Navigating employment retention with a chronic health condition: a meta-ethnography of the employment experiences of people with musculoskeletal disorders in the UK

Purpose: Musculoskeletal disorders (MSDs) are associated with high rates of work disability in the UK. This review synthesized qualitative evidence concerning the employment experiences of people with MSDs to explore the factors shaping their employment trajectories post-onset and the resources they draw on to remain in work.Material and methods: Systematic database searches identified 16 qualitative studies of the employment consequences of having a chronic MSD in the UK. Meta-ethnographic methods were utilized to synthesize this body of evidence. This included a translation of concepts across studies to produce a line of argument synthesis.Results: The lack of certainty associated with often fluctuating and invisible MSD symptoms leads to employees struggling to maintain a stable work identity. Work retention is aided by having: a clear diagnosis, occupational tasks commensurate with altered abilities, and employers and colleagues who understand the nature of the condition. The ability to negotiate and implement workplace adjustments aids work retention but is dependent upon having good quality employee–employer relationships and the degree of autonomy available to the employee.Conclusion: Individuals with MSDs must draw on a range of personal, social, organizational and institutional resources to remain in or return to work post-onset.Implications for rehabilitationThe fluctuating and invisible nature of chronic musculoskeletal disorders (MSDs) creates uncertainty for individuals about their ability to remain working or return-to-work.Individuals with MSDs must draw on a range of personal, social, organizational, and institutional resources to remain in work following onset.Work retention is aided by having a clear diagnosis; occupational tasks commensurate with altered abilities; and understanding employers and coworkers.Organizational flexibility and the ability to act autonomously by changing occupations or self-implementing or requesting work adjustments are particularly important for work retention.