Does Self Management Increase The Effectiveness Of Vocational Rehabilitation For Chronic Compensated Musculoskeletal Disorders?
Does Self Management for Chronic Compensated Musculoskeletal Disorders increase the effectiveness of Vocational Rehabilitation outcomes?
Health Services Australia Group
366 participants
Sep 15, 2009
Interventional
Conditions
Summary
In this project a new intervention for the vocational rehabilitation of chronic compensated musculoskeletal disorders will be developed. The intervention will add self-management training to usual care for injured workers who have transitioned from the acute to chronic stage of their musculoskeletal condition. Study participants will be recruited through one of the industry partners, Health Services Australia, a national provider of occupational health services and vocational rehabilitation. The participants who meet the inclusion criteria will be recruited from clinics in Brisbane, Canberra, Melbourne, Tasmania or Adelaide. Participants will be randomised into two study arms: the new model for management or a control group who will receive usual care. Acceptability, effectiveness (job readiness, health efficacy and pain) and the cost-effectiveness and cost-benefit of the new model compared to usual care will be assessed using tools which have been pre-tested with this target group. Aims: 1. To develop and document, in care protocols, an intervention which adds self-management to vocational rehabilitation for patients with chronic compensated musculoskeletal disorders. 2. To test the acceptability of the intervention to patients, their vocational rehabilitation providers’, policy makers and regulators through qualitative research with representatives from each group. 3. To test the effectiveness of the intervention by comparing readiness to return-to-work, health efficacy and pain in a group of patients who receive the intervention and a control group who receive usual care (single blind randomised controlled trial). 4. To assess the cost-effectiveness, and cost-benefit of the intervention. Hypotheses: 1. That adding self management to vocational rehabilitation will be acceptable to patients, health-care providers, policy makers and regulators. 2. The proportion of workers who are classified as ready to return-to-work based on a validated scale (the ‘Prepared for action - Self-evaluative or Maintenance-Uncertain or Maintenance-Uncertain category’) will be significantly different for those participating in the self-management program. This will be achieved through an improvement in their health efficacy (as defined by the heiQ questionnaire). 3. Adding self-management to active treatment and vocational rehabilitation will be worthwhile from an efficiency perspective, i.e. the productivity gains from adding the program shall be greater in dollar value than the societal costs of the program.
Eligibility
Inclusion Criteria8
- Participants will comprise 366 clients of the participating clinics of Work Solutions, part of the Health Services Australia Group, an industry partner. All participants will have a musculoskeletal disorder. Participants will have been referred to Work Solutions via their private insurer or a government provider.
- (1) A musculoskeletal disorder diagnosed by a medical practitioner of 3 months or more in duration, causing the client too be off work
- (2) Referred to Work Solutions for vocational or occupational rehabilitation
- (3) Agreement (in writing) by the payer (private insurer, government provider) for clients (participants) to participate in the research
- (4) Note clients must have been working at the time of the injury to be eligible for the study
- (5) Clients have to be new referrals to Work Solutions to be eligible
- (6) It is anticipated that clients will be 3 to 6 months post injury but can be up to 2 years post injury
- (7) English language skills adequate to complete the Self Management course
Exclusion Criteria3
- (i) Clients will be excluded if they demonstrate signs and symptoms suggestive of a red flag condition (eg tumor, systemic illness, inflammatory disease or infection screened using the criteria outlined in the Evidence based management of acute musculoskeletal pain (Australian Acute Musculoskeletal Pain Guidelines Group).
- (ii) Clients whose primary condition is psychiatric
- Note: co-morbid psychiatric conditions are not grounds for exclusion
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Interventions
The study introduces a vocational rehabilitation intervention (self management) to the vocational rehabilitation sector. The model will add self-management training to usual care for injured workers with subacute or chronic compensated musculoskeletal conditions. Self-management is a process that involves engaging individuals in activities and practices that sustain and promote health and well-being. It has been shown to be effective in chronic illness care through improving self-efficacy and wellness behaviours. The well-established Lorig self-management program (developed by the Stanford University in the USA) shall be used as the intervention in this study, but it has been adapted to cater more specifically for our study population. That is, modules concerned with ‘managing return-to-work’ and ‘navigating the compensation systems’ have been developed and will be added to the existing six module training program. Thus, the intervention being evaluated consists of eight 2-hour self-management training sessions. The sessions will be held weekly, over consecutive eight-week periods. The program will be delivered by health professionals and lay leaders who have been trained to conduct the sessions.
Locations(1)
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ACTRN12609000843257