FRI0592-HPR Work rehabilitation in inflammatory arthritis: A pilot randomised controlled trial

Hammond, A; Prior, Y; O'Brien, R.; Woodbridge, S.; Radford, K.

Abstract

Background Work problems are common in people with inflammatory arthritis (IA): with 28-40% of people with rheumatoid arthritis (RA) stopping work in 5y of diagnosis. There is little research into effectiveness of job retention vocational rehabilitation (JRVR)for employed people with IA. Brief JR-VR led to significantly fewer job losses at 3.5 years in the USA (Allaire et al, 2003) and a
UK pilot trial demonstrated 6m improvements in work instability and work satisfaction (Macedo et al, 2009).
Objectives: To conduct a pilot randomised controlled trial (RCT) evaluating a JR-VR intervention with employed people with IA,to facilitate planning a full RCT.

Methods: Participants with IA were recruited from 6 Rheumatology departments and randomised to VR (delivered by
Rheumatology OTs with VR training) or a control group. Both groups received written self-help information about managing work problems. The VR group could receive up to 6h JR-VR, including a work visit. Presenteeism outcomes included: RA-Work Instability Scale (RAWIS:0-23), Work Limitations Questionnaire Productivity Loss (WLQPL: %), Work Activities Limitations Scale (WALS:0-33). Absenteeism was measured using monthly work diaries. Health outcomes included: SF12v2 Physical component(SF12-PC), pain, fatigue and perceived health status VAS (0-100). Mean (SD) change scores and effect sizes were calculated.
Results: 213 eligible employed patients with IA were identified, of whom 55 (26%) participated (34 with RA): 13M, 42F; aged 49y (SD 8.8); 7.9y (SD 8.9) disease duration; 33 worked full-time; job types were professional (27%), associated professional/skilled
(15%), partly skilled/admin/caring/retain (53%), unskilled (5%). Both groups were comparable at baseline (see Table). At 9m: effect sizes were moderate to large for changes in work and health outcomes in the JR-VR group and none to small in the control group; %working days lost due to sickness: JR-VR =9.6% (SD 13.6); control = 20% (SD 27.1). JR-VR lasted on average 3.08 (SD 1.8)hours and cost £74.98 (SD £46.80) per patient.

Conclusions: This pilot suggests brief JR-VR provided by Rheumatology OTs can improve presenteeism, absenteeism and health status, indicating a RCT is warranted. Recruitment was problematic, with many not consenting. Potential reasons include: fear about employers (in a recession) learning they have arthritis; concerns about time out of work attending VR; and not perceiving VR is needed as yet. JR-VR intends to prevent work problems. Support is needed to enable employed people with IA and work problems
to attend JR-VR.

Citation

Hammond, A., Prior, Y., O'Brien, R., Woodbridge, S., & Radford, K. (2014). FRI0592-HPR Work rehabilitation in inflammatory arthritis: A pilot randomised controlled trial. Annals of the Rheumatic Diseases, 73(Suppl), 1209-1209. https://doi.org/10.1136/annrheumdis-2014-eular.5378

• Journal Article Type: Article
• Online Publication Date: Jun 10, 2014
• Publication Date: Jun 10, 2014
• Deposit Date: Jan 28, 2015
• Publicly Available Date: Jan 28, 2015
• Journal: Annals of the Rheumatic Diseases (ARD)
• Print ISSN: 0003-4967
• Electronic ISSN: 1468-2060
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 73
• Issue: Suppl
• Pages: 1209-1209
• DOI: https://doi.org/10.1136/annrheumdis-2014-eular.5378
• Publisher URL: http://dx.doi.org/10.1136/annrheumdis-2014-eular.5378
• Related Public URLs: http://ard.bmj.com/