Helpful detailed info: How to recruit, train and deliver brief services to workers

Jennifer Christian MD

Hello, RETAINers –


Here are two documents that should be very helpful for those who are responsible for planning, training, and supervising the delivery of one-on-one SAW/RTW interventions with workers, either as part of a RETAIN program or in another similar effort.   

  1. First is “Effectiveness and costs of a vocational advice service to improve work outcomes in patients with musculoskeletal pain in primary care: a cluster randomised trial (SWAP trial ISRCTN 52269669).   It describes the Study of Work and Pain (SWAP) trial in the UK which enriched the services available in primary care medical clinics by adding the option of brief consultations with “Vocational Advisors” to workers who were either (a) still at work but struggling due to the effects of illness/injury or (b) had been out of work for LESS than 6 months.   


The vocational advice was a very modest intervention (most frequently a single telephone conversation) yet it successfully and significantly reduced days away from work – and at a favorable cost-effectiveness ratio.   The study was a randomized controlled trial (RCT)  involving 6 general practices.  Three practices were randomly selected to deliver the intervention; the physicians in those practices could refer their patients for vocational advice.   The other three practices served as controls and did NOT have that service available.     



    • The difference in outcomes between the two groups was not due to the physician’s awareness of how to provide best current work-focused primary care.  The physicians in ALL SIX practices had previously received one hour of education on.  The education emphasized four key messages:  (1) work is usually good for people with musculoskeletal pain, (2) long periods of absence are generally harmful, (3) musculoskeletal pain can generally be accommodated at work, and (4) planning and supporting return to work are important aspects of clinical management. 
    • The fact that the physician REFERRED the patient for VA should be considered part of the intervention because it established a POSITIVE CONTEXT for the VA.  The referral signaled to the patients that the doctor thought VA was needed or might be helpful, which probably enhanced the intervention’s “legitimacy” and thus its impact.   Remember this about advice or instruction:  it isn’t the words that are spoken which makes the difference ---  it is what is HEARD and TAKEN TO HEART and then APPLIED.   Thus, context/relationship/credibility is critical.

  1. Next is “The Development and Content of the Vocational Advice Intervention and Training Package for the Study of Work and Pain (SWAP) Trial”.   This article describes in detail how the intervention was designed and carried out, and how the Vocational Advisors were selected and trained.   The article includes a lot of practical details, including for example Table 1 “Common Obstacles to SAW/RTW and the actions VA’s were to take to overcome them,”  and Table 2 which describes the sequence of three potential steps in the Vocational Advice intervention.


Here’s the abstract:  

Purpose     There are substantial costs associated with sickness absence and struggling at work however existing services in the UK are largely restricted to those absent from work for greater than 6 months. This paper details the development of an early Vocational Advice Intervention (VAI) for adult primary care consulters who were struggling at work or absent due to musculoskeletal pain, and the structure and content of the training and mentoring package developed to equip the Vocational Advisors (VAs) to deliver the VAI, as part of the Study of Work and Pain (SWAP) cluster randomised trial.

Methods     In order to develop the intervention, we conducted a best-evidence literature review, summarised evidence from developmental studies and consulted with stakeholders.

Results     A novel early access, brief VAI was developed consisting of case management and stepped care (three steps), using the Psychosocial Flags Framework to identify and overcome obstacles associated with the health-work interface. Four healthcare practitioners were recruited to deliver the VAI; three physiotherapists and one nurse (all vocational advice was actually delivered by the three physiotherapists). They received training in the VA role during a 4-day course, with a refresher day 3 months later, along with monthly group mentoring sessions. Conclusions     The process of development was sufficient to develop the VAI and associated training package. The evidence underpinning the VAI was drawn from an international perspective and key components of the VAI have the potential to be applied to other settings or countries, although this has yet to be tested.



Jennifer Christian, MD, MPH

Moderator, RETAINers List-Serv and Website on

(a volunteer activity – not an officially sponsored group)

Chair, 60 Summits Project

(non-profit organization founded in 2006 and mothballed since 2010)