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BMJ Open. 2019 Jun 20;9(6):e025743. doi: 10.1136/bmjopen-2018-025743.

The work of return to work. Challenges of returning to work when you have chronic pain: a meta-ethnography.

Author information

1
Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, UK.
2
Department of Health Sciences, Kristiania University College, Oslo, Norway.
3
Warwick Research in Nursing, University of Warwick, Warwick Medical School, Coventry, UK.

Abstract

AIMS:

To understand obstacles to returning to work, as perceived by people with chronic non-malignant pain and as perceived by employers, and to develop a conceptual model.

DESIGN:

Synthesis of qualitative research using meta-ethnography.

DATA SOURCES:

Eleven bibliographic databases from inception to April 2017 supplemented by citation tracking.

REVIEW METHODS:

We used the methods of meta-ethnography. We identified concepts and conceptual categories, and developed a conceptual model and line of argument.

RESULTS:

We included 41 studies. We identified three core categories in the conceptual model: managing pain, managing work relationships and making workplace adjustments. All were influenced by societal expectations in relation to work, self (self-belief, self-efficacy, legitimacy, autonomy and the meaning of work for the individual), health/illness/pain representations, prereturn to work support and rehabilitation, and system factors (healthcare, workplace and social security). A mismatch of expectations between the individual with pain and the workplace contributed to a feeling of being judged and difficulties asking for help. The ability to navigate obstacles and negotiate change underpinned mastering return to work despite the pain. Where this ability was not apparent, there could be a downward spiral resulting in not working.

CONCLUSIONS:

For people with chronic pain, and for their employers, navigating obstacles to return to work entails balancing the needs of (1) the person with chronic pain, (2) work colleagues and (3) the employing organisation. Managing pain, managing work relationships and making workplace adjustments appear to be central, but not straightforward, and require substantial effort to culminate in a successful return to work.

KEYWORDS:

chronic pain; meta-ethnography; return to work

Conflict of interest statement

Competing interests: RF is chief investigator on the Versus Arthritis grant from which this project was funded. He has published multiple papers on chronic pain, some of which are referenced in this paper. RF and MU are part of an academic partnership with Serco related to return-to-work initiatives. RF and MU are directors and shareholders of Clinvivo, a university spin-out company that provides data collection services for health services research. MU was Chair of the NICE Accreditation Advisory Committee until March 2017 for which he received a fee. He is chief investigator or coinvestigator on multiple previous and current research grants from the UK National Institute for Health Research and Versus Arthritis, and is a coinvestigator on grants funded by the Australian NHMRC. He is an NIHR Senior Investigator. He has received travel expenses for speaking at conferences from the professional organisations hosting the conferences. He is a coinvestigator on a study receiving support in kind from OrthoSpace. He has accepted an honorarium from CARTA. He is an editor of the NIHR journal series, and a member of the NIHR Journal Editors Group, for which he receives a fee. KS is an investigator in multiple previous and current research grants from the UK National Institute for Health Research and Versus Arthritis. She has received travel and accommodation expenses for speaking at conferences from the professional organisations hosting the conferences. She has published multiple papers on pain, some of which are referenced in this paper.

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