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Kluit L, van Bennekom CAM, Beumer A, Sluman MA, de Boer AGEM, de Wind A. Clinical Work-Integrating Care in Current Practice: A Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2023:10.1007/s10926-023-10143-1. [PMID: 37966538 DOI: 10.1007/s10926-023-10143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE Clinical work-integrating care (CWIC) refers to paying attention to work participation in a clinical setting. Working patients may benefit from CWIC. The purpose of this study is to explore the extent and nature to which medical specialists provide CWIC and what policies and guidelines oblige or recommend specialists to do. METHODS A scoping review was conducted. The databases MEDLINE, EMBASE, Psychinfo, CINAHL, and Web of Science were searched for studies on the extent and nature of CWIC and supplemented by gray literature on policies and guidelines. Six main categories were defined a priori. Applying a meta-aggregative approach, subcategories were subsequently defined using qualitative data. Next, quantitative findings were integrated into these subcategories. A separate narrative of policies and guidelines using the same main categories was constructed. RESULTS In total, 70 studies and 55 gray literature documents were included. The main findings per category were as follows: (1) collecting data on the occupation of patients varied widely; (2) most specialists did not routinely discuss work, but recent studies showed an increasing tendency to do so, which corresponds to recent policies and guidelines; (3) work-related advice ranged from general advice to patient-physician collaboration about work-related decisions; (4) CWIC was driven by legislation in many countries; (5) specialists sometimes collaborated in multidisciplinary teams to provide CWIC; and (6) medical guidelines regarding CWIC were generally not available. CONCLUSION Medical specialists provide a wide variety of CWIC ranging from assessing a patient's occupation to extensive collaboration with patients and other professionals to support work participation. Lack of medical guidelines could explain the variety of these practices.
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Affiliation(s)
- Lana Kluit
- Department of Public and Occupational Health, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, The Netherlands.
| | - Coen A M van Bennekom
- Department of Public and Occupational Health, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Research and Development, Heliomare Rehabilitation Centre, Wijk aan Zee, The Netherlands
| | - Annechien Beumer
- Department of Public and Occupational Health, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Upper Limb Unit Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Maayke A Sluman
- Department of Cardiology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Angela G E M de Boer
- Department of Public and Occupational Health, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Astrid de Wind
- Department of Public and Occupational Health, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, The Netherlands
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Codd Y, Coe Á, Mullan RH, Kane D, Stapleton T. 'You don't want to be seen as a burden' experiences of working with early inflammatory arthritis: a qualitative study. Disabil Rehabil 2022:1-9. [PMID: 35948012 DOI: 10.1080/09638288.2022.2107084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To describe the impact of early inflammatory arthritis on work participation. MATERIALS AND METHODS Thirty individuals (24 women) of working age (age 18-69 years) with inflammatory arthritis (<2 years duration) who were in paid employment or fulltime education were interviewed using qualitative description methodology. Data was analysed using thematic analysis. RESULTS Half of participants (n = 15) reported work disability within the first two-years of diagnosis. Five descriptive themes were identified that explained the early impact of IA on participation in paid employment. These themes were: (i) altered capacity for work; (ii) work comes first; (iii) the invisible burden; (iv) the disclosure effect; and (v) a reconstructed work future. CONCLUSION The scale of early work disability appears to be higher than previously understood. Although early medical intervention has improved disease management, significant work-based restrictions requiring intervention remain. Internalised and invisible work-related anxieties present early in the disease and need to be acknowledged and addressed by healthcare providers.IMPLICATIONS FOR REHABILITATIONEarly inflammatory arthritis causes significant challenges in work ability, and early work-based participation restrictions are present despite early use of drug therapy.Assessment of the client's subjective experience, including understanding the invisible burden, is an important aspect in determining the types of work interventions required.Disclosure of diagnosis in the work environment is associated with anxiety and fear, however, disclosure is influential in supporting capacity to retain work participation and should be included in work interventions.Routine healthcare should include early interventions to address work-based restrictions and supporting work retention to avoid work disability.
