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Purpose Osteoarthritis (OA) causes pain and disability, with onset often during working age. Joint pain is associated with functional difficulties and may lead to work instability. The aims of this systematic review are to identify: the impact of OA on work participation; and biopsychosocial and work-related factors associated with absenteeism, presenteeism, work transitions, work impairment, work accommodations, and premature work loss. Methods Four databases were searched, including Medline. The Joanna Briggs Institute Critical Appraisal tools were used for quality assessment, with narrative synthesis to pool findings due to heterogeneity of study designs and work outcomes. Results Nineteen studies met quality criteria (eight cohort; 11 cross-sectional): nine included OA of any joint(s), five knee-only, four knee and/or hip, and one knee, hip, and hand OA. All were conducted in high income countries. Absenteeism due to OA was low. Presenteeism rates were four times greater than absenteeism. Performing physically intensive work was associated with absenteeism, presenteeism, and premature work loss due to OA. Moderate-to-severe joint pain and pain interference were associated with presenteeism, work transition, and premature work loss. A smaller number of studies found that comorbidities were associated with absenteeism and work transitions. Two studies reported low co-worker support was associated with work transitions and premature work loss. Conclusions Physically intensive work, moderate-to-severe joint pain, co-morbidities, and low co-worker support potentially affects work participation in OA. Further research, using longitudinal study designs and examining the links between OA and biopsychosocial factors e.g., workplace accommodations, is needed to identify targets for interventions. Systematic review registration PROSPERO 2019 CRD42019133343 .

Background Although the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is widely used in the UK, no British English version is available. The aim of this study was to linguistically validate the DASH into British English and then test the reliability and validity of the British English DASH, (including the Work and Sport/Music DASH) and QuickDASH, in people with rheumatoid arthritis (RA). Methods The DASH was forward translated, reviewed by an expert panel and cognitive debriefing interviews undertaken with 31 people with RA. Content validity was evaluated using the ICF Core Set for RA. Participants with RA ( n  = 340) then completed the DASH, Health Assessment Questionnaire (HAQ), Short Form Health Survey v2 (SF36v2) and Measure of Activity Performance of the Hand (MAPHAND). We examined internal consistency and concurrent validity for the DASH, Work and Sport/Music DASH modules and QuickDASH. Participants repeated the DASH to assess test-retest reliability. Results Minor wording changes were made as required. The DASH addresses a quarter of Body Function and half of Activities and Participation codes in the ICF RA Core Set. Internal consistency for DASH scales were consistent with individual use (Cronbach’s alpha = 0.94–0.98). Concurrent validity was strong with the HAQ (r s  = 0.69–0.91), SF36v2 Physical Function (r s  = − 0.71 - − 0.85), Bodily Pain (r s  = − 0.71 - − 0.74) scales and MAPHAND (r s  = 0.71–0.93). Test-retest reliability was good (r s  = 0.74–0.95). Conclusions British English versions of the DASH, QuickDASH and Work and Sport/Music modules are now available to evaluate upper limb disabilities in the UK. The DASH, QuickDASH, Work and Sport/Music modules are reliable and valid to use in clinical practice and research with British people with RA.

The objective was to develop evidence -based recommendations and a research and educational agenda for the non-pharmacological management of hip and knee osteoarthritis (OA). The multidisciplinary task force comprised 21 experts: nurses, occupational therapists, physiotherapists, rheumatologists, orthopaedic surgeons, general practitioner, psychologist, dietician, clinical epidemiologist and patient representatives. After a preliminary literature review, a first task force meeting and five Delphi rounds, provisional recommendations were formulated in order to perform a systematic review. A literature search of Medline and eight other databases was performed up to February 2012. Evidence was graded in categories I–IV and agreement with the recommendations was determined through scores from 0 (total disagreement) to 10 (total agreement). Eleven evidence-based recommendations for the non-pharmacological core management of hip and knee OA were developed, concerning the following nine topics: assessment, general approach, patient information and education, lifestyle changes, exercise, weight loss, assistive technology and adaptations, footwear and work. The average level of agreement ranged between 8.0 and 9.1. The proposed research agenda included an overall need for more research into non-pharmacological interventions for hip OA, moderators to optimise individualised treatment, healthy lifestyle with economic evaluation and long-term follow-up, and the prevention and reduction of work disability. Proposed educational activities included the required skills to teach, initiate and establish lifestyle changes. The 11 recommendations provide guidance on the delivery of non-pharmacological interventions to people with hip or knee OA. More research and educational activities are needed, particularly in the area of lifestyle changes.

