Supporting Arthritis and Employment Across the Life Course: A Qualitative Study

Addressing education and employment outcomes in the provision of healthcare for young people with physical long-term conditions: A systematic review and mixed methods synthesis

OBJECTIVE

To identify and synthesise the experiences and benefits of addressing vocational issues in the provision of healthcare for young people (YP) with long-term conditions (LTCs).

METHODS

We searched 10 bibliographic databases. Restrictions were applied on publication date (1996-2020) and language (English). Two reviewers independently screened records against eligibility criteria. Articles reporting relevant qualitative and/or quantitative research were included. Quality appraisal was undertaken following study selection. Qualitative data were synthesised thematically, and quantitative data narratively. A cross-study synthesis integrated qualitative and quantitative findings.

RESULTS

43 articles were included. Thematic synthesis of qualitative studies (n = 23) resulted in seven recommendations for intervention (psychological support; information/signposting; skills training; career advice; healthcare-school/workplace collaboration; social support; flexible/responsive care). The narrative synthesis summarised results of 17 interventions (n = 20 quantitative studies). The cross-study synthesis mapped interventions against recommendations. Transitional care was the intervention type that most comprehensively met our proposed recommendations.

CONCLUSIONS

Evidence from YP perspectives highlights that vocational development is an important area to address in healthcare provision. Robust intervention studies in this area are lacking.

PRACTICE IMPLICATIONS

Our evidence-based recommendations for intervention can support health professionals to better address vocational issues/outcomes. With minimal adaptations, transitional care interventions would be particularly well suited to deliver this.

A Sensibility Assessment of the Job Demands and Accommodation Planning Tool (JDAPT): A Tool to Help Workers with an Episodic Disability Plan Workplace Support

Purpose Sensibility refers to a tool's comprehensiveness, understandability, relevance, feasibility, and length. It is used in the early development phase to begin assessing a new tool or intervention. This study examined the sensibility of the job demands and accommodation planning tool (JDAPT). The JDAPT identifies job demands related to physical, cognitive, interpersonal, and working conditions to better target strategies for workplace supports and accommodations aimed at assisting individuals with chronic health conditions. Methods Workers with a chronic health condition and workplace representatives were recruited from health charities, workplaces, and newsletters using convenience sampling. Cognitive interviews assessed the JDAPT's sensibility. A 70% endorsement rate was the minimum level of acceptability for sensibility concepts. A short screening tool also was administered, and answers compared to the complete JDAPT. Results Participants were 46 workers and 23 organizational representatives (n = 69). Endorsements highly exceeded the 70% cut-off for understandability, relevance, and length. Congruence between screening questions and the complete JDAPT suggested both workers and organizational representatives overlooked job demands when completing the screener. Participants provided additional examples and three new items to improve comprehensiveness. The JDAPT was rated highly relevant and useful, although not always easy to complete for someone with an episodic condition. Conclusions This study highlights the need for tools that facilitate accommodations for workers with episodic disabilities and provides early evidence for the sensibility of the JDAPT.

How Does Job Insecurity and Workplace Activity Limitations Relate to Rheumatic Disease Symptom Trajectories in Young Adulthood? A Longitudinal Study

OBJECTIVE

Workplace and labor market conditions are associated with the health of the working population. A longitudinal study was conducted among young adults with rheumatic disease to examine workplace activity limitations and job insecurity and their relationship with disease symptom trajectories.

METHODS

Three online surveys were administered to young adults with rheumatic disease over 27 months. Self-reported data on pain, fatigue, and disease activity were collected. Workplace activity limitations and job insecurity were measured. Group-based discrete mixture models determined pain, fatigue, and disease activity trajectory groups. Robust Poisson regression models were fitted to examine the relationship among workplace activity limitations, job insecurity, and trajectory group membership.

RESULTS

In total, 124 participants (mean ± SD age 29 ± 4.5 years) with rheumatic disease were recruited. At baseline, participants reported considerable workplace activity limitations (10.35 ± 5.8), and 36% of participants indicated experiencing job insecurity. We identified 2 latent rheumatic disease symptom trajectory groups. The first group had high persistent pain, fatigue, or disease activity; the second group had low persistent disease symptoms over time. Greater workplace activity limitations were associated with an increased relative risk (RR) of being in the high persistent severe pain (RR 1.02 [95% confidence interval (95% CI) 1.01, 1.03]), fatigue (RR 1.02 [95% CI 1.01, 1.03]), and disease activity trajectory groups (RR 1.02 [95% CI 1.01, 1.03]). Job insecurity was associated with an increased RR of membership in the high persistent pain (RR 1.14 [95% CI 1.04, 1.25]) and disease activity trajectory groups (RR 1.11 [95% CI 1.00, 1.22]).

