Arthritis Research-UK/MRC Centre for …projects.socialsciences.manchester.ac.uk/hawwn/wp...Arthritis Research-UK/MRC Centre for Musculoskeletal Health and Work A new national research

Arthritis Research-UK/MRC Centre for Musculoskeletal Health and Work

A new national research network aiming to reduce work disability from musculoskeletal

disorders

Dr Karen Walker-Bone, Deputy Director

Source: OECD (2014), Mental Health and Work: United

Kingdom, Paris: OECD Publishing. Courtesy Shruti Singh

New UK disability claims are among the highest in the OECD

New claims per 1,000 of the working-age population (inflow rates), latest year available

0

2

4

6

8

10

12

OECD

average

UK: Disability burden and the benefit system

Earlier intervention could

improve this

In developed world, TWO main causes of work disability..

• Mental health

• Musculoskeletal disorders

Regional YLD percentages for 21 common causes, 2010

Global burden of Disease 2010 Study Lancet 2012; 380 (9859)

MSDs

Developed countries Developing countries

Mental

Proportion

of YLDs

The ageing workforce

By 2030, approximately 21 million people of working age will have at least one long term health condition

Prevalence of back pain

Work and musculoskeletal health

• Many of the 21st Century work and health issues affect the musculoskeletal system

• Back and neck pain, shoulder and knee pain

• Osteoarthritis

• 5 of the top 6 problems that impact work productivity are musculoskeletal or musculoskeletal-related (fatigue /depression)

• Responsible for 10 million days lost per year and £7 billion societal costs

The need for training and capacity building

• Recruitment to occupational health research in UK challenged

• Significant need for strengthening and developing academic capacity

• There are currently no NIHR Clinical Lecturers in Occupational Medicine nationally

….. Centre for Musculoskeletal Health and Work • An internationally recognised centre of

excellence providing national leadership in research and translation

• Address important and tractable questions

• Bring together multiple disciplines and centres in constructive collaboration to deliver enhanced outputs

• Capitalise on strengths to augment funders’ investment with complementary funding from external sources

• Train a new generation of researchers

Themes

• Back, neck and upper limb pain

• Osteoarthritis and knee injury

• Inflammatory arthritis

• Musculoskeletal health and work at older ages

The ARM pain trial: An RCT

Maintained physical activity and physiotherapy in the management of distal arm pain

Aberdeen

Southampton Brighton

Bath

Cambridge

Hypotheses

• Among patients referred to physiotherapy with an episode of distal arm pain . . .

. . . advice to remain active and maintain usual participation results in a long-term reduction in arm pain and disability, compared with advice to rest the arm

Physiotherapy

referral

Advice to

remain active Fast-track

physiotherapy

Advice to

rest

Pre-trial

assessment

Physiotherapy

(optional)

Follow-up

6, 13 and 26 wks

Advice to remain

active Advice to rest

Treatment: Group 1

Advice to remain active

• Upper limb pain is common

• Early RTW is (probably) helpful

• Lasting damage is rare

• Recovery can be expected

• Many cases settle with self-management

• Maintaining activity is (probably) helpful

Burton et al. HSE Research Report RR596; 2008

Treatment: Group 2

Material available via NHS-Direct

• Advice to rest

• Biomedical “injury-diagnosis-treatment” model

• Advice about rest and avoidance of activity

• Similar in length and format

Physiotherapy

referral

Advice to

remain active Fast-track

physiotherapy

Advice to

rest

Pre-trial

assessment

Physiotherapy

(optional)

Follow-up

6, 13 and 26 wks

Fast-track

physiotherapy

Physiotherapy

(optional)

Advice to remain

active Advice to rest

ARM trial

• 540 patients recruited end Jan 2014

• 6-month month follow-up completed August 2014

• >80% retention in follow-up phase at each point: 6 weeks, 3 months, 6 months

• Database locked recently

• Results coming…

Health and Employment After Fifty (HEAF) Study

HEAF study questions

At older ages...

