Rheumatic and musculoskeletal conditions are leading causes of work disability, and 23–45% of people with inflammatory rheumatic conditions become unemployed within 10 years of diagnosis. Many patients also experience productivity loss at work. Past research has demonstrated the efficacy of a vocational rehabilitation intervention for patients with rheumatic diseases, which resulted in a 40% reduction in work loss for the intervention group compared with an active control.
New research from Julie J. Keysor, PhD, PT, of Boston University Sargent College of Health and Rehabilitation Sciences, Boston, and colleagues sought to expand on this idea. They modified the vocational rehabilitation program, using trained occupational therapists and physical therapists to deliver information on work limitation and work loss to participants. Researchers primarily examined if those receiving this work disability prevention program had reduced work limitations.
In the two-year study, published in July 2018 Arthritis Care & Research, 287 participants were randomized into an intervention (n=143) or control group (n=144). The intervention group had a 90-minute meeting with an OT/PT, and received an action plan, written materials about disability-related employment issues and access to career counseling resources. Follow up phone calls were conducted after three weeks and three months. The control group received the packet of written resources.
“The intervention had no impact on our measurement of work limitations, but did reduce work loss,” write the authors. “We encountered more work loss in our sample than expected, suggesting a significant unmet need in this population.”
Between October 2011 and January 2014, 264 participants (92%) completed data collection. No difference in the mean SD work limitations questionnaire change scores from baseline were found during follow-up. Of the 36 participants who experienced permanent work loss, 11 (8%) were intervention participants and 25 (18%) control participants.
After two efficacious trials, strong evidence exists that programs with multiple components, including job accommodations, health service systems and coordinated care, may help people maintain work in the context of health-related challenges. The authors note an intervention’s ability to encourage advocacy, as well as promote behavioral changes through problem identification, solution generation and the development of action plans, may result in its effectiveness.
“This simple, non-intensive work disability prevention program can prevent work loss in people with chronic rheumatic and musculoskeletal conditions, a group of diseases where work loss is a dreaded and common outcome,” the authors conclude. “This approach could easily be implemented and widely used.”
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