WORK TO BE DONE: integrating work participation into shared decision-making in physical therapy practice

Background: Musculoskeletal disorders (MSDs) are the primary cause of disability worldwide and a major societal burden. Recent qualitative research found that although a patient’s work is considered important, physical therapists take work participation insufficiently into account as a determining factor in the treatment of patients with MSDs. Therefore, the aim of this study is to improve the effectiveness and efficiency of physical therapy (in primary healthcare) with respect to the work participation of employees with MSDs by increasing the knowledge and skills of generalist physical therapists and by improving the collaboration between generalist physical therapists and physical therapists specialised in occupational health.
Methods/Design: This trial is a two-arm non-blinded cluster randomised controlled trial. Working patients with MSDs visiting a physical therapy practice are the target group. The control group will receive normal physical therapy treatment. The intervention group will receive treatment from a physical therapist with more knowledge about work-related factors and more skills in terms of integrating work participation into the patients’ care. Data at the start of the intervention, four months after the start of the intervention and eight months after the start of the intervention. Primary outcomes are the limitations in specific work-related activities and pain during work. Secondary outcomes include limitations in general work-related activities, general pain, quality of life, presenteeism, absenteeism, estimated risk for future work disability, work-related psychosocial risk factors, job performance, and work ability. Based on a sample size calculation we need to include 221 patients in each arm (442 in total). During data analysis, each outcome variable will be analysed independently at T1 and at T2 as a dependent variable using the study group as an independent variable. In addition to the quantitative evaluation, a process evaluation will be performed by interviewing physical therapists as well as with patients.
Discussion: The trial is expected to result in a more effective and efficient physical therapy process for working patients with MSDs. This will mean a substantial reduction of costs: lower costs thanks to a more effective and efficient physical therapy process and lower costs due to less or shorter sick leave and lower presenteeism.

Our hypothesis is that the intervention will result in better patient health and an increase in the knowledge of generalist physical therapists regarding work participation and the relevant factors that influence work participation, which will make it easier for them to integrate work participation into care and to decide when referral to or consulting with a physical therapist specialised in occupational health or another occupational health professional is appropriate.

Data will be collected at the start of the intervention (T0), four months after the start of the intervention (T1, short-term effects) and eight months after the start of the intervention (T2, long-term effects).

Control group
Physical therapy practices randomised to the control group will provide regular physical therapy (according to the existing guidelines) to their patients. These patients will be asked to participate in the study and to fill in the baseline and follow-up questionnaires.

Intervention group
Physical therapy practices randomised to the intervention group will provide regular physical therapy (according to the existing guidelines). In addition, they are able to use all the ‘WORK TO BE DONE’ intervention components and materials. These invention components and materials are:
 
Symposium. At the start of the intervention, a full-day symposium will be held with presentations about the importance of work-focused healthcare, information about the trial and collaborating with other occupational health professionals. There will also be a three-hour masterclass about shared decision-making. The symposium will be video recorded for physical therapists who are unable to attend the symposium.
E-learning. Physical therapists must follow an e-learning course consisting of two parts. The first part contains general information about the importance of work-focused healthcare, the interaction between work and health, and (work-related) factors influencing participation in work. The second part contains more specific information and guidance about addressing patients’ work participation in the diagnostic and treatment phase and about working with occupational health professionals, including guidance on cooperation between generalist physical therapists and physical therapists specialised in occupational health.
Online toolkit. Physical therapists can use an online toolkit to easily find information about providing work-focused care. Using the keyword search functionality, they can find information about laws and regulations, assessment and other tools, questionnaires, and occupational health professionals. Moreover, the toolkit contains short information about all the topics covered in the e-learning course.
Network. Physical therapists will be part of a local network through which they can easily contact occupational health physical therapists, exercise therapists specialised in occupational health, and occupational therapists with additional training in occupational health.
Patient information. Physical therapists can use patient information highlighting the importance of work-focused healthcare.