, early multifaceted care that timely integrates clinical and occupational care, coordinated by a case manager, appears effective.