Theme 2 projects:

Musculoskeletal health from the perspective of healthcare providers and patients with MSDs

How should we optimally manage patients referred to physiotherapy with distal arm pain? The ARM pain trial
Investigators: G. Jones, G. Macfarlane, D. Coggon, K. Palmer, K Walker-Bone, K Burton

Objectives:
1. To determine whether, among patients referred for physiotherapy with an episode of distal arm pain, advice to remain active and maintain usual participation would result in a long-term reduction in disability, compared with advice to rest.
2. To determine, in the same patient group, whether fast-track (immediate) physiotherapy would result in a long-term reduction in disability, compared with treatment delivered after routine NHS waiting times.
3. To assess the relative cost-effectiveness of the above management strategies.

What factors influence the course and outcome of an episode of pain in the distal upper limb?
Investigators: G Jones, G Macfarlane
Research Fellow: D Whibley (PhD student)

Objectives:
1. To undertake three systematic reviews of the literature: firstly, about variables on the causal path between distal upper limb pain and disability; secondly, on prognostic factors for pain and functional outcomes in episodes of distal upper limb pain; and thirdly, about effect modifiers of conservative treatments for painful distal upper limb disorders
2. To use data collected for the Arthritis Research UK-funded Arm Pain Trial (ISRCTN79085082) to:
• Examine the relationship between distal upper limb pain and disability at the time of physiotherapy referral
• Investigate the longitudinal relationship between pain and disability in the distal upper limb from the time of physiotherapy referral
• Identify factors detectable at the time of physiotherapy referral that predict poor functional outcome of an episode of distal upper limb pain
• Explore the possibility that subgroups of patients with distal upper limb pain respond differently to different management approaches (advice to rest v advice to remain active; fast-track or usual timed care).

Reviews of evidence for pain therapies which improve work outcomes
Investigators: G Macfarlane, G Jones, J Shim, G Dean

Objectives:
1. To explore the evidence available on the pain interventions that improve work outcomes for back pain.

Predicting Work Outcomes in Ankylosing Spondylitis
Investigators: G Macfarlane, G Jones
Research Fellow: J Shim (post-doctoral scientist)

Objectives:
1. To explore factors associated with job loss and job change due to ankylosing spondylitis (AS): Scotland Registry of Ankylosing Spondylitis (SIRAS) study.
2. To investigate predictors of work impact using data from the BSRBR-AS study with a view to developing an intervention in those at high risk of adverse work impact.

Impact of biologic therapy on work outcomes in patients with axial Spondyloarthritis (axSpA): the British Society for Rheumatology Biologics Register in axSpa (BSRBR-AS) and meta-analysis
Investigators: G Macfarlane, G Jones
Research Fellow: J Shim (post-doctoral scientist)

Objectives:
1. To assess the impact of commencing biologic therapy on work outcomes in patients with axSpA using data from the BSRBR-AS study.
2. To undertake a systematic review of the literature (with meta-analysis) to evaluate the evidence on the effectiveness of biologic therapy on work outcomes in patients with axSpA.

Experiences of disclosure and non-disclosure of diagnosis in people with ankylosing spondylitis/axial spondyloarthritis
Investigators: J Martindale, P Holland, J Goodacre
Academic Clinical Fellow: R Shukla

Objectives:
To investigate why workers with ankylosing spondylitis do/ do not choose to disclose the nature of their condition to their employer, family members, friends and healthcare professionals.

What is the impact of osteoarthritis amongst workers?
Investigators: Y Prior, A Hammond, K Walker-Bone, R Wilkie, G Peat

Objectives:
To understand the impact of osteoarthritis on people’s working lives.

Employees’ journey through sickness absence: from certification back to work
Investigators: J Goodacre, P Holland
Research Fellow: M Dobras (PhD Student)

Objectives:
1. What do employees expect from the GP during the sickness certification process?
2. What do employees report on communication about return to work with their GP?
3. What are employees’ views on the outcome of their discussions about return to work with GPs and employers?

Return to Employment after Carpal Tunnel Release (REACTS)
Investigators: K Walker-Bone, J Adams, D Warwick, D Coggon
Research Fellow: L Newington (PhD Student)

Objectives:
To identify and appraise the existing literature and current clinical practice pertinent to return to work after carpal tunnel release (CTR).
To identify the outcomes and experiences of a prospective group of CTR patients who are workers.

Return to work following lower limb arthroplasty
Investigators: K Walker-Bone, CH Linaker, KT Palmer, D Coggon
Research Fellow: L Shipway (PhD Student)

Objectives:
To explore which factors impact on the time taken for people to return to work (RTW) following hip and knee replacement surgery, aiming to identify determinants of optimal sustained RTW, and build an evidence base from which to advise patients about RTW following arthroplasty.

Do patients return to heavy physical work after large joint surgery, and what impact, if any, does it have on rates of joint failure and other complications?
Investigators: N Arden, EC Harris, K Walker-Bone, D Coggon
Research Fellow: E Zaballa (PhD Student)

Objectives:
To explore, after lower limb arthroplasty, whether returning to work involving heavy physical tasks (lifting, kneeling/squatting) carries an increased risk of joint failure or other long-term complications.

Individualised supported employment to improve the health-related quality of life of people with chronic pain who are unemployed (In STEP)
Investigators: K Walker-Bone, CH Linaker, D Coggon, C Cooper, P Little, S Fraser, N Maguire, C Price, I Madan

Objectives:
To test whether it is feasible to undertake a randomized controlled trial of Individual Placement and Support for people unemployed as a result of chronic pain.