Background: People with chronic inflammatory arthritis (IA) (in this study IA includes rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA)) often have a reduced work ability. Consequently, they are at high risk of losing their job and to become permanently excluded from the labor market. Based on the Medical Research Council's framework for Complex Interventions we therefore developed a new context-specific vocational rehabilitation 'WORK-ON', for people with IA at the Danish Hospital for Rheumatic Diseases [1]. WORK-ON includes: 1) initial assessment and goalsetting by an occupational therapist experienced in rheumatology rehabilitation; 2) coordinated individually targeted support by the same occupational therapist, including assistance in navigating the primary and secondary healthcare and social care systems; 3) group sessions for peer support; and 4) individually tailored consultations with physiotherapists, nurses or social workers if needed. Objectives: The objective was to test the feasibility of the six-month WORK-ON intervention. Methods: A single-arm feasibility study was performed. The primary outcome was work ability, measured by the Work Ability Index (WAI) single item and the Work Productivity and Activity Impairment questionnaire (WPAI:GH). Secondary outcomes were occupational balance measured by the Occupational Balance Questionnaire, health related quality of life measured by the EQ-5D-5L, number of days of sickness absence per month collected by text messages, fatigue measured by the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scales (NRSv2) and mental well-being measured by the WHO-5 wellbeing index. Results: We identified 119 potentially eligible patients with IA from May-October 2022 who had answered unlikely or not certain to question number #6 from the WAI Questionnaire: 'Do you believe, according to your present state of health, that you will be able to do your current job two years from now?' We included 19 participants (17 women and two men); 15 with RA, two with axSpA and two with PsA, who all completed the 6-month WORK-ON rehabilitation. The mean age was 53 (range 34–64) years. The results indicated a slight tendency to improvement at 6-months follow-up in work ability and quality of life from baseline (Table 1). In total, 10 of the 19 participants reported an increase in number of days of sick leave during the 6-month intervention. Two participants went on full time sick leave during the intervention period. Days of sick leave reported per month per participant were median [IQR]: 0 [0–2,5]. Each participant had 4-6 individual consultations with the coordinating occupational therapist including the initial assessment and goalsetting. Twelve participants had a consultation with a social worker, five with a physiotherapist, and three with a nurse. The coordinating occupational therapist spent in average 10.2 hours per participant during the 6-month intervention, whereas the social worker, the physiotherapist and the nurse in total spent 4.8 hours per participant during the intervention. Conclusion: It is considered feasible to deliver the WORK-ON for people with IA who are concerned about losing their jobs. The rehabilitation needs adaptation to be able to lead to reduced job loss through improvement in work ability and reduce sickness absence. A larger study with a control group and longer follow-up period is needed to demonstrate the efficacy of the adjusted WORK-ON rehabilitation on work ability, sick leave and job loss. REFERENCES: [1] Madsen, CMT et al. 2023: DOI: 10.1186/s12913-023-09780-2 Acknowledgements: NIL. Disclosure of Interests: None declared.
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Madsen et al. (2024) studied this question.