Work Difficulties in People with Multiple Sclerosis

PURPOSE

This study identifies potential predictors of unemployment and describes specific work difficulties and their determinants in a subgroup of employed people with multiple sclerosis (PwMS). The specific work difficulties were evaluated using a validated tool that measures the impact of respondents' symptoms and of workplace features.

METHODS

A cross-sectional study was carried out in Italy during 2021-2022. The subjects included were adults (18-65 years) with a diagnosis of MS, currently employed or unemployed. Logistic regression models were used to determine the association between each potential determinant and employment status, while linear regression models were used to determine the association between determinants and specific work difficulties.

RESULTS

The main risk factors associated with a higher risk of being unemployed were being older, living in the South of Italy/islands, and having a higher disability level, while protective factors against unemployment were having a high level of education and 'stable' employment (an open-ended contract). Fatigue was found to be associated with all work difficulties analyzed; mood disorders emerged as the main predictors of mental health-related work difficulties; level of disability and comorbidity significantly impacted physical health-related ones, and a good quality of life was found to improve both workplace-related and mental health-related difficulties at work.

CONCLUSION

Identifying the most significant difficulties is a crucial step in the development of vocational rehabilitation interventions tailored to maximize the ability of PwMS to handle their job-related duties and demands.

Home-based telerehabilitation in multiple sclerosis: a scoping review

BACKGROUND

Introducing home-based telerehabilitation (TR) approaches helps clinical experts to choose appropriate and effective interventions and researchers identify knowledge gaps to design clinical trial studies and systematic reviews.

PURPOSE

This study aimed to review the knowledge of home-based TR in multiple sclerosis.

METHOD

This scoping review study was conducted based on Arksey and O'Malley's five-step approach. The Embase, PubMed, Cochrane, Web of Sciences, Scopus and ProQuest databases were searched in 2017-2024 to find full-text English-language articles.

FINDINGS

In 25 studies reviewed, various and extensive home-based interventions have been used in physical and cognitive aspects.

CONCLUSION

Home-based rehabilitation is applicable, useful, safe and affordable, maintains the continuity of the rehabilitation process and increases patients' adherence to the rehabilitation programme. However, there are challenges such as patients' lack of familiarity with technology and limitations of outcome measurement tools that should be addressed in future studies.

Evaluation of Active Labor Market Policy Reform: Employment Outcomes of Vocational Rehabilitation Services

PURPOSE

The purpose of this study is to examine the effect of the Estonian active labor market reform in 2016, which introduced a new policy concerning vocational rehabilitation services. As a research question, we investigate how such services may have affected the employment outcomes of people with mental and/or physical impairments.

METHODS

Our sample includes 9244 people from 2016 to 2020, with a mean age of 46 years. Due to multiple entries to the services, we have more than 11,000 cases with over 100,000 monthly observations. We use propensity score matching in combination with fixed effects panel regressions to analyze how the completion of the scheduled rehabilitation plan affected monthly employment duration.

RESULTS

Our findings indicate that completing the rehabilitation service results on average in 2.6 months longer post-rehabilitation employment, compared to matched individuals who discontinued the service. This effect was larger when already employed and male participants entered the service, while weaker effects were observed in the case of individuals with only mental disabilities.

CONCLUSIONS

Overall, we conclude that while completing the scheduled rehabilitation plan has a positive effect on employment outcomes, still maintaining employment status seems to remain a challenge, based on the relatively modest effect sizes. Thus, we question the economic arguments behind the reform.

Work Barriers and Job Adjustments of People with Multiple Sclerosis: A Systematic Review

Purpose The aim was to carry out a systematic review dedicated to describing the work barriers and the job adjustments that are particularly sensitive to people with Multiple Sclerosis (PwMS). Methods Four electronic databases (PubMed/MEDLINE, Scopus, SciVerse ScienceDirect, and Web of Science) were searched for peer-reviewed original articles reporting the barriers at work and/or the job adjustments used by PwMS. MS must have been diagnosed according to accepted international criteria at the time of the study and/or confirmed by a doctor. No time limits were set for the search. Articles that were published in English, Italian, Spanish, French, and Portuguese were accepted. Each article was screened by three experienced and trained investigators. The protocol was registered in PROSPERO (CRD42022299994). Results The initial systematic search yielded 104,228 results, of which 49 articles provided sufficient information and were considered suitable for inclusion in the study. Overall, the studies included 30283 participants with MS. Thirteen (27.1%) studies reported on barriers to work, 14 (29.2%) addressed reasonable adjustments and 21 (43.7%) assessed both outcomes. Job characteristics are the most important barriers for PwMS. Other reported barriers concern the work environment, social relationships at work, negative work events and lack of information. PwMS are more vulnerable to the need for adjustments at the workplace, being the management of the workload the most commonly used one. Conclusions PwMS are exposed to a wide variety of work barriers and job adjustments. Future studies are still highly encouraged on the topic.

