Missed Work Days Research Articles

Employment is maintained and sick days decreased in psoriasis/psoriatic arthritis patients with etanercept treatment.

BackgroundPsoriasis and psoriatic arthritis (PsA) impair quality of life, including reduction in employment or job duties. The PRESTA (Psoriasis Randomized Etanercept STudy in Patients with Psoriatic Arthritis) study, a randomized, double-blind, two-dose trial, examined the efficacy of etanercept treatment in patients with moderate-to-severe plaque psoriasis and PsA and the main results have been presented previously. This analysis examined employment status, job duties and sick days, pre-defined endpoints in PRESTA, among this patient population.MethodsParticipants (N = 752) were randomized to receive etanercept 50 mg twice weekly (BIW; n = 379) or 50 mg once weekly (QW; n = 373) for 12 weeks by subcutaneous injection. All participants then received open-label etanercept 50 mg QW for 12 additional weeks, while remaining blinded to the randomization. A pharmacoeconomic questionnaire was administered at baseline, week 12 and week 24 of treatment. The questionnaire included employment status and changing job responsibilities and sick time taken due to psoriasis or PsA. The statistical methods included analysis of covariance, t-test, Fisher’s exact test and McNemar’s test. Last-observation-carried-forward imputation was used for missing data.ResultsEmployment was at least maintained from baseline to week 24 in both dose groups (56% [BIW/QW] and 60% [QW/QW] at baseline, 61% and 60%, respectively, at week 24). Among employed participants, the proportion of patients whose job responsibilities changed due to PsA decreased significantly from baseline to week 24 (17–23% to 5–8%; p < 0.01). Similar results were seen with job responsibility changes due to psoriasis (11–14% to 4%; p < 0.01). The number of monthly sick days also decreased from baseline to week 24 (2.4 days for both treatment groups to 0.7 (BIW/QW) and 1.1 (QW/QW); p ≤ 0.03 for each). No significant differences between the treatment groups were observed for any economic endpoint at any time point.ConclusionsFor patients with moderate-to-severe plaque psoriasis and PsA, etanercept treatment resulted in reducing job responsibility changes due to disease and in reducing sick time. Effective treatment of psoriasis and PsA may reduce missed work days.

Response: observational study demonstrates that OMT is associated with reduced analgesic prescribing and fewer missed work days.

Article Response: Observational Study Demonstrates That OMT Is Associated With Reduced Analgesic Prescribing and Fewer Missed Work Days was published on July 1, 2014 in the journal Journal of Osteopathic Medicine (volume 114, issue 7).

Bilateral Vestibular Deficiency: Quality of Life and Economic Implications.

Bilateral vestibular deficiency (BVD) causes chronic imbalance and unsteady vision and greatly increases the risk of falls; however, its effects on quality of life and economic impact are not well defined. To quantify disease-specific and health-related quality of life, health care utilization, and economic impact on individuals with BVD in comparison with those with unilateral vestibular deficiency (UVD). Cross-sectional survey study of patients with BVD or UVD and healthy controls at an academic medical center. Vestibular dysfunction was diagnosed by means of caloric nystagmography. Survey questionnaire. Health status was measured using the Dizziness Handicap Index (DHI) and Health Utility Index Mark 3 (HUI3). Economic burden was estimated using participant responses to questions on disease-specific health care utilization and lost productivity. Fifteen patients with BVD, 22 with UVD, and 23 healthy controls participated. In comparison with patients with UVD and controls, patients with BVD had significantly worse DHI (P < .001) and HUI3 scores. Statistically significant between-group differences were observed for overall HUI3 score (P < .001) and for specific attributes including vision, hearing, ambulation, emotion, and pain (P < .001 for all). Generalized linear model analysis of clinical variables associated with HUI3 scores after adjustment for other variables (including sex, race, education, age, and frequency of dizziness-related outpatient clinic visits) showed that the presence of UVD (P < .001) or BVD (P < .001), increased dizziness-related emergency room visits (P = .002), and increased dizziness-related missed work days (P < .001) were independently associated with worse HUI3 scores. Patients with BVD and UVD incurred estimated mean (range) annual economic burdens of $13,019 ($0-$48,830) and $3531 ($0-$48,442) per patient, respectively. Bilateral vestibular deficiency significantly decreases quality of life and imposes substantial economic burdens on individuals and society. These results underscore the limits of adaptation and compensation in BVD. Furthermore, they quantify the potential benefits of prosthetic restoration of vestibular function both to these individuals and to society.

