I18. Patient Perspectives on Vocational Rehabilitation Provision

Abstract

Work problems are common among patients with inflammatory forms of arthritis (e.g. rheumatoid arthritis (RA), psoriatic arthritis (PA), undifferentiated inflammatory arthritis (IA)) with RA being the commonest long-term severe disabling condition in the United Kingdom (UK). Research suggests that work status, health, well-being and income are strongly related. RA related work instability can lead to work disability, and later to job loss. Loss of valued activities such as work could result in reduced self-esteem, life satisfaction, perceived health status and higher levels of depression and pain in people with RA. In the long term, these factors are associated with worse functional status, disease outcome and increased health service use. Vocational rehabilitation is a process to overcome the barriers individuals with work instability or disability counter when accessing, remaining or returning to work. In the context of health care provision, this could include practical advice and support to enable participants to disclose their condition to their employers, job modifications or accommodations such as ergonomic changes, psychosocial and informational strategies, and multidisciplinary team referral to manage the condition. It is recommended that early intervention either when the person is still working and experiencing difficulties, or in the first few weeks of sick leave, delivered in a format convenient to the patient is likely to result in better outcomes, such as reduced job loss. Thus, it is preferable to help people stay at work, as research suggests that once out of work people with IA are much less likely to go back to employment. In order to deliver vocational rehabilitation to employed patients in a format convenient to the patient requires individualised treatment. Thus it is important to understand the patient’s experience of undergoing vocational rehabilitation to help plan and deliver job retention interventions to patients with rheumatological conditions. This presentation will provide an overview of studies investigating people with inflammatory arthritis’ experience of undergoing vocational rehabilitation. It will focus on employed people with work problems, wanting to stay at work, with particular reference to the qualitative interviews conducted with participants in the Work Rehabilitation in Inflammatory Arthritis Study (WORK-IA). Factors such as access to vocational rehabilitation, and the barriers to and facilitators for staying at work will be discussed using participants’ narratives.