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FRI0592-HPR Work Rehabilitation in Inflammatory Arthritis: A Pilot Randomised Controlled Trial
  1. A. Hammond1,
  2. Y. Prior1,
  3. R. O'Brien2,
  4. S. Woodbridge3,
  5. K. Radford4
  1. 1Health Sciences Research, University of Salford, Salford
  2. 2Health & Wellbeing, Sheffield Hallam University, Sheffield
  3. 3Occupational Therapy, Royal Derby Hospital, Derby
  4. 4Rehabilitation and Ageing, University of Nottingham, Nottingham, United Kingdom

Abstract

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.

References

  1. Allaire SH, Li W, La Valley MP (2003). Arthritis Rheum 48(11): 3212–3218.

  2. 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

DOI 10.1136/annrheumdis-2014-eular.5378

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