Does the Knowledge of a "Non-return to Work" Predictive Score Influence Vocational Rehabilitation?
Condition: Pain
Study type: Interventional

Summary: 
      Background: Orthopaedic trauma are a leading cause of long-lasting sick-leave and persistent
      disability. People suffering from persistent sick-leave often need vocational rehabilitation
      (VR). Vocational programs are planned to improve the likelihood of returning to work (RTW).
      Physical conditioning, professional evaluation and training, as well as psychological and
      social interventions are the core of the treatments. Efficiency of these programs is moderate
      and there is scope for improvements. For instance, rehabilitation programs tailored to the
      individual needs and potentials are called for. However, the allocation remains difficult.
      Decision-supportive tools may be convenient to achieve this goal. Recently, the WORRK model
      was proposed to assess early on the risk of non-returning to work for those patients. The
      main goal of this research is to measure if the WORRK model improves patients' allocation to
      different vocational programs according to their "non-return to work" risk.
    

Detailed description: 
      Methods:

      Vocational inpatients after orthopaedic trauma (n=280), aged between 18-60 years. Three
      different vocational pathways can be selected: Simple (for patients with low "non-return to
      work" risk, 5 weeks stay), Coaching (intermediate risk, 5 weeks), Evaluation (high risk, 3
      weeks). Design: randomized-controlled trial. In the intervention group, the probability not
      to return to work estimated with the WORRK model will be offered to the clinician team before
      the allocation decisions. In the control group, the probability will also be estimated but
      not known by the clinician team. The primary outcome is the proportion of patients allocated
      to the Evaluation Pathway. Secondary outcomes: the patients' satisfaction is not worse in the
      intervention group; the decisions makers' satisfaction with the information available for the
      decision process is better in the intervention group; the proportion of patients changing the
      treatment pathway during the vocational stay is not higher in the intervention group; and the
      calibration of the WORRK model remains satisfactory; the non-return to work rate is not
      higher in the intervention group than in the control group (follow-up at 3, 12, and 24
      months);

      Relevance and impact:

      The investigators expect that the WORRK model will improve the efficiency of vocational
      rehabilitation after orthopedic trauma. This will due to better allocation to the vocational
      pathways according to the patients' risk profile. If this is the case, an increase of the
      shorter vocational program is expected without jeopardizing the chance of returning to work
      and the patient satisfaction with quality of care. The ability of the WORRK model to detect
      patients with similar risk profiles could also strengthen the interest for this
      decision-supportive tool in clinical practice and trials.
    

Intervention name(s): Risk Score for non-return to work
Intervention type(s): Other
Intervention description(s): The WORRK tool will be filled in for all patients, even the patients in the control group. However, the probability score will only be accessible for the medical doctors in the intervention group, along with guidelines for interpretation ("1. With a probability score over 50% (not to return to work), patient's allocation to the "Evaluation Pathway" should be considered" "2. With a probability score over 70% (not to return to work), the "Evaluation Pathway" is probably the most suitable choice").
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Screening
Keywords: disability; vocational; rehabilitation; prediction