1
|
Löfgren M, Törnbom K, Gyllenhammar D, Nordeman L, Rembeck G, Björkelund C, Svenningsson I, Hange D. Professionals' experiences of what affects health outcomes in the sick leave and rehabilitation process-A qualitative study from primary care level. PLoS One 2024; 19:e0306126. [PMID: 39074087 DOI: 10.1371/journal.pone.0306126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/10/2024] [Indexed: 07/31/2024] Open
Abstract
OBJECTIVE To explore frontline employees' experiences of how to create a purposeful sick leave and rehabilitation process (SRP) with the best interest of patients' long-term health in focus. METHODS Qualitative design based on focus group interviews in a primary care context in Region Västra Götaland, Sweden. Strategically selected professionals from different SRP organizations discussed sick leave outcomes and the rehabilitation process. Analysis was performed with Systematic text condensation. SUBJECTS General practitioners (n = 6), rehabilitation coordinators and/or healthcare professionals from primary healthcare (n = 13), caseworkers from the Social Insurance Agency, the Employment Agency, and Social Services (n = 12). RESULTS The outcome of the SRP was described to depend upon the extent to which the process meets patients' bio-psycho-social needs. Aspects considered crucial were: 1) early bio-psycho-social assessments, including medical specialist consultations when needed, 2) long-term realistic planning of sick leave and rehabilitation alongside medical treatment, 3) access to a wide range of early rehabilitative and supportive interventions, including situation-based, non-medical practical problem solving, and 4) trusting relationships over time for all involved professions and roles to maximize process quality and person-centeredness. A gap between the desired scope of the SRP and existing guidelines was identified. CONCLUSION Interviewees perceived that successful outcomes from the sick leave and rehabilitation process in a primary care context depend on consensus, person-centeredness, and relationship continuity for all involved professions. An extended process scope and relationship continuity for all involved professionals were suggested to improve process outcomes.
Collapse
Affiliation(s)
- Märit Löfgren
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development & Innovation Primary Health Care, Research, Education, Development & Innovation Center Södra Älvsborg, Sweden
| | - Karin Törnbom
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - Daniel Gyllenhammar
- Department of Technology Management and Economics, Centre of Healthcare Improvements, Chalmers University of Technology, Gothenburg, Sweden
| | - Lena Nordeman
- Region Västra Götaland, Research, Education, Development & Innovation Primary Health Care, Research, Education, Development & Innovation Center Södra Älvsborg, Sweden
- University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gun Rembeck
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development & Innovation Primary Health Care, Research, Education, Development & Innovation Center Södra Älvsborg, Sweden
- Regional Health, Youth Guidance Center, Borås, Sweden
| | - Cecilia Björkelund
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development & Innovation Primary Health Care, Sweden
| | - Irene Svenningsson
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development & Innovation Primary Health Care, Research, Education, Development & Innovation Center Fyrbodal, Sweden
| | - Dominique Hange
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development & Innovation Primary Health Care, Sweden
- Region Västra Götaland, Research, Education, Development & Innovation Primary Health Care, Research, Education, Development & Innovation Center Skaraborg, Sweden
| |
Collapse
|
2
|
Furlan AD, Harbin S, Vieira FF, Irvin E, Severin CN, Nowrouzi-Kia B, Tiong M, Adisesh A. Primary Care Physicians' Learning Needs in Returning Ill or Injured Workers to Work. A Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:591-619. [PMID: 35511378 DOI: 10.1007/s10926-022-10043-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 06/14/2023]
Abstract
Primary care physicians are uniquely positioned to assist ill and injured workers to stay-at-work or to return-to-work. Purpose The purpose of this scoping review is to identify primary care physicians' learning needs in returning ill or injured workers to work and to identify gaps to guide future research. Methods We used established methodologies developed by Arksey and O'Malley, Cochrane and adapted by the Systematic Review Program at the Institute for Work & Health. We used Distiller SR©, an online systematic review software to screen for relevance and perform data extraction. We followed the PRISMA for Scoping Reviews checklist for reporting. Results We screened 2106 titles and abstracts, 375 full-text papers for relevance and included 44 studies for qualitative synthesis. The first learning need was related to administrative tasks. These included (1) appropriate record-keeping, (2) time management to review occupational information, (3) communication skills to provide clear, sufficient and relevant factual information, (4) coordination of services between different stakeholders, and (5) collaboration within teams and between different professions. The second learning need was related to attitudes and beliefs and included intrinsic biases, self-confidence, role clarity and culture of blaming the patient. The third learning need was related to specific knowledge and included work capacity assessments and needs for sick leave, environmental exposures, disclosure of information, prognosis of certain conditions and care to certain groups such as adolescents and pregnant workers. The fourth learning need was related to awareness of services and tools. Conclusions There are many opportunities to improve medical education for physicians in training or in continuing medical education to improve care for workers with an illness or injury that affect their work.
