Exploring the views of stakeholders about the feasibility of carrying out a randomised controlled trial of Individual Placement and Support for people unemployed with chronic pain based in primary care (the InSTEP study)

Abstract

Background: Individual Placement and Support (IPS) is a model of vocational rehabilitation originally developed to help people with severe mental illness obtain and maintain employment. Work disability is common amongst people with chronic pain conditions, yet few effective interventions exist. As part of mixed-methods feasibility research and as a forerunner to a pilot trial (In STEP), we investigated the barriers and facilitators to carrying out a future randomised controlled trial of IPS set in primary care amongst people unemployed with chronic pain.

Methods: Semi-structured interviews and focus groups were conducted with: unemployed people with health conditions receiving IPS (clients), Employment Support Workers (ESWs) delivering IPS for people with chronic health conditions and primary healthcare professionals. Interviews and focus groups were transcribed verbatim and analysed with field notes using thematic analysis.

Results: All stakeholders generally viewed a future trial of IPS positively and deemed both the intervention and treatment as usual acceptable. Themes that emerged regarding potential barriers were recruitment, the importance of recruiting people voluntarily who wanted to return to work and were motivated to do so and giving them agency in the process; a need for additional training and support of the ESWs; and a risk of over-burdening participants with paperwork. Regarding facilitators however, the themes were offering the intervention early after unemployment, the importance of relationship and continuity with the ESWs and that an employment intervention could bring a range of health benefits.

Conclusions: All stakeholders thought that a randomised trial was potentially feasible and highlighted some potential advantages of participation.