Factors associated with requesting accommodations among people with multiple sclerosis

BACKGROUND

Almost one million individuals are living with multiple sclerosis (MS) in the United States with a majority being diagnosed when they are in their 20s or early stages of their careers. Employees with MS experience various job-related challenges such as high unemployment and underemployment. Accommodations assist individuals with MS to obtain and maintain employment, yet the current understanding of factors affecting decisions to request or withhold accommodations is limited.

OBJECTIVE

This study aimed to explore barriers and facilitators of workplace accommodation requests among individuals with MS through a qualitative approach.

METHODS

Eighty-six participants were recruited from agencies serving individuals with MS in the US. Content analysis was conducted to examine responses to one open-ended question related to their perception of barriers or facilitative strategies to request accommodations.

RESULTS

Ten overarching themes related to barriers and facilitators for requesting accommodations were identified. Among them were three facilitators (i.e., positive work environment, employer compliance and flexibility, and employee self-advocacy and proactivity) and seven barriers (i.e., employers' lack of knowledge of Americans with Disabilities Act and accommodations, employers' discrimination and resistance to accommodation requests, employees' fear/anxiety to request due to associated stigma, employees' lack of knowledge about accommodations/disability/resources as well as inaccessible workspace).

CONCLUSIONS

Rehabilitation professionals can educate and empower employees with MS to disclose disability and request needed accommodations. Rehabilitation professionals also can educate employers for individuals with MS about their obligations under the laws to provide accommodations and sensitize coworkers of individuals with MS regarding the disability.

The clinical and paraclinical correlates of employment status in multiple sclerosis

PURPOSE

To identify the clinical and paraclinical markers of employment status in multiple sclerosis (MS).

METHODS

This was a cross-sectional sub-study investigating 1226 MS patients. To minimalized confounding effect, two groups of patients, matched by sex, age, and education, were selected: 307 patients with full time employment and 153 unemployed patients receiving disability pension. We explored associations between employment status and Expanded Disability Status Scale (EDSS), 25 Foot Walk Test (25FWT), Nine Hole Peg Test (9HPT), Brief International Cognitive Assessment for MS (BICAMS), Paced Auditory Serial Addition Test (PASAT), Beck Depression Inventory (BDI), SLOAN charts (SLOAN), and brain volumetric MRI measures.

RESULTS

Both groups differed significantly on all variables of interest (p < 0.001). In the univariate analyses, EDSS, SDMT (Symbol Digit Modalities Test) adjusted for BDI, 25FWT, and 9HPT best explained variability in vocational status. In multivariate analyses, the combination of EDSS, 25FWT, SDMT, BDI, and corpus callosum fraction (CCF) explained the greatest variability. As a next step, after patients were matched by EDSS, differences in SDMT, 25FWT (both p < 0.001), 9HPT, CCF, and T2 lesion volume were still present (all p < 0.005) between both groups. The best multivariate model consisted of SDMT, BDI, and T2 lesion volume.

CONCLUSIONS

EDSS, walking ability, cognitive performance, and MRI volumetric parameters are independently associated with employment status.

Personal, health and function, and career maintenance factors as determinants of quality of life among employed people with multiple sclerosis

BACKGROUND

Multiple sclerosis (MS) is an intrusive disease that significantly affects labor force participation.

OBJECTIVE

This study examined the extent to which factors at the personal, health and function, and environmental/career maintenance levels contribute to the predictability power for quality of life among employed people with MS.

METHOD

Participants consisted of 523 members of nine National Multiple Sclerosis Society chapters representing 21 states and Washington, DC. These individuals were employed at the time of the survey, and they were primarily middle age (average age of 48 years) and Caucasian (74%).

