Reduction of job loss in persons with rheumatic diseases receiving vocational rehabilitation
Health-related job loss is a major consequence of rheumatic diseases. Incidence rates can be expected to increase because the portion of the US workforce that is 55 years of age and older is increasing. Vocational rehabilitation is one approach to addressing health-related job loss. However, there is a shortage of studies evaluating the effectiveness of vocational rehabilitation with this population.
The purpose of this study was to evaluate the efficacy of vocational rehabilitation provided as primary prevention, using randomized controlled trial of vocational rehabilitation provided to persons with rheumatic diseases who were at risk for job loss, but while they were still working.
The primary setting for the study consisted of multiple workplaces in eastern Massachusetts. Some study components were conducted in participants' homes, state vocational rehabilitation agency offices, and public meeting places (i.e., libraries, restaurants, etc.).
Participants were 242 employed persons with a rheumatic disease who were at risk for job loss and who resided in eastern Massachusetts. Recruitment was carried out through rheumatologists, who sent letters about the study and a screening form to their patients who had a diagnosis of rheumatoid diseases. Participants were randomized into the treatment and control groups. Participants were overwhelmingly white females.
Information about job characteristics included the title and three main duties of participants primary job and the physical demands and autonomy of these jobs. Job type was classified according to 12 main categories in the Dictionary of Occupational Titles. Information about demographic, disease, and job characteristics was collected at baseline. The main outcome was time to the first of either permanent job loss, consisting of permanent disability or retirement, or temporary job loss. The demographic and disease characteristics of the experimental and control groups were compared by unpaired t-test or chi-square test. Poisson regression was used to analyze the counts of permanent and temporary job losses.
The intervention consisted of vocational rehabilitation services designed to promote job retention. The intervention consisted of 3 components: job accommodation, vocational counseling and guidance, and education and self-advocacy. Service duration was from 5 to 9 months.
Control group participants were mailed copies of the same pamphlets and flyers about how to manage health-related employment problems and available resources that the experimental group participants received.
At 48 months of follow-up, only 25 permanent and temporary job losses combined occurred in the experimental group, compared with 48 in the control group. Of permanent job losses, 12 occurred in the experimental group and 22 in the control group. Of temporary job losses, 13 occurred in the experimental group versus 26 in the control group. Beginning 12 months post-intervention, a greater percentage of experimental group participants than control group participants remained employed with no job loss. The difference between the groups increased
at 18 months and was sustained over 42 months.
Vocational rehabilitation interventions have the capacity to reduce job loss due to rheumatic disease and the high indirect costs associated with rheumatic diseases. Also, because the intervention was relatively brief and the effect persisted over 3.5 years of follow-up, it should be an inexpensive intervention to deliver.
