Job retention vocational rehabilitation for employed people with inflammatory arthritis (WORK-IA): a feasibility randomized controlled trial

Abstract

BackgroundInflammatory 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.MethodsA 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.ResultsFifty 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.ConclusionsThis 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1671-5) contains supplementary material, which is available to authorized users.

Impact of a fatigue management in work programme on meeting work demands of individuals with rheumatic diseases: A pilot study

“…It appeared that by incorporating these strategies into elements of their work, participants’ fatigue levels improved. Furthermore, given that fatigue had been identified in previous studies as the biggest challenge affecting the ability to work, with qualitative reports stressing the negative impact of fatigue on managing work demands (Connolly et al, ; Feldthusen et al, ), the present results are promising, and are consistent with those of similar studies examining the effectiveness of work‐based programmes in those with RDs (Hammond et al, ; Hoving et al, ).…”

“…Hoving et al () reported inconclusive evidence for non‐pharmacological interventions in their systematic review, and recommended that further studies were required to identify suable interventions to reduce work‐related disabilities. The results of this pilot study of FAME‐W compared favourably with those of a recent study that reported significant improvements for the intervention group in work‐related outcomes such as reduced presenteeism and absenteeism (Hammond et al, ). However, the intervention in that study was delivered individually, which is more resource intensive than the group‐based approach of FAME‐W.…”

“…The first half of each session consists of education and information‐sharing on topics related to fatigue management, including energy management, pain and stress management, joint protection, ergonomics, effective communication in work, and employment legislation. The inclusion of these topics were based on findings from previous fatigue‐related studies in an Irish context, and work‐related intervention studies (Connolly et al, , ; Hammond et al, ; Macedo et al, ; van Vilsteren et al, ). In order to facilitate health behaviour change related to fatigue management, the second half of each session consisted of individual goal setting, where participants set goals to apply fatigue management strategies into their work practices over the coming week (Lorig & Holman, ).…”

“…They stated that further research was required to identify effective interventions to improve work outcomes. More recently, Hammond et al () delivered an individual‐based vocational rehabilitation intervention, which resulted in significant work‐related improvements for the intervention group, including reduced presenteeism and absenteeism. Presenteeism is defined as a reduced quantity or quality in productivity by workers with illness or injury who are present in work (Roy, Desmeules, & MacDermid, ).…”

The effect on work presenteeism of job retention vocational rehabilitation compared to a written self-help work advice pack for employed people with inflammatory arthritis: protocol for a multi-centre randomised controlled trial (the WORKWELL trial)

“…In this, we: developed a JRVR training programme for OTs, effective in increasing OTs knowledge of and confidence in delivering JRVR [6]. We also modified and further developed for the UK the: Work Environment Survey for Rheumatic Conditions (WES-RC) [22,23]; the WES-RC Manual [24]; and the brief JRVR intervention developed by Allaire et al [17,25]. We developed a Workwell Solutions Manual of work resources and solutions for therapists, linked to the WES-RC.…”