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

Association of patient-reported cognitive impairment with quality of life and employment in multiple sclerosis

BACKGROUND

Cognition is frequently affected in persons with multiple sclerosis (MS). Cognitive impairment (CI) is associated with decreased quality of life (QOL) and employment status. Yet, CI assessed using patient-reported outcome measures is not as well studied and is thought to be influenced by other symptoms. Health Utilities Index 3 (HUI3) is a multi-attribute health-status classification system that assesses 8 different single attributes, including cognition.

METHODS

The North American Consortium of Multiple Sclerosis (NARCOMS) Registry, a voluntary, self-report registry for persons with MS, Spring 2019 survey collected the HUI3 and self-reported assessment of health-related QOL (RAND-12), cognitive status, depression, fatigue, disability, employment, disease-modifying therapy use, and sociodemographic data. We assessed the relationship between patient-reported cognitive CI from the HUI3 (HUI-C), QOL, and employment while adjusting for factors previously associated with the outcomes. For employment outcomes, the cohort was limited to participants 65 years of age or younger.

RESULTS

Of the 6,227 respondents, 56.4 % reported cognitive difficulty with the HUI-C. After adjusting for multiple covariates, cognitive difficulty was associated with 1.2 point lower physical QOL for each 0.1 decrease in HUI-C (p < 0.0001). Mental QOL decreased by 2 points for each 0.1 decrease in HUI-C (p < 0.0001). Cognitive difficulty was associated with a 10 % decreased odds of employment in the multivariable model (p < 0.0001).

DISCUSSION

Patient-reported CI was associated with lower health-related and vocational outcomes for MS patients, even after accounting for age, income, depression, fatigue, and disability associated with cognition. The HUI-C is a single attribute score derived from the HUI3 that may facilitate the evaluation of CI in MS.

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.

Cost-consequence analysis of ofatumumab for the treatment of relapsing-remitting multiple sclerosis in Canada

Aim: The costs and consequences of initial and delayed ofatumumab treatment were evaluated in relapsing-remitting multiple sclerosis with active disease in Canada. Materials & methods: A Markov cohort model was used (10-year horizon, annual cycle length, 1.5% discounting). Scenario analyses examined ofatumumab as first-line treatment versus 3 and 5 years following switch from commonly used first-line therapies. Results: Ofatumumab resulted in improvements in clinical outcomes (relapses and disease progression) and productivity (employment and full-time work), and reduction of economic burden (administration, monitoring and non-drug costs) that were comparable to other high-efficacy therapies (ocrelizumab, cladribine and natalizumab). Switching to ofatumumab earlier in the disease course may improve these outcomes. Conclusion: Results highlight the value of a high-efficacy therapy such as ofatumumab as initial treatment (i.e., first-line) in newly diagnosed relapsing-remitting multiple sclerosis patients with active disease.

Predictive factors associated with trajectory of job satisfaction of workers with physical disabilities: A latent growth curve analysis

BACKGROUND

Job satisfaction is a highly useful factor in maintaining a successful work life for the disabled.

OBJECTIVE

This study aimed to evaluate how job satisfaction among workers with physical disabilities evolves over time, and to identify predictive factors that influence the trajectory of job satisfaction.

METHODS

A longitudinal data analysis using the three-year databases of the 2016-2018 Employment Panel Survey for the Disabled (n = 693). A latent growth curve model analysis was conducted to determine the trajectory of the job satisfaction among workers with physical disabilities, as well as the predictive factors affecting it.

RESULTS

Job satisfaction among workers with physical disabilities increased over time, and there were substantial individual differences in the trajectory of the job satisfaction. The significant predictors for the job satisfaction over the three years were degree of disability, computer usage ability, employment support services, and experience of discrimination. Gender, educational background, interpersonal relationship/organizational adaptability, convenience facilities for the disabled, job suitability, disability acceptability, and self-esteem had a considerable impact on the intercept of the job satisfaction, but not on the slope.

CONCLUSION

The findings would inform healthcare providers to establish mid-to-long-term vocational rehabilitation intervention plans that could increase the job satisfaction among workers with physical disabilities.

