Effectiveness and costs of a vocational advice service to improve work outcomes in patients with musculoskeletal pain in primary care: a cluster randomised trial (SWAP trial ISRCTN 52269669)

Abstract

Musculoskeletal pain is a common cause of work absence, and early intervention is advocated to prevent the adverse health and economic consequences of longer-term absence. This cluster randomised controlled trial investigated the effect of introducing a vocational advice service into primary care to provide occupational support. Six general practices were randomised; patients were eligible if they were consulting their general practitioner with musculoskeletal pain and were employed and struggling at work or absent from work ,6 months. Practices in the intervention arm could refer patients to a vocational advisor embedded within the practice providing a case-managed stepwise intervention addressing obstacles to working. The primary outcome was number of days off work, over 4 months. Participants in the intervention arm (n 5 158) had fewer days work absence compared with the control arm (n 5 180) (mean 9.3 [SD 21·7] vs 14·4 [SD 27·7]) days, incidence rate ratio 0·51 (95% confidence interval 0·26, 0·99), P 5 0·048). The net societal benefit of the intervention compared with best care was £733: £748 gain (work absence) vs £15 loss (health care costs). The addition of a vocational advice service to best current primary care for patients consulting with musculoskeletal pain led to reduced absence and cost savings for society. If a similar early intervention to the one tested in this trial was implemented widely, it could potentially reduce days absent over 12 months by 16%, equating to an overall societal cost saving of approximately £500 million (US $6 billion) and requiring an investment of only £10 million.

Early workplace dialogue in physiotherapy practice improved work ability at 1-year follow-up—WorkUp, a randomised controlled trial in primary care

“… 16 The SWAP study found that a vocational advice service in primary care was successful in improving work ability for patients with musculoskeletal pain. 54 “Convergence Dialogue Meetings” (CDMs) were developed in Sweden for patients on sick leave due to burnout. 29 The CDM model is a 3-step structured interview model where the patient, the health care provider, and the employer meet for shared discussions on concrete suggestions and actions to support sustainable work ability and, when applicable, return-to-work.…”

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

“…The SWAP trial was therefore the first to provide an early VAI, embedded in UK general practice, to people with musculoskeletal pain, a leading cause of work absence. The results of the trials showed that the VAI significantly reduced days absent over 4 months and was cost effective compared to best care [ 16 ], however, exploratory subgroup analysis in those participants with < 10 days absence versus ≥ 10 days but < 6 months absent at baseline found that the intervention was more successful in those with the longer absence duration. These results suggest that a VAI might be better targeted to those with > 10 days (2 working weeks) of absence.…”

“…Whilst this intervention has not yet been tested in other settings or countries the publication of the development and content of the VAI means that it can more easily be tested for generalisability. Full results of the SWAP randomised trial, which tested the VAI, have recently been published [ 16 ].…”

“…The Study of Work and Pain (SWAP) trial was delivered in six general practices in the United Kingdom and aimed to determine whether the addition of an early vocational advice service to best current primary care could reduce work absence in patients consulting their GP for musculoskeletal pain who were either absent from work or struggling to remain in work because of their pain [ 15 – 17 ]. The trial demonstrated that the Vocational Advice Intervention (VAI) significantly reduced days absent over 4 months and was cost effective compared to best care [ 16 ]. This paper details the development of the early VAI, and describes the structure and content of the training and mentoring package developed to equip the Vocational Advisors (VAs) to deliver it.…”

“…This paper details the development of the early VAI, and describes the structure and content of the training and mentoring package developed to equip the Vocational Advisors (VAs) to deliver it. It is a companion paper to three other papers, the SWAP trial protocol paper [ 15 ], the SWAP trial results paper [ 16 ] and a qualitative paper exploring the acceptability of the VAI to general practitioners, the VAs and patients [ 17 ].…”