Rheumatology (Oxford, England) · 2026
The WORKWELL programme: a randomized controlled trial of job retention vocational rehabilitation for people with inflammatory arthritis.
СтатьяРандомизированное исследованиеМногоцентровое исследованиеPragmatic Clinical TrialПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Hammond Alison, Parker Jennifer, Cotterill Sarah, Sutton Chris, Mirza Selman, Ching Angela, O'Neill Terence W, Holland Fiona, Marsden Antonia, Holland Paula, Radford Kathryn, Verstappen Suzanne M M, Eden Martin, Dalal Garima, Battista Simone, Culley June, Walker-Bone Karen, Woodbridge Sarah, O-Brien Rachel, Hough Yvonne, Prior Yeliz
Аннотация
OBJECTIVE: People with inflammatory arthritis (InfA) frequently experience work instability, absenteeism, and reduced productivity, culminating in early job loss. This study evaluated the effectiveness and cost-effectiveness of WORKWELL job retention vocational rehabilitation (JRVR) delivered by occupational therapists, compared with a control group receiving written self-help advice.
METHODS: A pragmatic, multicentre randomized controlled trial was conducted across 18 UK National Health Service (NHS) Trusts. Employed adults (n = 249) with InfA experiencing moderate to severe work instability were randomized (1:1) to intervention or control groups. WORKWELL included structured work assessment, individually tailored action plans, and interventions over 2-4 months. Follow-up was at 6, 12 and 36 months. The primary outcome was measured using the Work Limitations Questionnaire-25 (WLQ-25). Analyses used linear mixed-effects regression adjusted for baseline characteristics and occupational skill level. A NHS perspective was used for the within-trial cost-effectiveness analysis. Much of the trial was affected by the COVID-19 pandemic.
RESULTS: At 12 months, there was no significant difference in WLQ-25 between groups (adjusted mean difference: -1.8; 95% CI -7.4-3.8; P = 0.53), or in most secondary outcomes at 12 or 36 months. However, absenteeism showed a relative reduction of 46% at 12 months (P = 0.08), and employment retention at 36 months was higher in the intervention (93%) than in the control group (85%). The intervention was not cost-effective from an NHS perspective.
CONCLUSION: WORKWELL did not lead to improved work productivity compared with self-help advice. Future research should explore more flexible delivery methods, including digital tools, to support sustainable employment for people with InfA. A plain-language abstract is available in the supplementary material.
TRIAL REGISTRATION: ClinicalTrials.gov, http://clinicaltrials.gov, NCT03942783. ISRCTN Registry, ISRCTN61762297, https://doi.org/10.1186/ISRCTN61762297.
METHODS: A pragmatic, multicentre randomized controlled trial was conducted across 18 UK National Health Service (NHS) Trusts. Employed adults (n = 249) with InfA experiencing moderate to severe work instability were randomized (1:1) to intervention or control groups. WORKWELL included structured work assessment, individually tailored action plans, and interventions over 2-4 months. Follow-up was at 6, 12 and 36 months. The primary outcome was measured using the Work Limitations Questionnaire-25 (WLQ-25). Analyses used linear mixed-effects regression adjusted for baseline characteristics and occupational skill level. A NHS perspective was used for the within-trial cost-effectiveness analysis. Much of the trial was affected by the COVID-19 pandemic.
RESULTS: At 12 months, there was no significant difference in WLQ-25 between groups (adjusted mean difference: -1.8; 95% CI -7.4-3.8; P = 0.53), or in most secondary outcomes at 12 or 36 months. However, absenteeism showed a relative reduction of 46% at 12 months (P = 0.08), and employment retention at 36 months was higher in the intervention (93%) than in the control group (85%). The intervention was not cost-effective from an NHS perspective.
CONCLUSION: WORKWELL did not lead to improved work productivity compared with self-help advice. Future research should explore more flexible delivery methods, including digital tools, to support sustainable employment for people with InfA. A plain-language abstract is available in the supplementary material.
TRIAL REGISTRATION: ClinicalTrials.gov, http://clinicaltrials.gov, NCT03942783. ISRCTN Registry, ISRCTN61762297, https://doi.org/10.1186/ISRCTN61762297.