• To what extent does work harm MS health?

• How does MS health impact on ability for work?

• Does MSD-related job loss harm mental health?

• What factors modify employment outcomes?

• What can be done to support the older worker?

• >8,000 people aged 50-64 yrs

• 24 general practices

• Baseline assessment

• Items on – work; attitudes to work & retirement; expectations; finances; health; social, lifestyle, & demographic data

• Annual follow-up – employment transitions, job status, effect modifiers

The HEAF study

+

• Nested within the CPRD... - Many health measures from medical records - Richly detailed, contemporaneous, date-stamped - Low marginal cost

The HEAF study

HEAF extension

• 500 subjects – North-west & Southern England

• Phenotypic assessment – joint, muscle & bone health

• Validation of CPRD records

• Impact of objective disease on work capability/ participation (& modifiers)

Capacity building

• 8 PhD studentships across 7 academic centres: Aberdeen, Lancaster, Liverpool, Manchester, Oxford, Salford, Southampton

• 2 post-doctoral fellowships: Aberdeen, Imperial

• Annual scientific meetings

• Additional annual research ‘retreat’

• Secondment

• Network and learning opportunities across disciplines

• Mentoring

Aims of public engagement

Recognised as an authoritative source of comprehensive, multidisciplinary expertise on musculoskeletal health and work in the UK

• Active dialogue with representatives of all our stakeholders

• Demonstrate ability to respond to changes

• Collaboration with researchers in the UK and elsewhere

DWP

Researchers

Royal College of Physicians

Employers

Clinicians

Patients

Workers Trades Unions

Health & Safety Executive

NHS England, Scotland Wales and Ireland

Public Health England

DoH

NICE

Stakeholders

Policy developers

People affected

Implementers

• Faculty of Occupational Medicine

• Royal Colleges and Faculties

• Public Health England

• NICE guidance

• GP colleagues through Arthritis Research UK Primary Care Centre, University of Keele

• Council for Work and Heath

Government and policy makers

• Identify research needs

• Lobby for support for research

• Monitor relevant Government activities for opportunities

• Respond to consultations

• Assist with translation of research output into policy

• Actively transfer knowledge

Media

Responsive and proactive communication

• Press offices and Science Media Centre

• Radio and TV, newspapers, trade magazines

• Funders publications

• Scientific Journals

• Scientific Conferences

http://www.mrc.soton.ac.uk/cmhw/

Outputs

• Advice for researchers

• Information for employers

• Evidence-based information for patients/workers

• Prof Nigel Arden

• Dr Neil Basu

• Prof Steve Bevan

• Prof Marijn de Bruin

• Prof Anthony Bull

• Prof Kim Burton

• Prof Susan Cartwright

• Prof Cyrus Cooper

• Ms Stefania D’Angelo

• Prof John Goodacre

• Dr Nicky Goodson

• Prof Alison Hammond

• Prof Alison McGregor

• Prof Rob Moots

• Dr Fehmidah Munir

• Ms Georgia Ntani

• Prof Katherine Payne

• Prof Keith Palmer

• Dr Yeliz Prior

• Dr Julia Smedley

• Prof Deborah Symmons

• Dr Suzan Verstappen

• Dr Sian Williams

• Dr Clare Harris

• Dr Mark Harrison

• Prof Elaine Hay

• Prof Markus Heller

• Dr Paula Holland

• Dr Kassim Javaid

• Ms Cheryl Jones

• Dr Gareth Jones

• Dr Cathy Linaker

• Prof Gary Macfarlane

• Dr Ira Madan

• Dr Jane Martindale

Finally…

• Inclusive multi-disciplinary group of researchers

• Assist with prosecution of research in this area

• Can coordinate communication with funders, policy makers, workers

• Keen that we can learn from each other’s initiatives

• Contact us….

• [email protected]

• [email protected]

• [email protected]