The Arthritis Newsletter

Fall 2011

Employment and Arthritis: Making it WorkTM

You have arthritis and you’re having a difficult time at work.  What’s your biggest challenge – fatigue –pain – stress – inability to meet work productivity – depression?  These are just a few of the challenges you may face at work if you live with arthritis.  What if there were a computer program designed to help you manage your disease related problems at work?  It’s coming …


Dr. Diane Lacaille and her team are creating an educational program called Making It WorkTM; designed to help you stay employed.  Here’s what Dr. Lacaille told us about Making It WorkTM:


What does the program involve?


It is a 5-week group educational program designed to help people with inflammatory arthritis stay employed for as long as they wish to work.  It combines:


  • the benefits of group sessions,
  • self-learning modules aimed at enhancing self-management of work-related problems, and
  • individualized assessments by employment-related health professionals aimed at job retention: an ergonomic assessment by an occupational therapist and job retention vocational rehabilitation counselling.

Have you tested this program?


Yes, we have pilot tested this program and found it was well received; in fact, all participants were successful in obtaining job accommodations, changing work tasks to better suit their arthritis and remain employed.


How was the program created?


The original program development was based on:


  • a strong theoretical background,
  • the self-management approach, already proven effective in arthritis management,
  • the Precede-Proceed model – a validated model successfully used for developing health education programs.

Program content was selected to modify known risk factors for work disability and problems at work identified in initial focus groups. We performed a pilot study of the intervention in two groups of participants with a 12-month follow-up. Results were very favourable


The e-learning conversion was made possible through a Canadian Institutes of Health Research Knowledge Translation grant. This grant allowed us to collaborate with Masters students from the Centre of Digital Media (a consortium of four universities: University of British Columbia, University of Simon Fraser, Emily Carr University of Art and Design, and the British Columbia Institute of Technology) to design and convert our original face-to-face program to a web format using mixed media technology including a website, slides, video, animation, and audio.


What is an online e-Learning program?


An online e-learning program is an educational program that takes place online, using a computer.


Why convert the program to an e-Learning program?


We have converted our original face-to-face, 5-week program to a web-based format in order to allow a broader dissemination across Canada and elsewhere, including to remote communities.  Each module presents the identical content of the self-learning modules through mixed media such as slides, videos, animations, and audio recordings.


What are the benefits of an eLearning style of education?


Web-based, self-management programs have been successfully developed across a variety of chronic diseases. Advantages include:


  • accommodating different learning styles,
  • providing a self-paced program through the use of computer adaptive technology, and
  • tailoring information to an individual’s situation and needs.

This approach is also consistent with recent trends towards a more patient-centred approach to health care. Research has shown that most patients have no difficulty using web-based technologies, including elderly populations. Group interactions are enhanced through the use of a variety of communication mediums: e-mails, blogs, message boards, Skype, text chat, webinars, etc.


Why was the program created?


Reported rates of work disability for people with rheumatoid arthritis (RA), the prototype of inflammatory arthritis, are remarkably high, ranging from 25% to 50% at 10 yrs and increasing to 50% to 90% after 30 yrs of disease.  Studies show that work disability occurs early on in the course of RA, with the greatest loss occurring within the first 1–2 years, followed by a steady decline.


Additionally, recent studies have drawn attention to the importance of decreased productivity while at work. Despite the importance of the problem, there has been little study of interventions to reduce the impact of arthritis on employment. The arthritis employment literature has emphasized the importance of changing our approach to a preventative strategy and recommends targeting employed people to prevent work disability.


Finally, the web format also addresses feedback from people who participated in our pilot study. They found it difficult to attend sessions at the end of a workday, given the fatigue and difficulty commuting associated with their inflammatory arthritis. This feedback is consistent with recent trends introducing patient e-Learning in adult learning, health education and in self-management programs.


What expertise was consulted in making of the program?


Many different people contributed to the making of this program.


  • People living with arthritis who informed us of their difficulties at work and what they would require to enable them to continue working.
  • Consultations with rheumatologists, employment specialists, vocational rehabilitation, ergonomists, patient educators, and a health psychologist.
  • Published research findings about work disability, job accommodations, ergonomics, occupational therapy, and vocational rehabilitation counselling for people with inflammatory forms of arthritis

At all phases of research design and implementation, including the conversion to a web format, we benefitted from the valuable insight of the Consumer Advisory Board (CAB), people who live with arthritis.


When will it be available to people?


It will be available when we complete our random control trial which will begin this year. The random control trial will involve approximately 500 participants recruited from the community at four sites: Vancouver, Victoria, Calgary, and the Toronto area.


For whom was the program created?


It was created for people with confirmed inflammatory forms of arthritis, between the ages of 18 and 60 years, who can read and write English, are currently employed, and at risk of losing their job due to the symptoms of arthritis.


What is the significance of this program?


We have created a novel program for people with inflammatory arthritis to improve an important element of disease management and one too often ignored by health professionals, namely the management of employment issues. Our program is unique in that it combines the benefit of group sessions focused on improving self-management, with assessments by health professionals specifically addressing employment. The web-based technology for delivering our program is at the leading edge of trends in the field of adult education and self-management programs. It offers a number of advantages for facilitating both learning and program dissemination.  Its use for the vocational rehabilitation counselling assessments will be a first. It draws on the concepts of Telehealth, used by health professionals to provide consultations in remote areas. This strategy overcomes a barrier to program implementation—that of limited availability of vocational rehabilitation counselling in most areas.


Our research initiative is one of few worldwide to develop and test the effectiveness of interventions specifically targeted at employment. Before our program can be implemented as part of routine care, it is essential that its effectiveness be rigorously evaluated. In this age of evidence-based health care delivery, the highest level of evidence, provided by a Random Control Trial is needed for our research to translate into a new service offered to people with arthritis. This knowledge will be crucial for health care professionals to refer to the program; for health care policy planners to agree to fund it as part of multidisciplinary arthritis services; and for arthritis stakeholders to endorse the program, promote it and help disseminate it widely.  By preventing work disability, our program has the potential for great cost savings to society and huge personal impact on people’s lives.

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