Andy Cochrane

The Perceived-Threat Behavioral Approach Test (PT-BAT): Measuring Avoidance in High-, Mid-, and Low-Spider-Fearful Participants

One hundred twenty female participants, with varying levels of spider fear were asked to complete an automated 8-step perceived-threat behavioral approach test (PT-BAT). The steps involved asking the participants if they were willing to put their hand into a number of opaque jars with an incrementally increasing risk of contact with a spider (none of the jars actually contained a spider). There was a negative correlation between the number of steps completed and self-reported spider fear as measured with the Fear of Spiders Questionnaire (FSQ). Additionally, the task discriminated between high, mid, and low fear on 2 behavioral measures: (a) the number of steps completed and (b) reported willingness to return and repeat the task. The automated procedure provides a psychological challenge with a high level of experimental control.

Early interventions to promote work participation in people with regional musculoskeletal pain: a systematic review and meta-analysis

Objectives: To determine the effectiveness of early multidisciplinary interventions in promoting work participation and reducing work absence in adults with regional musculoskeletal pain. Data sources: Seven databases (CENTRAL, CINAHL, EMBASE, MEDLINE, Scopus, OT Seeker, PEDro; 1990 to December 2016) were searched for eligible studies. Review methods: Trials were included if they reported on work-based outcomes for participants experiencing difficulties at work or ≤ three months’ sick leave. Interventions had to include two or more elements of the biopsychosocial model delivered as a coordinated programme. Quality was assessed using the GRADE criteria. Results were analysed by hazard ratios for return to work data; continuous outcomes were analysed as standardised mean difference with 95% confidence intervals. Results: A total of 20 randomized controlled trials, with 16,319 participants were included; the interventions were grouped according to their main components for meta-analyses. At 12-months follow-up, moderate quality evidence suggests that programmes involving a stepped care approach (four studies) were more effective than the comparisons in promoting return to work (hazard ratio (HR) 1.29 (95% confidence interval (CI) 1.03 to 1.61), p = 0.03), whereas case management (two studies) was not (HR 0.92 (95% CI 0.69 to 1.24), p = 0.59). Analyses suggested limited effectiveness in reducing sickness absences, in pain reduction or functional improvement across the intervention categories. Conclusion: There is uncertainty as to the effectiveness of early multicomponent interventions owing to the clinical heterogeneity and varying health and social insurance systems across the trials.

The Role of Philanthropic Funding in Building Research Evidence to Support an Aging Population: A Case Study from Ireland

ABSTRACT This case study examines the role of philanthropic funding in building capacity for aging research in Ireland, and how this investment has addressed the lack of evidence to support planning for an aging population. The funding has supported a range of initiatives including the national longitudinal study on aging (TILDA), the creation of three professorships/chairs, and the establishment of four new research centers. Important potential outcomes are emerging across other domains including research-informed policy development and the generation of health benefits. The efforts of academic researchers to ensure that their findings are readily accessible to end users and to forge robust working relationships with all stakeholders have helped to enhance the use of research findings. Overall, philanthropy has played a pivotal role in building capacity, infrastructure, and expertise in academic settings in Ireland. Moreover, this work provides an excellent example of how such efforts can begin to inform effective planning and service provision.

THU0550 Early Multidisciplinary Interventions To Promote Work Participation in People with Regional Musculoskeletal Pain: A Systematic Review

Background Musculoskeletal disorders are amongst the leading causes of disability in the working age population. Whilst there is a growing body of evidence suggesting that early targeted multidisciplinary interventions can promote work retention and prevent disability, the evidence is far from conclusive as to which interventions are the most effective. Objectives To review randomised controlled trials evaluating the effectiveness of early interventions in promoting work participation in adults with regional musculoskeletal pain (RMSKP). Methods CENTRAL, MEDLINE, EMBASE, Scopus, PEDro and OT Seeker (1990 to April 2015) were searched. Reference lists of identified articles and reviews were hand searched. Only RCTs reporting on work-related outcomes were eligible for inclusion. The intervention had to include two or more elements of the biopsychosocial model delivered as an integrated programme. Participants were either experiencing difficulties at work or had less than three months sick leave as a result of their RMSKP at enrolment. Each RCT was assessed independently by two reviewers for risk of bias. Results were analysed by hazard ratios for return to work data, while continuous outcomes were analysed as mean difference (MD) with 95% confidence intervals. Results 19 RCTS were included; the considerable variation in the components employed in the interventions limited the option to pool the data statistically using meta-analysis. There was some evidence that programmes involving a stepped care approach (4 studies) increased the probability of return to work at the 12-month follow-up [HR 1.29 (95% CI, 1.03 to 1.61), p=0.03]. However, preliminary analyses indicate a lack of consistent evidence for effects on reducing sickness absences, pain reduction and functional improvement across the intervention types. Conclusions The lack of agreement as to what constitutes “early” in the context of treating RMSKP may have contributed to the rather ambiguous findings. In addition, the different health and social insurance systems across the trials have made it difficult to generalise the results. There remains a need to establish the active components that promote work retention in this population, and to identify the patients who are most likely to benefit from an integrated and cost-effective intervention. Disclosure of Interest None declared

THU0625 Healthcare Professionals' Perspectives on The Design and Implementation of An Early Integrated Care Intervention for Musculoskeletal Pain in The Irish Healthcare Setting: A Qualitative Study

Background Musculoskeletal disorders are amongst the leading causes of disability in the working age population. Growing evidence suggests early screening and targeted interventions during the acute phase can promote work retention and prevent disability. Objectives This study aims to develop and feasibility test an early, case manager-led intervention focusing on work as a clinical outcome. Here we report qualitative findings from focus groups and interviews conducted to consider issues of content, delivery and optimal timing, and to explore key priorities and potential challenges in service delivery. Methods Two focus groups and three individual interviews were conducted, involving 17 experts representing the multidisciplinary team. Thematic analysis was used to summarise the views and ideas expressed. Results Participants highlighted the importance of early access to diagnosis, relevant investigations and referral to specialists as necessary in reducing the risk of long term disability; noting the critical importance of GPs in facilitating early access. The need to provide reassurance and education about the patients condition was highlighted, as was the importance of screening for psychosocial risk factors. Patients most likely to benefit from the intervention were identified as those highly motivated to maintain their current work roles. Ready access to the MDT and the skill set of the case manager were noted as critical concerns, resource constraints pose considerable challenges. Conclusions Introduction of an early integrated care intervention that targets risk of work disability is warranted. Considerable “buy-in” is required from all stakeholders involved. The data will help to inform the planned feasibility study. Acknowledgement We would like to thank all of the individuals who participated in the interviews and focus groups. Disclosure of Interest None declared