RESULTS

The final hierarchical multiple regression model explained 54 percent of the variability in participants' quality of life scores, although none of the hypothesized personal/demographic predictors were significant. Participants who perceived better overall health and lower levels of stress, who experienced less severe cognitive and mobility-related MS symptoms, and who expressed stronger job-person matches and higher levels of job satisfaction reported higher quality of life scores than did other participants.

CONCLUSIONS

The findings underscore the complexity involved in predicting perceived quality of life among employed people with MS. Implications of these findings for future research and clinical practice are discussed.

Differences in employment concerns between Hispanic and Caucasian persons with multiple sclerosis: A propensity score matching analysis

BACKGROUND: Little is known about the experiences and concerns of Hispanic Americans with multiple sclerosis (MS), especially how their experiences and concerns compare to those of Caucasian Americans with MS. OBJECTIVE: The purpose of this study was to examine differences in satisfaction with the overall employment situation between two matched samples of adults with MS, namely, Hispanics and Caucasians. METHODS: Participants in this study responded to a national survey of the employment and community living concerns of people with MS. A propensity score matching (PSM) procedure was used to match participants based on demographic and MS-related variables. RESULTS: A two-sample Hotelling T2 test revealed no statistically significant between-group differences on satisfaction regarding fair treatment in the workplace but between-group differences were observed on satisfaction regarding legal rights and personal-environmental resources related to work. CONCLUSIONS: Implications for future research and clinical practice in rehabilitation counseling in the COVID-19 era are discussed.

Functional limitations and worrying to lose employment among individuals with chronic conditions and disabilities during COVID-19: A hierarchical logistic regression model

BACKGROUND: As an unexpected environmental factor causing significant economic, financial, and health challenges for everyone, it is no wonder that COVID-19 presents significant employment-related worries for people with chronic health conditions and disabilities. OBJECTIVE: The purpose of this study was to explore whether higher levels of functional limitations are associated with worry about job loss for individuals with disabilities and chronic conditions. METHODS: Data for this study were collected to understand the effects of COVID-19 on individuals with disabilities and chronic conditions. A total of 219 employed participants were extracted from a total of 269 individuals with disabilities and chronic conditions. The mean age among participants was 37.83 (SD = 10.97). RESULTS: Our hierarchical logistic regression analysis revealed that (a) demographic variables were not associated with worry about job loss in the first block, (b) perceived COVID-19 stress (AOR = 2.90, p < 0.001) was correlated with worry about job loss in the second block, and (c) functional limitations (AOR = 1.06, p < 0.001) were positively correlated with worry about job loss in the third block. Overall, the entire model containing all predictor variables in three blocks explained 23% (Nagelkerke R2) of the variance in worry about job loss. CONCLUSIONS: This study contributes to the disability and vocational rehabilitation literature by examining the relationship between functional limitations and worry to lose jobs in people with disabilities.

The Importance of the Cognitive Aspects of Vocational Rehabilitation for Individuals With Multiple Sclerosis

Background:

Individuals with multiple sclerosis (MS) face symptoms that affect them physically and cognitively; 80% of individuals diagnosed with MS are out of work within 10 years, and 58% are unemployed. It appears that a diagnosis of MS creates a barrier to individuals obtaining and maintaining work. To combat this, vocational rehabilitation (VR) has been utilized by individuals with MS but with limited success. This may be due to the lack of interventions that address cognitive symptoms that occur.

Purpose:

The purpose of this perspective is to review the interaction between individuals with MS and the components of VR and discuss implications that could potentially increase the success of individuals with MS obtaining work.

Implications:

Approximately 48.1% of clients with MS receiving services from state VR agencies obtain or retain employment compared to 60% of clients with other diagnoses. This disparity highlights a disconnect in VR services. It has been seen that individuals with MS who were employed at application were more likely to receive services that include cognitive retraining-type services. Including more opportunities for cognitive retraining-type services may decrease this disparity and help more individuals with MS maintain or obtain work.

