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Vocational advice in primary care supports a faster return to work for patients with musculoskeletal pain

Photo of someone with elbow pain

Research career development funding from the NIHR Academy supported Gwenllian Wynne-Jones in her development of a vocational advice intervention that significantly reduced work absence among patients with musculoskeletal disorders.

Published: 24 November 2022

Supporting future research leaders to improve patient care

Pain, joint stiffness, fatigue and reduced mobility are all symptoms associated with musculoskeletal disorders and are incredibly common among people of working age. Musculoskeletal disorders such as arthritis, fibromyalgia and injuries are collectively a leading cause of sickness absence and work disability in the UK, with the Health and Safety Executive estimating that nearly 9 million work days were lost as a direct result during 2019-2020.

More than 20 million people in the UK live with musculoskeletal disorders and up to one in seven GP appointments relate to these disorders and patients’ concerns around managing their pain at work.

The health and economic benefits of remaining in work despite musculoskeletal pain mean that GPs assess patients’ fitness for work by providing a “fit note”. They also offer advice about altering work activities to enable their return to work. However, GPs often feel ill-equipped to manage patients’ work issues and there is a strong case for more options to refer patients for work-related health interventions.

In 2009, the NIHR Programme Grants for Applied Research awarded funding to a team of researchers at Keele University to investigate whether the provision of a vocational advisor within GP practices could provide an effective method of managing work-related issues for patients with musculoskeletal pain problems. Led by Professor Gwenllian Wynne-Jones, the Study of Work and Pain (SWAP) was designed to provide evidence that would inform primary care practice and service development to support patients with musculoskeletal pain and related work issues.

Understanding how best to manage the impact of musculoskeletal disorders on people’s ability to work has been a strong focus of Professor Wynne-Jones’ research career. Following her initial training as a nurse and completion of her PhD, Professor Wynne-Jones gained a research post at the Arthritis Research UK Primary Care Centre at Keele University. She was subsequently awarded a 7-year NIHR Post-doctoral Research Fellowship by the NIHR Academy, which supports promising researchers to gain specific skills and experience to enhance their careers.

Now the Director of Research for the School of Nursing and Professor of Nursing at Keele University, Professor Wynne-Jones explained how this funding has enabled her to develop the research understanding and skills to undertake clinical trials in primary care with a focus on work.

A new approach to reduce musculoskeletal-related work absence

In the first trial of its kind, Professor Wynne-Jones’ SWAP trial recruited more than 300 adult patients with musculoskeletal pain from six general practices. The practices were randomly assigned so that three offered patients with musculoskeletal pain a referral to a vocational advisor at the practice.

The advisor’s role was to help them address difficulties around working with musculoskeletal pain, with the aim of supporting a quicker return to work. Patients from the remaining three practices formed the control group and received best standard primary care from their GP.

The success of the vocational advice referral was assessed by the number of days each patient was absent from work. Published in the journal Pain, the team found that patients who received vocational advice had significantly fewer days off work (9 days) than the control group (14 days) in the 4 months following their GP appointments.

“An important feature of this intervention was that the vocational advice engaged the patients, provided reassurance and improved their confidence for managing their pain at work.”
Professor Wynne-Jones

An economic analysis indicated that the intervention was also cost-effective for society, saving £733 per person on days lost from work. The researchers noted that if a similar intervention was offered more widely to patients at an early stage in primary care, it could reduce work absence over 12 months by 16%. This would save society approximately £500 million against the £10 million cost of providing the service.

In 2017, the trial’s results were recommended by Public Health England in their Musculoskeletal conditions: return on investment tool, which helps local authorities and commissioners choose the most appropriate interventions for their local populations based on their effectiveness and costs.

Evidence from the trial was also included in the 2019 joint Public Health England, NHS England and Versus Arthritis’ report Musculoskeletal Health: A 5 year strategic framework for prevention across the lifecourse, in which they outlined their plan to support people with musculoskeletal disorder pain and prevent its development.

The importance of Professor Wynne-Jones’ contribution to patient care was further evidenced by the Royal College of General Practitioners awarding its 2017 Health Service Delivery and Public Health Research Paper of the Year to her published SWAP research. This award acknowledges a researcher’s exceptional piece of research relating to primary care.

Professor Wynne-Jones noted how the research supported practice in primary care, saying: “Developing the role of the vocational advisor to provide more comprehensive and timely occupational health support would be of benefit to primary care clinicians, patients and society more broadly”.  

Extending research benefits for wider patient benefit

The positive outcomes from the SWAP trial led to Professor Wynne-Jones‘ team receiving new funding of £200,000 in 2018 from the cross-government Health and Work Unit’s Work and Health Challenge Fund to further develop the vocational advice intervention.

The resulting project, Implementation of learning from the Study of Work And Pain (I-SWAP), investigated whether vocational advice for patients with musculoskeletal conditions could be offered by trained first contact practitioner services in primary care. This study showed that first contact practitioners appeared well-placed to discuss musculoskeletal-related work issues with patients and refer them to other services, but were less suited to support them with other aspects of vocational advice.

While leading the SWAP trial, Professor Wynne-Jones successfully applied for an NIHR Clinical Trials Fellowship - an NIHR Academy award that supports the training of future clinical trial leaders. For Professor Wynne-Jones, this gave her the opportunity to spend time with the Keele University Clinical Trials Unit to further understand how trials are run, attend training courses and work with the University’s Impact Accelerator Unit and patient and public involvement and engagement team.

This experience supported her team’s funding application to build upon the successful outcomes of the SWAP trial, and led to a £1.5 million award from the NIHR Health Technology Assessment Programme to conduct the Work And Vocational advicE in primary care (WAVE) trial. Currently underway, the WAVE trial will test whether the vocational advice intervention could be adapted to support people with a variety of health conditions to return to work before their absence becomes long term. The outcomes, and whether it is a cost-effective approach, will have important implications for patients, the NHS and policy.

In addition to Professor Wynne-Jones’ research and teaching commitments, she now supervises NIHR Pre-doctorate Fellowship researchers in the early stages of their careers, building their skills for future research within workforce health promotion interventions. 

“I’ve been well supported by the NIHR throughout my career, both through direct funding from grants and also through the Fellowship training scheme. The training scheme has ensured that I can access the appropriate research training at the right point in my career, allowing me to build my knowledge and directly apply it to my research.”
Professor Wynne-Jones

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