PHYSIOTHERAPISTS AS VOCATIONAL ADVISORS

Sowden G.^1,2, Main C.J.¹, Wynne Jones G.¹, van der Windt D.¹, Burton A.K.^3,4, Lewis M.¹

¹Keele University, Research Institute for Primary Care & Health Sciences, Staffordshire, United Kingdom, ²Staffordshire and Stoke-on-Trent Partnership NHS Trust, IMPACT Service, Staffordshire, United Kingdom, ³University of Huddersfield, Institute for Research in Citizenship and Applied Human Sciences, Huddersfield, United Kingdom, ⁴University of Huddersfield, Centre for Applied Psychological and Health Research, Huddersfield, United Kingdom

Background: Work absence attributed to musculoskeletal pain is associated with significant costs to the individual and to society. Primary care clinicians feel ill-equipped to deal with work issues. Training and supporting physiotherapists to provide vocational advice (VA) is one potential solution.

Purpose: The Study of Work and Pain (SWAP), a cluster randomised controlled trial (ISRCTN 52269669), aimed to test the clinical and cost-effectiveness of adding brief early access vocational advice to best current primary care for people with musculoskeletal conditions. Participants were UK adults consulting in primary care who reported struggling at work, or were absent from work, due to musculoskeletal pain. Here we summarise 1) the role of the Vocational Advisors (VAs) based in general practices, 2) the training and mentoring package for VAs to identify and address participant's psychosocial obstacles to staying at work (SAW) or returning to work (RTW), 3) the main obstacles identified, and 4) the key ways in which the VAs addressed them.

Methods: There were two phases: 1. The development of the VA role and associated training and mentoring package, based on relevant policy and practice documents, academic publications and grey literature. 2. Analysis of the VA case report forms which they completed after every contact with SWAP trial participants. .

Results: The VA was “light touch”, consisting of case management, using the coloured Psychosocial Flags approach to the health-work interface (Kendall et al, 1997, Burton & Main, 2000). It incorporated the principles of stepped care, with the VA’s “stepping up” support for participants when necessary (initial phone call, subsequent phone calls, face-to-face meeting, worksite visit/meeting). Three physiotherapists were trained to provide VA. The training consisted of a face to face course, one day per week for four weeks, with a refresher day three months later. The VAs also received monthly group mentoring sessions lasting 1.5 hours, for 12 months. 97 participant case report forms were analysed. The majority of contacts between VAs and participants were by telephone (89%); 8% had a face-to-face visit and one patient had a worksite visit. The main obstacles to SAW or RTW were symptom severity, participant’s perceptions regarding the relationship between work and health, and the lack of options for modified work. The VAs explored health (for 99% of participants) and work issues (97%); assessed psychosocial obstacles/flags (72%); provided oral information (74%); gave written information (20%); and developed RTW plans (7%).

Conclusion(s): A novel VA role was developed along with a supporting training package aimed at equipping physiotherapists to fulfil this role. The nature of the obstacles identified by the VAs was consistent with the available evidence base. There were fewer face-to-face and worksite visits than expected. Psychosocial obstacles were identified for the majority of participants. Although few RTW plans were developed, some participants did not require one as they already had one or were still at work. Results of the SWAP trial (days lost from work and cost-effectiveness) will be reported separately.

Implications: A novel early access, brief VA service can be delivered by physiotherapists in primary care.

Funding acknowledgements: The SWAP trial was funded by a National Institute for Health Research (NIHR) Programme Grant for Applied Research (NIHR-RP-PG-0707-10131).

Topic: Musculoskeletal: spine

Ethics approval: The National Research Ethics Service West Midlands - Staffordshire approved the protocol (REC reference: 12/WM/0020)

All authors, affiliations and abstracts have been published as submitted.