Abstract
Purpose To perform a process evaluation of a stratified vocational advice intervention (SVAI), delivered by physiotherapists in primary care, for people on sick leave with musculoskeletal disorders participating in a randomised controlled trial. The research questions concerned how the SVAI was delivered, the content of the SVAI and the physiotherapists’ experiences from delivering the SVAI. Methods We used qualitative and quantitative data from 148 intervention logs documenting the follow-up provided to each participant, recordings of 18 intervention sessions and minutes from 20 meetings with the physiotherapists. The log data were analysed with descriptive statistics. A qualitative content analysis was performed of the recordings, and we identified facilitators and barriers for implementation from the minutes. Results Of 170 participants randomised to the SVAI 152 (89%) received the intervention and 148 logs were completed. According to the logs, 131 participants received the correct number of sessions (all by telephone) and 146 action plans were developed. The physiotherapists did not attend any workplace meetings but contacted stakeholders in 37 cases. The main themes from the recorded sessions were: ‘symptom burden’, ‘managing symptoms’, ‘relations with the workplace’ and ‘fear of not being able to manage work’. The physiotherapists felt they were able to build rapport with most participants. However, case management was hindered by the restricted number of sessions permitted according to the protocol. Conclusion Overall, the SVAI was delivered in accordance with the protocol and is therefore likely to be implementable in primary care if it is effective in reducing sick leave.
Highlights
Musculoskeletal disorders include injuries and disorders affecting joints, bones and soft tissues [1] and are major contributors to years lived with disability worldwide [2]
170 participants were randomised to the stratified vocational advice intervention (SVAI), 135 (79%) in the low/medium risk group and 35 (21%) in the high-risk group
Eighteen participants did not receive the SVAI: eight had return to work (RTW) > 50% before the first phone call, five could not be reached, three were not contacted, one had been on sick leave for more than 26 weeks before the intervention commenced, and one withdrew from the study
Summary
Musculoskeletal disorders include injuries and disorders affecting joints, bones and soft tissues [1] and are major contributors to years lived with disability worldwide [2]. Journal of Occupational Rehabilitation colleagues [8] identified common barriers to RTW for people with chronic pain. They proposed that RTW interventions should be individualised and focus on collaboration with the person on sick leave and their employer, to find ways to manage pain at the workplace. They suggested that interventions could be delivered by case managers located in primary health care [8]
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