The WORKWELL programme: a randomised controlled trial of job retention vocational rehabilitation for people with inflammatory arthritis.

Abstract

People with inflammatory arthritis (IA) frequently experience work instability, absenteeism, and reduced productivity, culminating in early job loss. This study evaluated the effectiveness and cost-effectiveness of WORKWELL job retention vocational rehabilitation (JRVR) delivered by occupational therapists, compared to a control group receiving written self-help advice. A pragmatic, multi-centre randomised controlled trial was conducted across 18 UK NHS Trusts. Employed adults (n = 249) with IA experiencing moderate to severe work instability, were randomised (1:1) to intervention or control groups. WORKWELL included structured work assessment, individually tailored action plans, and interventions over 2-4 months. Follow-up was at 6, 12, and 36 months. The primary outcome was the Work Limitations Questionnaire-25 (WLQ-25). Analyses used linear mixed-effects regression adjusted for baseline characteristics and occupational skill level. An NHS perspective was used for the within-trial cost-effectiveness analysis. Much of the trial was affected by the COVID-19 pandemic. At 12 months, there was no significant difference in WLQ-25 between groups (adjusted mean difference: -1.8; 95% CI -7.4 to 3.8; p = 0.53), or in most secondary outcomes at 12- or 36-months. However, absenteeism showed a relative reduction of 46% at 12 months (p = 0.08), and employment retention at 36 months was higher in the intervention (93%) vs. control group (85%). The intervention was not cost-effective from an NHS perspective. WORKWELL did not lead to improved work productivity compared to self-help advice. Future research should explore more flexible delivery methods, including digital tools, to support sustainable employment for people with IA. A plain-language abstract is available in the supplementary material. ClinicalTrials.gov; NCT03942783. ISRCTN Registry; ISRCTN61762297.