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)

Gwenllian Wynne-jones, Majid Artus, Annette Bishop, Sarah A Lawton, Martyn Lewis, Sue Jowett, Jesse Kigozi, Chris Main, Gail Sowden, Simon Wathall, Anthony Burton, Danielle Van Der Windt, Elaine M Hay, Nadine E Foster, The SWAP Study Team

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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 = 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.

LanguageEnglish
Pages128-138
Number of pages11
JournalPain
Volume159
Issue number1
Early online date30 Oct 2017
DOIs
Publication statusPublished - Jan 2018

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Musculoskeletal Pain
Cost-Benefit Analysis
Primary Health Care
Cost Savings
General Practice
Health Care Costs
General Practitioners
Randomized Controlled Trials
Economics
Confidence Intervals
Costs and Cost Analysis
Incidence
Health

Cite this

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title = "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 = 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.",
keywords = "Cluster randomised controlled trial, Vocational advice, Occupational advice, Musculoskeletal pain, Primary care",
author = "Gwenllian Wynne-jones and Majid Artus and Annette Bishop and Lawton, {Sarah A} and Martyn Lewis and Sue Jowett and Jesse Kigozi and Chris Main and Gail Sowden and Simon Wathall and Anthony Burton and {Van Der Windt}, Danielle and Hay, {Elaine M} and Foster, {Nadine E} and {The SWAP Study Team}",
year = "2018",
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doi = "10.1097/j.pain.0000000000001075",
language = "English",
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journal = "Pain",
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T1 - Effectiveness and Costs of a Vocational Advice Service to Improve Work Outcomes in Patients with Musculoskeletal Pain in Primary Care

T2 - Pain

AU - Wynne-jones, Gwenllian

AU - Artus, Majid

AU - Bishop, Annette

AU - Lawton, Sarah A

AU - Lewis, Martyn

AU - Jowett, Sue

AU - Kigozi, Jesse

AU - Main, Chris

AU - Sowden, Gail

AU - Wathall, Simon

AU - Burton, Anthony

AU - Van Der Windt, Danielle

AU - Hay, Elaine M

AU - Foster, Nadine E

AU - The SWAP Study Team

PY - 2018/1

Y1 - 2018/1

N2 - 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.

AB - 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.

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KW - Vocational advice

KW - Occupational advice

KW - Musculoskeletal pain

KW - Primary care

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