Updated projections of total joint arthroplasty demands in America. Commentary on an article by Steven M. Kurtz, PhD, et al.: "Impact of the Economic Downturn on Total Joint Replacement Demand in the United States. Updated Projections to 2021".

Commentary Total hip and knee arthroplasties are major orthopaedic procedures that are reliable and cost-effective and deliver excellent long-term implant survivorships and clinical and patient-reported outcomes1. These procedures also have other extensive medical and non-medical benefits for patients and for society2,3. An analysis of 185,829 patients by Dall et al.2 proposed that working-age individuals in the United States who had undergone a total hip or total knee arthroplasty had a 20% to 28% increase in likelihood of employment, $4300 to $6200 higher mean annual income, six to twenty-two fewer missed work days each year, and a 24% decreased probability of receiving supplemental security income compared with adults with untreated musculoskeletal disorders. Thus, because of the success of these procedures in treating end-stage joint arthritis, total joint arthroplasties are being increasingly offered to younger, more active patients, as well as to those who have a higher body mass index. It is expected that the demand for these procedures will continue to rise in the future, and thus, studies that attempt to provide accurate trends and future projections may help orthopaedic surgeons and policy makers to better structure the health-care system for improvements in patient care. The economic downturn in 2001, in conjunction with the terrorist attacks on the World Trade Center, and the recession in 2008 to 2009 have been associated with a higher rate of unemployed individuals and a lower national Gross Domestic Product (GDP) in the United States. All of these events might have impacted the number of lower-extremity total joint arthroplasties performed. Kurtz et al. used data from the Nationwide Inpatient Sample (NIS) and the National Health Expenditure from 1993 to 2010 in an attempt to better evaluate future trends on the number of total joint arthroplasties. These authors previously reported their projections4 using the NIS database (1990 to 2003); however, in the present work, they attempted to update these outcomes and to evaluate the effects of the economic downturns during the past decade. They found that although the total number of primary and revision total hip and knee arthroplasties was reduced and/or plateaued during the recent downturns (especially in 2008 to 2009), overall the long-term growth trends for these procedures for the United States population were insensitive during these times. Kurtz and colleagues reported that the new model proposed a higher number of total hip arthroplasties and a lower number of total knee arthroplasties by 2020 compared with the results in their previous report in 2007. Among the economic indicators that were evaluated, the National Health Expenditure was found to have the strongest correlation in historical variance with the incidence of primary total joint arthroplasties (97% to 98%) and revision total joint arthroplasties (69% to 94%). We believe that there were several limitations of this study, some of which are inherent to any report that attempts to evaluate large databases; these points were correctly mentioned by the authors. Although their model accurately evaluated the NIS historical database, future projections based on these data cannot account for potential radical changes that the Affordable Care Act of 2010 may be imposing on orthopaedic surgeons and patients, as well as the availability and affordability of total hip and knee arthroplasties for Americans with end-stage arthritis during the next decade. Also, the numbers of baby boomers are expected to increase markedly during the next two decades (from approximately 40 million in 2010 to more than 70 million by 2030). Therefore, with higher life expectancies, the demand for these procedures may be even higher than expected. Furthermore, because of the relatively short duration of economic downturns (six months in 2000 and a maximum of twenty-four months during 2008 and 2009, as stated by the authors), a general conclusion that the growth trends of arthroplasties are insensitive to the economy may not be correct. With a more extended economic recession period, the reduced rate of these procedures (as evident in the figures showing data for 2008 and 2009) may affect the long-term projections. Overall, Kurtz and colleagues should be commended for attempting to assess the effects of economic downturns on the incidence of lower-extremity total joint arthroplasty in the United States. The present study advances the theory that the National Health Expenditure explains most of the growth and incidence of primary total hip and knee arthroplasties since the 1990s. We encourage the authors to revisit this subject after the nationwide initiation of the Affordable Care Act to better assess their outcomes to provide a potentially superior basis for planning for the future demand for total joint arthroplasty.

