Occupational therapists’ views of a structured interview to identify and prioritise the work problems of people with rheumatoid arthritis Y Prior, S Bodell, A Amanna, A Hammond (Presenter) Centre for Health Sciences Research, University of Salford Greater Manchester, UK
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Nothing to disclose
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Background In people with rheumatoid arthritis (RA): ❑ within 5 years of diagnosis: 28-40% stop work (Young et al 2002; Eberhardt et al 2007)
❑ Before becoming work disabled many experience work instability and reduced productivity (Allaire et al 2006) ; Zirkzee et al 2008) ❑ Unlikely to return to work once ceased working (Young et al 2009)
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Vocational rehabilitation (VR) provision for rheumatology service users in the NHS* National Audit Office report (2009): ✓ Only 20% RA patients satisfied with work advice given. ✓ Very variable and dependent on location ✓ Provided by a range of professionals e.g. Occupational Therapists, Physiotherapists, Nurses ✓ More often than not, offered to few patients, often in crisis situation ✓ Infrequently part of service agreement.
* National Health Service (UK)
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Work in Inflammatory Arthritis (WORK-IA) Study
A multi-centre pilot randomised controlled trial (RCT) to investigate: ✓ the vocational, clinical and cost effectiveness of an OT led VR programme for people with inflammatory arthritis 5
Vocational Rehabilitation (VR) Training programme for Rheumatology OTs Consists of.. ✓ Two day practical course: the Work Experience Survey (WES-RC) • Additional take-home study tasks to reinforce learning ✓ Telephone role play of WES-RC ✓ Follow-up study day. 6
Training programme content ✓ Assessment of clients’ physical and psychosocial functioning related to work ✓ Training in use of Work Experience Survey – rheumatic conditions (WES-RC) (Allaire & Keysor, 2009) ✓ Analysing jobs (e.g. task analysis, working positions, postures, activity cycles) ✓ Providing solutions for work based problems (e.g. ergonomic modifications, job redesign, specialist equipment)
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Training programme content
✓ Applying condition management skills e.g. fatigue management, joint protection, stress management ✓ Negotiation and communication skills e.g. disclosure ✓ Current work related legislation, e.g. Equality Act 2010; Statutory and third sector employment, support and advisory services in the UK, e.g. Disability Employment Advisory Service ✓ How health is managed in the workplace 8
Interventions Control group: Usual care + advice pack ➢ Self help information pack: ➢ written information about job modifications; accessing existing VR support; employment rights for people with disabilities
Intervention group: Usual care+advice pack + VR ➢ Usual care and advice pack (as above)
➢ 3 x 1.5 hour 1:1 meetings, + 30 minute telephone review ➢ Optional 1.5 hour contact for those with more significant work problems 9
The Work Experience SurveyRheumatoid Conditions (WES-RC) • • •
A structured interview identifying work barriers of people with arthritis Developed in the USA (Allaire & Keysor, 2009) Takes about 45 minutes to complete
•WES-RC: http://usir.salford.ac.uk/29319/ •WES-RC User Manual: http://usir.salford.ac.uk/29320/ 10
Aim of the study Explore participating occupational therapists’ views:
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about conducting the WES-RC to identify and prioritise work problems of people with arthritis.
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Methods Semi-structured face-to-face interviews with OTs (n=9)
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Analysis
The interviews: ✓ recorded, transcribed and thematically analysed (Braun & Clarke, 2006)
✓ by three researchers to maximise validity.
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Six Phases of Thematic Analysis*
1. 2. 3. 4. 5. 6.
Familiarising with data and identifying items of potential interest Generating initial codes Searching for themes Reviewing potential themes Defining and naming themes Producing a report
* Thematic map is reviewed and evaluated circularly
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Managing the coding process
✓ Data initially coded and analysed manually ✓ Nvivo software used to manage, revise and further develop the coding structure, confirm categories and explore connections between categories ✓ Software assisted systematic searching of text and organising categories and themes
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Validity ✓Validity of data analysis tested by: ❑ All transcribed interviews carefully checked for accuracy and intonation against original tape ❑ Two researchers independently performed preliminary analysis; results compared ❑ Selection of interview transcripts and coding checked by third researcher ❑ Participants invited to check transcripts 16
Confidentiality
✓ Participants assured of anonymity in report ✓ All materials kept in a secure filing cabinet in a locked office/ secure server.
