Abstract
BackgroundInflammatory arthritis leads to work disability, absenteeism and presenteeism (i.e. at-work productivity loss) at high cost to individuals, employers and society. A trial of job retention vocational rehabilitation (VR) in the United States identified this helped people keep working. The effectiveness of this VR in countries with different socioeconomic policies and conditions, and its impact on absenteeism, presenteeism and health, are unknown. This feasibility study tested the acceptability of this VR, modified for the United Kingdom, compared to written advice about managing work problems. To help plan a randomized controlled trial, we tested screening, recruitment, intervention delivery, response rates, applicability of the control intervention and identified the relevant primary outcome.MethodsA feasibility randomized controlled trial with rheumatoid, psoriatic or inflammatory arthritis patients randomized to receive either job retention VR or written information only (the WORK-IA trial). Following three days VR training, rheumatology occupational therapists provided individualised VR on a one to one basis. VR included work assessment, activity diaries and action planning, and (as applicable) arthritis self-management in the workplace, ergonomics, fatigue and stress management, orthoses, employment rights and support services, assistive technology, work modifications, psychological and disclosure support, workplace visits and employer liaison.ResultsFifty five (10%) people were recruited from 539 screened. Follow-up response rates were acceptable at 80%. VR was delivered with fidelity. VR was more acceptable than written advice only (7.8 versus 6.7). VR took on average 4 h at a cost of £135 per person. Outcome assessment indicated VR was better than written advice in reducing presenteeism (Work Limitations Questionnaire (WLQ) change score mean: VR = −12.4 (SD 13.2); control = −2.5 (SD 15.9), absenteeism, perceived risk of job loss and improving pain and health status, indicating proof of concept. The preferred primary outcome measure was the WLQ, a presenteeism measure.ConclusionsThis brief job retention VR is a credible and acceptable intervention for people with inflammatory arthritis with concerns about continuing to work due to arthritis.Trial registrationISRCTN 76777720. Registered 21.9.12.
Highlights
Inflammatory arthritis leads to work disability, absenteeism and presenteeism at high cost to individuals, employers and society
People experience work instability, i.e. a mismatch between abilities and job demands which threatens employment [2]. This is associated with increased: absenteeism, as employed people with rheumatoid arthritis (RA) average 40 days sick leave per year compared to the 6.5 days United Kingdom (UK) average [1]; and presenteeism, with 24% of working time lost due to health problems [3]
Neither study measured effects on absenteeism or presenteeism. These findings suggest brief job retention vocational rehabilitation (VR), based on that developed in the United States of America (USA) [10], delivered by occupational therapists with job retention VR training as part of Rheumatology National Health Service (NHS) services, could be effective in the UK
Summary
Inflammatory arthritis leads to work disability, absenteeism and presenteeism (i.e. at-work productivity loss) at high cost to individuals, employers and society. A trial of job retention vocational rehabilitation (VR) in the United States identified this helped people keep working The effectiveness of this VR in countries with different socioeconomic policies and conditions, and its impact on absenteeism, presenteeism and health, are unknown. People experience work instability, i.e. a mismatch between abilities and job demands which threatens employment [2] This is associated with increased: absenteeism, as employed people with RA average 40 days sick leave per year compared to the 6.5 days United Kingdom (UK) average [1]; and presenteeism (i.e. reduced at-work productivity), with 24% of working time lost due to health problems [3].
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