Employment and vocational rehabilitation
Hedström AK, Akerstedt T, Hillert J, et al. Shift work at young age is associated with increased risk for multiple sclerosis. Ann Neurol. 2011; 70(5):733-41.
The association between shift work at a young age and occurrence of MS in two independent studies strengthens the notion of a true relationship. Consequences of shift work such as circadian disruption and sleep restriction are associated with disturbed melatonin secretion and enhanced proinflammatory responses and may thus be part of the mechanism behind the association.
Glad SB, Nyland H, Aarseth JH, et al. How long can you keep working with benign multiple sclerosis? J Neurol Neurosurg Psychiatry 2011; 82(1):78-82.
188 patients with onset of MS during 1976-1986, were interviewed and clinically examined. After a mean disease duration of 22.2 years, 32.4% of the cohort were still employed. A relapsing-remitting course, higher educational level and light physical work significantly predicted longer time to disability pension in the total MS population. Among the benign MS patients, depressive symptoms, although mild, were strongly associated with not being employed.
Honarmand K, Akbar N, Kou N, et al. Predicting employment status in multiple sclerosis patients: the utility of the MS functional composite. J Neurol 2011; 258(2):244-9.
This study examined the demographic, neurological, neuropsychological, and personality factors associated with unemployment in MS. 106 patients (61.3% unemployed) completed the Brief Repeatable Battery of Neuropsychological Tests (BRBN), Hospital Anxiety and Depression Scale (HADS), and NEO Five-Factor Personality Inventory. The MSFC emerged as the most robust predictor of employment status in MS patients. Furthermore, a strong association was found between unemployment and the personality construct "Agreeableness", and severity of depression.
Morrow SA, Drake A, Zivadinov R, et al. Predicting loss of employment over three years in multiple sclerosis: clinically meaningful cognitive decline. Clin Neuropsychol 2010; 24(7):1131-45.
Aimed to determine neuropsychological (NP) markers of the transition from employment to work disability in MS, as indicated by degree of decline on individual tests. It was concluded that decline on NP testing over time is predictive of deterioration in vocational status, establishing a magnitude of decline on NP tests that is clinically meaningful.
Krokavcova M, Nagyova I, Van Dijk JP, et al. Self-rated health and employment status in patients with multiple sclerosis. Disabil Rehabil 2010; 32(21):1742-8.
Explores the association between self-rated health and employment status in patients with multiple sclerosis when controlling for age, gender, functional disability, disease duration, anxiety and depression. Patients with MS with good self-rated health are more likely to be employed, even after adjusting for age, gender, education, functional disability, disease duration, depression and anxiety.
Simmons RD, Tribe KL, McDonald EA. Living with multiple sclerosis: Longitudinal changes in employment and the importance of symptom management. J Neurol 2010; 257(6): 926-936.
In two large-sample, self-report surveys of MS patients performed 4 years apart, employment rates were measured both cross-sectionally and longitudinally. The reasons for employment loss and perceived risk of future employment loss were also assessed. The potential advantages of early, supported disclosure of diagnosis to
Rumrill PD. Challenges and opportunities related to the employment of people with multiple sclerosis. J Vocat Rehabil 2009; 31 (2): 83-90.
This article describes the current employment scene for individuals with multiple sclerosis (MS) and discusses a number of factors that have been associated with the high rate of joblessness among people with this chronic, unpredictable disease. Implications for research, policy, and vocational rehabilitation service delivery are presented throughout the article.
Pack TG, Szirony GM. Predicting readiness to return to work in a population with multiple sclerosis. J Voc Rehabil 2009; 31(2): 91-105.
An individual's readiness to return to work has been shown to be an effective predictor of that person's actual return to work. A survey of a population of people with MS (N = 663) was analyzed using correlation and multiple regression analyses. Severity of symptoms appeared to predict reported readiness to return to work over other factors. Issues including the relationship of self-efficacy to readiness to return to work are discussed.
Khan F, Ng L, Turner-Stokes L. Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis. Cochrane Database Syst Rev 2009; (1): CD007256.
