Changing perceptions of work ability in people with low back pain: a feasbility and economic evaluation

Background: Low back pain is a main cause of sickness absence and work disability in the UK. The economic impact of this is considerable and there is a growing urgency to address the occupational management of low back pain through a vocational focus on rehabilitation. However there is a lack of evidence as to how the needs of this client group can best be met. Objective: The aim of this study was to test the feasibility of delivering an NHS vocational intervention to this client group, assess how acceptable the intervention was to the participants, and examine the costs involved. Methods: The study followed an iterative process of development, evaluation and implementation. The study used survey and interview methods to investigate current NHS provision of work-related advice and support to this client group, and determine how the effectiveness of vocational interventions might be measured. The findings were used to inform the design and test the feasibility of an individually targeted vocational intervention and economic evaluation with patients concerned about their ability to work due to low back pain. Results: The findings of this research demonstrated that there is limited advice and support available to people who are concerned about their ability to work due to low back pain, either from clinicians or in the workplace. Although routine multidisciplinary group rehabilitation reduced patients' concerns, its impact depended on the ability of the patient to apply condition management tools and techniques to the workplace. A total of 51 patients were recruited over a six month period to a feasibility randomised controlled trial with concurrent economic evaluation. Eighty-seven individual work support sessions were delivered. Outcome data was obtained for 38 participants at six month follow-up. Post-trial interviews were conducted with 22 of the trial participants. The intervention and the trial were acceptable to many of the participants, although not all were willing for the researcher to involve the workplace and some did not engage. For some, the demands of work itself were an obstacle to accessing treatment. Conclusions: This study showed that it is feasible to deliver an individually targeted NHS vocational intervention to this client group, that the protocol was acceptable to many of the participants, and that an economic evaluation could be conducted. However, the current design cannot be recommended for a definitive randomised controlled trial. Considerable methodological changes are needed to address the method of recruiting participants, the delivery of the intervention and the measurement tools used. Furthermore, routine rehabilitation may not be sufficiently reliable as a control. Finally, the impact of vocational interventions is likely to be limited unless partnership working between clinicians and employers becomes customary practice

Changing perceptions of work ability in people with low back pain: a feasbility and economic evaluation

Background: Low back pain is a main cause of sickness absence and work disability in the UK. The economic impact of this is considerable and there is a growing urgency to address the occupational management of low back pain through a vocational focus on rehabilitation. However there is a lack of evidence as to how the needs of this client group can best be met. Objective: The aim of this study was to test the feasibility of delivering an NHS vocational intervention to this client group, assess how acceptable the intervention was to the participants, and examine the costs involved. Methods: The study followed an iterative process of development, evaluation and implementation. The study used survey and interview methods to investigate current NHS provision of work-related advice and support to this client group, and determine how the effectiveness of vocational interventions might be measured. The findings were used to inform the design and test the feasibility of an individually targeted vocational intervention and economic evaluation with patients concerned about their ability to work due to low back pain. Results: The findings of this research demonstrated that there is limited advice and support available to people who are concerned about their ability to work due to low back pain, either from clinicians or in the workplace. Although routine multidisciplinary group rehabilitation reduced patients' concerns, its impact depended on the ability of the patient to apply condition management tools and techniques to the workplace. A total of 51 patients were recruited over a six month period to a feasibility randomised controlled trial with concurrent economic evaluation. Eighty-seven individual work support sessions were delivered. Outcome data was obtained for 38 participants at six month follow-up. Post-trial interviews were conducted with 22 of the trial participants. The intervention and the trial were acceptable to many of the participants, although not all were willing for the researcher to involve the workplace and some did not engage. For some, the demands of work itself were an obstacle to accessing treatment. Conclusions: This study showed that it is feasible to deliver an individually targeted NHS vocational intervention to this client group, that the protocol was acceptable to many of the participants, and that an economic evaluation could be conducted. However, the current design cannot be recommended for a definitive randomised controlled trial. Considerable methodological changes are needed to address the method of recruiting participants, the delivery of the intervention and the measurement tools used. Furthermore, routine rehabilitation may not be sufficiently reliable as a control. Finally, the impact of vocational interventions is likely to be limited unless partnership working between clinicians and employers becomes customary practice

Development of an occupational advice intervention for patients undergoing elective hip and knee replacement: a Delphi study

