Job retention vocational rehabilitation for employed people with inflammatory arthritis (WORK-IA): a feasibility randomized controlled trial

Abstract

Background: Inflammatory arthritis leads to work disability, absenteeism and presenteeism (i.e. at-work productivity

loss) at high cost to individuals, employers and society. A trial of job retention vocational rehabilitation (VR) in the

United States identified this helped people keep working. The effectiveness of this VR in countries with different

socioeconomic policies and conditions, and its impact on absenteeism, presenteeism and health, are unknown.

This feasibility study tested the acceptability of this VR, modified for the United Kingdom, compared to written

advice about managing work problems. To help plan a randomized controlled trial, we tested screening,

recruitment, intervention delivery, response rates, applicability of the control intervention and identified the

relevant primary outcome.

Methods: A feasibility randomized controlled trial with rheumatoid, psoriatic or inflammatory arthritis patients

randomized to receive either job retention VR or written information only (the WORK-IA trial). Following three

days VR training, rheumatology occupational therapists provided individualised VR on a one to one basis. VR

included work assessment, activity diaries and action planning, and (as applicable) arthritis self-management

in the workplace, ergonomics, fatigue and stress management, orthoses, employment rights and support

services, assistive technology, work modifications, psychological and disclosure support, workplace visits and

employer liaison.

Results: Fifty five (10%) people were recruited from 539 screened. Follow-up response rates were acceptable

at 80%. VR was delivered with fidelity. VR was more acceptable than written advice only (7.8 versus 6.7). VR

took on average 4 h at a cost of £135 per person. Outcome assessment indicated VR was better than written

advice in reducing presenteeism (Work Limitations Questionnaire (WLQ) change score mean: VR = −12.4 (SD

13.2); control = −2.5 (SD 15.9), absenteeism, perceived risk of job loss and improving pain and health status,

indicating proof of concept. The preferred primary outcome measure was the WLQ, a presenteeism measure.

Conclusions: This brief job retention VR is a credible and acceptable intervention for people with

inflammatory arthritis with concerns about continuing to work due to arthritis.