Chronic pain affects over a quarter of the UK workforce with a high economic burden for individuals, employers and healthcare services. The Pain-at-Work (PAW) feasibility trial is a cluster randomised controlled trial (cRCT) to assess the feasibility and acceptability of a digital intervention, the Pain-at-Work (PAW) Toolkit, which was designed to provide education and self-management advice to support employees who experience chronic pain in the workplace. Intervention participants had the option to request support calls to assist with the application of the PAW Toolkit within the workplace. This fidelity study aimed to determine whether the calls were delivered as intended by the protocol using educational materials and self-management strategies from the PAW Toolkit.

Between August and October 2024, a total of six individual opt-in calls were conducted between an occupational therapist and participants of which all (five video calls and one telephone call) were recorded for fidelity assessment. A fidelity checklist was developed, including Toolkit components comprising the five PAW Toolkit sections, and four areas associated with the Toolkit usage:
(i) explanation of the PAW Toolkit resource;
(ii) sharing resource links;
(iii) demonstration of the PAW Toolkit; and
(iv) discussion of the concept of the PAW Toolkit.

Additionally, seven occupational support components were anticipated to be present during the calls: an explanation of the role of occupational therapists and occupational health and support in the workplace; activities of daily living; independent activities of daily living; health management; rest and sleep; education and work; and play, leisure and social participation. Two observers assessed fidelity by independently scoring the checklist against recordings, and making field notes regarding the topics discussed and the barriers and facilitators associated with the support calls.

The opt-in calls averaged 28 minutes in duration (range 10 to 39 minutes). The interrater reliability between the two observers was high, with a Cohen's kappa 92%. All sessions included PAW Toolkit components in addition to occupational support components. The most frequently discussed topics included pacing, disclosure and reasonable adjustments, which are all PAW Toolkit components. The calls also involved signposting to relevant sections of the PAW Toolkit and helping to identify appropriate contacts for further assistance in the participants’ workplace.

Fidelity was deemed acceptable, with only one instance of protocol deviation. The exceptionally low uptake of opt-in calls in the feasibility trial (n=11/171) indicates this component was not in demand by most participants. This supports the use of the PAW Toolkit as a stand-alone package (as originally designed) in a future definitive trial. Our learning from this adjunct support will inform the development of advice in the form of a ‘frequently asked questions,’ section as an addition to the PAW Toolkit.

Keywords: Digital health, Chronic Pain, Workforce, Toolkit, Feasibility Trial, Education, Support.