Collapse
Affiliation(s)
- Andrea D Furlan
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada.
- KITE, University Health Network, Toronto, ON, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Shireen Harbin
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada
| | - Fabricio F Vieira
- Faculty of Medicine, State University of Maringa, Avenida Colombo, 5790, CEP 87020-900, Maringa, PR, Brazil
| | - Emma Irvin
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Colette N Severin
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada
| | - Behdin Nowrouzi-Kia
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Margaret Tiong
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada
| | - Anil Adisesh
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Occupational Medicine, St Michael's Hospital, Toronto, ON, Canada
| |
Collapse
|
3
|
Aanesen F, Øiestad BE, Grotle M, Løchting I, Solli R, Sowden G, Wynne-Jones G, Storheim K, Eik H. Implementing a Stratified Vocational Advice Intervention for People on Sick Leave with Musculoskeletal Disorders: A Multimethod Process Evaluation. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:306-318. [PMID: 34606049 PMCID: PMC8489360 DOI: 10.1007/s10926-021-10007-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 06/13/2023]
Abstract
Purpose To perform a process evaluation of a stratified vocational advice intervention (SVAI), delivered by physiotherapists in primary care, for people on sick leave with musculoskeletal disorders participating in a randomised controlled trial. The research questions concerned how the SVAI was delivered, the content of the SVAI and the physiotherapists' experiences from delivering the SVAI. Methods We used qualitative and quantitative data from 148 intervention logs documenting the follow-up provided to each participant, recordings of 18 intervention sessions and minutes from 20 meetings with the physiotherapists. The log data were analysed with descriptive statistics. A qualitative content analysis was performed of the recordings, and we identified facilitators and barriers for implementation from the minutes. Results Of 170 participants randomised to the SVAI 152 (89%) received the intervention and 148 logs were completed. According to the logs, 131 participants received the correct number of sessions (all by telephone) and 146 action plans were developed. The physiotherapists did not attend any workplace meetings but contacted stakeholders in 37 cases. The main themes from the recorded sessions were: 'symptom burden', 'managing symptoms', 'relations with the workplace' and 'fear of not being able to manage work'. The physiotherapists felt they were able to build rapport with most participants. However, case management was hindered by the restricted number of sessions permitted according to the protocol. Conclusion Overall, the SVAI was delivered in accordance with the protocol and is therefore likely to be implementable in primary care if it is effective in reducing sick leave.
Collapse
Affiliation(s)
- Fiona Aanesen
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.
| | | | - Margreth Grotle
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Ida Løchting
- Research and Communication Unit for MSK Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Rune Solli
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Gail Sowden
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
- Connect Health, Newcastle upon Tyne, UK
| | - Gwenllian Wynne-Jones
- School of Medicine, and School of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Kjersti Storheim
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for MSK Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Hedda Eik
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
4
|
Saunders B, Foster NE, Hill JC, Sowden G, Evans N, Bishop A, Stynes S, Dziedzic K, Campbell L, Rankin G, Salmon P, Wynne-Jones G. First Contact Practitioners' (FCPs) and General Practitioners' Perceptions Towards FCPs Delivering Vocational Advice to Patients with Musculoskeletal Conditions: A Qualitative Investigation of the Implementation Potential of the I-SWAP Initiative. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:147-155. [PMID: 34241768 PMCID: PMC8858917 DOI: 10.1007/s10926-021-09992-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 05/09/2023]
Abstract
Purpose Musculoskeletal (MSK) pain is a common cause of work absence. The recent SWAP (Study of Work And Pain) randomised controlled trial (RCT) found that a brief vocational advice service for primary care patients with MSK pain led to fewer days' work absence and provided good return-on-investment. The I-SWAP (Implementation of the Study of Work And Pain) initiative aimed to deliver an implementation test-bed of the SWAP vocational advice intervention with First Contact Practitioners (FCP). This entailed adapting the SWAP vocational advice training to fit the FCP role. This qualitative investigation explored the implementation potential of FCPs delivering vocational advice for patients with MSK pain. Methods Semi-structured interviews and focus groups were conducted with 10 FCPs and 5 GPs. Data were analysed thematically and findings explored using Normalisation Process Theory (NPT). Results I-SWAP achieved a degree of 'coherence' (i.e. made sense), with both FCPs and GPs feeling FCPs were well-placed to discuss work issues with these patients. However, for many of the FCPs, addressing or modifying psychosocial and occupational barriers to return-to-work was not considered feasible within FCP consultations, and improving physical function was prioritised. Concerns were also raised that employers would not act on FCPs' recommendations regarding return-to-work. Conclusion FCPs appear well-placed to discuss work issues with MSK patients, and signpost/refer to other services; however, because they often only see patients once they are less suited to deliver other aspects of vocational advice. Future research is needed to explore how best to provide vocational advice in primary care settings.