A conceptual framework to promote career development for vocational rehabilitation consumers with traumatic brain injuries

The purpose of this article is to describe the Illinois Work and Well-being Model (ILW2M), a multi-domain framework for conceptualizing the employment development of people with traumatic brain injuries (TBIs). The model emphasizes the interaction of contextual and career development domains to improve participation in the areas of work, society, community, and home. A brief discussion of potential implications regarding vocational rehabilitation research and service is offered with the overall goal of reinforcing employment development as the foundation of vocational rehabilitation services for adults with TBIs.

Predictors of Change in Employment Status and Associations with Quality of Life: A Prospective International Study of People with Multiple Sclerosis

Purpose This prospective international study aimed to assess the changes in employment, and predictors thereof, and associated change in mental health quality of life in people with multiple sclerosis (MS). Methods People with MS were recruited online through social media, forums and newsletters to complete an online English-language survey in 2012 and again in 2015, to assess changes in employment and clinical characteristics. Results 1276 people with MS of working age were included of whom 35.9% were employed full time, 25.6% part-time, 3.1% were unemployed and seeking employment, 19.7% were retired due to disability and 15.7% were not in the labour force. Part/full time employment decreased from 61.4 to 57.1% of the sample 2.5 years later, and 25.5% experienced some change in employment status. Lower level of education and higher level of disability at baseline predicted loss of employment at follow-up. 62.0% of the sample indicated that MS impacted on employment over their lifetime, associated with a lower level of education and progressive MS at time of diagnosis. Retiring due to disability was predictive of a decreased mental health related QOL score. Conclusion Employment status was negatively impacted by MS for most participants. We showed for the first time that employment loss was prospectively associated with poorer mental health related quality of life. Employment support including vocational services, reasonable flexibility in the workplace, and legal protection against discrimination should be widely available to assist people with MS, especially for those with progressive onset MS, higher disability and lower levels of education who are at higher risk of employment loss.

The rate of neuropsychological assessments in multiple sclerosis has increased-A retrospective study in a Finnish Central Hospital

OBJECTIVE

To investigate possible changes in the rate of conducted neuropsychological assessments and rehabilitation process for patients with multiple sclerosis (pwMS) during the last two decades. The change in the rate of vocational rehabilitation process was also evaluated.

BACKGROUND

Cognitive deficits are frequent among pwMS and negatively affect patients' working ability and quality of life. Preliminary evidence suggests that neuropsychological rehabilitation positively affects cognitive symptoms. Vocational approaches are widely recommended for pwMS.

METHODS

A retrospective survey of all multiple sclerosis (MS) patients diagnosed and treated at the Department of Neurology in Kanta-Häme Central Hospital over the period 1988-2013 was conducted using hospital records. The rate of neuropsychological assessment and rehabilitation processes as well as vocational rehabilitation processes were evaluated.

RESULTS

A total of 417 pwMS were identified. A neuropsychological assessment was performed for 104 (24.9%) of these patients, of whom 21 (20.2%) were evaluated between 1988 and 1999 and 83 (79.8%) between 2000 and 2013. Of the 417 patients, eight (1.9%) received neuropsychological rehabilitation, each of these after the year 2000. Only 25 (6.0%) of the 417 pwMS received vocational rehabilitation. Fourteen (56.0%) of the 25 patients received vocational rehabilitation between 1988 and 1999 and 11 (44.0%) between 2000 and 2013.

CONCLUSIONS

Neuropsychological assessment has been a rarity in MS in Finland, but a marked increase in frequency has occurred since the year 2000. Although understanding of MS-related cognitive impairment and its impact on working ability has increased, the rate of neuropsychological and vocational rehabilitation has remained low.

The Relationship Between Resilience, Self-Efficacy, and Employment in People With Physical Disabilities

The aim of this cross-sectional study was to determine the importance of resilience and self-efficacy in explaining employment status for people with long-term physical disabilities when other sociodemographic and symptom variables were also examined. A multiple logistic regression with sequential predictor entry was used to predict employment status. Participants were individuals, 18 to 65 years of age, with a diagnosis of multiple sclerosis, muscular dystrophy, post-polio syndrome, or spinal cord injury ( N = 882). Results indicated resilience but not self-efficacy was uniquely predictive of employment status. The combined effects of resilience and self-efficacy, however, did not significantly contribute to the variance in employment status above and beyond the sociodemographic and symptom variables. Other variables uniquely predictive of employment included education, age, marital status, disability benefits, and anxiety. We found in this study preliminary evidence to suggest that rehabilitation counseling practitioners should consider a client’s resilience with respect to employment. Knowledge of sociodemographic and symptom factors in conjunction with psychometrically sound measures of resilience and self-efficacy may be used to identify individuals with long-term physical disabilities whose beliefs and behaviors may limit the extent to which they prepare for, obtain, or maintain employment.

