WORK AND VOCATIONAL ADVICE (WAVE) STUDY
Research type
Research Study
Full title
Work And Vocational advicE (WAVE) in primary care: a randomised controlled trial
IRAS ID
279481
Contact name
Tracy Nevatte
Contact email
Sponsor organisation
Keele University
Clinicaltrials.gov Identifier
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
4 years, 5 months, 30 days
Research summary
Summary of Research
BACKGROUND:\nMaintaining the population’s fitness for work is a priority for the UK Government. People with poor health often struggle at work and take sick leave. Few employees receive support to manage their health at work, known as vocational advice, so when their health affects work they visit their general practitioner (GP). Few GPs are confident in providing vocational advice.\n\nAIMS:\nTo adapt a previously used vocational advice intervention (for patients with joint aches and pains) for all patients visiting their GP with physical and mental health conditions affecting their ability to work.\nThe evaluate whether the vocational advice intervention reduces the number of days off work in adults who have received a fit note.\nThe evaluate the cost effectiveness of the vocational advice intervention.\n\nDESIGN AND METHODS:\nThe vocational advice intervention will be adapted through; workshops with stakeholders; independent expert advisory groups; development of a training programme to enable vocational support workers (VSWs) to deliver the intervention; testing ways to identify patients and their engagement.\n\nWe will conduct a trial testing the vocational advice intervention. We will recruit patients absent from work for at least 2 weeks and given a fit note from their GP. They will be posted a consent form and questionnaire. Eligible patients consenting to take part will be allocated by chance to either the vocational advice intervention plus usual care, or usual care alone. VSWs will offer the intervention: Step1. a phone call to discuss obstacles to return to work (RTW) and develop a RTW plan with the patient; Step2. further phone call, face-to-face/videoconferencing meeting to review, amend and support the RTW plan, if needed; Step3. with participant agreement, contact will be made with the workplace to agree and implement the RTW plan. Interviews will be held with some participants, GPs, VSWs and employers to understand their views about the intervention and RTW. Participants will be followed-up by fortnightly text messages about their health and RTW and postal questionnaires at 6 weeks and 6 months.\n
Summary of Results
Background: Very often people’s health impacts on their work ability, but not many people are able to access occupational health services for support. Primary care providers support with the health condition but are often not able to give Vocational Advice (VA) to help people get back to work after taking time off for sick leave.
Aim: The WAVE study aimed to find out whether adding a VA intervention to usual primary care helped people to get back to work more quickly than usual primary care alone if people had been off sick from work for any health condition for at least two weeks, but less than six-months.
Methods: There were three phases included in the WAVE study.
1. Intervention development
The VA intervention was developed by looking at research that had already been done to support people with health condition to work to find out what works and what doesn’t. We then talked to people whose health had impacted on their work and experts to create a model of the intervention (called a logic model) which tells us what should be included in the VA and how we think this will help people to work. We also looked at the best way for people to access the VA intervention. In addition to developing the VA intervention, we created a training package so that Vocational Support Workers (VSWs) could learn the skills needed to have appointments with patients using the WAVE intervention.2. Feasibility study
The feasibility study tested the plans for inviting people into the trial when they received a fit note in primary care. It also looked at how many people were offered the VA intervention, how many had appointments with VSWs and lastly what happened in these appointments.3. Randomised controlled trial
Using the results from the feasibility study we made some changes to our plans for inviting people into a randomised controlled trial. We then set up the trial and randomised people to either usual primary care or usual primary care plus our VA intervention. Participants completed a questionnaire when they joined the trial, and then again at six-weeks and six-months. Participants also replied to text messages from the research team asking whether they had returned to work and if so on what date. The main outcome was number of days off work over six-months, we also collected data that would help us work out the costs of sickness absence and our VA intervention.Results: We developed a VA intervention and training for VSWs to be able to run appointments helping people back to work if they had been off sick for at least two weeks but no more than six-months. The feasibility study included 19 people and we found that the VA intervention could be delivered and people were happy with the intervention. In the randomised controlled trial, we had 130 people (64 had usual primary care only and 66 had the VA intervention), but the trial had to close early as getting people to join the trial was difficult. An exploratory analysis of the data was carried out. When we looked at the results we had we found that there was a difference in days off work over six-months with those who received the VA intervention having 4.8 fewer days off work than those who received usual primary care. But this number was not “statistically significant” and there were big differences in the number of days off work between participants. When we looked at the costs of sickness absence, again people who received the VA intervention had lower productivity losses, as a result of having less time off work. At six-weeks we also found that those in the VA intervention had less absenteeism (time off work), less presenteeism (being at work when unwell) and were more productive at work than those in the usual primary care alone group, again this was not statistically significant.
Conclusions: We developed a VA intervention and training to allow VSWs to deliver the intervention. The feasibility study found that we could offer a VA intervention and that people were happy to have appointments, but we also needed to make changes to the way people were invited to the study. Exploratory analysis of the trial suggested that a VA intervention was useful in reducing days off work, but we did not have enough data to be sure. Future research should look at a new trial to evaluate this VA intervention to be sure that it works and is cost effective.
REC name
West of Scotland REC 5
REC reference
20/WS/0127
Date of REC Opinion
23 Sep 2020
REC opinion
Favourable Opinion