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Disability prevention program lessened work loss due to rheumatic, musculoskeletal conditions
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A non-rigorous, work disability prevention program appeared to be effective in avoiding work loss in patients with chronic rheumatic and musculoskeletal conditions, according to findings.
In the 2-year, single-blind, parallel-arm, randomized controlled trial, researchers evaluated 287 patients recruited from community medical organizations and social support resources. Eligible patients were 21 years to 65 years of age, employed for a minimum of 15 hours per week, were a resident of or working in Massachusetts, and were diagnosed with a rheumatic or musculoskeletal condition, such as rheumatoid arthritis, psoriatic arthritis, osteoarthritis, systemic lupus erythematosus, scleroderma of fibromyalgia. Patients also had self-reported concerns about their continued ability to work due to their health.
Researchers randomly assigned to patients to one of two disability prevention programs: an intervention that included a 1.5-hour meeting with a trained rehabilitation therapist and two telephone calls at 3 weeks and 12 weeks after the meeting, with information on remaining employed (n=143); and a control group that received written materials about retaining employment for patients with rheumatic or musculoskeletal conditions (n=144). The work barrier aspect of the intervention was provided using the work experience survey for rheumatic conditions (WES-RC). The primary outcome was work restriction evaluated through the work limitations questionnaire (WLQ).
At 24 months, researchers assessed available data on 264 patients (92% of randomized patients). The mean age of the group was 50.4 years. Most patients were female (73%), white (69%), not married (65%) and had a college degree or higher level of education (59%). The most common condition among the study population was osteoarthritis (43%), followed by rheumatoid arthritis (23%), chronic back pain (13%), fibromyalgia (11%) and psoriatic arthritis (5%).
Researchers found that at baseline, the control group had a WLQ score of 36.29 and the intervention group had a WLQ of 34.53. From baseline to 24 months, the mean change in WLQ job demand output subscale scores was -8.33 ±2.22 for the control group and -8.60 ±1.92 for intervention arm. No significant difference was seen between the change in WLQ subscale scores between the two groups between baseline and 24 months or at any other timepoint. Analyses that adjusted for age, sex, race and education did not alter the effect estimate or significance level for the effect treatment on change in WLQ subscale score from baseline to 24 months.
During follow-up, permanent work loss was experienced by 36 patients; 25 (18%) in the control group and 11 (8%) in the intervention group. A significant difference was seen between control and intervention groups in time to permanent work loss.
Overall, 4.6% of control patients and 3.5% of intervention patients experienced any loss of work, including temporary loss of work. The rate of permanent and temporary work loss was lower in the intervention group, but this difference was on the verge of being statistically significant.
The control group had a baseline work performance questionnaire (HPQ) score of 0.99, and the intervention group had a baseline relative HPQ score of 1.07. However, at 24 months, the score increased by 0.07 for controls but remained constant for intervention patients, equating to a nonsignificant treatment effect.
“Job loss is a dreaded outcome in people with arthritis and back pain,” Julie J. Keysor, PhD, told Healio Rheumatology. “The take-home message of this study is that people with arthritis and chronic back pain who are at risk of losing their jobs can remain employed by learning strategies to address job-related barriers. In this study, the learning strategies were taught by physical and occupational therapists who regularly treat people with chronic musculoskeletal conditions. This approach can be easily implemented within the context of care, although its feasibility needs to be evaluated more.” -by Jennifer Byrne
Disclosures: The researchers report no relevant disclosures.
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Keysor JJ, et al. Arthritis Care Res. 2017;doi:10.1002/acr.23423.
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