Reduction of job loss in persons with rheumatic diseases receiving vocational rehabilitation | Knowledge Translation for Employment Research Center

Authors:	Allaire, S. A., Li, W., & LaValley, M. P.
Year Published	2003
Publication	Arthritis & Rheumatism
Volume	48
Number	11
Pages	3212-3218
Publisher	American College of Rheumatology
Background	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.
Purpose	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.
Setting	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.).
Sample	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.
Data Collection	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.
Control	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.
Findings	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.
Conclusions	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.
URL	http://cicoach.com/pdf/ReductionofJobLossforpersonswithRheaumaticDiseasesthroughVocationalRehab.pdf
Disabilities	Orthopedic impairments
Populations	Male \| Female
Outcomes	Increase in tenure
NIDILRR Funded	No
Research Design	Randomized Controlled Trials (RCTs)
Peer Reviewed	Yes

Year Published

2003

Publication

Arthritis & Rheumatism

Volume

48

Number

11

Pages

3212-3218

Publisher

American College of Rheumatology

Background

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.

Purpose

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.

Setting

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.).

Sample

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.

Data Collection

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.

Control

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.

Findings

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.

Conclusions

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.

URL

http://cicoach.com/pdf/ReductionofJobLossforpersonswithRheaumaticDiseasesthroughVocationalRehab.pdf

Disabilities

Orthopedic impairments

Populations

Male | Female

Outcomes

Increase in tenure

NIDILRR Funded

No

Research Design

Randomized Controlled Trials (RCTs)

Peer Reviewed

Yes