The association between hope and employment among individuals with multiple sclerosis: A hierarchical logistic regression model

BACKGROUND

Most people with multiple sclerosis (MS) are employed at the time of their diagnosis; however, due to the unpredictable nature of MS, most exit the workforce shortly thereafter. A plethora of research has examined factors that negatively affect employment outcomes for people with MS. However, little is known about how hope, a modifiable positive psychology factor, affects employment.

OBJECTIVE

This study examined the role of hope and its association with employment outcomes for people with MS.

METHODS

Two-hundred and fifty-five adults with MS (mean ± SD age, 45.45 years ± 10.28) completed surveys about their MS, employment, disability-related stress, and hope. A three-step hierarchical logistic regression was conducted to examine the extent to which hope explains the variance in employment, over and above demographic and disability related covariates.

RESULTS

The final model explained 28% of the variance in employment, suggesting that the model was able to distinguish people with MS who were employed versus those who were unemployed. Higher levels of hope were associated with an increased probability of being employed (OR = 4.65; 95% CI [1.98, 10.92]).

CONCLUSION

This study supports that hope is associated with favorable employment outcomes for people with MS. Persons with MS may benefit from working with rehabilitation professionals to enhance their hope, and this study provides a foundation for the development of hope-based interventions to improve employment outcomes among this population.

Occupational outcomes of people with multiple sclerosis: a scoping review

OBJECTIVES

To update the knowledge on the occupational outcomes associated with multiple sclerosis (MS), systematically examine the extent, scope and nature of the pre-existing literature and identify research gaps in the existing literature.

DESIGN

Scoping review.

DATA SOURCES

A comprehensive database search of PubMed/MEDLINE, Scopus, SciVerse ScienceDirect and Web of Science was performed. There were no time limits.

ELIGIBILITY CRITERIA

We included any peer-reviewed original article reporting the occupational outcomes of people with MS between the ages of 18 and 65 years. We excluded those off-topic and with insufficient information.

METHODS

This review was conducted following the Joanna Briggs Institute recommendations and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping review checklist. Screening, reading of full-texts and data extraction was performed in a standardised way by expert reviewers from 14 July 2021 to 31 October 2021. We provided a narrative synthesis and an overview of findings.

RESULTS

The initial systematic search yielded 104 228 results. After removing duplicates and applying the exclusion criteria, 403 articles were included in the review. In total, the studies evaluated 492 062 subjects with MS. One hundred fifty-four (38.2%) articles were published in the last 5 years, mostly from Europe and North America (50.9% and 33.0%, respectively). Concerning the occupational outcomes, studies mostly addressed unemployment (311, 77.2%), early retirement (120, 29.8%), disability pension (117, 29.0%), sick leave (77, 19.1%), the indirect cost of MS (74, 18.4%) and work characteristics (57, 14.1%). The results were categorised into seven subtopics: 'Changes in work and occupational status due to MS', 'work-related socio-economic consequences of MS', 'risk factors for unfavourable occupational outcomes', 'reported barriers to employment', 'reported job accommodations and vocational rehabilitation strategies', 'job satisfaction, stigma, and disclosing the diagnosis in the workplace' and 'rating clinical scales'.

CONCLUSIONS

There are several issues that deserve further in-depth study by the scientific community in order to improve the occupational outcomes of people with MS.

Career satisfaction among working age individuals with multiple sclerosis or spinal cord injury

BACKGROUND: Joint studies of multiple sclerosis (MS) and spinal cord injury (SCI), both types of spinal cord dysfunction, have identified barriers and facilitators to employment and key outcomes including earnings and job benefits. However, there has been an absence of research on satisfaction with employment over one’s career. Such knowledge would help to establish the foundation for targeted vocational rehabilitation interventions. as well as differences in quality of employment outcomes, establishing the foundation for targeted vocational rehabilitation interventions. OBJECTIVE: Identify and quantify demographic, educational, vocational, and functional characteristics associated with career satisfaction, a quality employment outcome, among people with MS and SCI. METHODS: There were a total of 3,371 participants, 1,229 with MS and 2,142 with SCI, all of whom were in the traditional working age range (<  65 years old). Participants were identified from the Southeastern and Midwestern regions of the USA and data were collected, processed, and analyzed at a medical university in the Southeastern USA. Econometric modeling identified factors associated with career satisfaction, as defined by a five-item composite scale that was converted to Z-scores, integrating analysis using both diagnostic groups. RESULTS: Participants who were gainfully employed and those who had left the labor force (unemployed with no hopes to return to work), reported higher career satisfaction than those who were unemployed and hoping to return to work. Higher career satisfaction scores were associated with more formal education and having worked in management/professional, natural resources, or service occupations. Higher scores were also observed among those older, not single, and who had fewer functional deficits. No differences were identified as a function of diagnosis, race-ethnicity, sex, or time since injury/diagnosis. CONCLUSION: Career satisfaction was more strongly related to educational attainment, vocational history, and labor force participation, than to demographic and disability factors. Vocational counselors should target those still in the labor force for skills development, job retention and reacquisition to promote career satisfaction.

