Community-based Interventions to Sustain Employment Julie J. - - PDF document

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Community-based Interventions to Sustain Employment Julie J. - - PDF document

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Community-based Interventions to Sustain Employment Julie J. Keysor, PhD, PT Associate Professor Director, ENACT, the NIDRR Arthritis RRTC Promoting Activity and Participation Among Persons with Arthritis Arthritis State of the Science Meeting

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Promoting Activity and Participation Among Persons with Arthritis

Community-based Interventions to Sustain Employment

Julie J. Keysor, PhD, PT Associate Professor Director, ENACT, the NIDRR Arthritis RRTC

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Objectives

1) Definitions: “community-based” and “work disability” 2) Review rationale for community-based approaches 3) Discuss the evidence of community-based approaches 4) Discuss gaps in the field and future directions

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Promoting Activity and Participation Among Persons with Arthritis

Definitions: “Community-Based” and “Work Disability”

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Definition “Community-Based”: This Presentation

  • Programs delivered in the community by trained or

untrained health professionals that were aimed at minimizing or preventing work disability

  • Not: workplace settings
  • Not: health care settings

Keysor JJ, Arthritis State of the Science Meeting, April 6th 2014

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Work Disability

  • Work loss: Premature work cessation due to a health

condition (goal: sustain employment)

  • Work productivity:
  • Absenteeism: Time missed from work due to health reasons
  • Presenteeism: Time of impaired performance while at work due to

health reasons resulting in productivity loss

  • Work limitations:
  • Difficulty performing work related activities and functional tasks

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Promoting Activity and Participation Among Persons with Arthritis

Why Address “Work” Through the Community

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Why Community Approaches?

1) Challenges with intervening in the workplace

  • Workers with arthritis concerned about disclosure (Lacaille et al.

2007, Gignac et al. 2009)

  • Arthritis-focused worksite programs are not widely available

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Why Community Approaches?

2) Non-clinical and non-workplace factors may be important

  • Commuting and travelling
  • Personal, family, and work interaction

Robinson & Walters, Internat J Rehabil Med 1979; Reisine et al., Arthritis and Rheumatism, 1989; Reisine et al., Arthritis & Rheum 1995; Mancuso et al., Arthritis Care & Research 2000; Gignac et al., J Occup Rehabil 2013

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Why Address Arthritis Work Disability Through Community Approaches?

3) Policies and resources exist in the community

  • The Americans with Disabilities Act
  • Job Accommodations Network (http://askjan.org/ )
  • Vocational rehabilitation services

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Promoting Activity and Participation Among Persons with Arthritis

Community-based Approaches : A Review

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

The Americans with Disability Act

  • Requires most employers to provide job

accommodations to employees with disabilities

  • Job accommodation: Any change in the work

environment, or in the way a job is performed, that enables a person with a disability to work productively

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Job Accommodations May Sustain Employment

  • Use of a wide variety of job accommodations extended

employment tenure (Chirico, 2000; Welch et al. 2009; Varekamp et al.

2008)

  • Job accommodation increased the length of time between
  • nset of a condition that limits work capacity and the

application for disability pension (Burkhauser, 1999)

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Job Accommodation Use by Employees with Rheumatic Conditions

  • Employed persons with rheumatic conditions frequently

report needing a job accommodation (Allaire, 2001)

  • Few employed persons with rheumatic conditions

receive job accommodations (Yelin, 2000; Allaire, 2001)

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Reasons for Scant Use of Job Accommodations

  • Individuals have to initiate job accommodation
  • May not be fully aware of how their health condition impacts

work activities

  • May not be aware of resources that are available to them
  • May not be aware of possible job accommodations or how to

access them

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

http://askjan.org/index.htm l

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Vocational rehabilitation

Vocational rehabilitation (VR) programs assist individuals with disabilities obtain and maintain employment.

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Job Retention VR Program for Employed Persons with Arthritis (Allaire et al., Arthritis Rheum, 2003)

  • Sample: 242 U.S. employed adults with a rheumatological

condition

  • Intervention: Education & counseling VR session focused
  • n job accommodation, career counseling, and

self-advocacy, written job retention materials

  • Control: Written job retention materials
  • Outcomes: Employment retention

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

VR Employment Retention Program for People with Rheumatic Conditions

0.5 0.6 0.7 0.8 0.9 1 1.1 6 12 18 24 30 36 42 48 54

Percent Remaining Employed Months from Randomization

(OR 0.58 ) Log rank test P=0.03

Job Retention Program Control (Allaire et la. 2003)

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

WES Demographic, Health and Work History

Section 1. Demographics

  • 1. Age___
  • 2. Gender _____ 3: Marital/family status: ___________
  • 4. Number of years of education _______ 5. Highest diploma/degree: _____

Other vocational training, certification, or license: ____________________ Health

  • Primary rheumatic condition: _________________________________
  • Number of years with rheumatic condition ______________________
  • Other health conditions/disabilities: ____________________________
  • Medications: _______________________________________________
  • Health Symptoms or issues: check any that are a problem

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

WES Barrier Checklist Example

Barriers (problems)

Section 2. Getting Ready for Work and Traveling to and from, or for Work Please check the items that are sometimes, or always, a problem for you. Getting ready for work

  • ____ Getting out of bed
  • ____ Extra time needed for dressing, preparing breakfast, etc.
  • ____ Doing stairs at home

Traveling to and from, or for work

  • _x__ Using public transportation (describe)__ Walking/standing/stairs___
  • ____ Driving - check which items are problems
  • ____ Turn head as needed for rear view
  • ____ Get in and out of vehicle
  • ____ Turn key in ignition
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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Other Vocational Rehabilitation Employment Retention RCTs in Rheumatology Populations