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Affiliation(s)
- Yvonne Codd
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Rheumatology Departments, Naas General and Tallaght University Hospital, Naas, Ireland
| | - Áine Coe
- Rheumatology Departments, Naas General and Tallaght University Hospital, Naas, Ireland
| | - Ronan H Mullan
- Rheumatology Departments, Naas General and Tallaght University Hospital, Naas, Ireland
| | - David Kane
- Rheumatology Departments, Naas General and Tallaght University Hospital, Naas, Ireland
| | - Tadhg Stapleton
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Small SP, de Boer C, Swab M. Barriers to and facilitators of labor market engagement for individuals with chronic physical illnesses in their experiences with work disability policy: a qualitative systematic review. JBI Evid Synth 2021; 20:348-536. [PMID: 34669686 DOI: 10.11124/jbies-20-00482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review was to identify and synthesize the best available evidence to address two questions. From the perspectives of individuals with chronic physical illnesses: i) what are barriers in work disability policies with respect to labor market engagement? and ii) what are facilitators in work disability policies with respect to labor market engagement? INTRODUCTION Chronic physical illnesses have a high and increasing prevalence worldwide and are associated with significant disability in the working-age population. Individuals with chronic illnesses and disability have low employment and high unemployment rates, and low wages. Work disability policies have important role in reducing negative labor market impacts, but inadequate policies may also pose barriers to work engagement. INCLUSION CRITERIA This review included studies of individuals who were of working age, had one or more chronic physical illness, and had experience relevant to disability policy and work engagement. The phenomena of interest were perceived barriers and perceived facilitators in work disability policies with respect to labor market engagement. The context was any study setting globally. Studies considered for this review had qualitative data from a variety of methodologies. METHODS This review was conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. A literature search involved academic databases (ie, CINAHL Plus, MEDLINE, PsycINFO, AgeLine, SocINDEX, Social Work Abstracts, Sociological Abstracts, Social Services Abstracts) for published studies; gray literature sources (ie, ProQuest Dissertations and Theses, MedNar, Google Scholar, OpenGrey, OAIster, Google, and relevant websites) for unpublished studies; and reference lists of retrieved records. No language, date, or country limiters were applied to the searches. Retrieved records from the database and gray literature searches were screened, with potentially relevant records then examined in full against the inclusion criteria. Eligible studies were critically appraised for methodological quality and those included in this review were subjected to data extraction of descriptive details and the study findings that were relevant to the review questions. Study findings were synthesized and were assigned confidence scores. RESULTS Forty-four studies of various qualitative designs and varied methodological quality (from low to high) were included in this review. The study samples represented a number of different chronic physical illnesses. There were 301 credible and unequivocal study findings, which were aggregated into 20 categories and 5 synthesized findings. Persons with chronic physical illnesses perceived barriers and facilitators relevant to the adequacy of disability policies in meeting their needs for returning to work after leave due to illness and for sustaining ongoing work engagement. They also perceived barriers and facilitators relevant to stakeholders' communication, help, and support respecting workers' efforts toward work engagement. CONCLUSION Although confidence in the synthesized findings is low due to limitations in the methods and research findings across primary studies, the evidence suggests that both the adequacy and implementation of work disability policies need to be improved to meet the needs of workers with chronic physical illnesses, for their labor market engagement. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42016033476.
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Affiliation(s)
- Sandra P Small
- Faculty of Nursing, Memorial University, St. John's, NL, Canada Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group, St. John's, NL, Canada School of Social Work, Memorial University, St. John's, NL, Canada Health Sciences Library, Memorial University, St. John's, NL, Canada
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Abstract
BACKGROUND Rheumatoid arthritis is often associated with work disability, a term used to describe the inability to be or to remain employed. Work disability is a common implication of rheumatoid arthritis. OBJECTIVE This review aims to identify and analyze the predictive factors of work disability among patients with rheumatoid arthritis, as well as to group these factors into broader categories, based on the most current studies in this field. METHODS An electronic search was conducted using Google Scholar, MEDLINE and PsycINFO databases. Eighty-six international journal articles were finally selected. RESULTS The results suggest that occupational, personal, medical and societal factors are the main predictive categories of work disability for people with rheumatoid arthritis. CONCLUSIONS Medical progress has had a positive effect on the development and the rates of work disability among patients with RA. Work disability is, however, not only defined by medical factors. Occupational, personal and societal factors interact with each other and affect the development of work disability in RA. The results of this review emphasize the need for medical and vocational therapy interventions, social support and state policies that target the work status of patients with RA. Future holistic research approaches to the field are required for a complete picture and concrete solutions with the aim of keeping patients with RA employed.
