Development and feasibility of an intervention featuring individual supported work placements to aid return to work for unemployed people living with chronic pain

Abstract

Background: Working in good jobs is associated with good health. High unemployment rates are reported in those disabled with musculoskeletal pain. Supported employment interventions work well for helping people with mental health difficulties to gain and retain employment. With adaptation, these may be useful for people with chronic pain. We aimed to develop and explore the feasibility of delivering such an adapted intervention. Methods:We developed an intervention and recruited unemployed people with chronic pain from NHS pain clinics and employment services. We trained case managers to assess participants and match them to six-week work placements in the Midlands and provide ongoing support to them and their managers. Participants attended a two-day work preparation session prior to placement. Outcome measures included quality of life at baseline, sixweeks, 14-weeks, and six-months, and return to work at 14-weeks and six-months. We held focus groups or interviews with stakeholders to examine acceptability and experiences of the intervention.(Continued on next page) Results: We developed an intervention consisting of work preparation sessions, work experience placements, and individualised employment support. We enrolled 31 people; 27 attended work preparation sessions, and 15 attended placements. Four of our participants started jobs during the study period. We are aware of two others starting jobs shortly after cessation of follow-up. We experienced challenges to recruitment in one area where we had many and diverse placement opportunities and good recruitment in another area where we had a smaller range of placement opportunities. All stakeholders found the intervention acceptable, and it was valued by those given a placement. While there was some disappointment among those not placed, this group still valued the work preparation sessions. Conclusions: The developed intervention was acceptable to participants and partners. Trialling the developed intervention could be feasible with attention to three main processes. To ensure advanced availability of a sufficiently wide range of work placements in each area, multiple partners would be needed. Multiple recruitment sites and focus on employment services will yield better recruitment rates than reliance on NHS pain clinics. Maintaining an adequate follow-up response rate will likely require additional approaches with more than the usual effort.

A pilot trial investigating the feasibility of a future randomised controlled trial of Individualised Placement and Support for people unemployed with chronic pain recruiting in primary care

“…Despite testing a range of different methods in primary care, recruitment of individuals unemployed with chronic pain proved challenging and resource-intensive. Consequently, and in accord with the findings of another UK study (Froud et al, 2020), we have shown that, at least in the UK, a definitive trial would currently not be feasible with the major barrier being the lack of a whole systems approach to health and employment. If appropriate employment support is to be made available to people with pain, there is an urgent need for accurate and up-to-date employment status to be held in primary care records and to improve ability to link health and work data for the future.…”

“…Either way, as was suggested in our qualitative work with people with chronic pain (Holmes et al, 2020), follow-up over 12 months may be too soon to fully appreciate the effectiveness of IPS on return to work in a trial, and assessment of employment status at 24 months or longer may be a more appropriate primary outcome, as used by Hellstrom and co-workers in their study of IPS in people with mood and anxiety disorders (Hellstrom et al, 2017). We experienced difficulty in obtaining responses to follow-up questionnaires (40% non-receipt) despite incentives and reminders, with rates of attrition similar to those seen in a similar study (Froud et al, 2020). Interestingly, in a study of IPS amongst people with moderately severe mental ill-health, only a 60% response to questionnaires was anticipated (Reme et al, 2019).…”

“…The model is based on a 'place then train' approach rather than traditional approaches (sheltered employment or vocational training). Recently, therefore, there have been calls to extend this approach to people with other long-term health conditions (Bond et al, 2019), including chronic pain, and some pilot work has been undertaken in Norway (Rodevand et al, 2017, Linnemorken et al, 2018 and the UK (Froud et al, 2020) recruiting people with chronic pain from established hospital-based pain services. However, the majority of UK chronic pain patients do not attend pain services as these are usually commissioned with strict entry criteria usually related to local capacity of primary care services.…”

The effects of supported employment interventions in populations of people with conditions other than severe mental health: a systematic review

“…The review was part of a larger study (Return to work with Individualised Supported Employment -RISE), which was funded by Versus Arthritis, and was designed to determine the feasibility of delivering an individualised supported work placement intervention to people with chronic pain. The early phases of the present review informed the intervention development process and the choice of outcome measures used in the RISE intervention (Froud et al, 2020).…”

“…We recommend future trialists consider defining primary outcomes as sustained return to competitive employment within a specified time period, which may better align with real-world aims (Jensen et al, 2012). Further, this may allow time needed for secondary impacts on quality of life to be realised (Froud et al, 2020). That said, we note that quality of life was not included in most trials' measurement of non-vocational outcomes.…”