Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference

8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference

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The importance of work for social

participation and quality of life in

people with rheumatic diseases

Prof. Dr. Alison Hammond, FCOT

Professor in Rheumatology Rehabilitation

University of Salford

[email protected]



Introduction

1. The problems faced by people with RMDs

� staying at work (SAW) or

� returning to work (RTW).

2. The effectiveness and benefits of early rehabilitationto enable SAW or early RTW

3. Future developments to improve work participationand quality of life for people with RMDs



Work disability and sick leave

40-45%: rheumatoid arthritis (5 y )

18 26% ankylosing spondylitis

19-23% systemic lupus

17-33% psoriatic arthritis

34% systemic sclerosis

Sick leave in early RA range = 7-84 days/y

24% of work is impaired (presenteeism)Newhall-Perry et al 2000; Merkesdal et al 2001; Verstappen et al 2004; Burton et al

2006; Al-Dhahani et al 2009; Baker et al 2009; Wallenius et al 2009; Vliet Vlieland et al

2009; Ariza-Ariza et al 2009; Rohekar & Pope 2010; Zhang et al 2010)



Physical, work and knowledge

barriers

Fatigue (esp. RA)

Pain;

Physical limitations: hand function (eg using a computer/writing), moving quickly, standing, lifting, bending, higher

work speed) Work-life balance: reduced leisure activities/ADL

Low job autonomy

Unadapted work environments, transport difficulties

Asking for and obtaining ergonomic modifications/ job

accommodations (lack of knowledge and/ or advocacy skills)Qualitative: Mancuso 2000; Backman 2004; Allaire 2007; Lacaille 2007

Quantitative: Proctor et al, 2000; Allaire et al, 2001 ; Teasell et al, 2001; De Buck et al, 2002; Tubach et al,2002; Verstappen et al, 2004; Lacaille et al, 2004; Yelin, 2004; Manek et al, 2005; Eberhardt et al, 2007.



Psychosocial barriers

Unwilling to disclose arthritis

Reluctance & emotional barriers

Increasing role overload

Dealing with others responses

Guilt Future worries: employment and finances

Higher perceived job strain

Loss of work self -efficacy

Qualitative: Gignac 2006; Lacaille, 2007; Allaire 2007

Quantitative: Proctor et al, 2000; Allaire et al, 2001 ; Teasell et al, 2001; De Buck et al,2002; Tubach et al, 2002; Verstappen et al, 2004; Lacaille et al, 2004; Yelin, 2004; Manek et al, 2005; Eberhardt et al, 2007.



Increasing risk

extended periods of sick leave

longer duration of unemployment.

Survey: n =300; RA 4 y.

56% work disabled

only 18% of these willing to work again( Verstappen et al, 2005)

References for predictive factors:

Proctor et al, 2000; Allaire et al, 2001 ; Teasell et al, 2001; De Buck et al, 2002; Tubach et al, 2002; Verstappen et al,2004; Lacaille et al, 2004; Yelin, 2004; Manek et al, 2005; Eberhardt et al, 2007.



Reducing risk

Ergonomic modifications to workplace:

2.5 x less likely to stop work

Greater use of coping strategies (physical /psychological) to self manage arthritis

Support from family/ co-workers( Lacaille, 2004: survey n = 581)

Supportive management

Effective communication : need for job

accommodations and how to changework habits(Shaw et al, 2007)



Vocational Rehabilitation

A process to overcome the barriers an

individual faces when accessing, remaining or

returning to work following injury, illness or

impairment.

( DWP, 2004)



Assessment of needs/ barriers

Work site assessment

Ergonomic modifications/job accommodationsErgonomic modifications/job accommodations

Support & communication: individual, employer,Support & communication: individual, employer,

others (others (egeg family, cofamily, co--workers);workers);

Self Self--advocacy skills training;advocacy skills training;Disability awareness trainingDisability awareness training

Condition management (physical, psychological);Condition management (physical, psychological);

Medical treatment;Medical treatment;

Staged return to work management by employers.Staged return to work management by employers.

Career exploration / counselling;Career exploration / counselling;

Job finding skills training;Job finding skills training;

Job placements/ retrainingJob placements/ retraining..DWP, 2004;

Allaire et al, 2007.