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Affiliation(s)
- Doxa Papakonstantinou
- Department of Educational and Social Policy, University of Macedonia, 156 Egnatia street, 54636, Thessaloniki, Greece. Tel.: +30 2310 891403; E-mail: ; ORCID: https://orcid.org/0000-0002-3242-7629
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Fairley JL, Seneviwickrama M, Yeh S, Anthony S, Chou L, Cicuttini FM, Sullivan K, Briggs AM, Wluka AE. Person-centred care in osteoarthritis and inflammatory arthritis: a scoping review of people's needs outside of healthcare. BMC Musculoskelet Disord 2021; 22:341. [PMID: 33836697 PMCID: PMC8035722 DOI: 10.1186/s12891-021-04190-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/24/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Arthritis, regardless of cause, has significant physical, social and psychological impacts on patients. We aimed to identify the non-healthcare needs perceived by patients with inflammatory arthritis (IA) and osteoarthritis (OA), and to determine if these differ. METHODS We electronically searched MEDLINE, PsycINFO, EMBASE and CINAHL (1990-2020) systematically to identify non-healthcare-related needs of people with IA or OA. All citations were screened and quality appraised by two reviewers. Data was extracted by a single reviewer. RESULTS The search identified 7853 citations, with 31 studies included (12 for OA, 20 for IA). Six areas of need emerged and these were similar in both group These were: 1) Assistance with activities of daily living especially related to a lack of independence; 2) Social connectedness: need for social participation; 3) Financial security: worry about financial security and increased costs of health-seeking behaviours; 4) Occupational needs: desire to continue work for financial and social reasons, facilitated by flexibility of workplace conditions/environment; 5) Exercise and leisure: including limitation due to pain; 6) Transportation: limitations in ability to drive and take public transport due to mobility concerns. Many areas of need were linked; e.g. loss of employment and requiring support from family was associated with a sense of "failure" and loss of identity, as social isolation. CONCLUSIONS This review highlights the pervasive impact of arthritis on peoples' lives, regardless of aetiology, albeit with a limited evidence base. Improved identification and targeting of non-healthcare needs of people with arthritis is likely to improve person-centred care.
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Affiliation(s)
- Jessica L Fairley
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Maheeka Seneviwickrama
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Sabrina Yeh
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shane Anthony
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Louisa Chou
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kaye Sullivan
- Monash University Library, Monash University, Melbourne, Victoria, Australia
| | - Andrew M Briggs
- Curtin School of Allied Health, Curtin University, Perth, Western, Australia
| | - Anita E Wluka
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.
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Bosma A, Boot C, De Maaker M, Boeije H, Schoonmade L, Anema J, Schaafsma F. Exploring self-control of workers with a chronic condition: a qualitative synthesis. EUROPEAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2019. [DOI: 10.1080/1359432x.2019.1631801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- A.R. Bosma
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - C.R.L. Boot
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - M. De Maaker
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - H.R. Boeije
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - L.J. Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J.R. Anema
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - F.G. Schaafsma
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Prior Y, Amanna AE, Bodell SJ, Hammond A. A qualitative evaluation of occupational therapy-led work rehabilitation for people with inflammatory arthritis: Patients' views. Br J Occup Ther 2017; 80:39-48. [PMID: 30166772 PMCID: PMC6097118 DOI: 10.1177/0308022616672666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 09/05/2016] [Indexed: 01/30/2023]
Abstract
INTRODUCTION This qualitative study, nested in a pilot feasibility randomised controlled trial, explored the views of working people with inflammatory arthritis on the impact of a work rehabilitation programme received. METHOD Thirty-two participants, drawn from the 55 participants in the associated randomised controlled trial, were recruited from secondary care in the United Kingdom. Semi-structured telephone and face-to-face interviews were conducted at six (n = 32) and nine months follow-up (n = 31). Interviews were audio-recorded, transcribed, and analysed using a constant comparative approach, under the theoretical framework of critical realism. FINDINGS Three overarching themes emerged: (1) intervention group participants valued the work rehabilitation programme received, and highlighted the benefits of occupational therapy; (2) control group participants reported no benefits in relation to the written work advice pack, and lacked future aspirations to stay employed; (3) the majority of participants reported not reading the written work advice pack provided, which was the only work advice received by the control group. CONCLUSION Working people with inflammatory arthritis highly valued the practical support received from the therapists, and emphasised the value of the therapeutic relationship in the rehabilitation process. A tailor-made work rehabilitation programme, which incorporates cognitive-behavioural strategies into patient education, may help to reduce work instability in people with inflammatory arthritis, and increase their perceived self-efficacy.