Long-term movements of adult marine animals predicate spatial management measures. Sea cucumbers are intensely exploited worldwide, yet few studies have assessed their long-term movement potential. Elephant trunkfish, Holothuria (Microthele) fuscopunctata, is a large coral reef holothuroid. At four sites at Lizard Island, northern Great Barrier Reef, we photographically marked and georeferenced 36 H. fuscopunctata, ranging 1.4–5.1 kg in weight. In broader searches one year later, we recaptured 92% of the animals. Their displacements were comparable among sites and averaged 8.7 m yr−1. None of the movements could be characterised as nomadic; the maximum displacement was 21 m. Contrary to expectations, smaller animals tended to roam further than larger animals (p = 0.025). Our study shows that certain large-bodied sea cucumbers might not displace far over annual timescales. This empirical evidence of home ranging reshapes our understanding of echinoderm mobility and reveals a behaviour that would exacerbate Allee effects at low population densities.

Fishery stock assessments are often based on morphometric data from underwater diver surveys and landing surveys. Measurements of body length are usually converted to estimates of body weight, yet length–weight equations might differ among localities. We evaluated morphometric models for the sea cucumber, Pearsonothuria graeffei, collected at Lizard Island on the northern Great Barrier Reef, Australia, and explored differences in relative condition factor (Kn) across animal sizes. The estimation of body weight was compared among relationships with four different body size metrics: observed body length, SLW (square root of the body length–width product), recalculated body length (Le) from SLW, and body basal area. The basal area of the animals, the SLW index and Le provided more reliable estimations for body weight than using body length alone yet accounted for half of the variation in body weight. The length–weight relationship from animals at Lizard Island differed considerably from relationships published for the same species in New Caledonia and Philippines. Body condition was variable, and our model predicted a peak at 35 cm body length. Body metrics such as basal area, SLW index, and Le could offer more precise models for estimating the body weight of sea cucumbers for fishery purposes. Equations for estimating body weight from length and width of the sea cucumbers should be based on locality-specific data because morphometric relationships are spatially variable.

Ecology of many sea cucumbers, including the world’s heaviest holothuroid Thelenota anax, remains understudied, hindering effective fisheries management and conservation. We located, measured and weighed 38 T. anax over 10 days at Lizard Island, northeast Australia. Body length alone was a suitable predictor of body weight for this species. Short-term (1–4 h) rates of displacement and sediment defecation were measured on 30 animals across three sites. The animals were highly mobile, moving, on average, 57 cm h−1 (± 11 SE), and reworking 34 g dry weight of sediment h−1 (± 7 SE). The animals moved more and defecated more sediments in areas where surrounding sediments had lower levels of organic matter. Defecation rates increased through daytime hours. The high mobility of T. anax should confer an advantage for mate-finding but also could increase spillover from small marine reserves into fishing grounds. Our findings galvanise a pattern of high mobility in larger holothuroids and show that food resources and time of day modulate the extent of sediment reworking by deposit feeding holothuroids. The high sediment turnover rate highlights the detrimental effect that overfishing of these large holothuroids will have on the health of coastal marine ecosystems.