OMT Associated With Reduced Analgesic Prescribing and Fewer Missed Work Days in Patients With Low Back Pain: An Observational Study

Randomized controlled trials (RCTs) are considered the standard for establishing practice guidelines; however, they are expensive and time-consuming, and often the generalizability of the results is limited. To conduct an observational study using the findings of the American Osteopathic Association's Clinical Assessment Program (AOA-CAP) low back pain module, and to compare these findings with those of a major back pain-related RCT to determine the validity and generalizability of this pseudoexperimental model. Data were abstracted from the AOA-CAP for Residencies platform from April 1, 2006, through October 5, 2007, with a diagnosis code consistent with low back pain. Process and outcome measures were compared after segregating a similar patient population to an RCT that compared "osteopathic spinal manipulation" with standard care. A total of 1013 medical records were abstracted and entered into the AOA-CAP low back pain module. Mean (standard deviation [SD]) age was 44.7 (15.9) years, and body mass index was 29.6 (8.1). The eligible patients comprised 415 men (41.0%) and 598 women (59.0%), and common comorbid disease was found in 69 patients (6.8%). Activities of daily living were limited in 402 patients (42.4%), whereas 546 (57.6%) had no limitations. Previous exacerbations of low back pain occurred in 653 patients (65.9%). Most patients had no sensory or proprioception deficit (729 [87.7%]), and motor function was normal in 636 patients (74.5%). Normal ankle and knee reflexes were found in 744 of 814 (91.4%) and 755 of 829 (89.0%) patients, respectively. Osteopathic manipulative treatment (OMT) was performed on the lumbar spine (576 patients [56.9%]), thoracic spine (411 [40.6%]), sacrum/pelvis (440 [43.4%]), rib (261 [25.8%]), and lower extremity (256 [25.3%]). A segregated patient cohort (n=539) showed statistically significant differences between patients who received OMT and those who did not with the use of analgesics, steroids, spinal injections, straight-leg raising, and days off or limited work duties. The observational findings of the present study, which suggest that analgesic medication use is lower in patients who receive OMT, align with previous findings of RCTs and support the generalizability of these findings.

How Does Accounting for Worker Productivity Affect the Measured Cost-Effectiveness of Lumbar Discectomy?

BackgroundBack pain attributable to lumbar disc herniation is a substantial cause of reduced workplace productivity. Disc herniation surgery is effective in reducing pain and improving function. However, few studies have examined the effects of surgery on worker productivity.Questions/purposesWe wished to determine the effect of disc herniation surgery on workers’ earnings and missed workdays and how accounting for this effect influences the cost-effectiveness of surgery?MethodsRegression models were estimated using data from the National Health Interview Survey to assess the effects of lower back pain caused by disc herniation on earnings and missed workdays. The results were incorporated into Markov models to compare societal costs associated with surgical and nonsurgical treatments for privately insured, working patients. Clinical outcomes and utilities were based on results from the Spine Patient Outcomes Research Trial and additional clinical literature.ResultsWe estimate average annual earnings of $47,619 with surgery and $45,694 with nonsurgical treatment. The increased earnings for patients receiving surgery as compared with nonsurgical treatment is equal to $1925 (95% CI, $1121–$2728). After surgery, we also estimate that workers receiving surgery miss, on average, 3 fewer days per year than if workers had received nonsurgical treatment (95% CI, 2.4–3.7 days). However, these fewer missed work days only partially offset the assumed 20 workdays missed to recover from surgery. More fully accounting for the effects of disc herniation surgery on productivity reduced the cost of surgery per quality-adjusted life year (QALY) from $52,416 to $35,146 using a 4-year time horizon and from $27,359 to $4186 using an 8-year time horizon. According to a sensitivity analysis, the 4-year cost per QALY varies between $27,921 and $49,787 depending on model assumptions.ConclusionsIncreased worker earnings resulting from disc herniation surgery may offset the increased direct medical costs associated with surgery. After accounting for the effects on productivity, disc herniation surgery was found to be a highly cost-effective surgery and may yield net societal savings if the benefits of outpatient and inpatient surgery persist beyond 6 and 12 years, respectively.Level of EvidenceLevel II, economic and decision analysis. See the Instructions for Authors for a complete description of levels of evidence.