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Affiliation(s)
- Yeliz Prior
- Research Fellow, Centre for Health
Sciences Research, University of Salford, UK
- Advanced Clinical Specialist
Occupational Therapist, Mid Cheshire NHS Trust Hospitals, Leighton Hospital, Crewe,
UK
| | | | - Sarah Jane Bodell
- Senior Lecturer in Occupational Therapy,
School of Health Sciences, University of Salford, UK
| | - Alison Hammond
- Professor of Rheumatology,
Rehabilitation, Centre for Health Sciences Research, University of Salford, UK
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Zuidema RM, Repping-Wuts H, Evers AWM, Van Gaal BGI, Van Achterberg T. What do we know about rheumatoid arthritis patients' support needs for self-management? A scoping review. Int J Nurs Stud 2015; 52:1617-24. [PMID: 26117711 DOI: 10.1016/j.ijnurstu.2015.05.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 05/28/2015] [Accepted: 05/30/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Self-management support is essential to perform self-management behavior. To provide this support in an effective way, insight in the needs for self-management support is necessary. OBJECTIVE To give an overview of self-management support needs from the perspective of rheumatoid arthritis patients to help nurses to improve self-management. DESIGN We conducted a scoping review for the period of January 2002 to May 2013 using the following inclusion criteria: (1) studies on adult patients aged 18 years and older, (2) studies from the perspective of rheumatoid arthritis patients, (3) studies reporting results on support needs, and (4) empirical studies using any design. DATA SOURCES We searched in PubMed, CINAHL, and PsycINFO. REVIEW METHODS Following the steps of a scoping review, we (1) identified the research question, (2) identified relevant studies, (3) selected studies, (4) charted the data, and (5) collated, summarized, and reported results. We incorporated the optional sixth step of consultation of a multidisciplinary panel of professionals and patients to validate our findings. RESULTS Seventeen articles were included. Our review shows that rheumatoid arthritis patients have informational, emotional, social and practical support needs. We found an information need for various topics, e.g. exercises and medication. Patients express a need for emotional support in daily life, given through other RA patients, colleagues and supervisors and nurses. For information needs, emotional and social support it is important that it is tailored to the individual needs of the patient. CONCLUSION The most important support needs for self-management mentioned by rheumatoid arthritis patients are more informational, social and practical support and emotional support. Considering patients' perspective as a starting point for delivering support for self-management can lead to the development of nursing interventions tailored to the needs of rheumatoid arthritis patients.
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Affiliation(s)
- R M Zuidema
- Radboud university medical center, Radboud Institute for Health Science, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands.
| | - H Repping-Wuts
- Radboud university medical center, Department of Rheumatology, Radboud Institute for Health Science, Nijmegen, The Netherlands
| | - A W M Evers
- University of Leiden, Department of Health, Medical and Neuropsychology, The Netherlands; Radboud university medical center, Department of Medical Psychology, Nijmegen, The Netherlands
| | - B G I Van Gaal
- Radboud university medical center, Radboud Institute for Health Science, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
| | - T Van Achterberg
- KU Leuven, Centre for Health Services and Nursing Research, Leuven, Belgium; Radboud university medical center, Radboud Institute for Health Science, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
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de Jong M, de Boer AGEM, Tamminga SJ, Frings-Dresen MHW. Quality of working life issues of employees with a chronic physical disease: a systematic review. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:182-96. [PMID: 24832893 DOI: 10.1007/s10926-014-9517-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE To assess issues that contribute to the Quality of Working Life (QWL) of employees with a chronic physical disease. METHODS A systematic literature search was conducted using the databases PubMed, PsycINFO and EMBASE. Experiences and perceptions during the working life of employees with a chronic physical disease were extracted and synthesized into issues that contributed to their QWL. We organized these synthesized QWL issues into higher order themes and categories with qualitative data analysis software. RESULTS From a total of 4,044 articles identified by the search, 61 articles were included. Data extraction and data synthesis resulted in an overview of 73 QWL issues that were classified into 30 themes. The following five categories of themes were identified: (1) job characteristics with issues such as job flexibility and work-site access; (2) the social structure and environment containing issues about disclosure, discrimination, misunderstanding, and awareness by employers or colleagues; (3) organizational characteristics with issues such as requesting work accommodations; (4) individual work perceptions including issues about enjoyment and evaluating work or life priorities; and (5) effect of the disease and treatment including issues about cognitive and physical health and work ability. CONCLUSION This systematic review offers an extensive overview of issues that might contribute to the QWL of employees with a chronic physical disease. This overview may function as a starting point for occupational support, such as monitoring and evaluating the QWL of employees with a chronic physical disease during return-to-work and work continuation processes.
