Relationship between Job Demands-Resources and turnover intention in chronic disease - The example of multiple sclerosis

Considering the Job Demands-Resources (JD-R) model, this study investigated the relation between job demands, job resources and turnover intention among persons with multiple sclerosis (pwMS) as an example of chronic disease. We hypothesized that job demands and job resources are related to turnover intention, as mediated by work engagement, burnout, and MS-related work difficulties. Moreover, we assumed that MS-related work difficulties mediate the relationship between job demands/job resources and burnout and between job resources and work engagement. Using cross-sectional data (N = 360) of pwMS from the Swiss MS Registry, structural equation modelling was applied. The results confirm the JD-R model can be related to turnover intention among pwMS. Moreover, MS-related work difficulties mediated the relationship between job demands and burnout, between job resources and work engagement, and between job resources and burnout. The findings suggest that there may be benefit in applying and adapting the JD-R model for people with a chronic disease such as MS. This group of people might benefit from the promotion of job resources and a reduction in job demands, leading to changes in work engagement, burnout, and MS-related work difficulties and thus to an increased likelihood to stay at work.

How is and how should healthcare for people with multiple sclerosis in Germany be designed?-The rationale and protocol for the mixed-methods study Multiple Sclerosis-Patient-Oriented Care in Lower Saxony (MS-PoV)

BACKGROUND

Multiple sclerosis (MS) is the most common autoimmune inflammatory disease of the central nervous system in Europe, often causing severe physical, cognitive and emotional impairments. Currently, it is unclear whether the healthcare provisions of people with MS (PwMS) are in line with the recommendations for treatment based on guidelines or patients' needs. The main objectives of the study are as follows: (a) to investigate how well PwMS are treated; and (b) to develop a needs-oriented, patient-centred care model.

METHODS

This mixed-methods study focuses on adult PwMS living in Lower Saxony, a federal state in Germany. The qualitative study comprises focus groups with PwMS, physicians and people involved in the healthcare process as well as a future workshop. The quantitative study comprises a cross-sectional online survey and addresses the patient-relevant outcomes and needs, as previously determined by literature searches and focus groups. It will be administered to all PwMS who are insured by the statutory health insurance company involved in the project (n~7,000). The survey data will be linked to the longitudinal secondary data from the statutory health insurance company and data from the German MS registry where available. The linked and single data sources will be statistically analysed.

DISCUSSION

By comprehensively comparing the current healthcare provisions with the needs and requirements of PwMS, the strengths and weaknesses of the overall healthcare process and provision of assistive devices can be identified. The barriers and facilitators of the health service providers and their impact on daily life will be explored (qualitative analyses). Reliable recommendations for improvements will be given based on a study population drawn from the largest statutory health insurance company in Lower Saxony (quantitative analyses). However, the inherent advantages and limitations of the qualitative and quantitative research approaches need to be considered.

TRIAL REGISTRATION

The study is registered at German Clinical Trials Register DRKS00021741.

A Greek Validation Study of the Multiple Sclerosis Work Difficulties Questionnaire-23

The Multiple Sclerosis Work Difficulties Questionnaire-23 (MSWDQ-23) is a self-report instrument developed to assess barriers faced by People with Multiple Sclerosis (PwMS) in the workplace. The aim of this study was to explore the psychometric properties of the Greek version of the MSWDQ-23. The study sample consisted of 196 PwMS, all currently working in part- or full-time jobs. Participants underwent clinical examination and cognitive screening with the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and completed self-report measures of fatigue, psychological functioning, and quality of life, along with the MSWDQ-23 questionnaire. Confirmatory Factor Analysis (CFA) was performed, and goodness-of-fit measures were used to evaluate construct validity. Convergent validity was checked by correlating MSWDQ-23 scores with study measures. Cronbach's alpha value was produced to assess internal consistency. CFA yielded a model with a fair fit confirming the three-factor structure of the instrument. Higher work difficulties were associated with higher Expanded Disability Status Scale (EDSS) scores, poorer cognitive function, more fatigue, stress, anxiety, and depression, and poorer health status, supporting the convergent validity of MSWDQ-23. Internal consistency (Cronbach's alpha = 0.94) and test-retest reliability (ICC = 0.996, 95%, CI = 0.990-0.998) were excellent. The Greek MSWDQ-23 can be considered a valid patient-reported outcome measure and can be used in interventions aiming to improve the vocational status of PwMS.

