Significant study strengthens / validates COHE/RETAIN model

Jennifer Christian MD

The SWAP study (Study of Work and Pain) in the UK successfully improved work outcomes by embedding vocational advisors in primary care practices who provided guidance [relatively] early in illness/injury episodes.   The vocational services consisted of an initial phone call, one or more face-to-face meetings and contact with employers, and included updating the treating physician on the obstacles to SAW/RTW that had been identified and any progress.  The advisors used the "psychosocial flags framework" to assist patients in identifying and overcoming obstacles to SAW/RTW.   See attached paper, or the abstract and citation below.    I just bought a pdf of Tackling Musculoskeletal Problems: A Guide for Clinic and Workplace - Identifying Obstacles Using the Psychosocial Flags Framework at

Jennifer Christian, MD
Moderator, Work Fitness & Disability Roundtable (multi-disciplinary)
Section Chair and Moderator, ACOEM Work Fitness & Disability Section list-serv (ACOEM members only)

ABSTRACT:  Musculoskeletal pain is a common cause of work absence, and early intervention is advocated to prevent the adverse health and economic consequences of longer-term absence. This cluster randomised controlled trial investigated the effect of introducing a vocational advice service into primary care to provide occupational support. Six general practices were randomised; patients were eligible if they were consulting their general practitioner with musculoskeletal pain and were employed and struggling at work or absent from work < 6months. Practices in the intervention arm could refer patients to a vocational advisor embedded within the practice providing a case-managed stepwise intervention addressing obstacles to working. The primary outcome was number of days off work, over 4 months. Participants in the intervention arm (n 5 158) had fewer days work absence compared with the control arm (n 5 180) (mean 9.3 [SD 21·7] vs 14·4 [SD 27·7]) days, incidence rate ratio 0·51 (95% confidence interval 0·26, 0·99),P50·048). The net societal benefit of the intervention compared with best care was £733: £748 gain (work absence) vs £15 loss (health care costs). The addition of a vocational advice service to best current primary care for patients consulting with musculoskeletal pain led to reduced absence and cost savings for society. If a similar early intervention to the one tested in this trial was implemented widely, it could potentially reduce days absent over 12 months by 16%, equating to an overall societal cost saving of approximately £500 million (US $6 billion) and requiring an investment of only £10 million.

CITATION:   Wynne-Jones G, et al. Effectiveness and costs of a vocational advice service to improve work outcomes in patients with MSK pain in primary care: a cluster randomized trial.  Pain 159 (2018) 128-138 - January 2018