Effectiveness of Pre-Employment Medical Examinations in Preventing Occupational Injury and Disease: A Systematic Review

Background: Pre-employment medical examinations are widely used to assess fitness for work. Identifying health abnormalities does not establish prevention of occupational harm. This review examined their effectiveness in reducing occupational injury, disease, and sickness absence, distinguishing programme evaluations from studies of predictive validity. Methods: Comparative and longitudinal research published through 31 August 2026 was considered. Contextual literature addressed screening validity and employment consequences. Fifteen original research reports were synthesized narratively because examination content, occupations, comparators, and outcomes differed substantially. Results: Ten reports evaluated screening programmes or subsequent risk mitigation, and five examined prediction of later injury or disease. General examinations offered no clear benefit for nonhazardous light-duty work. Selected job-specific programmes reported fewer musculoskeletal injuries, although historical comparisons, differences between workers, and concurrent interventions restricted causal interpretation. A military trial reported 648 versus 612 days fit for duty over two years. Functional testing predicted injury in some industrial cohorts, whereas testing among 538 paramedics did not distinguish subsequent injury risk. Nerve-conduction screening produced inconsistent prediction of carpal tunnel syndrome and low positive predictive values. Data concerning occupational disease was sparse and concentrated on asthma and carpal tunnel syndrome. Conclusions: Findings favour cautious, occupation-specific assessment linked to accommodation and risk reduction rather than universal medical exclusion. Reliable prevention estimates require prospective comparisons. Comparisons must measure subsequent health outcomes, rejected applicants, costs, and employment consequences.