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Affiliation(s)
- Merel de Jong
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands,
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Hoving JL, Lacaille D, Urquhart DM, Hannu TJ, Sluiter JK, Frings-Dresen MHW. Non-pharmacological interventions for preventing job loss in workers with inflammatory arthritis. Cochrane Database Syst Rev 2014:CD010208. [PMID: 25375291 DOI: 10.1002/14651858.cd010208.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Work participation of patients with inflammatory arthritis (IA) is important not only economically but also for physical and psychological health. There is no Cochrane Review to date on studies of non-pharmacological interventions specifically aimed at preventing job loss in people with IA. OBJECTIVES To assess the effects of non-pharmacological interventions that aim to prevent job loss, work absenteeism or improve work functioning for employees with IA (rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), other spondylarthritis (SpA) or IA associated with connective tissue diseases, such as Systemic Lupus Erythematosus (SLE)). SEARCH METHODS We searched the following databases from inception up to 30 April 2014; The Cochrane Library (including Cochrane Central Register of Controlled Trials, i.e. CENTRAL and DARE), MEDLINE (PubMed), EMBASE (Embase.com), CINAHL (EbSCOhost), ClinicalTrials.gov and PsycINFO (ProQuest). We did not impose language restrictions in the search. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated interventions aimed at preventing job loss in adults of working age (18 to 65 years) diagnosed with IA, including RA, AS, PsA, SpA or other types of IA. Primary outcomes were job loss and sickness absenteeism and the secondary outcome was work functioning. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias in the included RCTs. MAIN RESULTS We included three RCTs with a total of 414 participants at risk of job loss. The majority of participants had IA, most with RA and to a lesser degree AS. The interventions aimed to prevent job loss and improve work functioning in several ways: firstly by evaluating work changes or adaptations and secondly by providing any person-directed interventions including vocational counselling, advice or education. Interventions directly targeted at the work environment were minimal and included workplace visits (one trial) or any actions by an occupational physician (one trial). The duration or dose of the interventions varied from two 1.5-hour sessions (one RCT) over five months, two consultation and multidisciplinary treatments during three months (one RCT), to six to eight individual or group sessions over six months (also one RCT). All participants were recruited through rheumatology clinics, both in or outside hospitals. Included trials investigated job loss (n = two RCTs; 382 participants), work absenteeism and work functioning (n = one RCT; 32 participants). Overall, we evaluated the two smaller trials as having a high risk of bias and the large trial as having a low risk of bias. Trials showed marked differences in how they performed on risk of bias items, particularly on performance bias.We assessed the quality of the evidence using the GRADE approach and judged there to be very low quality evidence across the three reported outcomes. Of the two RCTs investigating job loss, the larger one (n = 242 participants) reported a large statistically significant reduction in job loss (relative risk (RR) = 0.35, 95% confidence interval (CI) 0.18 to 0.68) and the other RCT (n = 140) reported similar effects in both groups, although the CI was very wide (RR = 1.05, 95% CI 0.53 to 2.06). The latter one probably suffered from performance bias and we judged it to have a high risk of bias. The one small trial investigating sickness absenteeism found uncertain results at six months' follow-up (MD = -2.42 days, 95% CI -5.03 to 0.19). Finally, in the same small trial investigating work functioning using the Rheumatoid Arthritis-Work Instability Scale (RA-WIS), there was a moderate improvement of intermediate term work functioning (six months; scale range 0 to 23; mean improvement -4.67 points, 95% CI -8.43 to -0.91). We identified no adverse effects in the publications of the three trials. AUTHORS' CONCLUSIONS This Cochrane review of three RCTs found very low quality evidence overall for job loss prevention interventions having an effect on job loss, work absenteeism and work functioning in workers with inflammatory arthritis. While this review highlights that further high quality RCTs are required, the results suggest that these strategies have potential to be effective.
