A new vocational advice service improves work outcomes in patients with musculoskeletal pain in primary care: The 'SWAP' Trial.

Talk Code: 
Majid Artus
Wynne-Jones G,Bishop A,Lawton SA,Lewis M,Main C,Sowden G,Wathall S,Burton K,van der WindtD,Hay EM,Beardmore R,Foster N
Author institutions: 
Keele University, University of Huddersfield, University of Birmingham


Musculoskeletal (MSK) pain is a common cause of absence from work. Early intervention is advocated to prevent longer term absence. The SWAP randomised controlled trial (RCT) tested the clinical and cost-effectiveness of adding a vocational advice (VA) service to best current primary care for adults consulting with MSK pain.


A cluster RCT in 6 UK general practices randomised to intervention (n=3) or control (n=3). Patients were eligible if they were ≥18 years old, absent from or struggling at work because of MSK pain for ≤6 months. Patients in intervention practices were offered the vocational advice service, based within the practice. Patients in control practices continued with best current primary care. The primary outcome was number of days off work over 4 months. Secondary outcomes included return-to-work self-efficacy (RTW-SE), pain intensity (0–10 rating scale), symptom bothersomeness (1-5 rating scale), and healthcare use at 4 and 12 months. Analysis was by intention-to-treat. Cost-effectiveness and cost-benefit analyses were undertaken to calculate cost per sick day avoided, net societal benefits and return on investment.


338 participants (158 intervention, 180 control) were recruited. 4 month follow-up rate was 79% (75% (intervention) and 82% (control). Baseline characteristics were comparable between arms; Intervention participants had significantly fewer days off work over 4 months (mean 9.3 days, SD 21.7) compared with control (mean 14.4, SD 27.7); adjusted incidence rate ratio (IRR) 0.51 (0.26, 0.99), p=0.048. This difference was largely due to fewer GP certified absent days, mean 8.4 days (SD 21.0) in the intervention arm, compared with 13.5 days (SD 27.5) in control). The addition of the vocational advice service led to a cost-saving of £7.20 per each sick day avoided, with a net societal benefit of £763 in favour of the intervention and return on investment of £51 for each £1 invested.


Adding a vocational advice service to best current primary care for adults with musculoskeletal pain leads to significantly fewer days lost from work. The service also led to broader societal cost-savings.

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Majid Artus
Funding acknowledgement: 
This submission presents independent research funded by the National Institute for Health Research (NIHR), under its Programme Grants for Applied Research funding scheme: “Optimal management of spinal pain and sciatica in primary care” (NIHR-RP-PG-0707-10131). NF and AB are funded by an NIHR Research Professorship for NE Foster (NIHR-RP-011-015). GW-J is funded by an NIHR Research Post-doctoral Fellowship (PDF-2009-02-54). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.