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)

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.

This project aims 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 will also seek the views of FCPs themselves to gain their perspective on work conversations as a potential outcome of their appointments.

To achieve this aim, the project addresses 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?

The study will interview approximately 15 First Contact Practitioners and approximately 15 people living with MSK pain, who are 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 will 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.

We will conduct this research via individual interviews with participants, which we will be audio recorded, transcribed verbatim and anonymised, and this anonymised data will then be subjected to thematic analysis.

For this study we are looking both for people who have experience of attending First Contact Practitioner (FCP) appointments, and also FCPs themselves. Please see the relevant section below for details of eligibility for the study, and how to register your interest:

If you are a patient:

This study is currently open to people interested in participating, and who:

• Have musculoskeletal (MSK) pain AND
• Are currently working in a ‘flexible’ employment situation (such as being self-employed, freelance or contract work, under a zero-hours contract, or any other flexible / irregular employment circumstances) OR
• Have prior experience of the above working conditions and had MSK pain at the time AND
• Have had an appointment with a First Contact Practitioner (FCP) within the past two years

Before you consider whether you would like to take part in this study, please read the following Participant Information Sheet carefully. It explains more about the study, including what the study involves, how we will use your information, any safety concerns, and how to get in touch with us if you have any questions. You can also get in touch with the study team to find out more by using the ‘Contact’ details in the section below.

If you have read the above Participant Information Sheet and wish to participate, please complete the following online Expression of Interest form to register your interest in the study. The information you provide via the form will help the study team to make sure you are eligible to take part in the study, and will help us make sure that we speak to as wide a range of people as possible.

• FocalPoint Study Patient Participant Information Sheet (Version 3, 11 July 2023)
• Expression of Interest form to register your interest

If you are a First Contact Practitioner (FCP):

This study is currently open to people interested in participating, and who are:

• Currently working as a First Contact Practitioner (FCP) OR
• Have previously worked as a FCP within the past two years AND
• Are based in the UK

Before you consider whether you would like to take part in this study, please read the following Participant Information Sheet carefully. It explains more about the study, including what the study involves, how we will use your information, any safety concerns, and how to get in touch with us if you have any questions. You can also get in touch with the study team to find out more by using the ‘Contact’ details in the section below.

If you have read the above Participant Information Sheet and wish to participate, please complete the following online Expression of Interest form to register your interest in the study. The information you provide via the form will help the study team to make sure you are eligible to take part in the study, and will help us make sure that we speak to as wide a range of people as possible.

• FocalPoint Study FCP Participant Information Sheet (Version 3, 11 July 2023)
• Expression of Interest form to register your interest

The study is currently recruiting participants, and further results of this research, including a Plain Language Summary, will be made available here once they are published.

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.

To view the University of Aberdeen's Privacy Policy for research participants, please visit:

https://www.abdn.ac.uk/about/privacy/research-participants-938.php

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

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