Arthritis And The Workplace

Transcription

1 1 Arthritis And The Workplace Work Wellness and Disability Prevention Institute Public Webinar Series January 16th, 2019 Diane Lacaille, MD MHSc FRCPC Professor, Rheumatology, University of British Columbia, Senior Scientist, Associate Scientific Director, Arthritis Research Canada

2 2 Disclosures No relevant disclosure

3 3 Learning Objectives Appreciate the impact of arthritis on employment Learn about the risk factors for work loss and for reduced productivity at work (presenteeism) Understand the workplace challenges faced by workers with arthritis Learn strategies to help workers with arthritis address work-related issues, including discussing disclosure, supporting job accommodations, and assessing the need for ergonomic modifications

4 4 IMPACT OF ARTHRITIS ON THE WORKPLACE

5 Work Disability from Arthritis High cost to society: (Public Health Agency of Canada, 2010) Indirect costs $4.3 Billion/yr in 2000 only incl. LT WD Exceeds direct costs ($2.1 Billion/yr) Arthritis and MSK conditions: most common health reason why people stop working in Canada. Systematic Reviews of work disability (WD) rates: In rheumatoid arthritis (RA) % within 10 years. In psoriatic arthritis 2 prevalence ranged 16-39% In systemic lupus (SLE) 3 prevalence ranged 20-40% 1. Burton W et al. 2006; 2. Tillet W et al. 2012; 3. Baker et al 2009

6 Occurrence of Work Disability Studies show that work disability occurs early in the course of RA Work disability rates 18% at 5 years 27% at 10 years Lacaille D et al

7 Work Loss from Arthritis WD rates have improved over time in RA, but remain high despite advances in treatment: Annual WD rates of 6% in a US cohort (Wolfe) treated with DMARDs and biologics as needed (Allaire 2008) Risk of adverse work outcomes RA vs. gen pop controls in Danish registry (DANBIO) (Hansen 2017) HR (95% CI) (HR (95% CI) Risk of sick leave 2.25 (1.99; 2.54) 1.63 (1.51; 1.75) Risk of WD 3.49 (2.83; 4.32) 2.40 (2.15; 2.69)

8 Other impact on work Sick leave 84% reported sick leave in prior 2.5 years (duration days per month) 1 Review European studies: days missed/year 2 Other forms of work loss 3 Fewer work hours/week Early retirement Choosing to stay at home Other impact on work Reduced career advancement Reduced job satisfaction 1. Lenssinck LB et al. 2014; 2. Birnbaum H et al. 2009; 3. Gignac MA et al

9 Presenteeism: Decreased Productivity at Work US workers reporting arthritis pain 1 : 86% reported reduced productivity from presenteeism productivity loss from presenteeism > 4 times greater than productivity loss from days missed (mean 4.5 vs 0.7 hrs/week) Canadian Study on indirect cost from OA and RA 2 : Cost from Presenteeism (41%) higher than from wage loss (37%) or absenteeism (12%) 2 US longitudinal study ( ) Workers with RA had 5% reduction in productivity compared to healthy workers 3 1. Stewart WF et al 2003; 2. Li X et al. 2006; 3. Walker N et al

10 10 Personal Impact of Job Loss Economic impact (lower income, retirement savings) Loss of access to benefits (meds, other treatments) Associated with lower self-reported physical and mental health and lower quality of life Loss of self-identity, sense of contribution to society Loss of social interactions, lower social support Higher risk of mortality in unemployed

11 11 FACTORS PREDICTING WORK DISABILITY OR AT-WORK PRODUCTIVITY

12 Clinical Features Measures of disease activity (joint counts, SLEDAI or SLAM, BASDAI) and severity Measures of physical function (e.g. HAQ, BASFI, SF36) Pain Fatigue Disease duration Extra articular features: uveitis, IBD (AS); Neuro (SLE) Co-morbidities: Depression, fibromylagia Good clinical care and control of arthritis are important

13 Socio-demographic Factors Factors linked to a greater risk of WD include Older age Being female Less education, lower income Not being married

14 Job Characteristics Associated with higher risk of WD or presenteeism: Greater physical demand, esp. repetitive tasks (physical demand not as important in some more recent studies) Low job autonomy: lack of control over pace and how the job is done Greater job strain, job stress, job spillover Preference for not working, Poor support from co-workers and employers Difficulty commuting

15 Job Characteristics Associated with lower risk of WD or presenteeism: Self-employment: 6-fold lower WD risk Ergonomic modification: 2.5-fold lower risk among people who had adapted their work station Employer awareness and support Family support for working

16 WORKPLACE CHALLENGES FACED BY PEOPLE LIVING WITH IA RESULTS OF QUALITATIVE STUDIES Lacaille D et al. Arthritis Rheum 2007;57:

17 Arthritis Symptoms Limiting Work Fatigue was THE most important problem at work Patients report not knowing how to manage it Other features limiting ability to work: Pain physical limitations Arthritis is not visible to others Variability/unpredictability of symptoms

18 Working Conditions a Priority Working conditions are a priority in job choice Need for control over organization of work Advantages of flexible work arrangements Not too much/too little physical activity Short commute/little need to travel for work Ergonomic modifications Helpful but difficult to obtain

