EULAR: Workplace support, inclusivity imperative for patients with RMDs
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For patients with rheumatic and musculoskeletal diseases to maintain healthy work lives, it is essential for workplaces to offer healthy and supportive attitudes and environments, according to new EULAR points to consider.
“In nearly all European countries, the work participation gap between people with chronic diseases, especially those with rheumatic and musculoskeletal diseases (RMDs), and the general population persists, varying between 10% and 15%,” Annelies Boonen, MD, PhD, of Maastricht University Medical Center, in the Netherlands, and colleagues wrote in the Annals of the Rheumatic Diseases. “To bridge the work participation gap, EULAR included in its strategic objectives that ‘By 2023, EULAR’s activities and related advocacy will have increased participation in work by people with RMDs.’”
“As part of these activities, a task force was assembled to formulate points to consider to support healthy and sustainable paid work participation for people with RMDs,” they added.
To establish the new points to consider, a steering committee, including experts and a patient representative, convened in January 2020. The group established six areas of research for guidance when formulating the document. Some of these included the relevancy of work to clinical outcomes, barriers and facilitators to working, the impact of various interventions, the impactful pieces of the social security system, how work participation rates differ in people with and without disease, and how employers can facilitate patients maintaining work.
Investigators conducted three systematic literature reviews to examine the pertinent research. The first focused on facilitators and barriers to work outcomes. The second investigated prospective studies evaluating non-pharmacological interventions. The third examined rates of work participation among people with and without RMDs. The researchers additionally conducted two surveys. The first asked rheumatology organizations to identify helpful guidelines for this purpose, while the second surveyed large companies about available policies and programs for patients with rheumatic and musculoskeletal diseases.
Members of the investigating group established the principles and points following a series of discussions and votes. Consensus for a specific point was reached if more than 75% of participants voted in favor in the first round. In the second round, this fell to 66%, and in a third, to 50%. After finalizing the points, taskforce members rated their levels of agreement for each point on a scale of 0 to 10 via an anonymous online survey.
The group ultimately approved three overarching principles and 11 points to consider. According to the overarching principles, work participation increases self-worth and other important traits, resulting in better overall well-being. In addition, the aim of work-related support should be to optimize working life to assure the best physical and mental health is attainable, and it is a shared responsibility of all society to support patients’ participation in work.
The 11 points to consider are:
- Patients should be “supported and encouraged” to work if possible while they are of working age.
- Patients with RMDs should have timely support to prevent long periods of absence.
- The employment gap can be addressed through cooperation by health professionals, patient organizations and policymakers.
- Patients with RMDs should be able to voice concerns relating to work-related challenges with their employers.
- Being consistently present at work is an indicator of future work outcomes.
- Biopsychosocial framework aspects must be considered when discussing workplace needs for patients with RMDs.
- Interventions that modify disease demonstrate a positive impact on work participation and should be initiated early.
- Non-pharmacological interventions can help patients with RMDs prevent absence due to illness.
- Social security systems should work toward developing policies to promote work sustainability and return-to-work efforts.
- Healthy workplace attitudes are essential for patients with RMDs to maintain work lives.
- Employers should promote policies prioritizing inclusivity, flexibility and support for patients with RMDs.
“A vast amount of research evidence points to the decisive role of the workplace in sustainable work for vulnerable persons,” Boonen and colleagues wrote. “While several terms and definitions have been proposed on what constitutes ‘good work,’ a generally agreed upon and (wherever possible) evidence-based working definition is highly needed.”
References:
Van der Zwan R, et al. J Eur Soc Policy. 2021;doi: 10.1177/09589287211002435.
Perspective
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Patients with rheumatic and musculoskeletal diseases (RMDs) face many challenges to maintain productive work. This paper presents several recommendations from a EULAR taskforce, based on studies, surveys and expert opinions, on how to close the work participation gap among patients with RMDs. The taskforce formulated comprehensive overarching principles and points to consider (PtC), which in in theory have great potential to benefit our patients but may not be practical.
For example, the population the taskforce is attempting to address is too broad. Some RMDs are more readily responsive to treatment while others can be refractory to treatment. Patients in the latter group often have difficulty returning to work in the same capacity. Thus, there should be an effort to tailor these recommendations to subgroups of conditions that share more similarities.
Many “stakeholders,” per the taskforce, will need to collaborate to close the work participation gap. Employers are mentioned as one of the stakeholders in this paper. For example, PtC 11 states, “Employers should develop and implement policies and practices to promote a workplace culture of inclusivity, flexibility and support.” Although most employers would agree that employees should be supported in ways to allow them to return to work, this recommendation is challenging given that some businesses may lack the bandwidth to provide the kind of support and accommodations needed for patients with RMDs to maintain their productivity.
PtC 7, which states, “Disease-modifying interventions for inflammatory rheumatic diseases have a beneficial effect on work participation and are recommended to be started as early as possible,” has an A+ strength of recommendation. However, this is challenging because U.S. rheumatologists face medication denials from insurance companies daily. Policymakers will need to step in to make the authorization process less burdensome and effective treatment more accessible.
Filling out work and disability forms for patients is an integral part of practicing rheumatology. I have filled countless disability forms and found that the type of information required for disability eligibility vary tremendously across different programs. Although it is ideal to standardize disability determination, it is often not well-defined when a patient is able to work or not and what type of accommodations they need. There are nuances in how each physician approaches different cases, based on various factors including patients’ type of work, socioeconomic background, psychologic state, family and employer support, government programs, etc.
I find that in my experience, some of the most important factors in determining how quickly patients can return to work are treatment access and response; degree of self-motivation to return to work, which in part may be related to how much they enjoy their work; financial need; and psychologic wellbeing. Some of these factors take time to modify and some unfortunately are not modifiable.
In summary, these recommendations are thoughtful and commendable, but may need to be simplified and prioritized in ways that can be more actionable.
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