Repair of Symptomatic Rotator Cuff Tears After Failed Nonoperative Treatment Is Cost-Effective

Repair of Symptomatic Rotator Cuff Tears After Failed Nonoperative Treatment Is Cost-Effective

Performance of Polygenic Scores for Predicting Phobic Anxiety

ContextAnxiety disorders are common, with a lifetime prevalence of 20% in the U.S., and are responsible for substantial burdens of disability, missed work days and health care utilization. To date, no causal genetic variants have been identified for anxiety, anxiety disorders, or related traits.ObjectiveTo investigate whether a phobic anxiety symptom score was associated with 3 alternative polygenic risk scores, derived from external genome-wide association studies of anxiety, an internally estimated agnostic polygenic score, or previously identified candidate genes.DesignLongitudinal follow-up study. Using linear and logistic regression we investigated whether phobic anxiety was associated with polygenic risk scores derived from internal, leave-one out genome-wide association studies, from 31 candidate genes, and from out-of-sample genome-wide association weights previously shown to predict depression and anxiety in another cohort.Setting and ParticipantsStudy participants (n = 11,127) were individuals from the Nurses' Health Study and Health Professionals Follow-up Study.Main Outcome MeasureAnxiety symptoms were assessed via the 8-item phobic anxiety scale of the Crown Crisp Index at two time points, from which a continuous phenotype score was derived.ResultsWe found no genome-wide significant associations with phobic anxiety. Phobic anxiety was also not associated with a polygenic risk score derived from the genome-wide association study beta weights using liberal p-value thresholds; with a previously published genome-wide polygenic score; or with a candidate gene risk score based on 31 genes previously hypothesized to predict anxiety.ConclusionThere is a substantial gap between twin-study heritability estimates of anxiety disorders ranging between 20–40% and heritability explained by genome-wide association results. New approaches such as improved genome imputations, application of gene expression and biological pathways information, and incorporating social or environmental modifiers of genetic risks may be necessary to identify significant genetic predictors of anxiety.

The Impact of an Urban Home‐Based Intervention Program on Asthma Outcomes in Children

This program evaluation examines the outcomes of a multicomponent urban home-based asthma program implemented through a city health department in a large Midwestern city. The purpose of the program was to improve asthma outcomes by controlling indoor asthma triggers in the home environment. This was a pre-post evaluation study. Participants received home-based education from a public health nurse or a health educator, cleaning and other supplies, and physical home interventions such as mold abatement and pest control. Asthma outcomes, caregiver quality of life, trigger-related activities, and asthma management activities at baseline and 6 months following the intervention were evaluated using survey data. A total of 115 participants for whom baseline and follow-up data were available were included in this analysis. This study used parent self-reported quantitative and qualitative data which were collected through baseline and follow-up surveys administered by program staff. Significant reduction in asthma symptom days, nighttime awakenings, days with activity limitation, and albuterol use were observed. Emergency department visits, missed school days, and caregiver missed work days also were significantly reduced, and caregiver quality of life improved. This multifaceted home-based intervention decreased asthma triggers and improved asthma outcomes in children, and improved the quality of life of their caregivers.