Background Inflammatory arthritis leads to work disability, absenteeism and presenteeism (i.e. at-work productivity loss) at high cost to individuals, employers and society. A trial of job retention vocational rehabilitation (VR) in the United States identified this helped people keep working. The effectiveness of this VR in countries with different socioeconomic policies and conditions, and its impact on absenteeism, presenteeism and health, are unknown. This feasibility study tested the acceptability of this VR, modified for the United Kingdom, compared to written advice about managing work problems. To help plan a randomized controlled trial, we tested screening, recruitment, intervention delivery, response rates, applicability of the control intervention and identified the relevant primary outcome. Methods A feasibility randomized controlled trial with rheumatoid, psoriatic or inflammatory arthritis patients randomized to receive either job retention VR or written information only (the WORK-IA trial). Following three days VR training, rheumatology occupational therapists provided individualised VR on a one to one basis. VR included work assessment, activity diaries and action planning, and (as applicable) arthritis self-management in the workplace, ergonomics, fatigue and stress management, orthoses, employment rights and support services, assistive technology, work modifications, psychological and disclosure support, workplace visits and employer liaison. Results Fifty five (10%) people were recruited from 539 screened. Follow-up response rates were acceptable at 80%. VR was delivered with fidelity. VR was more acceptable than written advice only (7.8 versus 6.7). VR took on average 4 h at a cost of £135 per person. Outcome assessment indicated VR was better than written advice in reducing presenteeism (Work Limitations Questionnaire (WLQ) change score mean: VR = −12.4 (SD 13.2); control = −2.5 (SD 15.9), absenteeism, perceived risk of job loss and improving pain and health status, indicating proof of concept. The preferred primary outcome measure was the WLQ, a presenteeism measure. Conclusions This brief job retention VR is a credible and acceptable intervention for people with inflammatory arthritis with concerns about continuing to work due to arthritis. Trial registration ISRCTN 76777720 . Registered 21.9.12.

Background Developed in the Norway, the Measure of Activity Performance of the Hand (MAP-Hand) assesses 18 activities performed using the hands. It was developed for people with rheumatoid arthritis (RA) using patient generated items, which are scored on a 0–3 scale and summarised into a total score range (0 to 54). This study reports the development and psychometric testing of the British English MAP-Hand in a UK population of people with RA. Methods Recruitment took place in the National Health Service (NHS) through 17 Rheumatology outpatient clinics. Phase 1 (cross-cultural adaptation) involved: forward translation to British English; synthesis; expert panel review and cognitive debriefing interviews with people with RA. Phase 2 (psychometric testing) involved postal completion of the MAP-Hand, Health Assessment Questionnaire (HAQ), Upper Limb HAQ (ULHAQ), Short-Form 36 (SF-36 v2 ) and Disabilities of the Arm Shoulder Hand (DASH) to measure internal consistency (Cronbach’s alpha); concurrent validity (Spearman’s correlations) and Minimal Detectable Difference (MDC 95 ). The MAP-Hand was repeated three-weeks later to assess test-retest reliability (linear weighted kappa and Intra-Class Correlations (ICC (2,1)). Unidimensionality (internal construct validity) was assessed using (i) Confirmatory Factor Analysis (CFA) (ii) Mokken scaling and (iii) Rasch model. The RUMM2030 software was used, applying the Rasch partial credit model. Results In Phase 1, 31 participants considered all items relevant. In Phase 2, 340 people completed Test-1 and 273 (80%) completed Test-2 questionnaires. Internal consistency was excellent (α = 0.96). Test-retest reliability was good (ICC (2,1) = 0.96 (95% CI 0.94, 0.97)). The MAP-Hand correlated strongly with HAQ20 (r s  = .88), ULHAQ (r s  = .91), SF-36 v2 Physical Functioning (PF) Score (r s  = −.80) and DASH (r s  = .93), indicating strong concurrent validity. CFA failed to support unidimensionality (Chi-Square 236.0 (df 120; p  < 0.001)). However, Mokken scaling suggested a probabilistic ordering. There was differential item functioning (DIF) for gender. Four testlets were formed, resulting in much improved fit and unidimensionality. Following this, testlets were further merged in pairs where opposite bias existed. This resulted in perfect fit to the model. Conclusions The British English version of the MAP-Hand has good validity and reliability in people with RA and can be used in both research and clinical practice.