State-Federal Vocational Rehabilitation in Traumatic Brain Injury: What Predictors Are Associated With Employment Outcomes?

This study identified predictors of employment for individuals with traumatic brain injury (TBI). Data from 4,923 individuals with TBI were extracted from the Rehabilitation Services Administration’s Case Service Report (RSA-911) database. A multiple logistic regression model using demographics, disability-related variables, vocational rehabilitation (VR) service variables, and their interactions correctly classified 69.5% of the cases as successfully employed or not successfully employed. The model explained approximately 27.1% of the variance in employment outcomes. Results indicated that level of education, race/ethnicity, age at application, preemployment status, Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), comorbid depression, and case expenditure were significantly associated with employment outcomes (all p ≤ .05). VR variables that showed the most significant positive effect on employment outcomes were on-the-job support, job placement, and on-the-job training. Race/ethnicity moderated the effect of college training, supported employment, transportation, and extended evaluation or work trial assessment services on employment outcomes. The findings have implications for promoting the use of those VR services that are strongly related to employment outcomes for persons with TBI. They also point to the need for rehabilitation personnel to address some of the demographic and disability-related barriers to successful employment.

Older age, higher perceived disability and depressive symptoms predict the amount and severity of work-related difficulties in persons with multiple sclerosis

Purpose: This cross-sectional study aims to identify the predictors of work-related difficulties in a sample of employed persons with multiple sclerosis as addressed with the Multiple Sclerosis Questionnaire for Job Difficulties. Materials and methods: Hierarchical linear regression analysis was conducted to identify predictors of work difficulties: predictors included demographic variables (age, formal education), disease duration and severity, perceived disability and psychological variables (cognitive dysfunction, depression and anxiety). The targets were the questionnaire's overall score and its six subscales. Results: A total of 177 participants (108 females, aged 21-63) were recruited. Age, perceived disability and depression were direct and significant predictors of the questionnaire total score, and the final model explained 43.7% of its variation. The models built on the questionnaire's subscales show that perceived disability and depression were direct and significant predictors of most of its subscales. Conclusions: Our results show that, among patients with multiple sclerosis, those who were older, with higher perceived disability and higher depression symptoms have more and more severe work-related difficulties. The Multiple Sclerosis Questionnaire for Job Difficulties can be fruitfully exploited to plan tailored actions to limit the likelihood of near-future job loss in persons of working age with multiple sclerosis. Implications for rehabilitation Difficulties with work are common among people with multiple sclerosis and are usually addressed in terms of unemployment or job loss. The Multiple Sclerosis Questionnaire for Job Difficulties is a disease-specific questionnaire developed to address the amount and severity of work-related difficulties. We found that work-related difficulties were associated to older age, higher perceived disability and depressive symptoms. Mental health issues and perceived disability should be consistently included in future research targeting work-related difficulties.

Employment of patients with multiple sclerosis: the influence of psychosocial-structural coping and context

Patients with multiple sclerosis tend to report higher levels of work difficulties and negative outcomes, such as voluntary and involuntary work termination and reduced work participation. In this article, we discuss the complex interactions of disease, personal coping strategies, and social and structural factors that contribute to their work experiences and outcomes. An overview of the coping strategies and actions that leverage personal and context-level factors and dynamics is also provided to support the overall goal of continued work in patients with MS.

Neurological, physical and sociodemographic correlates of employment in multiple sclerosis: A meta-analysis

Illness severity and sociodemographic characteristics of 7,053 employees with multiple sclerosis and 11,043 peers not in the workforce were compared (Hedges' g with 95% confidence interval and p values). Pooled findings from 25 studies confirmed the main role of a relapsing-remitting disease course and higher education to employment. To a lesser extent, disease duration, fatigue and pain symptoms and age also differentiated the two groups. Vocational interventions for persons with multiple sclerosis should focus on job retention, including mechanisms to accommodate and facilitate functional independence. Longitudinal data are needed to distinguish the characteristics of those who achieve and maintain competitive employment.

