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The effect on work presenteeism of job retention vocational rehabilitation compared to a written self-help work advice pack for employed people with inflammatory arthritis: protocol for a multi-centre randomised controlled trial (the WORKWELL trial)

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E-pub ahead of print
  • Alison Hammond
  • Chris Sutton
  • Sarah Cotterill
  • Sarah Woodbridge
  • Rachel O'Brien
  • Kate Radford
  • Denise Forshaw
  • Suzanne Verstappen
  • Cheryl Jones
  • Antonia Marsden
  • Martin Eden
  • Yeliz Prior
  • June Culley
  • Paula Holland
  • Karen Walker-Bone
  • Yvonne Hough
  • Terence O'Neill
  • Angela Ching
  • Jennifer Parker
Article number607
<mark>Journal publication date</mark>13/09/2020
<mark>Journal</mark>BMC Musculoskeletal Disorders
Number of pages20
Publication StatusE-pub ahead of print
Early online date13/09/20
<mark>Original language</mark>English


Background: Work problems are common in people with inflammatory arthritis. Up to 50% stop work within 10 years due to their condition and up to 67% report presenteeism (i.e. reduced work productivity), even amongst those with low disease activity. Job retention vocational rehabilitation (JRVR) may help prevent or
postpone job loss and reduce presenteeism through work assessment, work-related rehabilitation and enabling job accommodations. This aims to create a better match between the person’s abilities and their job demands. The
objectives of the Workwell trial are to test the overall effectiveness and cost-effectiveness of JRVR (WORKWELL) provided by additionally trained National Health Service (NHS) occupational therapists compared to a control group who receive self-help information both in addition to usual care.
Methods: Based on the learning from a feasibility trial (the WORK-IA trial: ISRCTN76777720), the WORKWELL trial is a multi-centre, pragmatic, individually-randomised parallel group superiority trial, including economic evaluation,
contextual factors analysis and process evaluation. Two hundred forty employed adults with rheumatoid arthritis, undifferentiated inflammatory arthritis or psoriatic arthritis (in secondary care), aged 18 years or older with work instability will be randomised to one of two groups: a self-help written work advice pack plus usual care (control intervention); or WORKWELL JRVR plus a self-help written work advice pack and usual care. WORKWELL will be delivered by occupational therapists provided with additional JRVR training from the research team. The primary outcome is presenteeism as measured using the Work Limitations Questionnaire-25. A comprehensive range of secondary outcomes of work, health, contextual factors and health resource use are included. Outcomes are
measured at 6- and 12- months (with 12-months as the primary end-point). A multi-perspective within-trial costeffectiveness analyses will also be conducted.

Discussion: This trial will contribute to the evidence base for provision of JRVR to people with inflammatory arthritis. If JRVR is found to be effective in enabling people to keep working, the findings will support decisionmaking about provision of JRVR by rheumatology teams, therapy services and healthcare commissioners, and providing evidence of the effectiveness of JRVR and the economic impact of its implementation.