[Multiple sclerosis in Germany: updated analysis of the German MS Registry 2014-2018]

Einleitung Unter Federführung der Deutschen Multiple Sklerose Gesellschaft (DMSG), Bundesverband e. V. wurde 2001 ein bundesweites MS-Register initiiert, um epidemiologische Daten zur MS, deren Verlaufsformen und der Versorgungssituation in Deutschland zu erheben. Das Ziel der vorliegenden Auswertung war es, die Daten der letzten Auswertung von vor 10 Jahren zu aktualisieren.

Methodik Zum Stichtag 28. Februar 2018 nahmen 168 Zentren verschiedener Versorgungsbereiche (Universitätskliniken, Akutkliniken, Rehabilitationskliniken und neurologische Praxen) teil. Von 2014 bis 2016 wurde der Wechsel der Dokumentationsplattform zu einem internetbasierten elektronischen Datenerfassungssysstem (EDC) vorgenommen, das eine umfassende Datenerhebung und die Integration verschiedener Dokumentationssysteme erlaubt. Eine Reihe von Qualitätssicherungsmaßnahmen sichert eine valide und representative Datenerhebung. Um eine möglichst aktuelle Beschreibung der Versorgungssituation zu gewährleisten, wurde die Querschnittsanalyse auf Patientendaten der aktuellsten Visite aus den letzten 4 Jahren beschränkt.

Ergebnisse Daten von 18.030 MS-Betroffenen konnten ausgewertet werden. Das mittlere (± Standardabweichung) Alter betrug 46,3 ± 12,2 Jahre, 72 % der Patienten waren weiblich, im Mittel waren die Patienten 10,6 ± 8,7 Jahre erkrankt, der mediane EDSS lag bei 3,0. Die Mehrzahl der Patienten litt an einem schubförmigen Verlauf (74,2 %), 16,1 % hatten einen sekundär und 5,5 % einen primär progredienten Verlauf. Eine Immuntherapie wurde bei 75,2 % durchgeführt, am häufigsten mit Interferonen, gefolgt von Fingolimod, Glatirameracetat, Dimethylfumarat, Natalizumab und Teriflunomid. Symptomatische Therapiemaßnahmen erhielten zwischen 28,3 % (kognitive Störungen) und 86,0 % (Spastik) der Patienten, die an diesen Symptomen litten. Voll berufstätig waren nur noch 37,5 % der Betroffenen; 22,5 % waren vorzeitig berentet. Die berufliche Leistungsfähigkeit war negativ mit dem Alter und dem Behinderungsgrad assoziiert.

Diskussion Die vorliegende Auswertung des deutschen MS-Registers gibt einen aktuellen Überblick zur MS und deren Versorgungssituation in Deutschland. Die Ergebnisse sprechen für einen günstigeren Verlauf der MS im Lauf der letzten 10 Jahre. Während die Mehrzahl der Patienten mit immunmodulatorischen Substanzen therapiert wird, sind nach wie vor einige Symptome der MS wie Fatigue und kognitive Störungen unzureichend behandelt. Zwar hat die Beschäftigungsrate im Vergleich zu früheren Auswertungen zugenommen; dennoch erfordert der hohe Anteil der vorzeitig Berenteten effektive Maßnahmen, um die funktionellen Einschränkungen der Betroffenen zu verringern und ihnen die Teilhabe am gesellschaftlichen und beruflichen Leben möglichst lange zu ermöglichen.

Efficacy of an Internet-Based Program to Promote Physical Activity and Exercise after Inpatient Rehabilitation in Persons with Multiple Sclerosis: A Randomized, Single-Blind, Controlled Study

