fit for work europe: work for social participation presentation at eu presidency conference
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8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 1/21
The importance of work for social
participation and quality of life in
people with rheumatic diseases
Prof. Dr. Alison Hammond, FCOT
Professor in Rheumatology Rehabilitation
University of Salford
a.hammond@salford.ac.uk
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 2/21
Introduction
1. The problems faced by people with RMDs
� staying at work (SAW) or
� returning to work (RTW).
2. The effectiveness and benefits of early rehabilitationto enable SAW or early RTW
3. Future developments to improve work participationand quality of life for people with RMDs
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 3/21
Work disability and sick leave
40-45%: rheumatoid arthritis (5 y )
18 26% ankylosing spondylitis
19-23% systemic lupus
17-33% psoriatic arthritis
34% systemic sclerosis
Sick leave in early RA range = 7-84 days/y
24% of work is impaired (presenteeism)Newhall-Perry et al 2000; Merkesdal et al 2001; Verstappen et al 2004; Burton et al
2006; Al-Dhahani et al 2009; Baker et al 2009; Wallenius et al 2009; Vliet Vlieland et al
2009; Ariza-Ariza et al 2009; Rohekar & Pope 2010; Zhang et al 2010)
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 4/21
Physical, work and knowledge
barriers
Fatigue (esp. RA)
Pain;
Physical limitations: hand function (eg using a computer/writing), moving quickly, standing, lifting, bending, higher
work speed) Work-life balance: reduced leisure activities/ADL
Low job autonomy
Unadapted work environments, transport difficulties
Asking for and obtaining ergonomic modifications/ job
accommodations (lack of knowledge and/ or advocacy skills)Qualitative: Mancuso 2000; Backman 2004; Allaire 2007; Lacaille 2007
Quantitative: Proctor et al, 2000; Allaire et al, 2001 ; Teasell et al, 2001; De Buck et al, 2002; Tubach et al,2002; Verstappen et al, 2004; Lacaille et al, 2004; Yelin, 2004; Manek et al, 2005; Eberhardt et al, 2007.
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 5/21
Psychosocial barriers
Unwilling to disclose arthritis
Reluctance & emotional barriers
Increasing role overload
Dealing with others responses
Guilt Future worries: employment and finances
Higher perceived job strain
Loss of work self -efficacy
Qualitative: Gignac 2006; Lacaille, 2007; Allaire 2007
Quantitative: Proctor et al, 2000; Allaire et al, 2001 ; Teasell et al, 2001; De Buck et al,2002; Tubach et al, 2002; Verstappen et al, 2004; Lacaille et al, 2004; Yelin, 2004; Manek et al, 2005; Eberhardt et al, 2007.
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 6/21
Increasing risk
extended periods of sick leave
longer duration of unemployment.
Survey: n =300; RA 4 y.
56% work disabled
only 18% of these willing to work again( Verstappen et al, 2005)
References for predictive factors:
Proctor et al, 2000; Allaire et al, 2001 ; Teasell et al, 2001; De Buck et al, 2002; Tubach et al, 2002; Verstappen et al,2004; Lacaille et al, 2004; Yelin, 2004; Manek et al, 2005; Eberhardt et al, 2007.
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 7/21
Reducing risk
Ergonomic modifications to workplace:
2.5 x less likely to stop work
Greater use of coping strategies (physical /psychological) to self manage arthritis
Support from family/ co-workers( Lacaille, 2004: survey n = 581)
Supportive management
Effective communication : need for job
accommodations and how to changework habits(Shaw et al, 2007)
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 8/21
Vocational Rehabilitation
A process to overcome the barriers an
individual faces when accessing, remaining or
returning to work following injury, illness or
impairment.
( DWP, 2004)
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 9/21
Assessment of needs/ barriers
Work site assessment
Ergonomic modifications/job accommodationsErgonomic modifications/job accommodations
Support & communication: individual, employer,Support & communication: individual, employer,
others (others (egeg family, cofamily, co--workers);workers);
Self Self--advocacy skills training;advocacy skills training;Disability awareness trainingDisability awareness training
Condition management (physical, psychological);Condition management (physical, psychological);
Medical treatment;Medical treatment;
Staged return to work management by employers.Staged return to work management by employers.
Career exploration / counselling;Career exploration / counselling;
Job finding skills training;Job finding skills training;
Job placements/ retrainingJob placements/ retraining..DWP, 2004;
Allaire et al, 2007.