Psychometric Validation of the Multiple Sclerosis Environmental Supports Scale: A Brief Report

The main objective of this study was to evaluate the measurement structure of the Multiple Sclerosis Environmental Supports Scale (MSESS) with 248 individuals with multiple sclerosis (MS). Exploratory factor analysis yielded three reliable factors (health and mental health services; rehabilitation, social, and support services; and independent living supports). The MSESS appears to be a promising rehabilitation assessment tool for individuals with MS, one that can be used by rehabilitation counselors to evaluate environmental support factors in their interview, assessment, and rehabilitation planning protocols.

Employment and absenteeism in working-age persons with multiple sclerosis

AIMS

To better understand the impact of the clinical course of multiple sclerosis (MS) and disability on employment, absenteeism, and related factors.

MATERIALS AND METHODS

This study included respondents to the North American Research Committee on Multiple Sclerosis Registry spring 2015 update survey who were US or Canadian residents, aged 18-65 years and reported having relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), or primary progressive MS (PPMS). The RRMS and SPMS participants were combined to form the relapsing-onset MS (RMS) group and compared with the PPMS group regarding employment status, absenteeism, and disability. Multivariable logistic regression was used to examine the relationship between employment-related outcomes and factors that may affect these relationships.

RESULTS

Of the 8004 survey respondents, 5887 (73.6%) were 18-65 years of age. The PPMS group (n = 344) had a higher proportion of males and older mean age at the time of the survey and at time of diagnosis than the RMS group (n = 4829). Female sex, age, age at diagnosis, cognitive and hand function impairment, fatigue, higher disability levels, ≥3 comorbidities, and a diagnosis of PPMS were associated with not working. After adjustment for disability, the employed PPMS sub-group reported similar levels of absenteeism to the employed RMS sub-group.

LIMITATIONS

Limitations of the study include self-report of information and the possibility that participants may not fully represent the working-age MS population.

CONCLUSIONS

In MS, employment status and absenteeism are negatively affected by disability, cognitive impairment, and fatigue. These findings underscore the need for therapies that prevent disability progression and other symptoms that negatively affect productivity in persons with MS to enable them to persist in the workforce.

Effectiveness of cognitive rehabilitation for people with multiple sclerosis: a meta-synthesis of patient perspectives

While previous randomised controlled trials and meta-analyses offer only limited evidence for the effectiveness of cognitive rehabilitation, qualitative studies examining patient perspectives report more positive outcomes. This meta-synthesis of qualitative studies examined patient perspectives of cognitive rehabilitation for memory, attention, and executive function problems in people with multiple sclerosis. Using set eligibility criteria, we screened electronic databases, reference lists, and academic networks for relevant papers. Seven papers (195 participants) were selected. Two independent researchers conducted quality appraisals of papers. Data analysis, guided by the thematic synthesis approach, yielded six main themes. These suggested that patients benefitted from the group environment in rehabilitation. Cognitive rehabilitation facilitated the participants' reflection and awareness of their cognitive deficits, and was associated with increased knowledge and understanding of their illness. Increased strategy use was reported and associated with improvements in cognitive functioning and greater confidence and perseverance. Participants reported emotional and social improvements, and felt more optimistic. Overall, these changes had a positive impact on participants' quality of life. This synthesis of qualitative studies indicates that people with multiple sclerosis who experience cognitive deficits benefit from cognitive rehabilitation programmes. This finding must, however, be viewed in light of the limitations of this meta-synthesis. The meta-synthesis was registered in the PROSPERO database under CRD42017040148.

Quality of life among people with multiple sclerosis: Replication of a three-factor prediction model

BACKGROUND

This article presents a replication of Rumrill, Roessler, and Fitzgerald's 2004 analysis of a three-factor model of the impact of multiple sclerosis (MS) on quality of life (QOL). The three factors in the original model included illness-related, employment-related, and psychosocial adjustment factors.

OBJECTIVE

To test hypothesized relationships between QOL and illness-related, employment-related, and psychosocial variables using data from a survey of the employment concerns of Americans with MS (N = 1,839).

