TY - JOUR
T1 - Individualised placement and support programme for people unemployed because of chronic pain
T2 - a feasibility study and the InSTEP pilot RCT
AU - Linaker, Cathy
AU - Fraser, Simon
AU - Price, Cathy
AU - Maguire, Nick
AU - Little, Paul
AU - Madan, Ira
AU - Pinedo-Villanueva, Rafael
AU - Coggon, David
AU - Cooper, Cyrus
AU - Ntani, Georgia
AU - Walker-Bone, Karen
N1 - Funding Information:
Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 5. See the NIHR Journals Library website for further project information.
Funding Information:
The research reported in this issue of the journal was funded by the HTA programme as project number 15/108/02. The contractual start date was in January 2017. The draft report began editorial review in January 2020 and was accepted for publication in July 2020. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors’ report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.
Funding Information:
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 5. See the NIHR Journals Library website for further project information. We would like to thank all of the participants who generously gave their time to take part in the study.We acknowledge the hard work and efforts of the local field workers at the nine participating GP sites who assisted so generously with the study, especially Martina Brown (Research Nurse), Kat Hampson (Operations Manager), Irina Pockberger (Administrator), Kathy Chamberlain (Assistant Practice Manager), Philippa Larard-Young (Advanced Nurse Practitioner) and Kathryn Carey-Jones (Research GP).We are grateful to the members of the Study Steering Committee for their oversight and expertise: Professor Karen Walker-Bone, Dr Cathy Linaker, Dr Cathy Price, Dr Nick Maguire, Dr Simon Fraser, Mrs Kathryn Rankin, Mr Gareth Davies, Mrs Liz Crate, Mrs Ruth Nash and Ms Claire Buchan. Our sincere gratitude is expressed to the TSC for their support and enthusiasm throughout this research: Professor Nicola Fear (chairperson), Dr Gwen Wynne-Jones, Dr Benjamin Ellis, Dr Dominic Aldington, Mr Gareth Jones (lay member), Dr Cathy Linaker and Professor Karen Walker-Bone. We are very grateful to the employment teams of Southampton City Council and Portsmouth City Council and all those involved with the SJP, which enabled provision of IPS for this research. We would particularly like to acknowledge the generous support of Kathryn Rankin and Liz Crate and the support workers Stephen Hogan and Harry Tucker. We thank Michelle Holmes and Sabina Stanesccu for their assistance in collection of the qualitative data and subsequent analysis for work packages 1-3.We are extremely grateful to Mrs Carol Stewart (Clinical Specialist OT) from the pain team at Solent NHS Trust for her expertise in the provision of specialist pain consultations with participants in the active arm of the pilot study. We are grateful to the University of Southampton for their sponsorship of the trial and for providing support and guidance, as required, especially to the research and development unit for their research governance and financial management support.
Publisher Copyright:
© Queen’s Printer and Controller of HMSO 2021.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Background: Chronic pain is a common cause of health-related incapacity for work among people in the UK. Individualised placement and support is a systematic approach to rehabilitation, with emphasis on early supported work placement. It is effective in helping people with severe mental illness to gain employment, but has not been tested for chronic pain. Objective: To inform the design of a definitive randomised controlled trial to assess the clinical effectiveness of individualised placement and support for people unemployed because of chronic pain. Methods: A mixed-methods feasibility study comprising qualitative interviews and focus groups with key stakeholders, alongside a pilot trial. Study participants: Primary care-based health-care professionals, employment support workers, employers, clients who participated in an individualised placement and support programme, and individuals aged 18-64 years with chronic pain who were unemployed for at least 3 months. Intervention: An individualised placement and support programme integrated with a personalised, responsive pain management plan, backed up by communication with a general practitioner and rapid access to community-based pain services. Outcomes: Outcomes included stakeholder views about a trial and methods of recruitment; the feasibility and acceptability of the individualised placement and support intervention; study processes (including methods to recruit participants from primary care, training and support needs of the employment support workers to integrate with pain services, acceptability of randomisation and the treatment-as-usual comparator); and scoping of outcome measures for a definitive trial. Results: All stakeholders viewed a trial as feasible and important, and saw the relevance of employment interventions in this group. Using all suggested methods, recruitment was feasible through primary care, but it was slow and resource intensive. Recruitment through pain services was more efficient. Fifty people with chronic pain were recruited (37 from primary care and 13 from pain services). Randomisation was acceptable, and 22 participants were allocated to individualised placement and support, and 28 participants were allocated to treatment as usual. Treatment as usual was found acceptable. Retention of treatment-as-usual participants was acceptable throughout the 12 months. However, follow-up of individualised placement and support recipients using postal questionnaires proved challenging, especially when the participant started paid work, and new approaches would be needed for a trial. Clients, employment support workers, primary care-based health-care professionals and employers contributed to manualisation of the intervention. No adverse events were reported. Conclusion: Unless accurate and up-to-date employment status information can be collected in primary care health records, or linkage can be established with employment records, research such as this relating to employment will be impracticable in primary care. The trial may be possible through pain services; however, clients may differ. Retention of participants proved challenging and methods for achieving this would need to be developed. The intervention has been manualised.
