Background Work capacity is primarily assessed by absenteeism and rheumatic patients may experience decreased productivity as well as presenteeism due to their health problems as well as its costs consequences.
Objectives To evaluate the relation between work disability, productivity and disease activity, quality of life and functional disability.
Methods 242 rheumatic patients were recruited, 33.3% employed (N=81) completed the questionnaires of work disability and productivity: WALS (Workplace Activity Limitations Scale), SPS 6 (Stanford Presenteeism Scale) and WPAI (Work Productivity and Activity Impairment) 4 scores - absenteeism, presenteeism, work and activity impairment. Patient-reported parameters included pain, fatigue, sleep quality and disease activity (VAS). Functional disability and quality of life outcomes were assessed by HAQ-DI, FACIT and SF-12. Data were collected during a 4-week period. The analysis included descriptive statistics, Mann-Whitney test and Spearman correlation, p <.05.
Results 81 gainfully employed patients (85% female) had 48±11 years old, with 10±4 schooling years. Mean VAS were: pain 47±32, fatigue 57±33, sleep quality 46±33 and disease activity 43±30; HAQ-DI: 1.76±0.9, FACIT:17±11 and SF-12: 39±13 in PCS and 43±18 in MCS. Productivity assessment revealed limitations in all measured scores: WALS 8±6 [0-25], SPS 6 12±3 [3-15], WPAI work impairment 29±32%, activity impairment 29±29%, absenteeism 2.1±12.3% and presenteeism 28±32%. WALS was positively correlated to HAQ (r=.657, p<.0001), FACIT (r=.720, p<.0001), both SF12 scores (r>.517, p<.0001), all 4 WPAI's scores (r>.296, p<.01) and inversely with SPS 6 (r= -.341, p=.002). WPAI's scores were all significantly associated to HAQ, FACIT, SF12 PCS and sick leave in the last 12 months (p<.05). SPS 6 was inversely related to HAQ and FACIT scores, WPAI presenteeism, work and activity impairment (p<.05), but not with absenteeism. Pain and fatigue were significantly higher in patients with higher WALS and WPAI scores, in exception to absenteeism, and pain was associated with SPS 6 (p<.05). Sleep quality was decreased when related to higher WALS and WPAI scores (p<.05). When comparing the employed/unemployed patients, WPAI activity impairment, PCS, MCS, HAQ, FACIT, pain and disease activity (p<.01), we verified significantly higher limitations and impairment in the unemployed group, in exception to SPS 6, fatigue and sleep quality.
Conclusions These findings suggest the significant impact of rheumatic disease in productivity losses, and that unemployed patients present worst quality of life and higher levels of pain, fatigue and disability. We found good correlations between the productivity assessment and the SF12, HAQ, FACIT, pain, fatigue, sleep quality and disease activity. This provides information about trend of work restrictions, useful in cost-effectiveness analysis for example of new treatment therapies. Moreover, these issues are particularly important because absenteeism and presenteeism have strong links to health related costs. Prevention of work disability and job changes/adaptations to the individual capabilities would be most effective in reducing socioeconomic and work related impact.
Disclosure of Interest None declared