Consequences of Interstitial Cystitis/Bladder Pain Symptoms on Women's Work Participation and Income: Results from a National Household Sample

We describe differences in work participation and income by bladder symptom impact and comorbidities among women with interstitial cystitis/bladder pain syndrome. Cross-sectional data from 2,767 respondents younger than 65 years identified with interstitial cystitis/bladder pain syndrome symptoms were analyzed. The data were taken from the RAND Interstitial Cystitis Epidemiology (RICE) survey, and included retrospective self-reports of interstitial cystitis/bladder pain syndrome impact, severity, years since onset, related comorbidities (depressive symptomatology, number of conditions), work participation and income, and personal characteristics. Multiple regressions predicted 5 current work outcomes of works now, kept from working by pain, missed work days, days worked when bothered by symptoms and real income change since symptom onset. Controlling for work status at symptom onset and personal characteristics, greater bladder symptom impact predicted a greater likelihood of not now working, kept more days from working by pain, missed more work days and working more days with symptoms. More depressive symptomatology and greater number of comorbidities predicted reduced work participation. Women experienced no growth in real income since symptom onset. Measures of symptom severity were not associated with any of the economic outcomes. Greater interstitial cystitis/bladder pain syndrome symptom impact, depressive symptomatology and count of comorbidities (but not symptom severity) were each associated with less work participation and leveling of women's long-term earnings. Management of bladder symptom impact on nonwork related activities and depressive symptomatology may improve women's work outcomes.

A multifaceted community-based asthma intervention in Chicago: effects of trigger reduction and self-management education on asthma morbidity

Objectives: Home-based, multifaceted interventions have been effective in reducing asthma morbidity in children. However, identification of independent components that contribute to outcomes and delineating effectiveness by level of asthma symptoms would help to refine the intervention and target appropriate populations. Methods: A community health educator led asthma intervention implemented in a low-income African-American neighborhood included asthma management education, individually tailored low-cost asthma home trigger remediation, and referrals to social and medical agencies, when appropriate. Changes in asthma morbidity measures were assessed in relation to implementation of individual intervention components using multivariable logistic regression. Results: Among the 218 children who completed the year-long program, there were significant reductions in measures of asthma morbidity, including symptoms, urgent care visits, emergency department (ED) visits, hospitalizations, missed school days, and missed work days for caretakers. We also found significant decreases in the prevalence of many home asthma triggers and improvements in asthma management practices. Improvement in caretaker’s ability to manage the child’s asthma was associated with reduction in ED visits for asthma and uncontrolled asthma. Specific home interventions, such as repair of water leaks and reduced exposure to plants, dust, clutter and stuffed toys, may be related to reduction in asthma morbidity. Conclusions: This program was effective in reducing asthma morbidity in low-income African-American children and identified specific interventions as possible areas to target in future projects. Furthermore, the intervention was useful in children with persistent asthma symptoms as well as those with less frequent asthma exacerbations.

AB1317 The effect of biological agents on participation in paid work in patients with chronic inflammatory arthritides: A meta-analysis of randomized controlled trials

BackgroundThe addition of biological agents in treatment strategies in chronic inflammatory arthritides have improved the possibility of controlling disease activity and slowing the progression of joint damage. However their impact...

SAT0469 Factors associated with work status and missed work days in rheumatoid arthritis

BackgroundWorking age patients with rheumatoid arthritis (RA) often struggle to maintain their physical functioning and ability to work outside the home due to the impact of chronic joint inflammation and...

IDENTIFICATION OF BIOMARKERS FOR EARLY TENDON DEGENERATION USING AN IN-VIVO RABBIT MODEL

IntroductionTendinopathy is a common and costly diagnosis in workers with Activity-related Soft Tissue Disorder (ASTD), and in recreational and professional athletes. The associated pain results in reduced physical activity, reduced...

PRS64 - Household Expenditure On Pediatric Atopic Dermatitis Across 12 Countries In The Asia Pacific Region

