Background Work problems are common in people with inflammatory arthritis (IA): with 28-40% of people with rheumatoid arthritis (RA) stopping work in 5y of diagnosis. There is little research into effectiveness of job retention vocational rehabilitation (JR-VR) for employed people with IA. Brief JR-VR led to significantly fewer job losses at 3.5 years in the USA (Allaire et al, 2003) and a UK pilot trial demonstrated 6m improvements in work instability and work satisfaction (Macedo et al, 2009).
Objectives To conduct a pilot randomised controlled trial (RCT) evaluating a JR-VR intervention with employed people with IA, to facilitate planning a full RCT.
Methods Participants with IA were recruited from 6 Rheumatology departments and randomised to VR (delivered by Rheumatology OTs with VR training) or a control group. Both groups received written self-help information about managing work problems. The VR group could receive up to 6h JR-VR, including a work visit. Presenteeism outcomes included: RA-Work Instability Scale (RAWIS:0-23), Work Limitations Questionnaire Productivity Loss (WLQPL: %), Work Activities Limitations Scale (WALS:0-33). Absenteeism was measured using monthly work diaries. Health outcomes included: SF12v2 Physical component (SF12-PC), pain, fatigue and perceived health status VAS (0-100). Mean (SD) change scores and effect sizes were calculated.
Results 213 eligible employed patients with IA were identified, of whom 55 (26%) participated (34 with RA): 13M, 42F; aged 49y (SD 8.8); 7.9y (SD 8.9) disease duration; 33 worked full-time; job types were professional (27%), associated professional/skilled (15%), partly skilled/admin/caring/retain (53%), unskilled (5%). Both groups were comparable at baseline (see Table). At 9m: effect sizes were moderate to large for changes in work and health outcomes in the JR-VR group and none to small in the control group; %working days lost due to sickness: JR-VR =9.6% (SD 13.6); control =20% (SD 27.1). JR-VR lasted on average 3.08 (SD 1.8) hours and cost £74.98 (SD £46.80) per patient.
Conclusions This pilot suggests brief JR-VR provided by Rheumatology OTs can improve presenteeism, absenteeism and health status, indicating a RCT is warranted. Recruitment was problematic, with many not consenting. Potential reasons include: fear about employers (in a recession) learning they have arthritis; concerns about time out of work attending VR; and not perceiving VR is needed as yet. JR-VR intends to prevent work problems. Support is needed to enable employed people with IA and work problems to attend JR-VR.
Allaire SH, Li W, La Valley MP (2003). Arthritis Rheum 48(11): 3212–3218.
Macedo A et al (2009). Arthr Care Res 61(11):1522-1530.
Acknowledgements This study was funded by Arthritis Research UK.
Disclosure of Interest None declared