SAW
RTW
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
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Ergonomic modifications
Mini keyboard: half size keys require less effort
Built in touch pad to reduce arm movement
Voice activated software
Ergonomic chair
Flex DeskBattery operated hand
held letter opener
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 11/21
Evidence for early work
rehabilitation
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 12/21
SAW: Rehabilitation services
Job retention intervention: (Macedo et al 2007: UK ):o RCT (n=28);
o employed RA
o usual care v
o comprehensive Occupational Therapy for functional,psychological and hand problems
o work site assessment, ergonomic modifications, disabilityrights advice
o liaison employer, Access to Work (work adaptations)
6m: Significant reduction work instability, improved worksatisfaction, pain, disability; No differences days missed work
Too small /short to identify changes in work status
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
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SAW: Rehabilitation services
Job retention intervention (Allaire et al 2003: US A):
All employed (not on sick leave, concerns re SAW)
RCT (n = 242; 58% RA; OA, SLE, PA, AS); average HAQ 0.54.
VR counsellor 2x 1.5 hrs; Optional work visit and employer
liaison. Structured interview needs/ barriers; computing, travel,
access, work hours; psychological aspects; jobaccommodation plan. Disability rights; disclosing andrequesting job accommodations. Career advice.
3.5 yrs: 49% fewer job losses; high levels satisfaction
Need for convenient services or clients delay accessingservice
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 14/21
SAW early sick leave: MDT interventions
Job retention intervention (Abasolo et al 2005, 2007: Spain)
Patients with RMDs/MSDs on sick leave
RCT n = n=13,077; (inflammatory: n = 187; OA n=258)
Intervention:
Level 1: Medical assessment; drug management; condition education;self -management education (avoid rest, exercise, ergonomic care, increase physical activity)
Level 2: (no improvement 2-6w): referral to rehabilitation, furtherinvestigations as necessary
Negotiated RTW
12m: reduction in sick leave:
OA = 45.4 days; Inflammatory arthritis = 35.4 days
Cost-effective
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 15/21
SAW early sick leave: disability
employment services
RCT postal information on RTW support available (F leten et al,2006: Norway)
n= 990 (inc. n=99 with RMDs)
Letter 2w+ sick leave: brief information work measure
available:
RTW adjusted job + benefits
RTW: co-operation employee, employer and NIO modifiedwork measures
At 12m: Sick leave reduced 8 days overall
In RMD sub-group: 68 days
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 16/21
SAW/RTW: MDT interventions
Job retention intervention: ( De Buck et al 2005: NL)
Mix extended sick leave, employed
RCT (n = 140 RA): NL
medical assessment Rheumatologist
Occupational health doctor liaison Vocational assessment and advice (finances, job
accommodations)
Rehab: OT, PT, counselling as appropriate
Average 6 hours contact.
No difference in job retention/ RTW at 2 years.
Improved mental health, less fatigue
?? Due to 40% already on extended sick leave too late?
Good disability benefits system in NL
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 17/21
Summary of studies
1. Early intervention more effective:
o In work: with work instability
oEarly stages of sick leave
oConveniently timed and located
2. Longer delay, more difficult to SAW/RTW.
3. VR and MDT interventions effective.
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 18/21
What more can be done?
1. In work:
Brief interventions :
Early screening: risk of work instability.
Enable: Work self-management education: exercise, pacing,
ergonomic modifications to work tasks),
Work assessment & advice: simple work and environment
modifications (equipment, flexible hours, adaptations, access) Employment rights education
Open communication employee and employer
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 19/21
What more can be done?
2. Early sick leave:
Advice and intervention early (eg by 2 weeks)
Assess for needs
Stepped care:
Medical management (eg drug therapy)
Condition and self-management education, work assessment
and advice
Work rehabilitation and therapy (Occupational therapy, physiotherapy, cognitive-behavioural therapy) as necessary
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 20/21
Future research
RCTs: Do effective interventions developed in the USA, Spain
and Norway, reduce sick leave and improve job retention in
other countries with different socioeconomic conditions and
employment benefits/ regulations/law?
What is their impact on health, participation, quality of work
and quality of life?
Observational studies and RCTs: effectiveness of current VR
services?
Are they cost-effective?
What are the most effective ways of delivering interventions
in practice?
8/7/2019 Fit for Work Europe: Work for Social Participation presentation at EU Presidency Conference
http://slidepdf.com/reader/full/fit-for-work-europe-work-for-social-participation-presentation-at-eu-presidency 21/21
Thank you
Please Contact
Prof. Dr Alison Hammond,
Professor in Rheumatology Rehabilitation, University of Salford
School of Health, Sport and Rehabilitation Sciences
C407Allerton Building
FrederickRoad
Salford
M6 6PU
United Kingdom
a.hammond@salford.ac.uk
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