Atopic dermatitis (AD), also known as eczema, is a common chronic skin condition in childhood that has a negative impact on both patients and their families. A survey was conducted to evaluate the disease burden, financial and quality of life impact of moderate to severe AD across 12 countries in the Asia Pacific region. In this analysis, we examine the costs incurred by households surveyed in managing pediatric atopic dermatitis. A cross sectional survey was conducted in Australia, China, Hong Kong, India, Indonesia, Korea, Malaysia, Philippines, Singapore, Taiwan, Thailand, and Vietnam in January 2011. An online questionnaire was administered to 1028 parents with children diagnosed with moderate to severe AD (aged 1 - 16 years). Household expenditure measured included expenses for health care services, treatment and investigations, cost of associated conditions and missed days of work. Local currency costs were converted to USD using 2011 exchange rates. Median household expenditure on AD was an average of USD 794 per annum, ranging from USD 258 in the Philippines to USD 1706 in Hong Kong. Across the various countries, spending on health care services and physician fees ranged from USD137 in India to USD622 in Singapore, while spending on treatments and investigations ranged from USD100 in Indonesia to USD721 in Hong Kong. Working mothers missed an average of 13.5 days of work in the past year to care for their children with AD. Missed work days ranged from 4.8 days in Korea to as high as 20 days in China. Median productivity losses ranged from USD34 in Vietnam to USD844 per year in Hong Kong. The results of the survey indicate that pediatric AD places considerable burden on household expenditure and productivity in the countries surveyed.

Value associated with mindfulness meditation and moderate exercise intervention in acute respiratory infection: The MEPARI Study

Acute respiratory infection (ARI) is among the most common, debilitating and expensive human illnesses. The purpose of this study was to assess ARI-related costs and determine if mindfulness meditation or exercise can add value. One hundred and fifty-four adults ≥50 years from Madison, WI for the 2009-10 cold/flu season were randomized to (i) wait-list control (ii) meditation or (iii) moderate intensity exercise. ARI-related costs were assessed through self-reported medication use, number of missed work days and medical visits. Costs per subject were based on cost of generic medications, missed work days ($126.20) and clinic visits ($78.70). Monte Carlo bootstrap methods evaluated reduced costs of ARI episodes. The total cost per subject for the control group was $214 (95% CI: $105-$358), exercise $136 (95% CI: $64-$232) and meditation $65 (95% CI: $34-$104). The majority of cost savings was through a reduction in missed days of work. Exercise had the highest medication costs at $16.60 compared with $5.90 for meditation (P = 0.004) and $7.20 for control (P = 0.046). Combining these cost benefits with the improved outcomes in incidence, duration and severity seen with the Meditation or Exercise for Preventing Acute Respiratory Infection study, meditation and exercise add value for ARI. Compared with control, meditation had the greatest cost benefit. This savings is offset by the cost of the intervention ($450/subject) that would negate the short-term but perhaps not long-term savings. Meditation and exercise add value to ARI-associated health-related costs with improved outcomes. Further research is needed to confirm results and inform policies on adding value to medical spending.

Extent of Lumbar Discectomy in Modern-Day Neurosurgery

umbar disc herniation is one of the most common pathologic conditions affecting the lumbar spine, with an inciL dence of 1% to 2% inNorthAmerica andwith over 300,000 lumbar discectomies performed annually (5, 7, 10, 11). Although routine lumbarmicrodiscectomies decrease leg pain and disability, same-level recurrent lumbar discherniation is a complication that is not infrequent. Recurrent disc herniation in this setting is noted in multiple published studies to be within the range of 3% to 18%, and recurrence of radiculopathy is seen in 17% to 33%. This not only contributes to increased patient cost, but also dramatically increases the economic burden to the United States health care system, not to mention economic cost from patient missed work days (4, 8). In fact, Ambrossi et al. estimated that reoperation led to a normalized cost of $298,797 per 100 primary discectomies (1).

A Cost Analysis for a Community-Based Case Management Intervention Program for Pediatric Asthma

Objective. Evaluate the costs and benefits of the Boston Children’s Hospital Community Asthma Initiative (CAI) program through reduction of Emergency Department (ED) visits and hospitalizations and quality of life (QOL) for patients and their families due to reduced missed school days and work days. Methods. Cost–benefit analysis was used to determine an adjusted Return on Investment (ROI) for all 102 patients enrolled in the CAI program in the calendar year 2006 after controlling for changes in a comparable population without CAI intervention. A societal ROI (SROI) was also computed by including additional indirect benefits due to reduced missed school days for patients and work days for caregivers. Results. Adjusted cost savings from fewer ED visits and hospitalizations resulted in an adjusted ROI of 1.33 (adjusted Net Present Value, (NPV) of savings = $83,863) during the first 3 years after controlling for factors other than the CAI intervention. When benefits due to reduced missed school days and missed work days were added to adjusted cost savings, the SROI increased to 1.85 (Societal NPV of savings = $215,100). Conclusions. Multidisciplinary, coordinated disease management programs offer the opportunity to prevent costly complications and hospitalizations for chronic diseases, while improving QOL for patients and families. This cost analysis supports the business case for the provision of proactive community-based asthma services that are traditionally not reimbursed by the fee-for-service health care system.

