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Table 3 Framework

From: Obstacles to returning to work with chronic pain: in-depth interviews with people who are off work due to chronic pain and employers

Theme People with chronic pain Employers Common themes
Obstacles to return to work Psychological obstacles
 - Fear and anxiety
 - Fear of pain becoming worse
 - Worried about what others think (of me)
 - Negative experiences in the past
Pain related obstacles
 - Unpredictability of pain
 - Reduced mobility
 - Sleep difficulties
Financial and economic obstacles
 - No financial incentive
 - Competitive job market
 - Cost to company (productivity)
Educational obstacles
 - Lack of qualifications
 - Challenges of dealing with technology
Work history obstacles
 - Being out of work for a long time
 - Gaps in CV
Work environment and nature of work
 - Pressure of work
 - Finding suitable employment
 - Not being able to pull your weight
 - Feels work offered is unsuitable
 - Unable to fulfil job requirements
 - Difficulties fulfilling previous role
Employer related obstacles
 - Inflexible manager
 - Perceived discrimination and unfair treatment
 - Employer unwilling to make adjustments
 - Being judged by potential employers
 - Unsupportive manager
Attitudinal obstacles
 - Attitude of person with chronic pain
 - Attitudes of others towards people with chronic pain
 - Stigma
Managerial obstacles
 - Managers lack of people skills
 - Managers lack of understanding about pain
Organisational context
 - Reasonable adjustments not possible or affordable
 - Dismissal if unable to redeploy
 - Ageing work population and increased demand for redeployment
 - Conflict between occupational health and employer about what adjustments are reasonable and realistic
 - Austerity and limited rehabilitation & resources in NHS
 - Culture and size of organisation
 - Fairness and potential for conflict with colleagues
 - Fear of litigation
Capability related obstacles
 - Ability to do the job
 - Poor performance
 - Physical demands of job
 - Absence
 - Hospital appointments
 - Lack of confidence
 - Reliability
 - Travelling to work
Facilitators of return to work Workplace adjustments
 - Temporary job swap
 - Finding suitable job
 - Flexibility from employer
 - Small family run business
Good working relationships
 - Good relationship with employer, manager and colleagues
 - Understanding manager and colleagues
 - Being listened to
 - Being treated as a person and not a disability
 - Help from colleagues
Education
 - Education for managers about pain
 - Understanding of capabilities
Preparing for RTW
 - Interview preparation support
 - Placements
 - Support looking for a job
 - Training
 - Trial period
Interventions
 - Effective pain relief
 - Specialised physiotherapy
Workplace adjustments
 - Accommodation of hospital appointments
 - Reducing physical demands of job
 - Support, training and investment from employer
Interventions
 - Provision of ergonomic work space
 - Coaching
 - Individually tailored to support to return to work
 - Private medical insurance provided by company
 - Occupational health provision
Cultural factors
 - Caring and compassionate company
 - Changing culture and attitudes to employment for people with disabilities and chronic pain
 - Political will and coordination of Department of Work and Pensions and Department of Health
Workplace adjustments
 - Making changes to job and hours
 - Adaptation of the environment or provision of equipment
 - Making reasonable adjustments
 - Phased return
 - Redeployment
 - Working from home
 - Reduced hours
 - Taking breaks
 - Light duties
 - Help with travelling to work (Access to work or providing transport)
Interventions
 - Access to cognitive behavioural therapy and counselling
 - Access to physiotherapy
Disclosure of chronic pain to employer  - Not disclosing during application or interview process
 - Fear of not getting an interview or job
 - Fear of consequences of not disclosing
 - Fear of losing job
 - Disclosure so employer can make reasonable adjustments
 - Disclosure to access interventions in the workplace
 - Disclosing to occupational health not recruiting manager
 - Understanding and accommodating non-disclosure
 - Need to be open and honest