Background: Multimodal rehabilitation improves fatigue and mobility in persons with multiple sclerosis (PwMS). Effects are transient and may be conserved by internet-based physical activity promotion programs. Objective: Evaluate the effects of internet-based physical activity and exercise promotion on fatigue, quality of life, and gait in PwMS after inpatient rehabilitation. Methods: PwMS (Expanded Disability Status Scale (EDSS) ≤ 6.0, fatigue: Würzburg Fatigue Inventory for Multiple Sclerosis (WEIMuS) ≥ 32) were randomized into an intervention group (IG) or a control group (CG). After rehabilitation, IG received 3 months of internet-based physical activity promotion, while CG received no intervention. Primary outcome: self-reported fatigue (WEIMuS). Secondary outcomes: quality of life (Multiple Sclerosis Impact Scale 29, MSIS-29), gait (2min/10m walking test, Tinetti score). Measurements: beginning (T0) and end (T1) of inpatient rehabilitation, 3 (T2) and 6 (T3) months afterwards. Results: 64 of 84 PwMS were analyzed (IG: 34, CG: 30). After rehabilitation, fatigue decreased in both groups. At T2 and T3, fatigue increased again in CG but was improved in IG (p < 0.001). MSIS-29 improved in both groups at T1 but remained improved at T2 and T3 only in IG. Gait improvements were more pronounced in IG at T2. Conclusions: The study provides Class II evidence that the effects of rehabilitation on fatigue, quality of life, and gait can be maintained for 3–6 months with an internet-based physical activity and exercise promotion program.

Factors associated with employment and expected work retention among persons with multiple sclerosis: findings of a cross-sectional citizen science study

Background

Multiple sclerosis (MS) notably affects adults of working age. For persons with MS (PwMS), being employed enhances their quality of life and it may be regarded as an indicator of overall functioning. Thus, ensuring work participation in PwMS is of general public health interest.

Objective

To examine relevant socio-demographic, MS-, health- and work-related factors, including psychosocial working conditions, associated with currently working PwMS in Switzerland and their expected work retention.

Methods

Using cross-sectional data of PwMS in the Swiss MS Registry (n = 541, median age = 48 [IQR 40;55]), multivariable logistic regression models were computed. First, currently working PwMS were characterised in comparison with those not currently working. Second, expected work retention, operationalized as subjective judgement “likely to work in the same job in 2 years”, was examined within the group of currently working PwMS.

Results

The factors age (OR 0.96, 95% CI 0.92–0.99), sex (OR 0.28, 95% CI 0.13–0.60), highest achieved job position (OR 1.21, 95% CI 1.01–1.46), health-related quality of life (HRQoL) (OR 1.02, 95% CI 1.01–1.04) and the number of MS symptoms (OR 0.90, 95% CI 0.82–0.98) were associated with currently working PwMS. Moreover, HRQoL (OR 1.07, 95% CI 1.04–1.10) and psychosocial working conditions, such as job resources (e.g. autonomy, control or social support) (OR 2.83, 95% CI 1.50–5.33) and job demands (e.g. workload, time pressure) (OR 0.41, 95% CI 0.18–0.90) were important factors for expected work retention among this group.

Conclusions

Resourceful psychosocial working conditions are crucial for PwMS to maintain employment. Employers could contribute to work retention among PwMS by creating a work environment with resourceful psychosocial working conditions and providing, for instance, social support.

Electronic supplementary material

The online version of this article (10.1007/s00415-020-09973-3) contains supplementary material, which is available to authorized users.

Workplace difficulties, health-related quality of life, and perception of stigma from the perspective of patients with Multiple Sclerosis

INTRODUCTION

In Multiple Sclerosis (MS), withdrawal from employment is a critical problem. This study explores relationships between disease characteristics, work difficulties, health-related quality of life, depression, and stigma and how these factors affect employment status.

METHODS

A multicenter, non-interventional, cross-sectional study was conducted in adults with relapsing-remitting MS (RRMS) and primary progressive MS (PPMS). Patient-reported questionnaires included: 23-item Multiple Sclerosis Work Difficulties Questionnaire, 29-item Multiple Sclerosis Impact Scale, Stigma Scale for Chronic Illness, and Beck Depression Inventory-Fast Screen.

RESULTS

A total of 199 individuals (mean age = 43.9 ± 10.5 years, 60.8% female, 86.4% with RRMS) participated in the study. Mean time from diagnosis was 9.6 ± 7.2 years and median Expanded Disability Status Scale score was 2.0 (interquartile range: 1.0-3.5). Employment rate was 47.2% (n = 94). Mean physical and psychological MSIS-29 impact sub-scores were 40.38 ± 17.1 and 20.24 ± 7.8, respectively. Forty patients (19.9%) had at least one SSCI-8 item with a score of 4 or 5, suggesting the presence of stigma often or always. Eighty-one patients (40.7%) were depressed and 25 (12.6%) had moderate-to-severe depression. Work difficulties were higher in those with worse functional status, a diagnosis of PPMS, and lower educational levels. Employed participants had lower perceptions of stigma and depressive symptoms than those not employed. Higher perceptions of stigma were also strongly linked to higher physical and psychological impact on health-related quality of life and greater work difficulties. Depressive symptoms were also strongly related to work-related problems.

