Vocational rehabilitation trial finds no benefit on work limitations, and mixed results on retention and cost

A UK multicentre randomised controlled trial across 18 NHS trusts (n=249) compared occupational-therapy-delivered job-retention vocational rehabilitation against written self-help advice for people with inflammatory arthritis [Primary Study]. There was no significant difference between the two arms in the primary work-limitations outcome at 12 months. At 36 months, employment retention was higher in the vocational rehabilitation arm (93% versus 85%), but the intervention was not found to be cost-effective from an NHS perspective.

This is a genuine multicentre RCT with a null primary outcome and a mixed secondary picture: a longer-term employment-retention signal that did not translate into NHS cost-effectiveness. The population studied is working-age adults with inflammatory arthritis, not an older or frailty population, and much of the trial period was affected by the Covid-19 pandemic.

For commissioners of occupational therapy vocational rehabilitation, this is a useful negative and cost data point: it does not support commissioning structured vocational rehabilitation over self-help advice on cost-effectiveness grounds alone, even though a longer-term employment-retention signal exists.