Abstract
Purpose Musculoskeletal (MSK) pain is a common cause of work absence. The recent SWAP (Study of Work And Pain) randomised controlled trial (RCT) found that a brief vocational advice service for primary care patients with MSK pain led to fewer days’ work absence and provided good return-on-investment. The I-SWAP (Implementation of the Study of Work And Pain) initiative aimed to deliver an implementation test-bed of the SWAP vocational advice intervention with First Contact Practitioners (FCP). This entailed adapting the SWAP vocational advice training to fit the FCP role. This qualitative investigation explored the implementation potential of FCPs delivering vocational advice for patients with MSK pain. Methods Semi-structured interviews and focus groups were conducted with 10 FCPs and 5 GPs. Data were analysed thematically and findings explored using Normalisation Process Theory (NPT). Results I-SWAP achieved a degree of ‘coherence’ (i.e. made sense), with both FCPs and GPs feeling FCPs were well-placed to discuss work issues with these patients. However, for many of the FCPs, addressing or modifying psychosocial and occupational barriers to return-to-work was not considered feasible within FCP consultations, and improving physical function was prioritised. Concerns were also raised that employers would not act on FCPs’ recommendations regarding return-to-work. Conclusion FCPs appear well-placed to discuss work issues with MSK patients, and signpost/refer to other services; however, because they often only see patients once they are less suited to deliver other aspects of vocational advice. Future research is needed to explore how best to provide vocational advice in primary care settings.
Highlights
Musculoskeletal (MSK) pain is a common cause of work absence, and early intervention is encouraged to prevent negative health and economic consequences that result from longer-term absence and work loss [1, 2]
GPs felt that First Contact Practitioners (FCP) were well-placed to discuss work with patients, both because FCPs have longer consultations, and GPs recognised that FCPs may possess more specialist MSK knowledge than themselves: I think is very well-placed because he has more time, longer consultations...plus he’s probably got a bit more knowledge on musculoskeletal things than GPs
The lack of opportunity to build rapport with patients in a single consultation was identified by FCPs as a barrier to addressing RTW barriers: FCP 5: I think it would be hard within the timeframe of 30 min to do any sort of greater depth...that might be something more if you refer on to be looked at FCP 3: Definitely the psychosocial element
Summary
Musculoskeletal (MSK) pain is a common cause of work absence, and early intervention is encouraged to prevent negative health and economic consequences that result from longer-term absence and work loss [1, 2]. In order to explore new models of care to improve access to vocational advice and support, the SWAP (Study of Work And Pain) randomised controlled trial (RCT) tested the effectiveness of a brief vocational advice (VA) service in general practice, providing support for patients struggling or absent from work due to MSK pain. This VA service was provided by physical therapists trained to identify obstacles to working with MSK pain and to support patients to overcome these obstacles [4].
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