BackgroundInflammatory arthritis leads to work disability, absenteeism and presenteeism (i.e. at-work productivity loss) at high cost to individuals, employers and society. A trial of job retention vocational rehabilitation (VR) in the United States identified this helped people keep working. The effectiveness of this VR in countries with different socioeconomic policies and conditions, and its impact on absenteeism, presenteeism and health, are unknown. This feasibility study tested the acceptability of this VR, modified for the United Kingdom, compared to written advice about managing work problems. To help plan a randomized controlled trial, we tested screening, recruitment, intervention delivery, response rates, applicability of the control intervention and identified the relevant primary outcome.MethodsA feasibility randomized controlled trial with rheumatoid, psoriatic or inflammatory arthritis patients randomized to receive either job retention VR or written information only (the WORK-IA trial). Following three days VR training, rheumatology occupational therapists provided individualised VR on a one to one basis. VR included work assessment, activity diaries and action planning, and (as applicable) arthritis self-management in the workplace, ergonomics, fatigue and stress management, orthoses, employment rights and support services, assistive technology, work modifications, psychological and disclosure support, workplace visits and employer liaison.ResultsFifty five (10%) people were recruited from 539 screened. Follow-up response rates were acceptable at 80%. VR was delivered with fidelity. VR was more acceptable than written advice only (7.8 versus 6.7). VR took on average 4 h at a cost of £135 per person. Outcome assessment indicated VR was better than written advice in reducing presenteeism (Work Limitations Questionnaire (WLQ) change score mean: VR = −12.4 (SD 13.2); control = −2.5 (SD 15.9), absenteeism, perceived risk of job loss and improving pain and health status, indicating proof of concept. The preferred primary outcome measure was the WLQ, a presenteeism measure.ConclusionsThis brief job retention VR is a credible and acceptable intervention for people with inflammatory arthritis with concerns about continuing to work due to arthritis.Trial registration ISRCTN 76777720. Registered 21.9.12.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1671-5) contains supplementary material, which is available to authorized users.

Background: Perinatal mental illnesses are a major public health issue, which untreated can have devastating impacts on women and their families. Problems with emotion regulation are a common feature across perinatal mental illnesses. Aims: This study sought to evaluate the impacts of dialectical behaviour therapy (DBT) skills groups for mothers and babies in a community perinatal service. We hypothesised that community perinatal DBT skills groups that included babies would reduce distress and improve emotional regulation. Method: A mixed-methods within-subjects design was utilised with outcome measures collected pre- and post-intervention. Qualitative interviews exploring mothers’ experiences of bringing their baby to group were also conducted. Results: Results indicated that DBT skills groups significantly improved levels of psychological distress and emotional regulation. Conclusions: Community perinatal DBT skills groups are effective when babies are present. Moreover, benefits of including babies were identified, under the themes of Self as Mother, Shared Experience, and Impact of Babies.

Background Work problems are common in people with inflammatory arthritis. Up to 50% stop work within 10 years due to their condition and up to 67% report presenteeism (i.e. reduced work productivity), even amongst those with low disease activity. Job retention vocational rehabilitation (JRVR) may help prevent or postpone job loss and reduce presenteeism through work assessment, work-related rehabilitation and enabling job accommodations. This aims to create a better match between the person’s abilities and their job demands. The objectives of the Workwell trial are to test the overall effectiveness and cost-effectiveness of JRVR (WORKWELL) provided by additionally trained National Health Service (NHS) occupational therapists compared to a control group who receive self-help information both in addition to usual care. Methods Based on the learning from a feasibility trial (the WORK-IA trial: ISRCTN76777720), the WORKWELL trial is a multi-centre, pragmatic, individually-randomised parallel group superiority trial, including economic evaluation, contextual factors analysis and process evaluation. Two hundred forty employed adults with rheumatoid arthritis, undifferentiated inflammatory arthritis or psoriatic arthritis (in secondary care), aged 18 years or older with work instability will be randomised to one of two groups: a self-help written work advice pack plus usual care (control intervention); or WORKWELL JRVR plus a self-help written work advice pack and usual care. WORKWELL will be delivered by occupational therapists provided with additional JRVR training from the research team. The primary outcome is presenteeism as measured using the Work Limitations Questionnaire-25. A comprehensive range of secondary outcomes of work, health, contextual factors and health resource use are included. Outcomes are measured at 6- and 12- months (with 12-months as the primary end-point). A multi-perspective within-trial cost-effectiveness analyses will also be conducted. Discussion This trial will contribute to the evidence base for provision of JRVR to people with inflammatory arthritis. If JRVR is found to be effective in enabling people to keep working, the findings will support decision-making about provision of JRVR by rheumatology teams, therapy services and healthcare commissioners, and providing evidence of the effectiveness of JRVR and the economic impact of its implementation. Trial registration Clinical Trials.Gov: NCT03942783. Registered 08/05/2019 (https://clinicaltrials.gov/ct2/show/NCT03942783); ISRCTN Registry: ISRCTN61762297. Registered:13/05/2019 (http://www.isrctn.com/ISRCTN61762297). Retrospectively registered.

