What helps people with musculoskeletal pain stay in the labour market, if they are self-employed, precarious or portfolio workers? Patients’ and First Contact Practitioners’ views (the FocalPoint study)

What helps people with musculoskeletal pain stay in the labour market, if they are self-employed, precarious or portfolio workers? Patients’ and First Contact Practitioners’ views (the FocalPoint study)

Duration: 01 July 2022  - 31 March 2024
Funder: NHS Grampian 
Chief investigator:  Dr Elaine Wainwright
Co-investigators:  Dr Rosemary Hollick, Dr LaKrista Morton, Dr Linda Gibson (NHS Grampian)
Associated research staff: Mr Stuart Anderson

Persistent musculoskeletal (MSK) pain is a major health problem, leading to poorer physical and psychological outcomes. Safe, appropriate work can be protective for people with MSK pain, and healthcare professionals including First Contact Practitioners (FCPs) are increasingly asked to see work as a specific health outcome. However, most current return-to-work research concerns organisational full and part-time contracts. We know little about supporting people living with MSK pain to stay in work if they are self-employed or in otherwise ‘non-traditional’ or flexible modes of employment such as freelance or contract work or zero-hours contract work. These working practices are getting more prevalent. We also know little about how FCPs can support people in pain with these working lives. This is important as they may be the person who sees a patients first in their healthcare journey.

In this study we aimed to interview workers living with MSK pain to explore their experiences of using these working practices, and of FCP consultations. We also sought to interview FCPs to investigate their experiences of supporting these workers. Data analyses included what patients and FCPs think works to keep people in pain in modern labour market patterns, and what supports the FCP role when discussing work and health.

What is the background to this research?

Chronic or musculoskeletal pain is defined as pain which lasts for over three months and may fluctuate or be perpetual, is often linked to musculoskeletal conditions, and is strongly linked to a wide range of poor physical and mental health outcomes such as limited functioning, and depression. Surveys suggest between 24-35% of adults report musculoskeletal pain at any time, and half state it that MSK pain interferes greatly with their work.

For most people, including people living with MSK pain, ‘good’ work can protect against many psycho-social and physical problems, aiding esteem and functioning. In this context ‘good’ work means any work which is physically and psychologically safe and appropriate.

Because of the value of ‘good’ work to the high numbers of people living with MSK pain, there is great interest in supporting them to stay in, or return to, work. We already know that early individualised vocational rehabilitation can be effective and cost-effective. However, recent systematic reviews show return-to-work research mainly considers mainstream full or part-time contracts - we still know little about what helps a person in pain stay in the labour market if they are self-employed, or a portfolio or ‘precariat’ worker. Such workers may have several successive careers or concurrent different jobs, or have fluid employment patterns and contractual status, with different legal rights from the mainstream employed

This is important as these working practices they are increasing in prevalence - in the UK self-employment as a proportion of total employment grew to over 15% and almost 3 million people in the UK worked precariously prior to the COVID-19 pandemic. Post-pandemic, it is estimated that both pain prevalence and non-traditional working patterns are likely to continue increasing, so it is crucial that we understand in detail what helps people in pain in these working practices stay in the labour market.

The starting point is to place the patient experience at the centre and interview them about this. A key issue is what kind of work and health conversations patients have with their healthcare practitioners. From 2021 many people with musculoskeletal pain will have important initial consultations with First Contact Practitioners (FCPs). FCPs are registered health professionals (usually physiotherapists) who can see patients in a primary care setting without GP referral, making the care pathway more efficient and timely. NHS Grampian has invested in a number of community based FCP roles across Aberdeen City, Aberdeenshire and Moray, and as their role develops, they will play a pivotal role in supporting the health and wellbeing of people with MSK conditions.

What were the aims of this study?

This project aimed to develop a better understanding of what people living with MSK pain, who are self-employed, or in flexible or otherwise ‘non-traditional’ work situations consider can best support them to stay in the labour market, with a focus on their FCP consultations. In parallel, we also sought the views of FCPs themselves to gain their perspective on work conversations as a potential outcome of their appointments.

The project addressed four related research questions:

  1. What are the experiences of FCP consultations for people living with MSK pain, if they are self-employed, or otherwise ‘non-traditional’ worker?

  2. What do these people consider helps or hinders their staying in the labour market?

  3. What are FCPs’ experiences of conversations about good work as a health outcome when MSK pain patients are in flexible or ‘non-traditional’ employment

  4. What do FCPs consider are the barriers and enablers to effective health and work conversations for these patients?

What did this research involve?

The study aimed to interview approximately 15 First Contact Practitioners and approximately 15 people living with MSK pain, working in the practices listed above, or who wish to. This is to explore First Contact Practitioners’ views of barriers and enablers to supporting people living with musculoskeletal pain to have sustainable working lives, when they are self-employed, work in precarious jobs or have portfolio working patterns like freelance or contract work.

We looked to explore the views of people living with musculoskeletal pain about how FCPs may be able to support their working lives, when they have worked, are working, or wish to work, in one of these working practices. Interviews were transcribed and then analysed to identify important themes from our interview data.

What has the study found so far?

The study has now finished recruiting and interviewing participants, and analysis is currently being undertaken by the study team.

Further results of this research, including a Plain Language Summary, will be made available here once they are published.

Data protection and privacy policy

For further information about how we will use data obtained within this study, please see the relevant section of the study's Participant Information Sheet, which is available under 'How can I take part in this study / Information for participants' above.

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If you have any queries about this research, please contact us using the following details:

Tel: 01224 437 863
Email: FocalPoint@abdn.ac.uk