19 Interpersonal Issues at Work Many workers don t disclose their arthritis at work 30-50% do not disclose their condition Emotional barriers Relationships with co-workers seemed more challenging than with supervisor Misconceptions and lack of understanding

20 Interpersonal Issues at Work Why some workers don t use available supports: Maintaining invisibility Avoiding co-workers resentment Concern about cost to employer Don t know what is available or how to get it Readiness to accept help

21 Emotional Challenges Anxiety, Depression, Guilt High personal cost of working Some gave up everything else to keep working No energy after work for family and friends Reduced self-confidence in abilities at work Reduced job satisfaction or career advancement Fear of financial insecurity

22 ADDRESSING WORK RELATED ISSUES

23 Routine Assessment of Work Health services addressing employment has been identified by patients as an important unmet need 1 3 Need to address issues of employment routinely with all patients Like functional assessment and ADLs Should be everyone s responsibility, not done by most Identify people at high risk of work loss 1. Mancuso CA et al.arthritis Care Res 2000; 13:89-99; 2. Gilworth G et al. Rheumatol 2001;40(11): ; 3. Lacaille D et al. Arthrits Rheum 2007;57:

24 Identifying People at High Risk of Work Loss Work Instability Scale (RA-WIS) Designed to identify RA patients at increased risk of work loss, warranting referral for vocational assessment Score reflects answers to 23 Yes/No questions Low risk Medium risk High risk Gilworth G et al. Arthritis Rheum 2003; 49(3):

25 Missing Work: Sign to intervene Frequent missed days from work, prolonged sick leave, or short-term WD should be a red flag to intervene Once an individual has completely stopped working, it is difficult to reverse the situation Longer work cessation reduces odds of returning to work 3 6 month absence <50% return rate 12 month absence <20% 1 80% of workers absent for 6 weeks need some assistance to return to work 2 1. NIDMAR 1995; 2. Thorne JM et al. Aust J Rehab Couns 2002; 8(1):50-63.

26 Education Help restore self-confidence in ability to work and ability to alter employment outcome Planning early is key; better to Anticipate problems Make changes early, while disease well controlled Employer likely more receptive to workplace adaptations before problems become worse

27 Roles of Health Care Professionals Help identify workplace problems and find solutions Work Experience Survey (WES-RC): structured interview modified for rheumatic conditions designed to identify problems at work and develop solutions Recommend job accommodations Liaise with the employer Letter helpful to legitimize the condition and the need for accommodation Share information on resources and services Discuss disclosure

28 Job Accommodations Adjustments to better adapt job to the abilities of the worker with arthritis Adjusting work hours Modifying job description or way job is done Ergonomic modifications Resource for identifying useful job accommodations on JAN website:

29 Duty to Accommodate Law Employers have Duty to Accommodate disability up to point of Undue Hardship Employer must provide reasonable accommodation not necessarily what was requested When requesting a job accommodation Do homework beforehand: present problem with solutions, research options, find out costs Think about what is the minimum acceptable HCPs can help improve people s self-efficacy at requesting job accommodations

30 Disclosure Need to think about what, when, how much and to whom to disclose Careful weighing of pros and cons Support measures at workplace may become available following disclosure However, no obligation to disclose unless disability affects performance of work duties Try role play with social worker, VRC, OT or friends Always present employer with a solution alongside disclosure of disability

31 Employment HCPs HCPs who specialize in employment issues are underutilized Occupational therapist (OT) Vocational rehabilitation counsellor (VRC) Social worker Ergonomic modifications, job accommodations and job retention vocational counselling have been associated with reduced risk of work loss

32 Occupational Therapist Ergonomic assessment at work Identify ergonomic risks Recommend and help obtain ergonomic modifications Ergonomist available through workplace or benefit plan At work vs outside assessment Issues of disclosure Ergonomic Assessment Tool for people with Arthritis (EATA) Backman CL et al. Arthritis Rheum 2008;59:

33 Vocational Rehabilitation Counsellors VRCs counsel for rehabilitation and work retention Better to prevent then wait until off-work New trend: job retention vocational counselling Evaluate work situation, suggest accommodations Provide career planning Suggest resources to help worker and employer Two sessions with a VRC significantly reduced job loss rate by 50% in people with IA Allaire SH et al. Arthritis Rheum 2003;48:

34 Making It Work TM Program Intervention to prevent WD and improve at-work productivity in people with IA Aims Modify risk factors for work disability Enhance self-management of work problems Features Individual e-learning modules Online group discussions and activities One-on-one sessions with professional OT or VRC Lacaille D et al

35 Summary Workers with arthritis face increased risk of WD, loss of income, emotional impact and financial insecurity Work issues should be addressed routinely by all members of healthcare team Identify at-risk workers and act early Helping workers address challenges at work: Effective disease control, access to health care services Referral to OTs and VRCs Workplace accommodation

36 Thank you!

37 37 Acknowledgements Co-investigators. Research funded by peer-reviewed grants from CIHR Dr Lacaille holds the Mary Pack Chair in Arthritis Research From The Arthritis Society and UBC