SAW

RTW



Ergonomic modifications

Mini keyboard: half size keys require less effort

Built in touch pad to reduce arm movement

Voice activated software

Ergonomic chair

Flex DeskBattery operated hand

held letter opener



Evidence for early work

rehabilitation



SAW: Rehabilitation services

Job retention intervention: (Macedo et al 2007: UK ):o RCT (n=28);

o employed RA

o usual care v

o comprehensive Occupational Therapy for functional,psychological and hand problems

o work site assessment, ergonomic modifications, disabilityrights advice

o liaison employer, Access to Work (work adaptations)

6m: Significant reduction work instability, improved worksatisfaction, pain, disability; No differences days missed work

Too small /short to identify changes in work status



SAW: Rehabilitation services

Job retention intervention (Allaire et al 2003: US A):

All employed (not on sick leave, concerns re SAW)

RCT (n = 242; 58% RA; OA, SLE, PA, AS); average HAQ 0.54.

VR counsellor 2x 1.5 hrs; Optional work visit and employer

liaison. Structured interview needs/ barriers; computing, travel,

access, work hours; psychological aspects; jobaccommodation plan. Disability rights; disclosing andrequesting job accommodations. Career advice.

3.5 yrs: 49% fewer job losses; high levels satisfaction

Need for convenient services or clients delay accessingservice



SAW early sick leave: MDT interventions

Job retention intervention (Abasolo et al 2005, 2007: Spain)

Patients with RMDs/MSDs on sick leave

RCT n = n=13,077; (inflammatory: n = 187; OA n=258)

Intervention:

Level 1: Medical assessment; drug management; condition education;self -management education (avoid rest, exercise, ergonomic care, increase physical activity)

Level 2: (no improvement 2-6w): referral to rehabilitation, furtherinvestigations as necessary

Negotiated RTW

12m: reduction in sick leave:

OA = 45.4 days; Inflammatory arthritis = 35.4 days

Cost-effective



SAW early sick leave: disability

employment services

RCT postal information on RTW support available (F leten et al,2006: Norway)

n= 990 (inc. n=99 with RMDs)

Letter 2w+ sick leave: brief information work measure

available:

RTW adjusted job + benefits

RTW: co-operation employee, employer and NIO modifiedwork measures

At 12m: Sick leave reduced 8 days overall

In RMD sub-group: 68 days



SAW/RTW: MDT interventions

Job retention intervention: ( De Buck et al 2005: NL)

Mix extended sick leave, employed

RCT (n = 140 RA): NL

medical assessment Rheumatologist

Occupational health doctor liaison Vocational assessment and advice (finances, job

accommodations)

Rehab: OT, PT, counselling as appropriate

Average 6 hours contact.

No difference in job retention/ RTW at 2 years.

Improved mental health, less fatigue

?? Due to 40% already on extended sick leave too late?

Good disability benefits system in NL



Summary of studies

1. Early intervention more effective:

o In work: with work instability

oEarly stages of sick leave

oConveniently timed and located

2. Longer delay, more difficult to SAW/RTW.

3. VR and MDT interventions effective.



What more can be done?

1. In work:

Brief interventions :

Early screening: risk of work instability.

Enable: Work self-management education: exercise, pacing,

ergonomic modifications to work tasks),

Work assessment & advice: simple work and environment

modifications (equipment, flexible hours, adaptations, access) Employment rights education

Open communication employee and employer



What more can be done?

2. Early sick leave:

Advice and intervention early (eg by 2 weeks)

Assess for needs

Stepped care:

Medical management (eg drug therapy)

Condition and self-management education, work assessment

and advice

Work rehabilitation and therapy (Occupational therapy, physiotherapy, cognitive-behavioural therapy) as necessary



Future research

RCTs: Do effective interventions developed in the USA, Spain

and Norway, reduce sick leave and improve job retention in

other countries with different socioeconomic conditions and

employment benefits/ regulations/law?

What is their impact on health, participation, quality of work

and quality of life?

Observational studies and RCTs: effectiveness of current VR

services?

Are they cost-effective?

What are the most effective ways of delivering interventions

in practice?



Thank you

Please Contact

Prof. Dr Alison Hammond,

Professor in Rheumatology Rehabilitation, University of Salford

School of Health, Sport and Rehabilitation Sciences

C407Allerton Building

FrederickRoad

Salford

M6 6PU

United Kingdom

[email protected]

Documents

Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference