Behaviour change techniques and theoretical mechanisms within psychological interventions seeking to improve work outcomes among individuals with chronic pain: a systematic review and network meta-analysis

Background The UK government wishes to support more disabled people into work by 2027. Chronic pain is a leading cause of disability. Over one-third of people with chronic pain cannot work or are at risk of work attrition. The impact of chronic pain on work is important to address as good work benefits health and wellbeing and reduces health inequalities. Psychological therapies are important in supporting people with chronic pain to work through addressing pain and mental health. However, whilst psychological interventions can be effective, little is known about their active content, or which specific components are most effective, especially in different job types and among those who are either unemployed, on sick leave or in work. Our aim is to better understand what works to support people with chronic pain to work and how best to deliver that support. Objectives Undertake a systematic review to evaluate the effectiveness of psychological interventions to improve work outcomes among individuals with chronic pain, in relation to behaviour change techniques (BCTs), theoretical domains and intervention delivery modes Identify the most effective component(s) within psychological interventions to improve work outcomes for people with chronic pain in and out of work, and in relation to types of work Take the review findings to collaborate with people with chronic pain who are struggling to work, on sick leave or unemployed to better understand their needs, what does/does not help and how they might access needed support Convene groups of “professional” stakeholders to consider the review evidence and the views of people with chronic pain to develop guidance, shape policy change, disseminate best practice, create better training, and translate our findings into real change for people with chronic pain Methods PPI: We have involved stakeholders in framing the objectives, the review design, stakeholder events and dissemination/impact plan. Review: We will follow Cochrane and PRISMA systematic review guidelines, including adults with chronic pain who are receiving a recognised psychological intervention to improve either return-to-work, presenteeism, work ability or work-related self-efficacy. Electronic databases will be searched from inception. Study quality will be assessed using Cochrane ROB 2 and ROBINS-I criteria, and interventions will be coded using the BCT taxonomy v1, the Theoretical Domains Framework and the TIDierR framework for reporting intervention content. Where appropriate, meta-analysis will be conducted to synthesise the evidence. Stakeholder events: Findings from each of four unemployed, short-term sick leave, long-term sick leave and in work categories will be taken first to four chronic pain groups for application to personal experience and then the review findings and chronic pain group outcomes will be taken to four corresponding professional stakeholder groups to consider their transferability into policy and practice. Timelines for delivery Register review protocol in PROSPERO (M1-2); search and screening (M1-5); data extraction and analysis (M3-10); stakeholder events (M12-16), reporting (M14-18). Anticipated impact and dissemination Impact: The findings will provide evidence-based strategies to enable stakeholders to support individuals with chronic pain to be in work. Dissemination to stakeholder groups: briefing paper, infographics, podcasts, presentations, and publications.