探讨利益相关者对于在初级医疗保健机构开展针对慢性疼痛失业者的个体化安置与支持随机对照试验（InSTEP研究）可行性的看法。

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).

作者信息

Holmes Michelle M, Stanescu Sabina C, Linaker Catherine, Price Catherine, Maguire Nick, Fraser Simon, Cooper Cyrus, Walker-Bone Karen

机构信息

1Psychology, University of Southampton, Southampton, SO17 1BJ UK.

2Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD UK.

出版信息

Pilot Feasibility Stud. 2020 Apr 4;6:44. doi: 10.1186/s40814-020-00588-z. eCollection 2020.

DOI:10.1186/s40814-020-00588-z

PMID:32280484

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7126410/

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.

TRIAL REGISTRATION

Study no ISRCTN30094062.

摘要

背景

个人安置与支持（IPS）是一种职业康复模式，最初旨在帮助重度精神疾病患者获得并维持就业。工作残疾在慢性疼痛患者中很常见，但有效的干预措施却很少。作为混合方法可行性研究的一部分以及一项试点试验（“逐步行动”）的先导，我们调查了在初级保健环境中针对失业的慢性疼痛患者开展未来IPS随机对照试验的障碍和促进因素。

方法

对以下人员进行了半结构化访谈和焦点小组讨论：接受IPS的健康状况不佳的失业人员（客户）、为慢性健康状况患者提供IPS的就业支持工作者（ESW）以及初级医疗保健专业人员。访谈和焦点小组讨论内容逐字记录，并结合现场笔记使用主题分析法进行分析。

结果

所有利益相关者总体上对未来的IPS试验持积极看法，并认为干预措施和常规治疗都是可以接受的。出现的关于潜在障碍的主题包括：招募，招募自愿且有动力重返工作岗位的人员并让他们在过程中有自主权的重要性；需要对ESW进行额外培训和支持；以及存在使参与者因文书工作负担过重的风险。然而，关于促进因素的主题包括：在失业后尽早提供干预措施、与ESW建立关系和保持连续性的重要性，以及就业干预可能带来一系列健康益处。