Reduction of job loss in persons with rheumatic diseases receiving vocational rehabilitation: A randomized controlled trial

Abstract

Objective. Job loss is a major consequence of rheumatic diseases, and clinicians may refer patients to vocational rehabilitation for help. When provided after job loss, the impact of vocational rehabilitation is short term. This randomized controlled trial with 48 months of followup was undertaken to determine the efficacy of vocational rehabilitation provided to persons with rheumatic diseases while they are still employed, but at risk for job loss.Methods. A total of 242 patients with rheumatic diseases residing in Massachusetts were recruited through their rheumatologists for study. Participants were randomly assigned to the experimental group (n ‫؍‬ 122) or the control group (n ‫؍‬ 120). Subjects in the experimental group received two 1.5-hour sessions of vocational rehabilitation; those in the control group received print materials about disability employment issues and resources by mail. The main outcome assessed was the time to first job loss. Job losses were defined as permanent disability, premature retirement, or a period of unemployment. All analyses were conducted on an intent-to-treat basis.Results. Job loss was delayed in the experimental group compared with the control group (P ‫؍‬ 0.03 by log rank test). After adjustment for confounders, participation in the experimental group was found to be protective against job loss (odds ratio 0.58 [95% confidence interval 0.34-0.99], P ‫؍‬ 0.05 by pooled logistic regression).Conclusion. Vocational rehabilitation delivered to patients at risk for job loss, but while they were still employed, delayed job loss. Such an intervention has the potential to reduce the high indirect costs, as well as the personal impact, of rheumatic diseases.Health-related job loss is a major consequence of rheumatic diseases. In the most recent analyses (1), costs stemming from lost wages, so-called indirect costs, for all forms of arthritis were 74% of the total costs, while the direct costs of medical care were 26% of the total. This burden can be expected to increase because the portion of the US work force that is 55 years of age and older is increasing (by 2020, it will account for one-fifth of the work force) (2) and because the incidence and prevalence of many rheumatic diseases rise substantially after age 50 years. Health-related job loss also exacts a substantial toll on the quality of life of individuals, being associated with lower levels of self-esteem, life satisfaction, adaptation, perceived health status, and in those with rheumatoid arthritis, higher levels of depression and pain (3-5).Vocational rehabilitation is one approach to addressing health-related job loss. Rheumatologists and other clinicians may wish to refer their patients with rheumatic diseases to vocational rehabilitation for help. However, there is a shortage of studies evaluating the effectiveness of vocational rehabilitation. Studies that have been done suggest that while it can be effective in helping persons with disabilities regain employment, this effect is often short-lived (6). Moreover, the...

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

“…Contrary to our results, the randomized controlled trial on vocational rehabilitation by Allaire et al did show a statistically significant delay and reduction of job loss (16). Like ours, their program also targeted patients at risk of job loss and included attention to job accommodation and promotion of belief in capacity for employment.…”

“…Due to the large variability of the productivity costs, it remains unclear whether, from a societal perspective, the program reduces or increases costs. Comparing our study with the study by Allaire et al (16) suggests that further research on effective vocational rehabilitation is warranted, with special attention to early detection of work problems and the collaboration between health care and vocational rehabilitation services.…”

Availability, Need for, and Use of Work Accommodations and Benefits: Are They Related to Employment Outcomes in People With Arthritis?

“…Research by Yelin et al found that few individuals with musculoskeletal conditions reported receiving workplace accommodations and that, with the exception of help from others, most accommodations were not associated with changes in employment rates (39). Similarly, Allaire et al found that, despite participants in their study reporting numerous work barriers, over 60% did not use any kind of workplace accommodation (5). In both these studies there were no data on availability or perceived need for different accommodations or policies among individuals with arthritis.…”

“…Studies suggest that, despite improvements in treatment for rheumatic diseases, many individuals continue to report difficulties working, have elevated absenteeism rates, and report reduced productivity (1)(2)(3)(4). In addition to the physical symptoms of the disease creating difficulties for people in remaining employed, factors like job stress, symptom unpredictability, disruptions to work because of time needed for treatment, and employment factors like a lack of job control and absence of workplace support can create barriers to working (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

The Work-It Study for people with arthritis: Study protocol and baseline sample characteristics

“…Intervening on work factors prior to health-related employment cessation can sustain employment and improve the performance of work-related activities and tasks among people with arthritis and rheumatological conditions [8,9]. Allaire et al demonstrated that people receiving an experimental intervention comprised of work-related barrier reduction, promotion of disability self-advocacy, and career guidance had nearly 40% lower odds of employment cessation over four years compared to the control group [8].…”