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

Abstract

Purpose To perform a process evaluation of a stratified vocational advice intervention (SVAI), delivered by physiotherapists in primary care, for people on sick leave with musculoskeletal disorders participating in a randomised controlled trial. The research questions concerned how the SVAI was delivered, the content of the SVAI and the physiotherapists’ experiences from delivering the SVAI. Methods We used qualitative and quantitative data from 148 intervention logs documenting the follow-up provided to each participant, recordings of 18 intervention sessions and minutes from 20 meetings with the physiotherapists. The log data were analysed with descriptive statistics. A qualitative content analysis was performed of the recordings, and we identified facilitators and barriers for implementation from the minutes. Results Of 170 participants randomised to the SVAI 152 (89%) received the intervention and 148 logs were completed. According to the logs, 131 participants received the correct number of sessions (all by telephone) and 146 action plans were developed. The physiotherapists did not attend any workplace meetings but contacted stakeholders in 37 cases. The main themes from the recorded sessions were: ‘symptom burden’, ‘managing symptoms’, ‘relations with the workplace’ and ‘fear of not being able to manage work’. The physiotherapists felt they were able to build rapport with most participants. However, case management was hindered by the restricted number of sessions permitted according to the protocol. Conclusion Overall, the SVAI was delivered in accordance with the protocol and is therefore likely to be implementable in primary care if it is effective in reducing sick leave.

Effectiveness of adding motivational interviewing or a stratified vocational advice intervention to usual case management on return to work for people with musculoskeletal disorders: the MI-NAV randomised controlled trial

“…Although the SVAI was mainly delivered according to protocol, some intervention elements were poorly implemented. 16 The physiotherapists did not attend workplace meetings or arrange face-to-face meetings with participants. They also had few contacts with important RTW stakeholder such as NAV caseworkers, employers and general practitioners.…”

“…We conducted the trial in cooperation with the Norwegian Labour and Welfare Administration (NAV). The methods have been reported previously in the study protocol, 15 in the process evaluation of the SVAI, 16 and in the fidelity evaluation of the MI intervention. 17 The Norwegian Centre for Research Data approved the project (861249), and the trial was conducted in accordance with the Helsinki declaration and the General Data Protection Regulation (GDPR).…”

“…The interventions are described in detail in online supplemental appendix 1 , and in the published fidelity and process evaluation. 16 17 All participants were offered UC for people on sick leave in Norway. In Norway, workers on sick leave are entitled to full wage replacement benefits for up to 12 months.…”

Can a workplace dialogue impact the perceived influence of neck and/or backpain on everyday activities and performance at work? A secondary analysis from the randomized controlled trial WorkUp

“…Some interventions have been explored directed towards returning to work for individuals with neck and back pain after being on sick leave [ 16 ]. Normally, these conditions are managed in primary care, but the workplace itself has been found to be important in this process [ 17 ].…”

“…However, sick leave is still the costliest option for both employee and employer [15], and it seems the best solution to keep employees at work. Some interventions have been explored directed towards returning to work for individuals with neck and back pain after being on sick leave [16]. Normally, these conditions are managed in primary care, but the workplace itself has been found to be important in this process [17].…”