Randomized comparison of a multidisciplinary job‐retention vocational rehabilitation program with usual outpatient care in patients with chronic arthritis at risk for job loss

Abstract

Objective. Work disability is a major consequence of inflammatory rheumatic conditions. Evidence regarding the effectiveness of interventions aimed at the prevention or reduction of work disability in rheumatic diseases is limited. We conducted a randomized controlled trial to investigate the effectiveness of a multidisciplinary job-retention vocational rehabilitation (VR) program in patients with a rheumatic condition who were at risk for job loss. Methods. A total of 140 patients with a chronic rheumatic condition were randomly assigned to either a multidisciplinary job-retention VR program (n ‫؍‬ 74) or usual outpatient care (UC) (n ‫؍‬ 66). Patients in the VR group were assessed and guided by a multidisciplinary team, whereas patients in the UC group received care as initiated by their rheumatologist, supplemented with written information. The main outcome measure was the occurrence of job loss (complete work disability or unemployment); additional outcome measures included job satisfaction, pain, functional status, emotional status, and quality of life. Results. There was no difference between the 2 groups regarding the proportion of patients having lost their job at any time point, with 24% and 23% of the patients in the VR and UC groups, respectively, having lost their job after 24 months. Over the total period of 24 months, patients in the VR group had a significantly greater improvement of the fatigue visual analog scale and of emotional status (all P values < 0.05). Conclusion. A job-retention VR program did not reduce the risk of job loss but improved fatigue and mental health in patients with chronic rheumatic diseases at risk for job loss.

Cost‐utility analysis of a multidisciplinary job retention vocational rehabilitation program in patients with chronic arthritis at risk of job loss

“…In a previous analysis of our study, we showed that a multidisciplinary job retention vocational rehabilitation program led to a greater improvement of fatigue levels and mental health, but without significant reduction of job loss (17). The purpose of the present study was to estimate, from a societal perspective, the cost-utility of the program for patients with chronic rheumatic diseases at risk of job loss.…”

“…Only 1 in 15 patients consulted a psychologist. The program led to a greater improvement of fatigue levels and mental health, but no reduction of job loss was established (17). In the economic evaluation reported here, we studied whether, from the societal perspective, effectiveness is attained with reasonable costs.…”

“…Patients participated in a multicenter, randomized controlled trial in which a multidisciplinary job retention vocational rehabilitation program was compared with normal outpatient care initiated by the treating rheumatologist (17,22). Patients were enrolled and registered between March 1999 and June 2001.…”

“…The total duration of the intervention varied depending on the contents of the individual guidance and treatment process, and ranged from 4 -12 weeks. Further details of the program have been described elsewhere (17,22).…”

“…Our patients were younger but had a worse functional status according to the HAQ measure, and may therefore have been included in the program at a later stage of their perceived problems at work. The differences between both trials have been discussed in more detail elsewhere (17).…”