CONCLUSIONS

Work difficulties, stigma and poor quality of life are common in MS patients, even in a population with low physical disability. Evaluation of these dimensions in clinical practice would allow the development of targeted rehabilitation and specific work plans for MS employers.

Welche Bedeutung haben „nicht-sichtbare MS-Symptome“ (Fatigue, kognitive Dysfunktion, Depression) für die berufliche Leistungsbeurteilung von Multiple-Sklerose-Erkrankten 2 Jahre nach der stationären Primärevaluation?

Zusammenfassung. Multiple Sklerose (MS) kann bereits in der mittleren Lebensphase (36 bis 55 Jahre) die berufliche Teilhabe entscheidend beeinflussen. Diese Studie untersuchte, inwieweit sich 86 MS-Erkrankte mit unterschiedlicher beruflicher Leistungseinstufung bezüglich ausgewählter Studienvariablen zum Zeitpunkt der Fragebogenerhebung (T1) und der stationären Entlassung (T0) unterschieden. Die Gesamtstichprobe zeigte leichtgradige kognitive Dysfunktionen und ausgeprägte Fatiguewerte. Mittels logistischer Regressionsanalysen prädizierten die Variablen Tonische Alertness (TAP), Motorische Fatigue (FSMC), Expanded Disability Status Scale (EDSS) und Cognitive Reserve Index questionnaire (CRIq; CRI-Arbeit) die Leistungsbeurteilung bei T0 zu 71 %. Den Variablen Krankheitsdauer, Motorische Fatigue, Selbstwirksamkeit (FERUS) und Neuropsychologischer Störungsindex gelang dies zu 67 % bei T1. Die Studienergebnisse zeigen, dass motorische Fatigue und (spezifische und globale) neuropsychologische Marker ein relevantes Erklärungspotenzial hinsichtlich der Erwerbseinstufung von MS-Erkrankten besitzen. Zudem scheint die Selbstwirksamkeit die Erwerbsfähigkeit positiv zu beeinflussen.

Symptomatology and symptomatic treatment in multiple sclerosis: Results from a nationwide MS registry

BACKGROUND

Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease. Over time, symptoms accumulate leading to increased disability of patients.

OBJECTIVE

The objective of this article is to analyze the prevalence of symptoms and symptomatic treatment patterns in a nationwide MS registry.

METHODS

Data sets from 35,755 patients were analyzed.

RESULTS

More than two-thirds of patients were women with a mean age of 46.1 (±12.8) years. Median Expanded Disability Status Score (EDSS) was 3.0. The most frequently reported symptoms were fatigue, spasticity, and voiding disorders. In patients with short disease duration, fatigue was reported most frequently. Symptomatic treatment was most common for spasticity and depression, whereas fatigue was treated only in a third of affected patients. Almost a fifth of patients with EDSS ⩽ 3.5 and neuropsychological symptoms had retired from work.

CONCLUSION

Whereas treatment for spasticity and depression is common in our cohort, sexual dysfunction, dysphagia, cognitive dysfunction, and fatigue are treated to a far lesser extent. The need for psychological support, physical, and occupational therapy has to be recognized as neuropsychological symptoms have a great impact on retirement at an early stage. Overall symptomatic treatment rates for the most common symptoms have increased over the last years (p < 0.001).

New insights into the burden and costs of multiple sclerosis in Europe: Results for Germany

INTRODUCTION

To estimate the value of interventions in multiple sclerosis (MS) - where lifetime costs and outcomes cannot be observed - outcome data have to be combined with costs. This requires that cost data be regularly updated.

OBJECTIVES AND METHODS

This study is part of a cross-sectional retrospective study in 16 countries collecting data on resource consumption and work capacity, health-related quality of life (HRQoL) and prevalent symptoms for patients with MS. Descriptive analyses are presented by level of severity, from the societal perspective, in EUR 2015.