Systematic review evaluated the effectiveness and cost-effectiveness of vocational rehabilitation programs compared to alternative programs or care as usual on return to work, workability and employment in people with MS. Authors conclude that there was inconclusive evidence to support vocational rehabilitation for people with MS. However, the review highlights some of the challenges in providing such programs and makes recommendations for implementation of and future research into vocational rehabilitation programs
Messmer Uccelli M, Specchia C, Battaglia MA, et al. Factors that influence the employment status of people with multiple sclerosis: a multi-national study. J Neurol 2009; Article in Press
A multi-national questionnaire assessed aspects related to employment that facilitate or hinder job maintenance. Data was collected in 18 European countries. A total of 1,141 questionnaires were completed. Of those responding, 694 (61%) subjects were employed and 477 (39%) were unemployed. The items that significantly differentiated the groups were related to MS symptoms, workplace environment and financial considerations
McCabe MP, Roberts C, Firth L, et al. Work and recreational changes among people with neurological illness and their caregivers. Disabil Rehabil 2008; 30(8): 600-610
The current study investigated changes in work and recreational activities among people with four different neurological conditions: 28 with multiple sclerosis; 27 with motor neurone disease; 31 with Parkinson's; and 24 with Huntingtons disease. In addition, 28 professionals who worked with these populations participated in the study. Individual interviews were conducted and the results are discussed in terms of proposed prevention and intervention programmes
Julian LJ, Vella L, Vollmer T, et al. Employment in multiple sclerosis: exiting and re-entering the work force. J Neurol 2008; 255 (9): 1354-1360
This investigation evaluated patient and disease characteristics associated with work loss and work initiation using the NARCOMS patient registry. Patient and disease characteristics associated with transitions to unemployment or employment were evaluated. Specific physical and mental health limitations confer risk of employment cessation over time, as well as the likelihood of employment initiation
Townsend, G. Supporting people with multiple sclerosis in employment: A United Kingdom survey of current practice and experience. Br J Occup Ther 2008; 71 (3): 103-111.
This article reports on one section of a larger project, which examined employment issues from the perspectives of people with MS and the professionals who may support them in retaining or regaining employment. A postal questionnaire was used to elicit a wide range of responses. The article identifies gaps in the provision of support and discusses the need to develop effective interventions targeted at supporting people with MS in work.
Sweetland J, Riazi A, Cano SJ, et al. Vocational rehabilitation services for people with multiple sclerosis: what patients want from clinicians and employers. Mult Scler 2007; 13 (9): 1183-1189.
The aim of the study was to identify what people with MS require from a vocational rehabilitation service in terms of content and service delivery. Study concludes that people with MS need support in the workplace in two distinct ways. The study highlights the key needs of people with MS and the support that ought to be offered to help them address these needs
Ville I, Winance M. To work or not to work? The occupational trajectories of wheelchair users. Disabil Rehabil 2006; 28(7): 423-6.
Found working and not working less dependent on wheelchair status than on person with MS’s adjustment and attitude to using a wheelchair. Interventions should focus on this adjustment as much as on return to work.
Johnson KL, Fraser RT. Mitigating the impact of multiple sclerosis on employment. Phys Med Rehab Clin America 2005;16:571-582.
Identifies societal social policy barriers as well as MS specific barriers faced in employment
Pompeii LA, Moon SD, McCrory DC. Measures of physical and cognitive function and work status among individuals with multiple sclerosis: a review of the literature. J Occup Rehabil 2005; 15(1): 69-84.
Review of literature shows that ability to work is dependent on a range of factors, not just level of physical and cognitive ability which are in themselves poor indicators of work status.
Rumrill R, Roessler R, Vierstra C, Hennessey M, Staples L. Workplace barriers and job satisfaction among employed people with multiple sclerosis: an empirical rationale for early intervention. J Vocat Rehabil 2004; 20(3): 177-83.
Difficulties with getting to work and barriers to some essential functions prevent more people from working than other, symptom-based, problems. Early intervention to anticipate some of these issues is suggested.
Johnson KL, Yorkston KM, Klasner ER, Kuehn CM, Johnson E, Amtmann D. The costs and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis. Arch Phys Med Rehabil 2004; 85(2): 201-9.
Qualitative study of benefits and drawbacks people with MS experience in relation to work. All involved valued work but were aware of the costs of being employed. Suggests that decisions to work or not work are complicated and that there are critical periods of intervention to stabilise the cost-benefit balance.
Dyck I, Jongbloed L. (2000). Women with multiple sclerosis and employment issues: A focus on social and institutional environments. Canadian Journal of Occupational Therapy, 67(5), 337-346.
This is written by OTs and is a mixed methods study of women and work discussion of how women’s employment may be impacted by non-MS issues e.g. support with child-care and domestic activities. Issues of identity and costs and benefits of employment are also discussed.
Fitzgerald MH, Paterson KA. The hidden disability dilemma for the preservation of self. Journal of Occupational Science 1995;2(1):31-21
Highlights the dilemmas that may be faced in disclosing a diagnosis of MS in the work environment.