  • Positive impact
  • Job satisfaction
  • Job self-efficacy
  • Fatigue
  • Work performance

Studies had smaller sample sizes and shorter follow-up than Allaire et al. 2003

(Verekamp et al. 2011; deBuck et al., 2005; Lacaille et al., 2008)

  • No impact on
  • Employment retention

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

VR Job Retention Studies: Systematic Review

  • Studies: 9 RCTs, chronic conditions (e.g., diabetes,

rheumatological conditions, hearing disorders, multiple sclerosis)

  • Intervention: solving work-related problems (job

accommodations) and empowerment

  • Results: 4/5 studies beneficial effect

(Varekamp et al. Int Arch Occup Environ Health (2006)

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Cost Effectiveness

  • Very little research in this area
  • Not cost effective: Multidisciplinary job retention VR

program (van den Hout et al. Arthritis & Rheum 2007)

  • Sample size (N=121); study did not show an effect on

employment retention

  • Allaire et al.’s study very modest intervention with a

significant effect but costs were not studied

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Another approach…Exercise

  • Work activity limitations decreased and were maintained for 1

year

  • Employment retention??

Nyrop et al. Arthritis Care & Res, 2011

  • 94 participants who participated in the

Walk with Ease program who were working at baseline

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Summary

  • Some evidence that approaches targeting job

accommodations, career counseling, and empowerment can promote employment retention

  • Vocational rehabilitation approaches and exercise

programs can decrease symptoms and work limitations

  • Cost-effectiveness of approaches not well established

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Promoting Activity and Participation Among Persons with Arthritis

Approaches on the Horizon

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

On the Horizon: Can Other Health Professionals Deliver Employment Retention Programs

  • Physical and occupational therapists
  • Training programs to enhance the ability to intervene using

job accommodations and work disability resources

  • Results: positive view of program & approach

(O’Brien et al. 2013; Allaire & Keysor, 2009) Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Efficacy of a Modified Vocational Rehabilitation Program to Minimize Work Disability among Persons with Arthritis: “The Work It Study”

Keysor JJ, Allaire SA, ENACT Research Project #1, Boston University

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Work It Study: Objective

To evaluate the efficacy of a modified VR intervention

(focused on problem identification, job accommodation, and solution problem-solving processes) delivered by physical and occupational therapists to enhance work

  • utcomes among employed persons with rheumatic

conditions.

Keysor JJ, Allaire SA, Boston University, USA

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

“Work It” Study Design

Randomized controlled trial (N=287) Enrolled 2011-2013 2 year follow-up (enrollment completed; follow-up in process) Eligibility:

Age 23-65 Self-report of arthritis or rheumatological conditions (e.g.,

Osteoarthritis, Lupus, Fibromyalgia, Scleroderma) or chronic back pain

Employed at least part-time and concerned about ability to remain

employed

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

“Work It” Study Intervention

Intervention:

  • 1.5 hour meeting with an occupational therapist or physical

therapist: Barrier identification and accommodation planning Resource packet

  • 2 follow-up phone calls at 1 and 3 months
  • 9 therapists trained (4 hours in-person and 4 hours vignettes

and conference call discussion)

Control:

  • Resource packet

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Work It Results: Self-Reported Diagnosis

Variable Value Diagnosis* Osteoarthritis Rheumatoid Arthritis Chronic Low Back Pain Fibromyalgia Lupus Psoriatic Arthritis Ankylosing Spondylitis Systemic Sclerosis Sjogren’s Syndrome 123 (42.9%) 66 (23.0%) 45 (15.7%) 33 (11.5%) 27 (9.4%) 15 (5.2%) 4 (1.4%) 5 (1.7%) 5 (1.7%)

*some participants reported more than one diagnosis

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Results (Baseline): Work Limitations--Output

Variable Mean (Standard deviation)

Work Limitations Questionnaire * 35.3 (21.4)

Participants in this study were limited 35.3% of the time in the past two weeks

*Output demand scale score, 0 least limited, 100 most limited.

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Work It (Baseline) Results: Work Outcomes

Variable Mean (Standard deviation)

Job hours 36.2 (14.3) Days missed in the past 3 months 3.2 (7.1)

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Work It (Baseline) Results

Variable (Visual Analogue Scale)* Mean (Standard deviation) Pain (0-10) 6.2 (2.2) Fatigue (0-10) 6.7 (2.0) Stress (0-10) 6.3 (2.5) Job Satisfaction (0-10) 6.5 (2.7)

* 0 the least, 10 the most

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

On the Horizon:

Randomized Controlled Trial of the Web-Based E-Learning Model of Making It Work

Ongoing RCT: Can online web-teleconferencing

technologies that support a group educational program in conjunction with in-person VR and occupational therapy services minimize presenteeism and work loss?

Lacaille, D. Arthritis Research Center, Vancouver, Canada

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Promoting Activity and Participation Among Persons with Arthritis

Future Opportunities and Needs

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Next Steps: Critical Issues for the Field

  • More research—more RTCs to evaluate what works
  • More research—translating effective approaches to

practice

  • More research—cost effectiveness
  • Measurement
  • Inconsistent use of measures across studies
  • Responsive and sensitive measures to capture important

employment retention outcomes

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Acknowledgements:

NIDRR PR/Award #H133B100003

Saralynn Allaire, ScD Michael LaValley, PhD David Felson, MD, MPH Rawan Alheresh MS, OT Molly Vaughan, DPT Inbar Hanouna, MS Faye Cochran, BS