To measure if a decision-supportive tool based on the WORRK model, developed to predict non-return to work (nRTW) after orthopaedic trauma, improves the allocation to various vocational pathways according to patients' "nRTW" risk, for use in clinical practice.
Randomized-controlled trial using vocational inpatients after orthopaedic trauma (n=280). In the intervention group, the nRTW risk estimated using the WORRK tool was given to the clinician team before allocation of the vocational pathway, while in the control group it was not. Three pathways are available: simple (SP) and coaching (CP) (patients with low to intermediate nRTW risk, average of 5 week hospitalization and 17hrs of therapy/week) and evaluation (EP) (high risk of nRTW, average of 3 week hospitalization and 14hrs of therapy/week, less individual therapies, evaluation without training in the vocational workshop). The following indications were given: the higher the percentage of the WORRK score, the lower the predicted chance of RTW; a score<50% indicates that probably the SP or CP is most adapted to the patient; a score of 50-69% indicates that the EP can/should be considered; a score>70% indicates that probably the EP is most adapted to the patient. The primary outcome was the proportion of patients allocated to the EP.
Four hundred and fifty patients were assessed for eligibility, 280 included, 139 randomized to the control group (mean age 42.3 years) and 141 to the intervention group (mean age 43.2 years). The two groups were similar regarding risk profile, age, education, native language, pain and quality of life. The patients in the intervention group were more often referred to the EP compared to the control group, having a 31% higher chance, but this difference was not statistically significant (risk ratio 1.31 [95% CI 0.70-2.46]). The NNT was 30.
The effect of the WORRK tool was smaller than expected, possibly because: clinicians did not have confidence in the score provided, being given inadequate guidelines for when to refer patients to which pathway, clinicians avoid using the EP by fear of disadvantaging patients or because the EP is not adapted to our patients.