©The Work Foundation Stephen Bevan Director, Centre for Workforce Effectiveness The Work Foundation & Honorary Professor Lancaster University The Clinical and Work Benefits of Early Intervention for MSKs’

Context Ageing Workforce Later Retirement More Chronic Ill-health among working age citizens Burden of MSDs in workforce Widening Health Inequalities & a recognition that ‘Work’ is a social determinant of health ©The Work Foundation

Musculoskeletal Disorders in the EU Workforce a

Employment rates (working age, England) Just 50.7% of individuals with MSDs are in employment compared to 71.6% of individuals without MSDs 41.9% of people with back problems are in employment Those with MSDs are more likely to work part time Over 32% of working age people with MSDs have co- morbid depression Over 60% of people working with MSDs are the primary income-earner in their household Source: TWF/Health Survey for England, 2015

Key Issues A diagnosis of a chronic illness should be no impediment to leading a healthy and fulfilling working life Well-timed workplace & healthcare investments among working age people deliver sustainable returns in terms of productivity gains and social inclusion ©The Work Foundation

Potential Benefits of Early Intervention Better treatment. The quicker an individual receives a diagnosis, the more rapidly they can get access to appropriate treatment which can stabilise or control their symptoms; Reducing the risk of developing co-morbid conditions. For many people with chronic conditions issues like pain, fatigue, depression or anxiety can become a significant issue which can increase healthcare costs and reduces functional capacity; Aiding a return to activities of daily living. Early intervention can ensure people with chronic conditions can become more self-reliant and rely less on health and social care services; Staying in or returning to work. People whose health conditions are being well-managed are more likely to remain economically active, continue to pay taxes and be less reliant on welfare payments Early Intervention is cost effective. An investment not a Cost ©The Work Foundation

Early Intervention for MSK Why focus on early healthcare interventions for working people? Does early intervention improve work ability – assessing the evidence? Case studies of early intervention successes What lessons can stakeholders draw from this evidence? From evidence to action – taking the next steps ©The Work Foundation

Methodological Considerations ©The Work Foundation The methods which have been used to estimate indirect costs – especially productivity gains or losses The measure of ‘return to work’ (RTW) being used The choice of comparator interventions used in drawing conclusions about cost-effectiveness

Example: Early Back Pain Intervention Over 120 patients with high risk of acute back pain randomly assigned to ‘early’ and ‘usual’ treatment groups ‘Early’ group received 3 months of physical therapy and cognitive behavioural therapy, including coping skills training, relaxation and biofeedback 12 month follow-up after the main intervention the study captured data on self-reported pain, health status, healthcare resource utilization and work days lost Rogerson et al, 2010

Results No difference in self-reported pain & health status (both improved) Health visits by ‘Early’ group declined but among ‘Usual’ group they increased Mean sick days for ‘Early’ group was 13.6 days and for the ‘Usual’ group it was 25.8 days Cost utility ratio for the ‘Early’ group revealed a cost of $49,593 per QALY gained: for the ‘Usual’ group it was $71,001 per QALY gained

Early Intervention Can… Reduce sick leave and lost work productivity among workers with MSDs by more than 50 per cent. Early intervention is commonly more cost-effective than ‘usual care’; Reduce healthcare costs by up to two-thirds; Reduce disability benefits costs by up to 80 per cent; Reduce the risk of permanent work disability and job loss by up to 50 percent; Reduce the risk of developing a co-morbid mental illness Deliver societal benefits by supporting people with work- limiting chronic conditions to optimise their functional capacity and remain active at work and maintain economic independence

Actions for Stakeholders

Job Quality - A Message From HILDA Household, Income and Labour Dynamics in Australia (HILDA) Survey Analysis (Butterworth et al, 2011) of seven waves of data from 7,155 respondents of working age (44,019 observations) from a national household panel survey. Longitudinal regression models evaluated the concurrent and prospective association between employment circumstances (unemployment and employment in jobs varying in psychosocial job quality) and mental health, assessed by the MHI-5

Psychosocial Job Quality (1) 1. My job is more stressful than I ever imagined 7. My job is complex and difficult 8. My job requires learning new skills 9. I use my skills in current job 10. I have freedom to decide how I do work 11. I have a lot of say about what happens 12. I have freedom to decide when I do work 4. I have a secure future in my job 5. Company I work for will be in business in 5yrs 6. I worry about the future of my job 3. I get paid fairly for the things I do in my job Job demands & complexity Job control Job security Effort- reward fairness Source: Butterworth et al, 2011

Psychosocial Job Quality (2) “As hypothesised, we found that those respondents who were unemployed had significantly poorer mental health than those who were employed. However, the mental health of those who were unemployed was comparable or more often superior to those in jobs of the poorest psychosocial quality.” Source: Butterworth et al, 2011

Improving Employment Outcomes for Those with MSDs Workforce health as a ‘Human Capital Asset’ ‘Work’ should be a clinical outcome of care The need to prevent premature work loss Interventions to support independent living Cost effectiveness of early interventions – making the case for investment Joining up the work of Healthcare, Social Insurance & Employers – and placing patients at the centre of their care