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Affiliation(s)
- Jan L Hoving
- Coronel Institute of Occupational Health and Research Center for Insurance Medicine, Academic Medical Center, University of Amsterdam, PO Box 22700, Amsterdam, Netherlands, 1100 DE
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Hoving JL, Zoer I, Meer MVD, Straaten YVD, Logtenberg-Rutten C, Kraak-Put S, Vries ND, Tak PP, Sluiter JK, Frings-Dresen MHW. E-health to improve work functioning in employees with rheumatoid arthritis in rheumatology practice: a feasibility study. Scand J Rheumatol 2014; 43:481-7. [DOI: 10.3109/03009742.2014.914568] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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McArthur MA, Birt L, Goodacre L. “Better but not best”: a qualitative exploration of the experiences of occupational gain for people with inflammatory arthritis receiving anti-TNFα treatment. Disabil Rehabil 2014; 37:854-63. [DOI: 10.3109/09638288.2014.946156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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McArthur M, Birt L, Goodacre L. A Narrative Literature Review of the Impact of Anti-TNFα Treatment on the Occupational Performance of People with Rheumatoid Arthritis or Ankylosing Spondylitis. Br J Occup Ther 2013. [DOI: 10.4276/030802213x13807217284260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction: Anti-TNFα treatment has revolutionised the disease pathway for some people with rheumatoid arthritis and ankylosing spondylitis, although physiological improvements do not always readily translate into re-engagement in occupational activities. This review explores the evidence base for the impact of anti-TNFα on occupational performance. Method: Literature was searched from 2000–11. A four-stage process resulted in the review of 19 articles. The Weight of Evidence framework was used to assess quality and relevance to the review question. Findings: People on anti-TNFα treatment experience increased engagement in functional, psychological and social domains. Most studies focused on employment issues, with conflicting evidence about how well anti-TNFα protected against work disability and very limited evidence that anti-TNFα enabled return to paid work. The increase in productivity was to the detriment of other occupational domains, with resulting occupational imbalance. Conclusion: The assumption that clinical improvement is relatively trouble free is incorrect, as some people on anti-TNFα treatment continue to experience difficulties in all occupational domains, particularly work. People on anti-TNFα treatment do not routinely have access to occupational therapy services. Further research needs to explore the nuanced experiences of treatment and the role of occupational therapy in maximising the treatment potential of anti-TNFα.
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Affiliation(s)
- Margaret McArthur
- Honorary Fellow, University of East Anglia, School of Rehabilitation Sciences, Norwich
| | - Linda Birt
- Research Associate, University of East Anglia, School of Rehabilitation Sciences, Norwich
| | - Lynne Goodacre
- Research Fellow, Lancaster University, School of Medicine and Health Sciences, Lancaster
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Sverker A, Thyberg I, Ostlund G, Waltersson E, Thyberg M. Participation in work in early rheumatoid arthritis: a qualitative interview study interpreted in terms of the ICF. Disabil Rehabil 2013; 36:242-9. [PMID: 23639067 DOI: 10.3109/09638288.2013.789086] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To explore what work-related dilemmas are experienced by patients with early rheumatoid arthritis (RA), according to their own descriptions, and to interpret this in terms of participation categories of the International Classification of Functioning, Disability and Health (ICF). METHOD In 48 patients with early RA, qualitative interviews were analyzed, followed by linking of concepts to the activity/participation component of the ICF and interpretation of general themes. RESULTS Work-related dilemmas represented different societal perspectives on work related to acquiring, keeping and terminating a job, self-employment, part-time, full-time and non-remunerative employment. Dilemmas also represented participation priorities in economic self-sufficiency, self-care such as health care, and avoiding social relationships and recreation in favor of work. Leisure time was influenced because efforts of working took energy and time of day-to-day procedures. Embedded actions in work-related dilemmas were carrying out daily routine, mobility including using transportation, self-care, domestic life and social interaction. CONCLUSION The general themes societal perspectives, participation priorities and embedded actions, with the included ICF categories that are described in detail according to the experiences of the patients, can support clinical reasoning and research on quantitative relations to disease activity, body functions, ability and contextual factors.
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Affiliation(s)
- Annette Sverker
- Rehabilitation Section, NSC, County Council of Östergötland, Linköping University Hosptial , Linköping , Sweden
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15
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Current World Literature. Curr Opin Rheumatol 2013; 25:398-409. [DOI: 10.1097/bor.0b013e3283604218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Hoving JL, van Zwieten MCB, van der Meer M, Sluiter JK, Frings-Dresen MHW. Work participation and arthritis: a systematic overview of challenges, adaptations and opportunities for interventions. Rheumatology (Oxford) 2013; 52:1254-64. [DOI: 10.1093/rheumatology/ket111] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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