The WORKWELL programme: a randomized controlled trial of job retention vocational rehabilitation for people with inflammatory arthritis.

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.