METHODS

An ex post facto, multiple correlational design was employed incorporating correlational and multiple regression analyses.

RESULTS

QOL was positively related to educational level, employment status, job satisfaction, and job-match, and negatively related to number of symptoms, severity of symptoms, and perceived stress level. The three-factor model explained approximately 37 percent of the variance in QOL scores.

CONCLUSIONS

The results of this replication confirm the continuing value of the three-factor model for predicting the QOL of adults with MS, and demonstrate the importance of medical, mental health, and vocational rehabilitation interventions and services in promoting QOL.

Factors Influencing Job Satisfaction for Employed Adults With Multiple Sclerosis

Given the high unemployment rates of adults with multiple sclerosis (MS) and the importance of job satisfaction as a predictor of turnover intention and job tenure, this investigation examined the relationship of perceived job satisfaction to social cognitive career theory and ecological model constructs. Highly compatible, the two formulations suggest that extent of job satisfaction is a function of personal or demographic, contextual or extrinsic, disability/health status, and self-perceived vocational situation variables. Based on responses to a national survey by 628 employed adults with MS, a four-block, hierarchical logistic regression analysis examined the extent to which the four variable groupings contributed to the prediction of job satisfaction. The following variables were retained in the regression equation: racial/ethnic status, satisfaction with current financial status, satisfaction with housing accessibility, illness duration, extent of job/person match, appropriateness of current work hours, and self-rated job performance level. Consequently, job satisfaction is influenced by multiple factors that counselors must consider in their rehabilitation planning and service delivery.

Defining the Role of Physiotherapy in Palliative Care in Multiple Sclerosis

With increasing prevalence of multiple sclerosis worldwide, India too has transitioned from low to medium prevalence region. This increases the overall burden of a number of people suffering from a chronic progressive disorder. Such scenario underlines the need for an early comprehensive and holistic patient management plan, aiming to provide a better quality of life. The presented case is one such example of a patient-centered, and interdisciplinary team approach for better management of a patient suffering from an incurable, progressive disorder. As physiotherapists tend to spend a considerable amount of time with their patients on a regular basis, it becomes imperative to view all the patient related problems from a wider angle and endeavor to address each of them individually/collaboratively. In a palliative care setting, physiotherapy can no longer be considered as only physical symptom management approach but a patient care approach considering their entire physical, emotional, psychosocial, and spiritual needs. This novel case report shall serve as a guiding strategy for physiotherapists to work in the domain of palliative care.

Multiple Sclerosis Questionnaire for Job Difficulties (MSQ-Job): definition of the cut-off score

Multiple Sclerosis (MS) mainly affects people of working age. The Multiple Sclerosis Questionnaire for Job Difficulties (MSQ-Job) was designed to measure difficulties in work-related tasks. Our aim is to define cut-off score of MSQ-Job to identify potential critical situations that might require specific attention. A sample of patients with MS completed the MSQ-Job, WHODAS 2.0 and MSQOL-54 respectively for work difficulties, disability and health-related quality of life (HRQoL) evaluation. K-means Cluster Analysis was used to divide the sample in three groups on the basis of HRQoL and disability. ANOVA test was performed to compare the response pattern between these groups. The cut-off score was defined using the receiver operating characteristic (ROC) curve analyses for MSQ-Job total and count of MSQ-Job items scores ≥3: a score value corresponding to the maximum of the sensitivity-to-specificity ratio was chosen as the cut-off. Out of 180 patients enrolled, twenty were clustered in the higher severity group. The area under the ROC curve was 0.845 for the MSQ-Job total and 0.859 for the count of MSQ-Job items scores ≥3 while the cut-off score was 15.8 for MSQ-Job total and 8 for count of items scored ≥3. We recommend the use of MSQ-Job with this calculation as cut-off for identifying critical situations, e.g. in vocational rehabilitation services, where work-related difficulties have a significant impact in terms of lower quality of life and higher disability.