People with inflammatory arthritis rapidly develop work disability, yet there is limited provision of vocational rehabilitation (VR) in rheumatology departments. As part of a randomized, controlled trial, ten occupational therapists (OTs) were surveyed to identify their current VR provision and training needs. As a result, a VR training course for OTs was developed which included both taught and self-directed learning. The course included: employment and health and safety legislation, work assessment and practical application of ergonomic principles at work.Pre-, immediately post- and two months post-training, the ten OTs completed a questionnaire about their VR knowledge and confidence On completion, they reported a significant increase (p < 0.01)in their knowledge and confidence when delivering vocational rehabilitation. They rated the course as very or extremely relevant, although seven recommended more practical sessions. The preference for practical sessions was highlighted, in that the aspects they felt most beneficial were role-playing assessments and sharing ideas through discussion and presentations.In conclusion, the course was considered effective in increasing both knowledge and confidence in using VR as an intervention, but, due to time constraints within the working day, some of the self-directed learning should be incorporated into the training days. Copyright © 2013 John Wiley & Sons, Ltd.

Objectives The aims were to linguistically validate a British English version of the Workplace Activity Limitations Scale (WALS), and then psychometrically test this in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), osteoarthritis (OA) and fibromyalgia (FM). Methods The WALS was forward translated, reviewed by an expert panel and cognitive debriefing interviews conducted. Participants completed a postal questionnaire booklet. Construct (structural) validity was examined by fit to the Rasch measurement model. Concurrent validity included testing between the WALS and the Work Limitations Questionnaire-25 (WLQ-25). Two weeks later, participants were mailed a second questionnaire booklet for test-retest reliability. Results Minor wording changes were made to the WALS, then 831 employed participants completed questionnaires: 267 men; 564 women; 53.5 (SD 8.9) years of age; with condition duration 7.7 (SD 8.0) years. The WALS satisfied Rasch model requirements and a WALS Rasch transformation table was created. Concurrent validity was strong with the: WLQ-25 (RA rs = 0.78; axSpA rs = 0.83; OA rs = 0.63; FM rs = 0.64). Internal consistency was consistent with group use (α  =  0.80 to 0.87). Test-retest reliability was excellent (ICC (2,1) at 0.90 or above. Conclusion A reliable, valid British English version of the WALS is now available for use in the United Kingdom. Lay Summary What does this mean for patients ? Working people with arthritis can have difficulties doing work activities. If not identified and addressed, people may struggle to keep working and even give up work. The Workplace Activity Limitations Scale (WALS), developed in Canada, measures work difficulties. With help from 48 people with rheumatoid arthritis, (RA), osteoarthritis (OA), axial spondyloarthritis (axSpA) or fibromyalgia (FM), we adapted the WALS into British English. They considered the WALS’ 12 questions reflected their work problems well. We sent a questionnaire booklet, including the WALS and other work and health questionnaires (e.g. pain, fatigue, daily activity ability), to over 800 people with either RA, OA, axSpA or FM. Several weeks later, we again sent them the WALS to complete. We found a good relationship between WALS scores and other questionnaires. That is, the WALS is a valid, or realistic, measure of work difficulties. It is also reliable; people gave very similar answers second time round. The WALS could be used in clinics to quickly (&lt; 5 min) identify people with problems at work due to their arthritis. A score of 7 or more indicates need for referral for work advice/rehabilitation to help resolve work problems, which could then help people keep working.

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Background: Water, sanitation, and hygiene (WASH) behaviors play a significant role in stunting. Knowledge and behaviors regarding WASH among caregivers are critical to providing children with chances to survive and thrive. The purpose of this study is to determine if exposure to a national communication campaign using media and interpersonal communication (IPC) is associated with WASH-related knowledge and behaviors among Indonesian mothers with children under the age of two. Methods: Data came from a cross-sectional survey of 1734 mothers with children under the age of two. The measures included exposure to two different interventions: media messages (media) and interpersonal communication strategies (IPC) and WASH-related knowledge and behavior. Multiple logistic regression was used to examine the association between intervention exposure and study variables. Results: Exposure to both media and IPC interventions was associated with participants having a higher knowledge of appropriate defecation practices (p < 0.001), higher knowledge of proper handwashing practices (p < 0.001), and higher self-reported handwashing at critical times (p < 0.001) but was not associated with reported practicing of appropriate defecation (OR = 0.780, 95% CI: 0.566–1.101). Mothers exposed to only media interventions were more likely to have knowledge of appropriate defecation practices (p < 0.001) and to have reported practicing appropriate defecation behaviors (OR = 1.539, 95% CI: 1.173–2.019). Mothers exposed to only IPC interventions were more likely to have reported handwashing at critical times (p = 0.009). Conclusions: Exposure to both media and IPC interventions was associated with increased knowledge and optimal behaviors related to WASH. These findings demonstrate the value of communications campaigns that use mass media coupled with IPC to improve WASH knowledge and behavior.