The Effectiveness of Individual Placement and Support in Chronic Pain Patients

Study Overview
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Brief Summary
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Individual Placement and support (IPS) is an evidence-based approach originally developed to help people with severe mental disorders to obtain and maintain employment. The effectiveness of IPS for patients with severe mental illness is well documented, but has never previously been tested for patients with chronic pain. In fact, employment support is rarely provided in pain clinics, despite an increasing focus on integrating work and health in all patient treatment (OECD, 2013). The aim of this study is to investigate the effectiveness of IPS as an integrated part of the interdisciplinary treatment for patients with chronic pain in a hospital outpatient clinic.

Detailed Description
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Individual Placement and support (IPS) is an evidence-based approach originally developed to help people with severe mental disorders to obtain and maintain employment. IPS represents a relatively new approach to vocational rehabilitation and incorporates following principles: (1) Every person that wants to work, can work given that the person is provided with the appropriate work and environment. (2)The goal is employment in regular, competitive employment. (3) IPS is integrated with treatment. (4) Job search is individualised; based on the participants' preferences and competence. (5) Work incentives planning is provided; which includes counselling about how work can influence social security and other public benefits. The intention of this benefits counselling is to enable the participant to make informed decisions about work (job starts and changes). (6) The job support is not time-limited. (7) Finally, IPS differs from more traditional employment services in that it does not involve pre-vocational training, often referred to as train, then place. (8) In IPS job search starts as soon as the client expresses an interest in work. Therefore, IPS follows the principle place, then train. The effectiveness of IPS for patients with severe mental illness is well documented. International research shows that IPS is more effective than other types of employment programs for this group of clients. However, the effect of IPS on patients with chronic pain in an outpatient hospital clinic is largely unknown.

Official Title
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A Randomized Controlled Trial Assessing the Effectiveness of the Individual Placement and Support Model for Patients With Chronic Pain in an Outpatient Hospital Pain Clinic

Conditions
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Chronic Pain

Intervention / Treatment
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* Behavioral: IPS
* Behavioral: Self-help
* Behavioral: Treatment as usual


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients referred to the pain clinic and eligible for interdisciplinary treatment Not currently working (long-term sick leave, disability pension or unemployed) Expressed desire to work Exclusion Criteria: Living too far away from the pain clinic (outside of Oslo)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Treatment as usual + self-help<br>Interdisciplinary treatment as usual at the outpatient pain clinic + an additional self-help binder with resources about pain management and employment advice. | Behavioral: Self-help<br>* Self-help resources on obtaining employment and coping with chronic pain<br>Behavioral: Treatment as usual<br>* Transdisciplinary treatment at the pain clinic. This includes medical, psychological and physiotherapy treatment.<br>|
| Experimental: Treatment as usual + IPS<br>Individual job support (IPS) as an integrated part of the interdisciplinary treatment at the outpatient pain clinic. | Behavioral: IPS<br>* Individualized job support provided by an employment specialist<br>Behavioral: Treatment as usual<br>* Transdisciplinary treatment at the pain clinic. This includes medical, psychological and physiotherapy treatment.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Competitive employment | Hours/days/weeks worked in competitive employment the last 12 months | At 12-months follow-up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Health-related quality of life | EQ5D termometer | 6 and 12 months follow-up | 
| Pain-related disability | Oswestry, modified to chronic pain patients | 6 and 12 months follow-up | 
| Pain intensity | Numeric Rating Scale | 6 and 12 months follow-up |