An Overview of Multiple Sclerosis: Medical, Psychosocial, and Vocational Aspects of a Chronic and Unpredictable Neurological Disorder

This article presents an overview of multiple sclerosis (MS), one of the most common neurological disorders in the western hemisphere. Medical and psychosocial aspects of the disease such as causes and risk factors, diagnosis, incidence and prevalence, symptoms, courses, and treatment are described. Existing research regarding the employment outcomes and concerns of people with MS, especially the factors associated with labor force participation, is reviewed. Intervention strategies to enable individuals with MS to retain their employment are discussed such as early education on the nature of MS, advocacy-supported disclosure, and accommodation techniques for symptom management at the workplace. Important workplace accommodations include flexible work hours and work breaks, ergonomic changes in equipment to address upper and lower body limitations, and job simplification or other compensatory strategies to minimize the impact of cognitive problems on job performance.

Effect of Rehabilitation Technology Services on Vocational Rehabilitation Outcomes of Individuals With Multiple Sclerosis

Objectives: To examine the effect of rehabilitation technology interventions on the employment or job retention outcomes of individuals with multiple sclerosis (MS) served by the state-federal vocational rehabilitation program using a case-control study design.

Participants: Data for this study were extracted from the Rehabilitation Services Administration Case Service Report database. The sample included 8,715 individuals with MS aged between 16 and 64 years old whose cases were closed between the fiscal years of 2007 and 2011.

Outcome measure: Competitive employment.

Results: The classification and regression tree method identified 5 homogeneous subgroups ranging from high to low propensity to receive rehabilitation technology services. Specifically, individuals with MS employed at application were most likely to receive rehabilitation technology intervention. The effect of rehabilitation technology on job retention was especially strong for individuals aged 35 years or older with a college education.

Conclusion: These findings suggest that rehabilitation technology is an effective service for enhancing job retention outcomes of middle-aged and older adults with MS and provide valuable information for policymakers, health care providers, rehabilitation counselors, and educators.

Differential Vocational Rehabilitation Service Patterns Related to the Job Retention and Job-Seeking Needs of Individuals With Multiple Sclerosis

The experience of living with multiple sclerosis (MS) can have a profound effect on employment. The impact of MS is a complex interaction of personal, medical, functional, financial, and psychosocial variables that ultimately results in up to 80% of persons with MS leaving their jobs within 10 years of their diagnosis. The aim of this study was to investigate whether the employment status of applicants with MS who were seeking services from state vocational rehabilitation (VR) agencies could be classified based on the type of services provided. A quantitative descriptive research design employing discriminant analysis (DA) was used to determine differential services received by employed and unemployed applicants with MS. Findings indicate that persons with MS who were employed at application were more likely to receive services geared toward career stabilization (i.e., assistive technology/accommodation services, counseling and guidance, and cognitive retraining-type rehabilitative services). Conversely, the unemployed applicant group had a higher propensity to receive services focused on job placement (i.e., job readiness, job seeking, and job placement services). Although a disparity persisted between the average worker in the United States and the outcomes achieved by VR service recipients regarding weekly wages and hours, services provided by the state-federal VR program reduce this disparity. In addition, the return on investment (ROI) associated with providing services to persons with MS was calculated as providing an $8 return for every dollar spent. Persons with MS employed at application had an ROI of more than $10 for every dollar spent. Implications for persons with MS, rehabilitation counselors, health care professionals, and policymakers are provided.

An empowerment model of workplace support following disclosure, for people with MS

Background:

Vocational interventions aimed at increasing job retention for people with multiple sclerosis (MS) are reliant upon a partnership with a supportive work environment. A better understanding of the types of psychosocial support that are most conducive to retaining employees’ sense of work-efficacy will enhance the success of interventions aimed at reducing workplace barriers to job maintenance.

Objective:

The objective of this study is to identify the types of psychosocial support that people with MS require post-disclosure, in order to maintain their employment status. In particular, we examined the roles of psychological safety and work-efficacy.

Methods:

We interviewed 40 employees with MS either individually ( n = 25) or within three focus groups ( n = 15). These interviews were audio-taped and the content analysed, using an inductive thematic approach.

Results:

Themes to emerge in organisational responses to disclosure were: a focus on ability (leading to enhanced perceptions of psychological safety and higher work-efficacy) and on disability (leading to diminished psychological safety and reduced perceptions of work-efficacy).

Conclusion:

Organisational responses to disclosure demonstrating trust and inclusive decision making, and focussing on employee abilities, enhance perceptions of psychological safety at work. This increases the likelihood that employees with MS will retain their sense of work-efficacy and reduce their intentions to leave.