Collapse
Affiliation(s)
- Benjamin Saunders
- Primary Care Centre of Excellence Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK.
| | - Nadine E Foster
- Primary Care Centre of Excellence Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
- STARS Research and Education Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Jonathan C Hill
- Primary Care Centre of Excellence Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Gail Sowden
- Primary Care Centre of Excellence Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
- Connect Health, Newcastle upon Tyne, UK
| | - Nicola Evans
- Primary Care Centre of Excellence Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Annette Bishop
- Primary Care Centre of Excellence Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Siobhan Stynes
- Primary Care Centre of Excellence Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
- Midlands Partnership Foundation NHS Trust, Haywood Hospital Spinal Interface Service, Staffordshire, UK
| | - Krysia Dziedzic
- Primary Care Centre of Excellence Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Laura Campbell
- Primary Care Centre of Excellence Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | | | - Paula Salmon
- Mid Cheshire Hospital Foundation Trust, Leighton Hospital, Crewe, UK
| | - Gwenllian Wynne-Jones
- Primary Care Centre of Excellence Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| |
Collapse
|
5
|
Näsi E, Perkiö M, Kokkinen L. The Complexity of Decreased Work Ability: Individuals' Perceptions of Factors That Affect Returning to Work after Sickness Absence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010113. [PMID: 35010374 PMCID: PMC8750323 DOI: 10.3390/ijerph19010113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022]
Abstract
Much of what has been written about decreased work ability is based on quantitative studies and has been written from the perspective of professionals, service providers or authorities. In our qualitative study, we sought to understand how affected individuals themselves perceive and experience the multifaceted factors that are related to their decreased work ability. Sixteen individuals in Finland with musculoskeletal diseases (MSD) participated in semi-structured interviews. The participants were potential clients of a multi-professional service pilot model, the TOIKE Work Ability Centre. Narrative and thematic analyses were utilised. The study found that individuals with decreased work ability have differing perspectives towards returning to work and often complex life situations. Five distinctive groups were identified based on self-assessed health, work ability and orientation towards work or pension: (1) the Successful; (2) the Persevering; (3) the Forward-looking; (4) the Stuck; and (5) the Pension-oriented. Health problems, unemployment, age discrimination, financial difficulties and skill deficits were the major challenges of the interviewees. Furthermore, they perceived the service and benefit systems as complicated. The TOIKE service proved useful to some of them. However, many had not utilised it due to a lack of understanding of its purpose. Identifying the distinctive groups and their needs may improve interventions. Ultimately, this may help to achieve Target 8.5 of the UN Sustainable Development Goals, which advocates the right to employment for all ages and for those with disabilities.
Collapse
Affiliation(s)
- Ella Näsi
- Research Unit, The Social Insurance Institution of Finland, Nordenskiöldinkatu 12, 00250 Helsinki, Finland
- Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33014 Tampere, Finland; (M.P.); (L.K.)
- Correspondence:
| | - Mikko Perkiö
- Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33014 Tampere, Finland; (M.P.); (L.K.)
| | - Lauri Kokkinen
- Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33014 Tampere, Finland; (M.P.); (L.K.)
