Effectiveness and delivery of the WORKWELL programme in the UK
This project looks to demonstrate the efficacy and effectiveness of the WORKWELL programme to improve job retention for those with inflammatory arthritis, and to develop its roll-out in digital format.
Inflammatory arthritis (IA) causes work disability, absenteeism (sick leave) and presenteeism (reduced productivity) at high cost to individuals, employers and society. A trial of job retention ‘vocational rehabilitation’ (VR) amongst people with IA in the United States showed that vocational rehabilitation was effective in reducing work disability. Despite this promising research, it is still unknown whether this approach transfers to the United Kingdom with its distinct approach to healthcare, social care and welfare structure.
In previous research funded by Arthritis UK (then Arthritis Research UK) we successfully modified the VR programme for the UK, which resulted in the development of the WORKWELL programme. This research also demonstrated this programme was both deliverable and acceptable in the UK context on a small scale via an associated feasibility trial. Our aim in this project was to build on this research to show the effectiveness and cost-effectiveness of WORKWELL on a nationwide basis.
Aims
WORKWELL Randomised Controlled Trial (RCT)
The main aim of the WORKWELL RCT was to investigate whether the WORKWELL work rehabilitation programme could be shown to be effective at improving the working lives of people with inflammatory arthritis, including improving outcomes in terms of job retention, absenteeism, presenteeism, and as a consequence reduce the associated costs for individuals, employers and society as a whole.
If shown to be effective and cost-effective, the ultimate goal of the programme was that WORKWELL be rolled out in Rheumatology services in the UK to help improve the quality and duration of people with arthritis' working lives.
WORKWELL DIGITAL
WORKWELL DIGITAL sought to create a brand-new online platform to increase access for people with inflammatory arthritis to the WORKWELL Programme. The WORKWELL digital platform has been designed with input from digital content creators, a clinical advisory group and a patient and public involvement panel to create an accessible resource which is responsive to the needs of working people with inflammatory arthritis.
What did this research involve?
WORKWELL RCT
This research consisted of a randomised controlled trial (RCT).
240 employed people with rheumatoid, psoriatic or inflammatory arthritis, who have concerns about continuing working due to arthritis, were be randomized to receive either the WORKWELL programme or alternative, written advice (the control intervention).
The WORKWELL programme includes individualised vocational rehabilitation (a maximum 4.5 hours over several months), including:
assessing work problems
encouraging arthritis self-management in the workplace
addressing ergonomic considerations
considering fatigue and stress management
providing orthoses and educating on employment rights and support services, assistive technology and work modifications
In addition, the programme also includes psychological and disclosure support, workplace visits and employer liaison (as applicable).
The main outcomes the trial looked at included presenteeism, work status, absenteeism, self-confidence about work efficacy, and other work productivity measures. These outcomes were assessed at 0 (baseline), 6 and 12 months by means of s self-completed questionnaire, with a further follow up at 3 years. The primary outcome was the Work Limitations Questionnaire-25 (measuring presenteeism as a summed score) at 12 months, including additional cost-effectiveness analysis.
As part of the trial process, we also conducted individual interviews with some participants to provide a deeper understanding of the needs of working people with inflammatory arthritis, in order to better design support services to help them stay in work.
WORKWELL DIGITAL
Working with a Patient and Public Involvement (PPI) panel we have now created a brand-new online platform to increase people with inflammatory arthritis’ access to the WORKWELL programme. This work was supported by a highly skilled and experienced digital partners to design the online components to ensure these are engaging, easy to use and accessible to all from variety of devices e.g., tablets and mobile phones.
The design and content of this online platform was further informed by extensive qualitative interviews conducted in the process evaluation of the WORKWELL programme, in order to understand the needs of working people with inflammatory arthritis to support them staying at work.
What did the study find?
WORKWELL RCT
The WORKWELL RCT is now completed, and data analysis and the 3-year follow-up data collection is also complete.
You can view the trial registration here: https://clinicaltrials.gov/ct2/show/NCT03942783.