Work Productivity Outcomes Associated with Ocrelizumab Compared with Other Disease-Modifying Therapies for Multiple Sclerosis

Objective

This study evaluated work and activity impairment in patients with multiple sclerosis (MS) treated with ocrelizumab (OCR) versus other disease-modifying therapies (DMTs).

Methods

Data were obtained from the Adelphi Real World Disease Specific Programme for Multiple Sclerosis. Patients with relapsing–remitting or secondary progressive MS who completed surveys in 2018 and 2019 and received ≥ 6 months of an eligible therapy, including OCR, injectable therapy, and oral therapy, were included. Outcomes were assessed using the patient-reported Work Productivity and Activity Impairment questionnaire. Doubly robust estimation, which combined propensity score weighting and regression modeling, was used to compare treatments, controlling for baseline clinical and demographic characteristics.

Results

This study included 630 patients (OCR, n = 90; injectable DMT, n = 224; oral DMT, n = 316) with a mean (standard deviation) age of 42 (11) years. A greater proportion of OCR-treated patients had an Expanded Disability Status Scale score of ≥ 3 at treatment initiation compared with those receiving oral and injectable DMTs (51 vs. 15% and 15%, respectively), and a smaller proportion of OCR-treated patients received treatment for ≥ 1 year (43 vs. 90% and 92%, respectively). OCR-treated patients had higher odds of employment [odds ratio (95% confidence interval) 3.4 (1.5–7.7) vs. oral DMT, 5.6 (2.6–12.0) vs. injectable DMT], lower overall work productivity loss [difference (95% confidence interval) − 10.0% (− 6.1 to − 15.0%) vs. oral DMT, − 13.0% (− 8.5 to − 17.0%) vs. injectable DMT] and lower activity impairment [difference (95% confidence interval) − 11% (− 7.1 to − 16.0%) vs. oral DMT, − 9.7% (− 5.0 to − 14.0%) vs. injectable DMT].

Conclusion

This real-world evidence suggests that patients with MS treated with OCR experience lower work and activity impairment than patients treated with other DMTs.

Electronic supplementary material

The online version of this article (10.1007/s40120-020-00224-1) contains supplementary material, which is available to authorized users.

Multiple sclerosis (MS) is the most common progressive neurological disease in young adults. It typically starts between the ages of 20 and 40 years—arguably some of the most productive years of an individual’s life—and it has a large impact on many aspects of everyday life for the rest of a person’s life. The reduction in the ability to do routine activities, including working, results in a large economic burden. Disease-modifying treatments (DMTs) available for MS, particularly high-efficacy DMTs, have been shown to improve work productivity. This study looked at work and activity impairment using the Work Productivity and Activity Impairment Questionnaire in patients with MS who were treated with ocrelizumab (OCR) or other DMTs for ≥ 6 months. A total of 630 patients with relapsing–remitting MS (RRMS) or secondary progressive MS (SPMS) from the Adelphi Real World Disease Specific Programme for Multiple Sclerosis were included in the study, including 90, 316 and 224 patients who completed ≥ 6 months of treatment with OCR, oral or injectable therapy. Compared with patients receiving oral or injectable DMTs, those receiving OCR had higher odds of employment [odds ratio (OR) vs. oral DMT 3.4; OR vs. injectable DMT 5.6], lower overall work productivity impairment (difference vs. oral DMT − 10%; difference vs. injectable DMT − 13%) and lower activity impairment (difference vs. oral DMT − 11%; difference vs. injectable DMT − 9.7%). These findings in patients with RRMS or SPMS being treated in the real world suggest that OCR may reduce the impact of MS disease on work productivity more than other DMTs.