Modeling the indirect economic implications of musculoskeletal disorders and treatment

BackgroundMusculoskeletal disorders impose a substantial economic burden on American society, but few studies have examined the economic benefits associated with treating such disorders. The purpose of this research is to estimate the indirect economic implications of activity limitations associated with musculoskeletal disorders and to quantifying the potential economic gains from elective surgery to treat arthritis of the knee and hip.MethodsUsing regression analysis with the National Health Interview Survey (2004-2010 data, n=185,829 adults) we quantify the relationship between severity of activity limitations (walking, sitting, standing, etc.) and employment, household income, missed work days, and receipt of supplemental security income for disability. Activity limitations are combined to create an index similar to the Functional Ability Index from the Short Form 36 Health Questionnaire (SF-36) often used in clinical trials to measure patient functional mobility. This index is included in the regression analyses. We use data from published, prospective clinical trials to establish the improvement in patient functional ability following surgery to treat arthritis of the knee and hip.ResultsImproved physical function is associated with higher likelihood of employment, higher household income and fewer missed work days for those who are employed, and reduced likelihood of receiving supplemental security income for disability. The magnitude of the impact and statistical significance vary by activity limitation and severity. Each percentage point increase in the index value is associated with a 2-percentage-point increase in the odds of being employed, a 3-percentage-point-day decline in work days missed and an additional $180 in annual household income if employed, and a 2-percentage-point decline in the odds of receiving supplemental security income for disability. All estimates are statistically significant at the 0.05 level.ConclusionsUsing a large, representative sample of non-institutionalized adults in the U.S., we find that physical activity limitations are associated with worse economic outcomes across multiple economic metrics. Combined with estimates of improved functional ability following knee and hip surgery, we quantify some of the economic benefits of surgery for arthritis of the knee and hip. This information helps improve understanding of the societal benefits of medical treatment for musculoskeletal conditions.

Quality of Life and Work Productivity Impairment among Psoriasis Patients: Findings from the National Psoriasis Foundation Survey Data 2003–2011

ObjectiveTo ascertain impairment in quality of life and work productivity among patients with psoriasis and psoriatic arthritis.DesignFrom 2003 through 2011, the National Psoriasis Foundation collected survey data from patients with psoriasis and psoriatic arthritis via email and telephone correspondences.SettingSurvey data were collected from psoriasis and psoriatic arthritis patients in the general community in the U.S.Main Outcome MeasuresQuality of life focusing on emotional impact (anger, frustration, helplessness, etc.) and physical impact (pain, pruritus, physical irritation, etc.); employment status.PatientsThe surveys were performed through random sampling of participants from a database of over 75,000 patients.ResultsFrom 2003 to 2011, 5,604 patients completed the surveys. Psoriasis and psoriatic arthritis affected overall emotional wellbeing in 88% of patients, and they interfered with enjoyment of life in 82%. Most patients reported experiencing anger (89%), frustration (89%), helplessness (87%), embarrassment (87%), and self-consciousness (89%). Many patients also actively concealed physical manifestations of their diseases (83%), and experienced pain (83%) and pruritus (93%) regularly. Of note, 12% of patients were unemployed, and 11% worked part-time. Among unemployed patients, 92% cited psoriasis and/or psoriatic arthritis as the sole reasons for not working. Among working patients, 49% missed work days regularly due to psoriasis. Compared to patients with mild psoriasis, patients with severe psoriasis have 1.8 times greater odds to be unemployed after adjusting for age and gender (Adjusted OR = 1.7, 95% CI 1.4–2.3).ConclusionPatients with psoriasis and psoriatic arthritis continue to experience significant impairment of quality of life and work productivity.