Objective: To obtain consensus on the content and delivery of an occupational advice intervention for patients undergoing primary hip and knee replacement surgery. The primary targets for the intervention were (1) patients, carers and employers through the provision of individualised support and information about returning to work and (2) hospital orthopaedic teams through the development of a framework and materials to enable this support and information to be delivered. Design: Modified Delphi study as part of a wider intervention development study (The Occupational advice for Patients undergoing Arthroplasty of the Lower limb (OPAL) study: Health Technology Assessment Reference 15/28/02) (ISRCTN27426982). Setting: Five stakeholder groups (patients, employers, orthopaedic surgeons, general practitioners, allied health professionals and nurses) recruited from across the UK. Participants: Sixty-six participants. Methods: Statements for the Delphi process were developed relating to the content, format, delivery, timing and measurement of an occupational advice intervention. The statements were based on evidence gathered through the OPAL study that was processed using an intervention mapping framework. Intervention content was examined in round 1 and intervention format, delivery, timing and measurement were examined in round 2. In round 3, the developed intervention was presented to the stakeholder groups for comment. Consensus: For rounds 1 and 2, consensus was defined as 70% agreement or disagreement on a 4-point scale. Statements reaching consensus were ranked according to the distribution of responses to create a hierarchy of agreement. Round 3 comments were used to revise the final version of the developed occupational advice intervention. Results: Consensus was reached for 36 of 64 round 1 content statements (all agreement). In round 2, 13 questions were carried forward and an additional 81 statements were presented. Of these, 49 reached consensus (44 agreement/5 disagreement). Eleven respondents provided an appraisal of the intervention in round 3. Conclusions: The Delphi process informed the development of an occupational advice intervention as part of a wider intervention development study. Stakeholder agreement was achieved for a large number of intervention elements encompassing the content, format, delivery and timing of the intervention. The effectiveness and cost-effectiveness of the developed intervention will require evaluation in a randomised controlled trial

The identification of research priorities for UK occupational therapists in work rehabilitation

Background/Aims: UK occupational therapists are recognised as having key skills in work rehabilitation, but there is limited evidence to underpin this. In order to use research resources to best effect, it is vital to identify the research priorities of occupational therapists in work rehabilitation. This study aims to gather the views of those with a special interest in the field in order to identify their research priorities. Methods: An online survey was developed and administered electronically to members (n=173) of the College of Occupational Therapists Specialist Section-Work (COTSS-Work). Respondents were asked to: i) prioritise and comment on research areas; ii) propose research questions. A final sample of 42 surveys was collected and analysed thematically Results: Responses reflected the diversity and complexity of work rehabilitation. Identifying a rank order of research priorities proved challenging as the majority (≥62%) of respondents considered all of the topic areas listed a high priority. Research into the following areas were included in the survey: interventions; outcome measurements; assessments; management and/or service delivery; planning and/or commissioning; and education. However, 'interventions' was rated highest overall. Conclusions: Occupational therapists in the UK need more evidence to justify their role in the work and health arena. Greater opportunities are required for occupational therapists in clinical practice, as well as those involved in research, to address areas in which evidence-based practice is lacking and the mechanisms to disseminate this knowledge base

Comparing face-to-face with online training for occupational therapists in advising on fitness for work: Protocol for the CREATE study

© The Author(s) 2020. Introduction: Occupational therapists play a key role in advising on fitness for work; however, there is a concern that they lack knowledge and confidence in using the Allied Health Professions health and work report (formerly the Allied Health Professions advisory fitness for work report), developed in the United Kingdom. Comparing a reusable learning object with face-to-face training for occupational therapists in advising on fitness for work (CREATE) compares face-to-face training with online training for occupational therapists in completing the Allied Health Professions health and work report. Method: A mixed methods study. Phase 1, occupational therapists will co-design an online training resource. A standardised face-to-face group-based training session will also be developed based on the same content. Phase 2, a feasibility study will be conducted. Thirty occupational therapists will either attend face-to-face group training or access the online resource. Data on self-reported knowledge and confidence in using the Allied Health Professions health and work report will be collected at baseline, 1 week and 8 weeks post-training. Feedback on the training will be collected by interview and, for the online resource, using an online tool. Results: Quantitative results will be predominantly analysed descriptively. If appropriate, between-group responses will be compared using the Mann–Whitney test. Qualitative findings will be analysed thematically. Conclusion: CREATE will have made a significant contribution to the debate around appropriate training methods in advising on fitness for work

Hip precautions after total hip replacement and their discontinuation from practice: patient perceptions and experiences

Background: Hip precautions are routinely provided to reduce the risk of dislocation following total hip replacement despite evidence suggesting they provide no additional benefit and may, actually, impede recovery. Our aim was to report the views of patients who had been recruited into a trial comparing outcomes in participants who were prescribed hip precautions with those who were not. Methods: Semi-structured interviews were conducted. Topics explored included experiences and opinions of the service (either hip precautions or no hip precautions), information offered, and equipment provided. Thematic analysis was used to identify and report themes. Results: Six themes were identified: perceived justification, and advantages and disadvantages for the postoperative recovery regime prescribed, perceived risk, and fear of dislocation, adherence to the postoperative regime prescribed, and experiences of adaptive equipment. Conclusions: Participants who received hip precautions had mixed views about their use: some felt they were restrictive whilst others believed they provided reassurance. Participants who did not receive hip precautions were less anxious about dislocating their hip but were unsure how to progress their rehabilitation. The discontinuation of precautions may decrease patients’ fears about dislocation but more guidance from rehabilitation staff about how to move safely during recovery is required.Implications for rehabilitation Hip precautions may unnecessarily exacerbate patients’ anxieties and fear about dislocation following total hip replacement. Hip precautions impact on patients’ recovery both physically and psychologically. Patients should be advised about moving and returning to activities following total hip replacement, whether they receive hip precautions or not