Publications
Main results paper
Hammond, A, Parker, J, Cotterill, S, Sutton, CJ, Mirza, S, Ching, A, O’Neill, TW, Holland, F, Marsden, A, Holland, PJ, Radford, K, Verstappen, SMM, Eden, M, Dalal, G, Battista, S, Culley, J, Walker-Bone, K, Woodbridge, S, O-Brien, R, Hough, Y, Prior, Y. The WORKWELL programme: a randomized controlled trial of job retention vocational rehabilitation for people with inflammatory arthritis. Rheumatology Volume 65, Issue 8, August 2026, keag373 (2026) DOI:10.1093/rheumatology/keag373
Trial protocols
Hammond, A, Sutton, CJ, Cotterill, S. et al. The effect on work presenteeism of job retention vocational rehabilitation compared to a written self-help work advice pack for employed people with inflammatory arthritis: protocol for a multi-centre randomised controlled trial (the WORKWELL trial). BMC Musculoskeletal Disorders 21, 607 (2020). DOI:10.1186/s12891-020-03619-1
Hammond A, Radford K, Ching A, et al. The WORKWELL trial: protocol for the process evaluation of a randomised controlled trial of job retention vocational rehabilitation for employed people with inflammatory arthritis. Trials 23, 937; 2022. DOI:10.1186/s13063-022-06871-z
Process evaluation
Battista, S, Parker, J, Ching, A, Culley, J, Long, S, Heard, A, Hammond, A, Radford, K, Holland, P, O’Neill, T, Walker-Bone, K, Prior, Y.WORKWELL process evaluation: qualitative data analyses of the participant interviews at 12- and 36-month follow-ups. Rheumatology Advances in Practice, Volume 9, Issue 2, 2025, rkaf034. DOI:10.1093/rap/rkaf034
Prior, Y, Battista, S, Mathew, A, Parker, J, Gates, S, Ching, A, Hammond, A, Radford, K, Holland, P, O’Neill, T, Culley, J, Walker-Bone, K. WORKWELL process evaluation: insights from therapists and line managers. Rheumatology Advances in Practice, rkaf076. DOI:10.1093/rap/rkaf076
Other publications
Ching, A, Parker, J, Haig, . et al.Job retention vocational rehabilitation for employed people with inflammatory arthritis: adaptations to the WORKWELL trial due to the impact of the COVID-19 pandemic. Trials23, 1030 (2022). DOI:10.1186/s13063-022-06941-2
Sutton CJ, Cotterill S, Forshaw D, Rhodes S, Haig A, Hammond A. Randomised evaluation of pre-notification of trial participants before self-report outcome data collection to improve retention: SWAT86. Research Methods in Medicine & Health Sciences. 2022;3(4):107-115. DOI:10.1177/26320843221098427
Hammond, A, O’Brien, R, Woodbridge, S, Prior, Y, Ching, A, Culley, J, Parker, J. Upskilling Rheumatology Occupational Therapists in Work Rehabilitation: An Evaluation of a Job Retention Vocational Rehabilitation Training Course (the Workwell Trial). Musculoskeletal Care, 23: e70067. DOI:10.1002/msc.70067
WORKWELL DIGITAL
In WORKWELL Digital, we worked with a Patient and Public Involvement (PPI) panel to co-design a brand-new online platform to increase access for people with inflammatory arthritis’ to the WORKWELL programme. This effort was supported by our highly skilled and experienced digital partners who helped to design the online components to ensure these are engaging, easy to use, and accessible from a variety of devices, such as tablets and mobile phones.
The design and content of this online platform was further informed by the extensive qualitative interviews conducted in the process evaluation of the WORKWELL programme. These interviews helped us understand the needs of working people with inflammatory arthritis to support them in staying at work. Phase 1 of the design and development is now completed, and the website has now been launched in advance of wider acceptability and usability testing in spring 2024. Phase 2 of the WORKWELL Digital will build upon the findings from Phase 1 to ensure that the final website is fully optimized and fit for purpose."
Study team
Chief investigators
Professor Yeliz Prior (University of Salford)
Co-investigators
Professor Alison Hammond (University of Salford)
Dr Sarah Cotterill (University of Manchester)
Dr Chris Sutton (University of Manchester)
Professor Terry O’Neill (University of Manchester)
Dr Suzanne Verstappen (University of Manchester)
Dr Martin Eden (University of Manchester)
Professor Kate Radford (University of Nottingham)
Dr Paula Holland (Lancaster University)
Professor Karen Walker-Bone (Monash University)
Trial manager
Dr Jen Parker (University of Salford)
Research collaborators
Denise Forshaw (Lancashire Clinical Trials Unit)
Sarah Woodbridge (Derby Teaching Hospitals NHS Foundation Trust)
Rachel O’Brien (Sheffield Hallam University)
Yvonne Hough (St Helens and Knowsley Teaching Hospitals)
June Culley (Patient and Public Involvement Lead)
WORKWELL Digital is led by Professor Prior and supported by an independent PPI panel, clinical advisory group and Wellknown Learning Limited.
Centre institutions
Research partners
Further information
For further information about this research please contact y.prior@salford.ac.uk