The Development and Content of the Vocational Advice Intervention and Training Package for the Study of Work and Pain (SWAP) Trial (ISRCTN 52269669)

Abstract

Purpose There are substantial costs associated with sickness absence and struggling at work however existing services in the UK are largely restricted to those absent from work for greater than 6 months. This paper details the development of an early Vocational Advice Intervention (VAI) for adult primary care consulters who were struggling at work or absent due to musculoskeletal pain, and the structure and content of the training and mentoring package developed to equip the Vocational Advisors (VAs) to deliver the VAI, as part of the Study of Work and Pain (SWAP) cluster randomised trial. Methods In order to develop the intervention, we conducted a best-evidence literature review, summarised evidence from developmental studies and consulted with stakeholders. Results A novel early access, brief VAI was developed consisting of case management and stepped care (three steps), using the Psychosocial Flags Framework to identify and overcome obstacles associated with the health-work interface. Four healthcare practitioners were recruited to deliver the VAI; three physiotherapists and one nurse (all vocational advice was actually delivered by the three physiotherapists). They received training in the VA role during a 4-day course, with a refresher day 3 months later, along with monthly group mentoring sessions. Conclusions The process of development was sufficient to develop the VAI and associated training package. The evidence underpinning the VAI was drawn from an international perspective and key components of the VAI have the potential to be applied to other settings or countries, although this has yet to be tested.

Integrating clinician support with intervention design as part of a programme testing stratified care for musculoskeletal pain in general practice

“…This paper has detailed the iterative development throughout the course of a large-scale programme, of clinician support to deliver a complex intervention in the context of an RCT, and as such, can be a valuable practical resource for researchers developing future primary care interventions. There is a wealth of literature on the development of theory-informed interventions that aim to change clinician behaviour, with varying results (see, for instance: [24][25][26][27]). Much of this literature focuses on development of behaviour change interventions themselves, and on evaluating clinicians' and patients' uptake and engagement [28][29][30]; and this research has highlighted some similar challenges to those identified here, including the practical and time issues involved in engaging clinicians, and the challenge of achieving clinician 'buy in' .…”

Implementing a Stratified Vocational Advice Intervention for People on Sick Leave with Musculoskeletal Disorders: A Multimethod Process Evaluation

“…The SVAI is an adaptation of the vocational advice intervention developed for the SWAP trial [ 12 ]. The intervention emphasizes the identification and problem solving of modifiable health and work-related obstacles to RTW [ 12 ].…”

“…The SVAI is an adaptation of the vocational advice intervention developed for the SWAP trial [ 12 ]. The intervention emphasizes the identification and problem solving of modifiable health and work-related obstacles to RTW [ 12 ]. The main adaption made to the intervention in the MI-NAV study was that the participants were stratified into two risk groups before random allocation (low/medium or high-risk for long-term sick leave) [ 13 ] and follow-up was customised according to risk group.…”

“…An individually tailored RTW intervention delivered by case managers in primary care was effective in reducing work absence, compared to best current care for people with musculoskeletal pain in the UK [the Study of Work And Pain (SWAP) trial] [ 11 , 12 ]. The intervention included advice about health and work, service coordination and stepped care.…”

Study protocol for a randomized controlled trial of the effectiveness of adding motivational interviewing or stratified vocational advice intervention to usual case management on return to work for people with musculoskeletal disorders. The MI-NAV study

“…The physiotherapists will receive monthly mentoring during the intervention period by the course instructor (GS) and two of the researchers (FA and AT). The SVAI is based on the SWAP trial from the UK [23], but delivered as a stratified intervention (see below) and adapted to fit a Norwegian context. The intervention emphasizes the assessment and problem solving of modifiable health and work-related obstacles to RTW, in collaboration with key stakeholders.…”