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Results ✓ Thematic analysis identified key concepts labelled as: ❑ Lack of previous experience using any structured assessments ❑ The WES-RC is an effective tool for identifying, prioritising and helping solve patients’ work problems
❑ Concerns about the feasibility of a lengthy interview in practice
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Initial thematic map: five main themes Gap between training & application
Lack of previous experience
Difficulty in recall
Intervention delivery
Losing confidence Job task analysis Patient interview
WES-RC +ves and -ves
Employer liaison
Structured Assessment
Lengthy assessment Patient’s problems
Accommodations Consent
Time constraints Identify
Prioritise Appointments Help to solve Taking leave
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Developed thematic map: three main themes Confidence
Lengthy initial assessment
Lack of previous experience in conducting structured interviews
Experience
Concerns about the feasibility
WES-RC is an effective tool for identifying & and helping solve work problems
Structured questioning Focused interview
Prioritisation Length of assessment & intervention delivery
Practical considerations
Workplace visits
Employer liaison
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Some direct quotes from participants….
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Lack of previous experience in using structured assessments
OT01: We had quite a bit of training. I know it had concentrated on that. Again I don’t know if it is just the fact that when you actually come to do it, live, it is like.. oh my goodness, did I not listen at this bit? I don’t know if that is where I am kind of thinking, if we were perhaps able to interview, [during training] sort of, clients who have got problems, or if we could observe somebody who does it day in and day out, …. and kind of see how they sort of apply it.
OT03: I was feeling the need to do everything and tick all the boxes. Whereas, previously, on the trial one that I’d done with the mentor over the phone, I hadn’t. And I wouldn’t normally do that and it was just interesting that it’s just becoming familiar with using a lengthy standardised assessment, I think.
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The WES-RC is an effective tool for identifying, prioritising and helping solve patients’ work problems OT04: It's because the questions we are asking promotes them to talk for longer or to open up more. I found both patients have actually opened up and talked a lot more than a normal patient would do for their initial interview. That I wouldn't normally see somebody for...
OT05: So I think the structure allowed me to be able to tweak out what potential problems were there. Even though they seemed very little problems, but the actual little action made a really big difference to his work. So that was quite a surprise really I think.
OT06: It was very helpful and well laid out as well, I thought that was brilliant!
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Concerns about the feasibility of a lengthy interview in practice OT04: So it's a shame, the WES-RC takes a long time in its own right . But then to do the action plan and the problem solving is another time on top of that.. and I just found it was too long for the patient.
OT05: “The other thing that has just popped into my mind, I do find it quite hard but this again might be a personal thing to me, is to do the hour and a half interview with the person, the initial assessment and then to sit down and actually complete the form. I do feel like I need to go in a darkened room after, you know because it is quite intense. You have had sort of lots of information going in there and then to actually transcribe it onto a piece of paper. So I know on Friday I did make loads and loads of notes and then I actually had a bit of a gap and then I came back to it because I felt I needed to clear my head and come back a little bit fresher”.
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Discussion Limitations: ✓ ✓
Gap between training and intervention delivery Small number of OTs (n=9) using the WES-RC, interviewed after one client assessment only
Later trial-closing interviews, after several assessments: ✓ OTs much more confident in use ✓ Quicker
Further research: ✓ investigate feasibility of OTs’ using WES-RC in clinical practice
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Conclusions
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WES-RC: good choice of work assessment; can be implemented in practice
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Rheumatology OTs: need more training to increase confidence and efficiency in its use.
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Training programme: needs increased practice time and feedback to OTs to ensure……
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WES-RC completed in under 1 hour including: recording directly on assessment; identifying priorities; beginning treatment planning. 26
Acknowledgments
• Participating OT’s and service users. • Arthritis Research UK for funding this study.
• Contact:
[email protected]
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References Allaire et al 2006. Arthritis Care and Research 55: 294–9. Allaire and Keysor 2009. Arthritis Care and Research 61: 988–95. Braun & Clarke, 2006. Qualitative Research in Psychology 3: 2 Eberhardt et al 2007. Journal of Rheumatology 34: 481–7 Young et al 2002. Annals of the Rheumatic Diseases, 61, 335–340 Young et al 2009. Rheumatology 48 (Suppl. 1): i111 (271) Zirkzee et al 2008. Clinical Rheumatology 27: 11–19.
Download the WES-RC from: • Interview: http://usir.salford.ac.uk/29319/ • User Manual: http://usir.salford.ac.uk/29320/
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