Work-Able Solutions: A Preliminary Report of an Occupational Therapy Vocational Rehabilitation Integrated Care Programme

The National Clinical Programme for Rheumatology pilot project Work-Able Solutions is an integrated care occupational therapy vocational rehabilitation service for people with musculoskeletal disorders and arthritis. Funded by the Sláintecare Integration Innovation Fund (2022) this pilot is delivering services across Dublin South, Wicklow, Kildare, and Waterford until December 2024. Two sites are based in the acute hospital setting (St Vincent’s University Hospital and Naas General Hospital) and delivering service outward into primary care; the third site is in primary care (Waterford Primary Care) with inward links to the rheumatology service in University Hospital Waterford. Referrals are accepted from primary care and hospital rheumatology multidisciplinary team members. Work-Able Solutions services deliver early access to individualised, flexible and tailored evidence-based interventions to people with musculoskeletal disorders and arthritis who require additional help to remain in or return to work. The service implements a ‘stepped-care approach’ starting with simple, low-intensity, low-cost interventions and with in-built mechanisms for progressively more intensive and structured interventions where required. This ‘stepped-care approach’ is aligned with established recommendations internationally and is associated with positive work outcomes including return to work rates, decreased absenteeism, increased productivity and self-management. Co-design of the service pathway, content, and modes for evaluation was completed by the National Clinical Programme team informed by the rheumatology programme of work and priorities, existing research and clinical practice, and included collaboration with the Department for Social Protection. Vocational rehabilitation in community settings is increasingly common practice internationally however, this service is unique in the Irish context and implementation of the Work-Able Solutions services aligns Irish management of this work-based need with international practice. Furthermore, the project incorporates the Sláintecare implementation strategy (2018) goals and actions which focus on integrated care with specialist acute care providers delivering timely interventions in tertiary services. Work-Able Solutions services have been fully operational since September 2023 with more than one hundred individuals seen to date. Monthly reporting to the funders is being completed to monitor how the service is supporting individuals to retain their work role or return to work after absences. In addition, a quasi-experimental study using a before and after design with a three-month follow up is being conducted to examine the effectiveness of the project. A detailed report to the funders will be completed at the end of pilot and formal research findings will be disseminated nationally and internationally. Findings will guide and influence the future development and national roll out of this service improvement initiative and improve access to timely work supports for this population. Furthermore, results will enable increased understanding of the influence of this type of service pathway and intervention in supporting a reduction in work absenteeism, improving work productivity, work presenteeism, work self-efficacy and health-related quality of life.