Background The Workwell trial is a multi-centre randomised controlled trial with the aims of evaluating the effectiveness and cost-effectiveness of job retention vocational rehabilitation for employed people with inflammatory arthritis, who are experiencing work difficulties due to their arthritis. Vocational rehabilitation is delivered by health service occupational therapists, who have received additional training in providing this Workwell intervention. A process evaluation will be undertaken alongside the main trial to investigate implementation fidelity; understand key stakeholders’ perspectives of the intervention and the social and structural context in which the intervention is provided; and explore issues related to future implementation in clinical practice. This protocol describes the aims, objectives, and methodology of the Workwell trial process evaluation. Methods This mixed methods process evaluation will follow the Medical Research Council’s Guidance on process evaluations for complex interventions. It will be underpinned by the conceptual framework for implementation fidelity (CFIF) and normalisation process theory (NPT). We will analyse treatment records, work assessments, and treatment notes to ascertain implementation fidelity. Semi-structured interviews with trial participants, their employer/line managers, treating therapists, and their therapy service managers will be undertaken to explore perceptions of the intervention, contextual factors, and potential for future implementation in practice. Interview topic guides will be informed by NPT. Therapists’ views about Workwell training will be explored via questionnaires following training, and interviews and focus groups following treatment delivery to inform future implementation. Quantitative data will be analysed descriptively. Qualitative data will be analysed using thematic analysis. NPT will guide data analysis and interpretation. Findings from the different elements of this embedded design process evaluation will be reported separately and then the elements integrated. The process evaluation data will be analysed independently of the Workwell trial outcome evaluation. The process evaluation data will then be reviewed in the light of the trial findings. Discussion Few trials of job retention vocational rehabilitation in arthritis have included process evaluations. This process evaluation will assist in understanding factors influencing trial outcomes and identifying potential contextual barriers and facilitators for the potential implementation of Workwell vocational rehabilitation into clinical services. Trial registration ClinicalTrials.gov NCT03942783. Registered on 08 May 2019. ISRCTN Registry ISRCTN61762297. Registered on 13 May 2019. Retrospectively registered.

There are high levels of work disability, absenteeism (sick leave) and presenteeism (reduced productivity) amongst people with inflammatory arthritis. WORKWELL is a multi-centre, randomised controlled trial of job retention vocational rehabilitation for employed people with inflammatory arthritis. The trial tested the effectiveness and cost-effectiveness of the WORKWELL programme compared to the receipt of written self-help information only. Both arms continued to receive usual care. In March 2020, due to the COVID-19 pandemic, the WORKWELL trial paused to recruitment and intervention delivery. To successfully re-start, protocol amendments were rapidly submitted and changes to existing trial procedures were made. The WORKWELL protocol was adapted in response to both the practical issues likely faced by many clinical research studies active across NHS sites during the pandemic and additional trial-specific challenges. A key eligibility criterion for the trial required participants to be in paid work for at least 15 h per week. However, UK national lockdowns led to a substantial proportion of the workforce suddenly being furloughed or unable to work, and many people with arthritis taking immunosuppressive medications were asked to shield themselves. Thus, the number of eligible participants was reduced. Those continuing to work were harder to identify, as hospital clinics moved to remote delivery, and also to then screen, consent and treat, as the hospital research staff and clinical therapists were re-deployed. New recruitment and consent strategies were applied, and where sites had reduced capacity, responsibilities were absorbed by the trial management team. Remote intervention delivery and electronic data capture were also implemented. By rapidly adapting the WORKWELL protocol and procedures, the trial successfully reopened to recruitment in July 2020, only 4 months after the trial pause. We were able to achieve recruitment figures above the pre-COVID target and maintain a high retention rate. In addition, we found many of the protocol changes beneficial, as these streamlined trial procedures, thus improving efficiency. It is likely that many strategies implemented in response to the pandemic may become standard practice in future research within trials of a similar design and methodology. Trial registration: ClinicalTrials.gov NCT03942783 . Retrospectively registered on 08 May 2019. ISRCTN Registry ISRCTN61762297 . Retrospectively registered on 13 May 2019.