Understanding Presenteeism in Patients With Ankylosing Spondylitis: Contributing Factors and Association With Sick Leave

Abstract

Objective. To understand the impact of ankylosing spondylitis (AS) on presenteeism and to explore its relationship to sick leave. Methods. AS patients completed a questionnaire consisting of sociodemographics, disease characteristics, and work outcomes, including sick leave and presenteeism, assessed by the Work Limitations Questionnaire (WLQ). Associations between a broad range of explanatory variables with the WLQ and AS-related sick leave were assessed by zero-inflated negative binomial and zero-inflated Poisson regressions. Results. Of 311 employed patients (204 men [65.6%]), 18% had sick leave in the past month. Limitations in meeting time management demands (33.7%), physical demands (30.2%), mental-interpersonal demands (20.2%), and output (19.0%) were noted. With the mean ؎ SD WLQ index score of 6.7 ؎ 5.9, the average decrease in work productivity attributable to health was 6.3%; an extra 7.1% of work hours would be needed to compensate for lost productivity. Helplessness, female sex, and impaired health-related quality of life (Ankylosing Spondylitis Quality of Life instrument [ASQoL]) were major contributors to the level of presenteeism (P < 0.01). At-work limitations (WLQ) and lower quality of life (ASQoL) were significantly associated with probability of sick leave, while the length of sick leave was strongly associated with lower educational level and helplessness (P < 0.01), and in some models, also with disease duration and country of residence (P < 0.05). Conclusion. AS hinders patients' work, mainly in time management and physical demand domains. The WLQ and ASQoL are able to identify patients who incur sick leave. Helplessness contributes independently to the level of presenteeism and the length of sick leave.

Importance of Contextual Factors When Measuring Work Outcome in Ankylosing Spondylitis: A Systematic Review by the OMERACT Worker Productivity Group

“…Supplementary Table 2 (available in the online version of this article at http:// onlinelibrary.wiley.com/doi/10.1002/acr.22573/abstract) shows the patient and study characteristics of the included studies as well as work outcomes reported in the included studies. Of the 25 studies, 22 were crosssectional (1,(5)(6)(7)(8)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35), 1 case-control (2), and 2 longitudinal (36,37). Different terminology was used to define work status.…”

“…Sick leave was reported either as the average days of sick leave per time interval or as the proportion of patients with at least 1 sick leave episode per interval. In the studies that assessed sick leave per year, the mean days of sick leave ranged from 6 to 69 days per year (5,25,27,33,34), and the proportion of patients with at least 1 sick leave episode varied between 40% and 69% per year (2,5,27,34). Presenteeism was also evaluated by different instruments.…”

“…Sick leave. Eight studies addressed the association between CoFa and sick leave (6,7,25,30,33,34,36,37). Due to the low number of studies per CoFa domain, no bestevidence synthesis was performed.…”

“…In univariable analysis, several factors were significantly associated with sick leave: sex, age, marital status, self-efficacy, nature of work, physical environment, and lack of workplace support (online Supplementary Table 5, available in the online version of this article at http://onlinelibrary.wiley.com/ doi/10.1002/acr.22573/abstract). Table 3 shows the contributions of CoFas to sick leave in multivariable analyses of 6 different studies (6,7,29,33,34,36). Age and sex were not associated with sick leave in 4 studies.…”

Work participation in spondyloarthritis across countries: analysis from the ASAS-COMOSPA study

“…Our aims were twofold: first, to assess the impact of clinical and individual SE characteristics on employment status, absenteeism and presenteeism12 among patients with SpA at working age, while accounting for country of residence; second, to explore the potential role of specific country-level SE factors on these outcomes.…”