Title: Work and Health
Funder: Medical Research Council

Abstract: Our research over the next five years will continue and build on the work carried out in the past quinquennium. We will complete our international study of musculoskeletal symptoms and associated disability (CUPID) and our case-control studies of low back pain and suspected carpal tunnel syndrome. Moving on from this observational research, we will explore whether the prognosis for arm pain can be improved by interventions aimed at modifying patients beliefs and behaviour. Evidence has accrued for low-back pain that maintained physical activity is superior to rest. We will explore, in a multi-centre randomised controlled trial, whether the same is true for distal arm pain. Trial participants will be recruited from physiotherapy services, offering a pragmatic opportunity to explore also the benefits of early as compared with deferred physiotherapy. In addition, we will develop a major new line of investigation on the risks and benefits from employment at older ages. There is a need to keep the ageing populations of Western countries economically active, but the health consequences of this policy require elaboration. Some evidence suggests that maximising employment may carry a net health benefit, but data at older ages are sparse. Questions persist, both about the extent to which observed associations between employment status and health are causal, and about potential effect modification (e.g. how benefits and risks vary by age, type of work, how job loss arises, and material and social means to support retirement). To address these questions, we propose a set of related investigations. As well as exploiting several publicly available longitudinal datasets that provide relevant data, we will establish a new cohort of 50-64 year-olds from practices belonging to the General Practice Research Database (GPRD). Participants will complete baseline and periodic questionnaires over 5-year follow-up. GPRD linkage will permit us to access participants primary care health records and also to trace their mortality and cancer experience. Data will be collected on change in job circumstances, with reasons; changes in health (e.g. major new illnesses, hospital referrals, new treatments, mortality and cancer incidence); and modifying social factors. This innovative use of the GPRD carries major scientific and logistic advantages – notably, highly cost-effective capture of detailed, objective health data with which to address our study questions. We will also use the GPRD database to assess the association of occupational injury with concurrent illness and prescribed medication. Older workers, with their higher prevalence of disease, may be at greater risk of workplace injury, and an evidence base is needed to manage safe job placement while maximising employment opportunity. Finally, we will conduct studies on other questions that fall within the risk management theme of the programme and which follow on from our earlier research.


Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;6.7 PHYSICAL;7.1 INDIVIDUAL CARE NEEDS
Health categories: GENERIC HEALTH RELEVANCE;MUSCULOSKELETAL