arthritis research-uk/mrc centre for...
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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….