RESULTS

A total of 5475 patients (mean age 52 years) participated in Germany. In all, 84% were below retirement age, and of these, 51% were employed. Employment was related to disease severity, and MS affected productivity at work for 80% of patients. Overall, 96% and 78% of patients experienced fatigue and cognitive difficulties as a problem, respectively. The mean utility and total annual costs were 0.786 and 28,200€ at Expanded Disability Status Scale (EDSS) 0-3, 0.586 and €44,000 at EDSS 4-6.5 and 0.273 and €62,700 at EDSS 7-9, respectively. The mean cost of a relapse was estimated at €2500.

CONCLUSION

This study provides current health economic data on MS in Germany that are important for the development of health policies and for estimating the value of the current and future treatments.

New insights into the burden and costs of multiple sclerosis in Europe: Results for Austria

Introduction:

In order to estimate the value of interventions in multiple sclerosis (MS) – where lifetime costs and outcomes cannot be observed – outcome data have to be combined with costs. This requires that cost data be regularly updated.

Objectives and Methods:

This study is part of a cross-sectional retrospective study in 16 countries collecting data on resource consumption and work capacity, health-related quality of life (HRQoL) and prevalent symptoms for patients with MS. Descriptive analyses are presented by level of severity, from the societal perspective, in EUR 2015.

Results:

A total of 516 patients (mean age, 53 years) participated in Austria; 72% were below retirement age, and of these, 46% were employed. Employment was related to disability, and MS affected productivity at work for 77% of those working. Overall, 94% and 67% of patients experienced fatigue and cognition as a problem. Mean utility and total annual costs were 0.778 and 25,100€ at Expanded Disability Status Scale (EDSS) 0–3, 0.579 and 44,100€ at EDSS 4–6.5, and 0.244 and 73,800€ at EDSS 7–9. The mean cost of a relapse was estimated at 2563€.

Conclusion:

This study illustrates the burden of MS on Austrian patients and provides current data on MS that are important for development of health policies.

New insights into the burden and costs of multiple sclerosis in Europe: Results for Italy

Introduction:

In order to estimate the value of interventions in multiple sclerosis (MS) – where lifetime costs and outcomes cannot be observed – outcome data have to be combined with costs. This requires that cost data be regularly updated.

Objectives and methods:

This study is part of a cross-sectional retrospective study in 16 countries collecting data on resource consumption and work capacity, health-related quality of life (HRQoL) and prevalent symptoms for patients with MS. Descriptive analyses are presented by level of severity, from the societal perspective, in EUR 2015.

Results:

A total of 1010 patients (mean age = 45 years) participated in Italy. In total, 94% were below retirement age, and of these, 56% were employed. Employment was related to disability, and MS affected productivity at work in 77% of the patients. Overall, 96% and 65% of the patients experienced fatigue and cognitive difficulties as a problem, respectively. Mean utility and total annual costs were 0.735 and €22,900 at Expanded Disability Status Scale (EDSS) of 0–3, 0.534 and €40,100 at EDSS of 4–6.5, and 0.135 and €53,300 at EDSS of 7–9. The mean cost of a relapse was estimated to be €2600.

Conclusion:

This study illustrates the burden of MS on Italian patients and provides current data on MS that are important for the development of health policies.

Closing the gap: Longitudinal changes in employment for Australians with multiple sclerosis

Background and objectives:

Previous studies have documented far lower employment participation rates for people with multiple sclerosis (PwMS) compared to the general population. In a large national sample of PwMS, we examined employment status, longitudinal changes in employment and the provision of modifications to work role/environment from 2010 to 2013.

Methods:

Employment data were collected through the Australian MS Longitudinal Study from 2010 to 2013, with 1260 people responding to all four surveys. Employment rates were compared with the Australian general population. The survey included questions on the provision of modifications to employees’ work role and work environment.

Results:

Employment (full- and part-time) increased from 48.8% in 2010 to 57.8% in 2013, mainly due to increases in male full-time employment. The employment gap between PwMS and the general population fell from 14.3% in 2010 to 3.5% in 2013. Male employment rates, however, remain significantly lower than the general population. The majority of PwMS who required adjustments to either their work role or environment received them.

Conclusion:

The gap in employment between PwMS and the general population has substantially reduced from 2010 to 2013, with organisations responding positively to requests for work role/environment adjustments.