Arthritis and Employment: Making it Work
PHASE I: Development and Pilot Testing of a Self-Management Program to Help People with Rheumatoid Arthritis Stay Employed
Diane Lacaille, MD, MHSc, FRCPC
Mary Pack Chair in Arthritis Research
Senior Research Scientist, Arthritis Research Canada
Associate Professor, University of British Columbia
Why do this research?
People with inflammatory arthritis commonly have to stop working because of the limitations imposed by their disease. This has a tremendous impact on their quality of life, and financially for themselves, their families and society. Arthritis and musculoskeletal problems are the most common reason why people have to stop working in Canada, with an estimated cost of $13.6 billion per year (Economic Burden of Illness in Canada). This research takes action to deal with this important problem.
We have developed and pilot tested a program aimed at preventing work disability and at helping people with arthritis deal with the difficulties they encounter at work. This project builds on previous research where we surveyed people with rheumatoid arthritis across BC to identify the risk factors for work disability.
To date, most research in the field of work disability in arthritis has been descriptive, documenting the extent of the problem and helping to understand what influences the risk of work disability. By creating an intervention aimed at preventing work loss from inflammatory arthritis, this research takes action to deal with an important and costly problem that is not otherwise adequately addressed. The potential impact for this intervention is tremendous given the magnitude of the problem.
What was found?
All participants made changes at their workplace in order to successfully keep working. Participants said the most important things that they learned from the program were realizing others shared similar experiences, understanding how to better manage their work with arthritis, and learning about government and non-government resources and services that can help them make changes at their job (job accommodations).
Participants met with an occupational therapist for an ergonomic assessment of their work and with a vocational rehabilitation counsellor for advice on requesting job accommodations. As a result of the program, 75% requested a job accommodation (the remainder stated they did not need any) and of these, 71% had been implemented within one year of the program. When comparing before and after the program, there were improvements in fatigue at work, reduction in limitations at work, increase in work productivity, and less concern about becoming work disabled in the future. The effectiveness of the program at preventing work disability and improving at work productivity is currently being tested in a randomized controlled trial.
How was this study conducted?
We used data from surveys of people with RA across BC and from people who spoke with us in focus groups about the problems they encounter at work and what they find helpful in dealing with those problems, to help us develop the content of the program.
The program consists of five group education sessions, supplemented by take-home self-learning material, and individual visits with two health professionals – an occupational therapist (OT) and a vocational rehabilitation counsellor (VRC) – to help remain employed. The concept of the education sessions is based on the principles of self-management, as used in the wellknown Arthritis Self-Management Program (ASMP), but with a very different and specific focus on the problems people encounter at work.
To obtain additional feedback, we conducted two pilot tests with 22 participants who were employed and had inflammatory arthritis. One pilot test was conducted in January 2005 and the other in April 2005. Results were positive, and led us to our next phase of research, conducting a randomized controlled trial with a large number of people.
This research was supported by the Canadian Institutes of Health Research (CIHR) and The Arthritis Society of Canada (TAS).
Lacaille D, White MA, Rogers PA, Backman CL, Gignac MA, Esdaile JM. A proof-of-concept study of the “Employment and Arthritis: Making It Work” program. Arthritis Rheum 2008:15;59(11):1647-55.
John Esdaile MD, MPH, FRCPC
Scientific Director, Arthritis Research Canada
Professor of Medicine, Division of Rheumatology, University of British Columbia
Catherine Backman PhD, OT, FCAOT
Research Scientist, Arthritis Research Canada
Professor and Head, Department of Occupational Science, University of British Columbia
Monique Gignac, PhD
Research Scientist, University Health Network, University of Toronto
Associate Professor, Dalla Lana School of Public Health, University of Toronto
Adjunct Scientist, Institute for Work and Health, Toronto
Co-Scientific Director, Canadian Arthritis Network
Daniel Pratt, PhD
Associate Professor, Department of Educational Studies, University of British Columbia
Matt Liang MD, MPH
Harold Robinson Chair in Rehabilitation Sciences
Professor, Harvard School of Medicine, Harvard School of Public Health
Andrew Chalmers, MD, FRCPC
Research Scientist, Arthritis Research Canada
Professor, University of British Columbia
Janet Finlayson, MA
Vocational Rehabilitation Counsellor, GF Strong and Mary Pack Arthritis Centre
Consumer Advisory Board, Arthritis Research Canada
Cheryl Koehn, President, Arthritis Consumer Experts (ACE)
Margaret A White, Research Associate
Pam A Rogers, MA, Research Coordinator, Arthritis Research Canada