Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis | Knowledge Translation for Employment Research Center

Authors:	Kidd, S. A., Boyd, G. M., Bieling, P., Pike, S. & Kazarian-Keith, D.
Year Published	2009
Publication	Cochrane Database of Systematic Reviews
Volume	1
Number	1
Pages	1-22
Publisher	John Wiley & Sons, LTD
Background	Multiple sclerosis is described as a neurological disease that frequently affects adults of working age, resulting in a range of physical, cognitive and psychosocial deficits that impact on workforce participation. Although, the literature supports vocational rehabilitation (VR) approaches in persons with multiple sclerosis (pwMS), the evidence for its effectiveness is yet to be established.
Purpose	The purpose of the study is to evaluate the effectiveness of VR programs compared to alternative programs or care as usual on return to work, workability and employment in patients with M.S.; and to evaluate the cost effectiveness of these programs.
Setting	This study is a systematic review. The included studies were undertaken in various locations and settings.
Sample	Trials were included if the study population was working age (i.e. mean age between 18-65 years) and had the diagnosis of MS (subtypes of MS were included- relapsing remitting, secondary progressive and primary progressive MS), irrespective of MS severity.
Data Collection	Two reviewers selected trials and rated their methodological quality independently. A 'best evidence' synthesis was performed, based on methodological quality. Trials were grouped in terms of type and setting of VR programs.
Control	There are no comparison on control conditions.
Findings	Two trials (one RCT and one CCT) (total 80 participants) met the review criteria. Both trials scored poorly on the methodological quality assessment. There was 'insufficient evidence' for VR programs for (a competitive employment in altering rates of job retention, changes in employment, improvement in rates of re-entry into the labor force; (b) for altering work ability' by improving participants confidence in the accommodation request process, or employability maturity or job seeking activity. No evidence could be assimilated for changes in proportions of persons in supported employment or on disability pensions, nor for cost-effectiveness.
Conclusions	There was inconclusive evidence to support VR for patients with MS However, the review highlights some of the challenges in providing VR for pwMS. Clinicians need to be aware of vocational issues, and to understand and manage barriers for maintaining employment. Proactive and timely VR programs should incorporate practical solutions to deal with work disability, workplace accommodation and educate employers, and the wider community. Liaison with policy makers is imperative for government initiatives that encourage work focused VR programs. Future research in VR should focus on improving methodological and scientific rigor of clinical trials; on the development of appropriate and valid outcome measures; and on cost effectiveness of VR programs.
URL	http://onlinelibrary.wiley.com/store/10.1002/14651858.CD007256.pub2/asset/CD007256.pdf;jsessionid=DB8AF3AB7E7D7D9A9280998D0E812DCD.f03t01?v=1&t=imnmwg11&s=378f4ad624105aa799bc84c37a0ca5d3c51082c5
Disabilities
Populations	Male & Female
Outcomes	Employment acquisition \| Other
NIDILRR Funded	Not Reported
Research Design	Systematic reviews and meta-analysis
Peer Reviewed	Yes

Year Published

2009

Publication

Cochrane Database of Systematic Reviews

Volume

1

Number

1

Pages

1-22

Publisher

John Wiley & Sons, LTD

Background

Multiple sclerosis is described as a neurological disease that frequently affects adults of working age, resulting in a range of physical, cognitive and psychosocial deficits that impact on workforce participation. Although, the literature supports vocational rehabilitation (VR) approaches in persons with multiple sclerosis (pwMS), the evidence for its effectiveness is yet to be established.

Purpose

The purpose of the study is to evaluate the effectiveness of VR programs compared to alternative programs or care as usual on return to work, workability and employment in patients with M.S.; and to evaluate the cost effectiveness of these programs.

Setting

This study is a systematic review. The included studies were undertaken in various locations and settings.

Sample

Trials were included if the study population was working age (i.e. mean age between 18-65 years) and had the diagnosis of MS (subtypes of MS were included- relapsing remitting, secondary progressive and primary progressive MS), irrespective of MS severity.

Data Collection

Two reviewers selected trials and rated their methodological quality independently. A 'best evidence' synthesis was performed, based on methodological quality. Trials were grouped in terms of type and setting of VR programs.

Control

There are no comparison on control conditions.

Findings

Two trials (one RCT and one CCT) (total 80 participants) met the review criteria. Both trials scored poorly on the methodological quality assessment. There was 'insufficient evidence' for VR programs for (a competitive employment in altering rates of job retention, changes in employment, improvement in rates of re-entry into the labor force; (b) for altering work ability' by improving participants confidence in the accommodation request process, or employability maturity or job seeking activity. No evidence could be assimilated for changes in proportions of persons in supported employment or on disability pensions, nor for cost-effectiveness.

Conclusions

There was inconclusive evidence to support VR for patients with MS However, the review highlights some of the challenges in providing VR for pwMS. Clinicians need to be aware of vocational issues, and to understand and manage barriers for maintaining employment. Proactive and timely VR programs should incorporate practical solutions to deal with work disability, workplace accommodation and educate employers, and the wider community. Liaison with policy makers is imperative for government initiatives that encourage work focused VR programs. Future research in VR should focus on improving methodological and scientific rigor of clinical trials; on the development of appropriate and valid outcome measures; and on cost effectiveness of VR programs.

URL

http://onlinelibrary.wiley.com/store/10.1002/14651858.CD007256.pub2/asset/CD007256.pdf;jsessionid=DB8AF3AB7E7D7D9A9280998D0E812DCD.f03t01?v=1&t=imnmwg11&s=378f4ad624105aa799bc84c37a0ca5d3c51082c5

Disabilities

Populations

Male & Female

Outcomes

Employment acquisition | Other

NIDILRR Funded

Not Reported

Research Design

Systematic reviews and meta-analysis

Peer Reviewed

Yes