AB - Background: Chronic pain is a common cause of health-related incapacity for work among people in the UK. Individualised placement and support is a systematic approach to rehabilitation, with emphasis on early supported work placement. It is effective in helping people with severe mental illness to gain employment, but has not been tested for chronic pain. Objective: To inform the design of a definitive randomised controlled trial to assess the clinical effectiveness of individualised placement and support for people unemployed because of chronic pain. Methods: A mixed-methods feasibility study comprising qualitative interviews and focus groups with key stakeholders, alongside a pilot trial. Study participants: Primary care-based health-care professionals, employment support workers, employers, clients who participated in an individualised placement and support programme, and individuals aged 18-64 years with chronic pain who were unemployed for at least 3 months. Intervention: An individualised placement and support programme integrated with a personalised, responsive pain management plan, backed up by communication with a general practitioner and rapid access to community-based pain services. Outcomes: Outcomes included stakeholder views about a trial and methods of recruitment; the feasibility and acceptability of the individualised placement and support intervention; study processes (including methods to recruit participants from primary care, training and support needs of the employment support workers to integrate with pain services, acceptability of randomisation and the treatment-as-usual comparator); and scoping of outcome measures for a definitive trial. Results: All stakeholders viewed a trial as feasible and important, and saw the relevance of employment interventions in this group. Using all suggested methods, recruitment was feasible through primary care, but it was slow and resource intensive. Recruitment through pain services was more efficient. Fifty people with chronic pain were recruited (37 from primary care and 13 from pain services). Randomisation was acceptable, and 22 participants were allocated to individualised placement and support, and 28 participants were allocated to treatment as usual. Treatment as usual was found acceptable. Retention of treatment-as-usual participants was acceptable throughout the 12 months. However, follow-up of individualised placement and support recipients using postal questionnaires proved challenging, especially when the participant started paid work, and new approaches would be needed for a trial. Clients, employment support workers, primary care-based health-care professionals and employers contributed to manualisation of the intervention. No adverse events were reported. Conclusion: Unless accurate and up-to-date employment status information can be collected in primary care health records, or linkage can be established with employment records, research such as this relating to employment will be impracticable in primary care. The trial may be possible through pain services; however, clients may differ. Retention of participants proved challenging and methods for achieving this would need to be developed. The intervention has been manualised.
KW - CHRONIC PAIN
KW - EMPLOYMENT
KW - FEASIBILITY STUDIES
KW - FOCUS GROUPS
KW - FOLLOW-UP STUDIES
KW - OUTCOME ASSESSMENT
KW - PAIN MANAGEMENT
KW - PILOT STUDIES
KW - PRIMARY HEALTH CARE
KW - QUALITY OF LIFE
KW - REHABILITATION
KW - REHABILITATION/VOCATIONAL
KW - RETURN TO WORK
KW - UNEMPLOYMENT
KW - VOCATIONAL
UR - http://www.scopus.com/inward/record.url?scp=85100483831&partnerID=8YFLogxK
U2 - 10.3310/hta25050
DO - 10.3310/hta25050
M3 - Article
C2 - 33501902
AN - SCOPUS:85100483831
SN - 1366-5278
VL - 25
SP - 1
EP - 72
JO - Health technology assessment (Winchester, England)
JF - Health technology assessment (Winchester, England)
IS - 5
ER -