CONCLUSION

Workplace activity limitations and job insecurity represent working conditions that are associated with the health of young adults with rheumatic disease and should be examined as potential targets for intervention.

Rheumatic Disease Disclosure at the Early Career Phase and Its Impact on the Relationship Between Workplace Supports and Presenteeism

OBJECTIVE

Young adults with rheumatic disease face challenges communicating health needs, accessing workplace support, and sustaining productivity. Our objective was to examine whether disclosure modifies the relationship between workplace support and presenteeism.

METHODS

An online survey was administered to Canadian young adults with rheumatic disease and asked about presenteeism (0 = health had no effect on work; 10 = health completely prevented working), workplace support need, availability, and use and whether health details were disclosed to an immediate supervisor. A multivariable robust linear regression model was conducted and stratified by those who did and did not disclose the details of their health to their supervisor.

RESULTS

A total of 306 participants completed the survey with a mean ± SD presenteeism score of 4.89 ± 2.65. More than 70% disclosed health details to their supervisor; those who disclosed reported greater presenteeism (mean ± SD 5.2 ± 2.5) when compared to those who did not disclose (mean ± SD 4.2 ± 2.61). Greater disease severity was associated with disclosure. Half of the participants reported unmet workplace support needs (53%), 32% reported that their workplace support needs were met, and 15% reported exceeded workplace support needs. The relationship between presenteeism and workplace support needs was modified by disclosure. For participants who disclosed, workplace support needs that were unmet (β = 1.59 [95% confidence interval (95% CI) 0.75, 2.43]) and that were met (β = 1.25 [95% CI 0.39, 2.11]) were associated with greater presenteeism when compared to those with exceeded workplace support needs.

CONCLUSION

To address presenteeism, strategies should be developed for young adults with rheumatic disease to foster access to available workplace supports and to navigate disclosure decisions.

'You don't want to be seen as a burden' experiences of working with early inflammatory arthritis: a qualitative study

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.

Disability and sex/gender intersections in unmet workplace support needs: Findings from a large Canadian survey of workers

INTRODUCTION

Individual attributes including disability and sex/gender have the potential to intersect and determine the likelihood of unmet workplace support needs. Our study compares unmet workplace support needs between workers with and without a disability, and according to disability type and sex/gender differences.

METHODS

Workers with (n = 901) and without (n = 895) a disability were surveyed to examine their need and use of workplace supports including job accommodations, work modifications and health benefits. A multivariable logistic model was conducted to examine the relationship between disability status, disability type and sex/gender and unmet workplace support needs. The model included interaction terms between sex/gender × physical disability, sex/gender × nonphysical disability, and sex/gender × physical and nonphysical disability.

RESULTS

Among participants with a disability, 24% had a physical disability, 20% had a nonphysical disability (e.g., cognitive, mental/emotional or sensory disability) and 56% had both physical and nonphysical disability. Over half of the respondents were women (56%). Results from the multivariable model showed that nondisabled women were more likely to report unmet workplace support needs when compared to nondisabled men (odds ratio [OR] = 1.54, 95% confidence interval [CI], 1.13-2.10). Findings also showed an intersection between the number and type of disability and sex/gender; women with both a physical and nonphysical disability had the greatest likelihood of reporting unmet workplace support needs when compared to nondisabled men (OR = 2.73; 95% CI, 1.83-4.08).

CONCLUSIONS

Being a woman and having one or more disabilities can determine unmet workplace support needs. Strategies to address workplace support needs should consider the intersection between disability and sex/gender differences.

Depressive Symptoms and the Arthritis-Employment Interface: A Population-Level Study

OBJECTIVE

To examine the relationship between depressive symptoms, arthritis, and employment, and to determine whether this relationship differs across young, middle-age, and older working-age adults with arthritis.

