Individualised Placement and Support (IPS) for people unemployed with chronic pain: a feasibility study

BACKGROUND: Chronic pain is a common cause of health-related incapacity for work in the UK. Individualised Placement and Support (IPS) is a systematic approach to rehabilitation with emphasis on early funded work placement. It is effective in helping people with severe mental illness to gain employment but has not been tested for chronic pain. OBJECTIVE: To inform the design of a definitive randomised controlled trial to assess the effectiveness of IPS for people unemployed due to chronic pain. METHODS: A mixed methods feasibility study comprising qualitative interviews and focus groups with key stakeholders, alongside a pilot trial. STUDY PARTICIPANTS: Health care professionals from primary care (PCPs), Employment Support Workers (ESWs), employers, clients who participated in an IPS programme, individuals aged 18-64 years with chronic pain unemployed for at least three months. INTERVENTION: An IPS programme integrated with a personalised, responsive pain management plan, backed up by communication with the GP and rapid access to community-based pain services. OUTCOME(S): Stakeholder views about a trial and methods of recruitment. The feasibility and acceptability of the IPS intervention, study processes (including methods to recruit participants from primary care, training and support needs of the ESWs to integrate with pain services, acceptability of randomisation, Treatment As Usual (TAU) comparator) and scoping of outcome measures for a definitive trial. RESULTS: All stakeholders viewed a trial as feasible and important and saw the relevance of employment interventions in this group. Using all suggested methods, recruitment was feasible through primary care but slow and resource-intensive. Recruitment through pain services was more efficient. Fifty people with chronic pain were recruited (37 from primary care and 13 from pain services). Randomisation was acceptable: 22 were allocated to IPS and 28 to TAU. TAU was found acceptable. Retention of TAU participants was acceptable throughout 12-months. However, follow-up of IPS recipients using postal questionnaires proved challenging, especially when the participant started paid work, and new approaches would be needed for a trial. Clients, ESWs, PCPs and employers contributed to manualisation of the intervention. HARMS: No adverse events were reported. CONCLUSION: A definitive trial is not feasible if recruitment is through primary care until employment status is collected systematically or linkage of employment and healthcare databases is possible. The trial may be possible through pain services but clients may differ. Retention of participants proved challenging and methods for achieving this would need to be developed. The intervention has been manualised.