| |
Collapse
|
6
|
Protheroe J, Saunders B, Hill JC, Chudyk A, Foster NE, Bartlam B, Wathall S, Cooper V. Integrating clinician support with intervention design as part of a programme testing stratified care for musculoskeletal pain in general practice. BMC FAMILY PRACTICE 2021; 22:161. [PMID: 34311697 PMCID: PMC8312999 DOI: 10.1186/s12875-021-01507-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/01/2021] [Indexed: 11/23/2022]
Abstract
Background Stratified care involves subgrouping patients based on key characteristics, e.g. prognostic risk, and matching these subgroups to early treatment options. The STarT-MSK programme developed and tested a new stratified primary care intervention for patients with common musculoskeletal (MSK) conditions in general practice. Stratified care involves changing General Practitioners’ (GPs) behaviour, away from the current ‘stepped’ care approach to identifying early treatment options matched to patients’ risk of persistent pain. Changing healthcare practice is challenging, and to aid the successful delivery of stratified care, education and support for GPs was required. This paper details the iterative development of a clinician support package throughout the lifespan of the programme, to support GPs in delivering the stratified care intervention. We argue that clinician support is a crucial aspect of the intervention itself, which is often overlooked. Methods Qualitative research with patients and GPs identified barriers and facilitators to the adoption of stratified care, which were mapped onto the Theoretical Domains Framework (TDF). Identified domains were ‘translated’ into an educational paradigm, and an initial version of the support package developed. This was further refined following a feasibility and pilot RCT, and a finalised support package was developed for the main RCT. Results The clinician support package comprised face-to-face sessions combining adult-learning principles with behaviour change theory in a multimethod approach, which included group discussion, simulated consultations, patient vignettes and model consultation videos. Structured support for GPs was crucial to facilitate fidelity and, ultimately, a successful trial. Clinician support is a two-way process– the study team can learn from and adapt to specific local factors and issues not previously identified. The support from senior clinicians was required to ensure ‘buy in’. Monitoring of GP performance, provision of regular feedback and remedial support are important aspects of effective clinician support. Conclusion Designing effective clinician support from the onset of trial intervention design, in an evidence-based, theory-informed manner, is crucial to encourage active engagement and intervention fidelity within the trial, enabling the delivery of a robust and reliable proof-of-principle trial. We offer practical recommendations for future general practice interventions.
Collapse
Affiliation(s)
- Joanne Protheroe
- Primary Care Centre Versus Arthritis, Keele School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Benjamin Saunders
- Primary Care Centre Versus Arthritis, Keele School of Medicine, Keele University, Staffordshire, ST5 5BG, UK.
| | - Jonathan C Hill
- Primary Care Centre Versus Arthritis, Keele School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Adrian Chudyk
- Primary Care Centre Versus Arthritis, Keele School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, Keele School of Medicine, Keele University, Staffordshire, ST5 5BG, UK.,STARS Research and Education Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Bernadette Bartlam
- Primary Care Centre Versus Arthritis, Keele School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Simon Wathall
- Primary Care Centre Versus Arthritis, Keele School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Vincent Cooper
- Primary Care Centre Versus Arthritis, Keele School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| |
Collapse
|
7
|
Rashid A. Yonder: Burnout, musculoskeletal pain, clinical leadership, and the female aging body. Br J Gen Pract 2019; 69:398. [PMID: 31345816 PMCID: PMC6650110 DOI: 10.3399/bjgp19x704861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
8
|
Sowden G, Main CJ, van der Windt DA, Burton K, Wynne-Jones G. The Development and Content of the Vocational Advice Intervention and Training Package for the Study of Work and Pain (SWAP) Trial (ISRCTN 52269669). JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:395-405. [PMID: 29982957 PMCID: PMC6531387 DOI: 10.1007/s10926-018-9799-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Purpose There are substantial costs associated with sickness absence and struggling at work however existing services in the UK are largely restricted to those absent from work for greater than 6 months. This paper details the development of an early Vocational Advice Intervention (VAI) for adult primary care consulters who were struggling at work or absent due to musculoskeletal pain, and the structure and content of the training and mentoring package developed to equip the Vocational Advisors (VAs) to deliver the VAI, as part of the Study of Work and Pain (SWAP) cluster randomised trial. Methods In order to develop the intervention, we conducted a best-evidence literature review, summarised evidence from developmental studies and consulted with stakeholders. Results A novel early access, brief VAI was developed consisting of case management and stepped care (three steps), using the Psychosocial Flags Framework to identify and overcome obstacles associated with the health-work interface. Four healthcare practitioners were recruited to deliver the VAI; three physiotherapists and one nurse (all vocational advice was actually delivered by the three physiotherapists). They received training in the VA role during a 4-day course, with a refresher day 3 months later, along with monthly group mentoring sessions. Conclusions The process of development was sufficient to develop the VAI and associated training package. The evidence underpinning the VAI was drawn from an international perspective and key components of the VAI have the potential to be applied to other settings or countries, although this has yet to be tested.
Collapse
Affiliation(s)
- G Sowden
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
- Interface Multidisciplinary Pain Assessment and Community Treatment Service Haywood Hospital, High Lane, Burslem, Stoke-On-Trent, ST6 7AG, UK.
| | - C J Main
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - D A van der Windt
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - K Burton
- Centre for Applied Research in Health, University of Huddersfield, Huddersfield, UK
| | - G Wynne-Jones
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| |
Collapse
|