METHODS

Data from the US National Health Interview Survey from 2013-2017 were analyzed. Analyses were restricted to adults with doctor-diagnosed arthritis of working age (ages 18-64 years) with complete data on depressive symptoms (n = 11,380). Covariates were sociodemographic information, health, and health system utilization variables. Employment prevalence was compared by self-reported depressive symptoms. We estimated percentages, as well as univariable and multivariable logistic regression models, to examine the relationship between depression and employment among young adults (ages 18-34 years), middle-age adults (ages 35-54 years), and older adults (ages 55-64 years).

RESULTS

Among all working-age US adults with arthritis, the prevalence of depressive symptoms was 13%. Those reporting depressive symptoms had a higher prevalence of fair/worse health (60%) and arthritis-attributable activity limitations (70%) compared to those not reporting depression (23% and 39%, respectively). Respondents with depressive symptoms reported significantly lower employment prevalence (30%) when compared to those not reporting depressive symptoms (66%) and lower multivariable-adjusted association with employment (prevalence ratio 0.88 [95% confidence interval (95% CI) 0.83-0.93]). Middle-age adults reporting depression were significantly less likely to be employed compared to their counterparts without depression (prevalence ratio 0.83 [95% CI 0.77-0.90]); similar but borderline statistically significant relationships were observed for both young adults (prevalence ratio 0.86 [95% CI 0.74-0.99]) and older adults (prevalence ratio 0.94 [95% CI 0.86-1.03]).

CONCLUSION

For adults with arthritis, depressive symptoms are associated with not participating in employment. Strategies to reduce arthritis-related work disability may be more effective if they simultaneously address mental health.

"I Would be More of a Liability than an Asset": Navigating the Workplace as a Younger Person with Arthritis

Purpose Over half the population in Australia with arthritis and other musculoskeletal conditions is aged 25-64 years. This reflects the peak income-earning years for most, yet little research has examined the influence of arthritis on work issues specific to younger people. The aim of this research was to examine the work-related experiences of younger people (defined as those aged 18-50 years). Methods A qualitative exploratory design was used. Participants with inflammatory arthritis or osteoarthritis were recruited from the community, including urban and rural settings. An interview guide was based on the World Health Organization's International Classification of Functioning, Disability and Health. Deductive and inductive coding techniques were used to identify emerging work-related themes from the data. Results Semi-structured interviews were conducted with 21 younger people (90% female) with a mix of arthritis conditions, vocational backgrounds and career stages. Three themes were identified: (1) the perceived impacts of arthritis on career trajectories, (2) the impacts of arthritis on participants' workplace environment, employers, and colleagues, and (3) the personal toll of working with arthritis. The personal toll of working with arthritis relates to the arthritis-attributable impacts of physical and psychological symptoms on productivity and presenteeism in the workplace. Conclusion Younger people with arthritis experience numerous challenges at key stages of their careers, from career planning through to productive working. This can be used to inform workplace accommodations for people with arthritis and increase awareness of likely barriers to work productivity among colleagues, employers and clinicians.

Work-focused interventions that promote the labour market transition of young adults with chronic disabling health conditions: a systematic review

Objective

Young adulthood is an important transitional life phase where careers are established. Young adults with chronic disabling health conditions are underrepresented in the labour market. Our study aims to examine the effectiveness of work-focused interventions that support the labour market transition of young adults with chronic disabling health conditions; and to examine whether the effectiveness of work-focused interventions differ across work transition phase (eg, preparation, entry and sustaining work, employment advancement) and disability type.

Methods

A systematic review of articles published between January 1990 and July 2018 was conducted. Medline, EMBASE and PsycInfo were searched, and titles/abstracts and full texts of articles were reviewed for eligibility. Relevant articles were appraised for methodological quality. A best evidence synthesis was applied to medium-quality/high-quality studies to develop recommendations.

Results

5816 articles were identified; 10 articles were relevant and of moderate–high methodological quality. Six intervention categories were identified which focused on young adults with mental health or intellectual/learning disabilities (n=3) and addressed employment preparation (n=10) and/or work entry (n=9). No interventions addressed at-work issues or career advancement. Strong evidence existed for tailored supported employment (SE) interventions having a positive impact on preparation and entry into competitive employment. Also, moderate evidence existed for the positive impact of SE on preparation and entry into competitive employment for young adults with mental health conditions.

Conclusions

Tailored SE is recommended to foster preparation and entry into the labour market. Evidence-based interventions are needed to facilitate sustained work and career advancement of young adults living with different disabling health conditions.