Do pre-employment examinations improve workers' occupational health outcomes?
There is limited evidence that task-focused examinations reduce sick leave and the incidence of musculoskeletal injuries; however, general pre-employment examinations have no effect on health outcomes. (Strength of Recommendation = B, based on inconsistent or limited-quality patient- oriented evidence)
Employers often ask family physicians to examine prospective employees to certify job fitness and to detect health risks that may be exacerbated by occupational factors. Prospective employees at increased risk of occupational diseases or injuries may be provided work accommodations or not offered employment. However, it is uncertain if pre-employment examinations actually improve workers' occupational health outcomes and, if so, which components of the examination are beneficial.
In this Cochrane review, the authors searched multiple electronic databases through December 2009 for randomized controlled trials, controlled before-after studies, and interrupted time-series that evaluated the effectiveness of pre-employment examinations in reducing occupational diseases or injuries, sickness absences, and/or medical visits. Nine studies met the inclusion criteria; six of these studies were conducted in the United States. Numbers of participants ranged from 71 to 6,125. Most studies had at least one year of follow-up.
One randomized trial found that Army recruits undergoing an examination that focused on the ability to perform specific work tasks had a mean of 36 fewer sick days (95% confidence interval, 3.76 to 68.24) than recruits undergoing a general examination. Another trial that randomized telephone company employees who underwent general examinations into groups in which results were or were not reported to the employer found no statistical difference in sick days taken. Several controlled before-after studies found that job-focused pre-employment examinations were associated with a reduced incidence of musculoskeletal injuries and medical visits. Evidence was conflicting about the effect of pre-employment examinations on the proportion of rejected job applicants.
An estimated one-half of U.S. workers undergo pre-employment examinations.1 The Americans with Disabilities Act forbids employers from requiring prospective employees to undergo a health examination before extending a job offer. However, employers may make job offers conditional on passing a pre-employment examination if this policy is applied consistently to all employees in a certain job category.2 Based on this Cochrane review, family physicians who are asked to perform pre-employment examinations should request detailed information from the patient or employer regarding essential job-related tasks and focus the examination on detecting existing conditions or injury risks that are relevant to those tasks.