Investigating the barriers and facilitators to implementing Mental Health First Aid in the workplace: a qualitative study

Purpose: There has been little research into the use and efficacy of Mental Health First Aid across UK workplaces. The present study investigated the implementation of MHFA across six UK organisations, identifying key barriers and facilitators.Design: Twenty-seven workplace representatives were recruited from six organisations through purposive sampling and took part in semi-structured interviews exploring their experiences of workplace MHFA. The data underwent thematic analysis, identifyingkey themes around implementation.Findings: Implementation varied across organisations, including different reasons for initial interest in the programme, and variable ways that MHFA-trained employees operated post-training. Key barriers to successful implementation included negative attitudes around mental health, the perception that MHFA roles were onerous, and employees’ reluctance to engage in the MHFA programme. Successful implementation was perceived to be based on individual qualities of MHFA instructors and good practice demonstrated by trained individuals in the workplace. The role of the innerorganisational setting and employee characteristics were further highlighted as barriers and facilitators to effective implementation.Research implications: MHFA is a complex intervention, presenting in different ways when implemented into complex workplace settings. As such, traditional evaluation methods may not be appropriate for gaining insights into its effectiveness. Future evaluations of workplace MHFA must consider the complexity of implementing andoperationalising this intervention in the workplace.Originality: This study is the first to highlight the factors affecting successful implementation of MHFA across a range of UK workplaces

Clinicians’ experiences of discontinuing routine hip precautions following total hip replacement surgery: a qualitative analysis

PurposeHip precautions are routinely provided in the UK, despite evidence suggesting that they are no longer needed. A change in practice was introduced into an orthopaedic service whereby the provision of routine hip precautions was discontinued for selected individuals receiving a primary total hip replacement. The change involved implementing a new regime of “no precautions” which was facilitated using a number of key strategies. The aim of this study was to explore the experiences of clinicians associated with the change in practice.Material and methodsIndividual semi-structured interviews were conducted with clinicians who had experience of delivering both hip precautions and no hip precaution regimes. Data were analysed thematically.ResultsTen orthopaedic staff (two senior occupational therapists, one occupational therapy support worker, three senior physiotherapists, two surgeons, and two senior nurses) were interviewed. Three main themes were identified: changes experienced, perceptions of the new regime, and challenges experienced.ConclusionSeveral barriers and facilitators to the successful changeover were identified. Successful strategies in changing practice included assigning “Hip Champions”, staff education and targeted training. It is proposed that holding multidisciplinary education and training would be the ideal model. Implications for rehabilitation - Key strategies for changing practice were educating staff and providing targeted training.- Multidisciplinary training might prevent discrepancies in the advice given to patients.- Appointing “Hip Champions” provided clear role models and enabled new clinical behaviours to be enforced

Improving occupational therapists’ confidence in completing the Allied Health Professions Health and Work Report: Results from the CREATE feasibility study

Introduction: There is a concern that occupational therapists lack confidence in advising on fitness to work. The aim of this study was to compare two training methods of improving occupational therapists’ confidence in completing the Allied Health Professions Health and Work Report (AHP H&WR). Method: A mixed-methods study was conducted. Occupational therapists were recruited to face-to-face (n = 14) or online (n = 18) training. Data were collected via questionnaires at baseline, one week and eight weeks post-training, and using semi-structured telephone interviews. Questionnaire data were analysed descriptively; interviews were analysed thematically. Results: It was possible to recruit and retain participants to the study. Occupational therapists from both groups reported that the training improved their confidence in completing the AHP H&WR. However, the majority did not have the opportunity to complete an AHP H&WR in practice during the follow-up period. Conclusion: Similar results for both training methods shows promise for further development and testing. There is therefore potential to conduct a definitive study in this area

Return-to-work outcomes and usefulness of actual fit notes received by employers

Background: GPs can use the fit note to advise that a patient ‘may be fit’ or is ‘not fit’ for work. Previous employer-based research on the fit note is largely qualitative and based on general perceptions and past experience. Knowledge of the return-to-work outcomes and usefulness of actual fit notes is needed to strengthen the evidence-base and inform practice. Objective: To investigate the return-to-work outcomes of fit notes issued to employed patients, and their employers’ opinions as to the usefulness of each note. Methods: Participating organizations collecting fit notes were asked to rate the outcome and usefulness of each fit note via postal questionnaires. Quantitative data were analysed descriptively; qualitative data were analysed using thematic content analysis. Results: Five hundred and sixteen questionnaires were posted, with a 97% return rate (n = 498). More than 80% of employees (n = 44) returned to work after the expiry date of a ‘may be fit’ note compared with 43% (n = 167) of those issued with a ‘not fit’ note. Fit notes were considered more useful if they provided information on the condition and its effect on the employee’s ability to work, if they stated whether or not the employee needed reassessment and if clear advice regarding return-to-work had been provided. Conclusions: ‘May be fit’ notes are useful in helping employees return to work. However, this option is infrequently used, and the completion and content of many fit notes does not meet employers’ needs. These factors need to be urgently addressed if the fit note is to reach its full potential