Individual supported work placements (ReISE) for improving sustained return to work in unemployed people with persistent pain: study protocol for a cohort randomised controlled trial with embedded economic and process evaluations

BACKGROUND

Around one-third of workdays lost in Norway are due to musculoskeletal conditions, with persistent (chronic) pain being the most frequent cause of sick leave and work disability. Increasing work participation for people with persistent pain improves their health, quality of life, and well-being and reduces poverty; however, it is not clear how to best help unemployed people who have persistent pain to return to work. The aim of this study is to examine if a matched work placement intervention featuring case manager support and work-focused healthcare improves return to work rates and quality of life for unemployed people in Norway with persistent pain who want to work.

METHODS

We will use a cohort randomised controlled approach to test the effectiveness and cost-effectiveness of a matched work placement intervention featuring case manager support and work-focused healthcare compared to those receiving usual care in the cohort alone. We will recruit people aged 18-64, who have been out of work for at least 1 month, had pain for more than 3 months, and want to work. Initially, all (n = 228) will be recruited to an observational cohort study on the impact of being unemployed with persistent pain. We will then randomly select one in three to be offered the intervention. The primary outcome of sustained return to work will be measured using registry and self-reported data, while secondary outcomes include self-reported levels of health-related quality of life and physical and mental health. Outcomes will be measured at baseline and 3, 6, and 12 months post-randomisation. We will run a process evaluation parallel to the intervention exploring implementation, continuity of the intervention, reasons for participating, declining participation, and mechanisms behind cases of sustained return to work. An economic evaluation of the trial process will also be conducted.

DISCUSSION

The ReISE intervention is designed to increase work participation for people with persistent pain. The intervention has the potential to improve work ability by collaboratively navigating obstacles to working. If successful, the intervention may be a viable option for helping people in this population.

TRIAL REGISTRATION

ISRCTN Registry 85,437,524 Registered on 30 March 2022.

Health systems strengthening to arrest the global disability burden: empirical development of prioritised components for a global strategy for improving musculoskeletal health

INTRODUCTION

Despite the profound burden of disease, a strategic global response to optimise musculoskeletal (MSK) health and guide national-level health systems strengthening priorities remains absent. Auspiced by the Global Alliance for Musculoskeletal Health (G-MUSC), we aimed to empirically derive requisite priorities and components of a strategic response to guide global and national-level action on MSK health.

METHODS

Design: mixed-methods, three-phase design.Phase 1: qualitative study with international key informants (KIs), including patient representatives and people with lived experience. KIs characterised the contemporary landscape for MSK health and priorities for a global strategic response.Phase 2: scoping review of national health policies to identify contemporary MSK policy trends and foci.Phase 3: informed by phases 1-2, was a global eDelphi where multisectoral panellists rated and iterated a framework of priorities and detailed components/actions.

RESULTS

Phase 1: 31 KIs representing 25 organisations were sampled from 20 countries (40% low and middle income (LMIC)). Inductively derived themes were used to construct a logic model to underpin latter phases, consisting of five guiding principles, eight strategic priority areas and seven accelerators for action.Phase 2: of the 165 documents identified, 41 (24.8%) from 22 countries (88% high-income countries) and 2 regions met the inclusion criteria. Eight overarching policy themes, supported by 47 subthemes, were derived, aligning closely with the logic model.Phase 3: 674 panellists from 72 countries (46% LMICs) participated in round 1 and 439 (65%) in round 2 of the eDelphi. Fifty-nine components were retained with 10 (17%) identified as essential for health systems. 97.6% and 94.8% agreed or strongly agreed the framework was valuable and credible, respectively, for health systems strengthening.

CONCLUSION

An empirically derived framework, co-designed and strongly supported by multisectoral stakeholders, can now be used as a blueprint for global and country-level responses to improve MSK health and prioritise system strengthening initiatives.

The Nordic Back Pain Subpopulation Program: A 1-Year Prospective Multicenter Study of Outcomes of Persistent Low-Back Pain in Chiropractic Patients

OBJECTIVES

The aims of the study are to describe the low-back pain and disability status at baseline, the fourth visit, and at 3 and 12 months in Norwegian patients treated by chiropractors for persistent low back pain (LBP) and to describe movements between various subgroups over time.

DESIGN

Prospective uncontrolled multicenter study.

METHODS

Self-reported pain was measured with a 0-10 box scale and disability with the revised Oswestry LBP questionnaire. The main outcome measures were mean pain or disability values and numbers of LBP-free patients. LBP status was assessed through patient questionnaires at baseline, the fourth visit, and after 3 and 12 months. STUDY SUBJECTS AND SETTING: Of 205 invited chiropractors, 115 Norwegian chiropractors were each willing to recruit 10 consecutive patients who had LBP for at least 2 weeks at the time of consultation and a minimum of 30 days altogether within the preceding year. The numbers of participants were 875 (baseline), 799 (fourth visit), 598 (3 months), and 512 (12 months).

RESULTS

Considerable improvement was noted between baseline and the fourth visit both for mean values and in numbers of LBP-free patients. There was virtually no further mean improvement up to the third month, whereas the number of LBP-free individuals doubled. At 12 months, no additional improvement was noted, and 80% reported that they had experienced recurrent problems. Less than 1% reported considerable worsening. Severity of symptoms at baseline determined the subsequent outcome, mild symptoms tending to worsen, and severe symptoms tending to improve.

CONCLUSION

The outcome pattern is similar to that found in other clinical studies. Treatment outcome should be measured early with follow-up at 3 rather than at 12 months, because patients will improve or recover quickly but may experience recurring problems. Numbers "cured" appear to be a feasible outcome variable in this type of study population.

Prognostic values of physical examination findings in patients with chronic low back pain treated conservatively: a systematic literature review

BACKGROUND

Most patients undergo physical examination. However, low back pain can only rarely be clearly diagnosed as having an irrefutable pathoanatomic cause on the basis of the classical battery of noninvasive physical examination procedures. However, physical examination findings are also used to predict the prognosis of treatment of chronic low back pain. A systematic review of the clinical literature is needed for an understanding of findings in this area.

OBJECTIVES

To establish whether various physical examination procedures can be used to predict treatment outcome in the conservative (noninvasive) treatment of chronic low back pain.

DATA SOURCES

From 910 titles published between 1986 and 1998, 10 original research reports were selected. These were obtained by means of a computerized MEDLINE search through use of various combinations of the key words low back pain, treatment, physical findings, predictors, prognosis, prognostic factors, prognostic indicators, and predictors and outcome(s); manual search strategies were also used.

DATA SYNTHESIS

Articles that fitted the objectives of this review were retained and systematically reviewed for the prognostic value of the relevant tests/observations. In addition, results were studied in relation to type of outcome variable and type of treatment.

RESULTS

The most commonly investigated tests were lumbar range-of-motion tests, which were found to have a clear-cut significant predictive value in 3 of 9 studies. Further analyses in relation to definition of outcome (back-to-work or reduction of symptoms) were not possible because study results were usually not clearly reported for each definition and because therapies were multimodal rather than distinctly well defined.

CONCLUSIONS

This area has not been fully investigated. Therefore, there is no satisfactory answer to the question of whether some physical examination tests have a prognostic value in the conservative treatment of chronic low back pain.