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.

Opportunities and challenges around adapting supported employment interventions for people with chronic low back pain: modified nominal group technique

PURPOSE

To identify and rank opportunities and challenges around adapting supported employment interventions for people with chronic low back pain (LBP).

METHODS

Delegates from an international back and neck research forum were invited to join an expert panel. A modified nominal group technique (NGT) was used with four stages: silent generation, round robin, clarification, and ranking. Ranked items were reported back and ratified by the panel.

RESULTS

Nine experienced researchers working in the fields related to LBP and disability joined the panel. Forty-eight items were generated and grouped into 12 categories of opportunities/challenges. Categories ranked most important related respectively to policy and legislation, ensuring operational integration across different systems, funding interventions, and managing attitudes towards work and health, workplace flexibility, availability of "good" work for this client group, dissonance between client and system aims, timing of interventions, and intervention development.

CONCLUSIONS

An expert panel believes the most important opportunities/challenges around adapting supporting employment interventions for people with chronic LBP are facilitating integration/communication between systems and institutions providing intervention components, optimising research outputs for informing policy needs, and encouraging discussion around funding mechanisms for research and interventions. Addressing these factors may help improve the quality and impact of future interventions.Implications for rehabilitationInteraction pathways between health, employment, and social systems need to be improved to effectively deliver intervention components that necessarily span these systems.Research-policy communication needs to be improved by researchers and policy makers, so that research outputs can be consumed by policy makers, and so that researchers recognise the gaps in knowledge needed to underpin policy.Improvements in research-policy communication and coordination would facilitate the delivery of research output at a time when it is likely to make the most impact on policy-making.Discussion and clarification surrounding funding mechanisms for research and interventions may facilitate innovation generally.

Inclusion and exclusion criteria used in non-specific low back pain trials: a review of randomised controlled trials published between 2006 and 2012

Background

Low back pain is a common health complaint resulting in substantial economic burden. Each year, upwards of 20 randomised controlled trials (RCTs) evaluating interventions for non-specific low back pain are published. Use of the term non-specific low back pain has been criticised on the grounds of encouraging heterogeneity and hampering interpretation of findings due to possible heterogeneous causes, challenging meta-analyses. We explored selection criteria used in trials of treatments for nsLBP.

Methods

A systematic review of English-language reports of RCTs in nsLBP population samples, published between 2006 and 2012, identified from MEDLINE, EMBASE, and the Cochrane Library databases, using a mixed-methods approach to analysis. Study inclusion and exclusion criteria were extracted, thematically categorised, and then descriptive statistics were used to summarise the prevalence by emerging category.

Results

We included 168 studies. Two inclusion themes (anatomical area, and symptoms and signs) were identified. Anatomical area was most reported as between costal margins and gluteal folds (n = 8, 5%), while low back pain (n = 150, 89%) with or without referred leg pain (n = 27, 16%) was the most reported symptom. Exclusion criteria comprised 21 themes. Previous or scheduled surgery (n = 84, 50%), pregnancy (n = 81, 48%), malignancy (n = 78, 46%), trauma (n = 63, 37%) and psychological conditions (n = 58, 34%) were the most common. Sub-themes of exclusion criteria mostly related to neurological signs and symptoms: nerve root compromise (n = 44, 26%), neurological signs (n = 34, 20%) or disc herniation (n = 30, 18%). Specific conditions that were most often exclusion criteria were spondylolisthesis (n = 35, 21%), spinal stenosis (n = 31, 18%) or osteoporosis (n = 27, 16%).

Conclusion

RCTs of interventions for non-specific low back pain have incorporated diverse inclusion and exclusion criteria. Guidance on standardisation of inclusion and exclusion criteria for nsLBP trials will increase clinical homogeneity, facilitating greater interpretation of between-trial comparisons and meta-analyses. We propose a template for reporting inclusion and exclusion criteria.

Electronic supplementary material

The online version of this article (10.1186/s12891-018-2034-6) contains supplementary material, which is available to authorized users.

Selective predation on parasitized prey--a comparison between two helminth species with different life-history strategies

In Lake Fjellfrøsvatn, northern Norway, the larval helminths Cyathocephalus truncatus and Cystidicola farionis use Gammarus lacustris as intermediate hosts and Arctic charr (Salvelinus alpinus) as final hosts. There was sampled 1,433 live G. lacustris from the lake and 1,964 G. lacustris from stomach contents of the charr. Prevalence of infection were, respectively, 0.49% and 3.72% for C. truncatus, and 0.21% and 0.20% for C. farionis. Usually, only 1 parasite was present in each host, and the 2 parasite species never co-occurred. Gammarus lacustris amphipods parasitized by C. truncatus were positively selected by the Arctic charr and were consumed approximately 8 times as often as were the unparasitized amphipods or the amphipods infected with C. farionis. This suggests that G. lacustris amphipods infected with C. truncatus larvae are more susceptible to predation than noninfected specimens, probably because of parasite-induced alterations in behavior or visibility. Alternatively, this could also be explained by selection toward the largest G. lacustris specimens observed, which are also the most frequently parasitized amphipods. However, the data show clearly that this was not a result of size-selective predation by the charr. In contrast, the presence of C. farionis did not increase the susceptibility to predation of its intermediate host. The discrepancy between the 2 helminth species supports the hypothesis that parasite-increased susceptibility to predation is related to the life history strategies of the parasites.

Heavy metal contamination in freshwater fish from the border region between Norway and Russia

The contents of Cd, Cu, Cr, Hg, Ni and Zn in muscle, liver and gills were studied in whitefish, perch, pike, brown trout, burbot and vendace from three lake localities in a watercourse in the border region between Norway and Russia, in the vicinity of mining activity and several metallurgic smelters. The contents of Cd and Ni in fish tissue increased with increasing proximity to the smelters, whereas the other elements showed similar concentrations at the three localities. The recorded heavy metal concentrations appeared to be within the ranges reported for fish from other metal-contaminated lakes, and higher than comparable observations from unpolluted systems. The heavy metal concentrations were usually lowest in muscle and highest in the liver or the gills. Significant differences in metal concentration levels were found between different fish species, but Hg was the only metal where these species differences were possibly related to biomagnification. For the other elements, the concentrations generally appeared to be inversely related to the trophic level of the fish species.