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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)

Wynne-Jones, Gwenlliana,*; Artus, Majida; Bishop, Annettea; Lawton, Sarah A.b; Lewis, Martyna,b; Jowett, Suea,c; Kigozi, Jessea,c; Main, Chrisa; Sowden, Gaila,d; Wathall, Simona,b; Burton, A. Kime; van der Windt, Danielle A.a; Hay, Elaine M.a; Foster, Nadine E.a,b the SWAP Study Team

doi: 10.1097/j.pain.0000000000001075
Research Paper
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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 = 158) had fewer days work absence compared with the control arm (n = 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 = 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.

Provision of vocational advice in primary care significantly reduced days absent over 4 months in patients consulting with musculoskeletal pain and was cost effective.

aFaculty of Medicine and Health Sciences, Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom

bKeele Clinical Trials Unit, Keele University, Staffordshire, United Kingdom

cHealth Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom

dIMPACT Service, Haywood Hospital, Stoke-on-Trent, United Kingdom

eCentre for Applied Research in Health, University of Huddersfield, Huddersfield, United Kingdom

Corresponding author. Address: Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Faculty of Medicine and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom. Tel.: +44 (0) 1782 733962; fax: + 44 (0) 1782 733911. E-mail address: g.wynne-jones@keele.ac.uk (G. Wynne-Jones).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

Received May 23, 2017

Received in revised form September 14, 2017

Accepted September 18, 2017

© 2018 International Association for the Study of Pain
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