Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2009 Jan 21;2009(1):CD007256.
doi: 10.1002/14651858.CD007256.pub2.

Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis

Fary Khan  1 , Louisa Ng, Lynne Turner-Stokes
Affiliations
Meta-Analysis

Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis

Fary Khan et al. Cochrane Database Syst Rev. .

Abstract

Background: Multiple sclerosis is a neurological disease that frequently affects adults of working age, resulting in a range of physical, cognitive and psychosocial deficits that impact on workforce participation. Although, the literature supports vocational rehabilitation (VR) approaches in persons with multiple sclerosis (pwMS), the evidence for its effectiveness is yet to be established.

Objectives: To evaluate the effectiveness of VR programs compared to alternative programs or care as usual on return to work, workability and employment in pwMS; to evaluate the cost effectiveness of these programs.

Search strategy: Electronic searches included: Cochrane Central Register of Controlled Trials "CENTRAL" 2008 issue 3, MEDLINE (PubMed) (1966- 2008), EMBASE (1988- 2008), CINAHL (1982- 2008), PEDro (1990- 2008), the Cochrane Rehabilitation and Related Therapies Field trials Register and the National Health Service National Research Register.

Selection criteria: Randomized and controlled clinical trials, including before - after controlled trials, that compare VR rehabilitation with alternative intervention such as standard or a lesser form of intervention or waitlist controls.

Data collection and analysis: Two reviewers selected trials and rated their methodological quality independently. A 'best evidence' synthesis was performed, based on methodological quality. Trials were grouped in terms of type and setting of VR programs.

Main results: Two trials (one RCT and one CCT) (total 80 participants) met the review criteria. Both trials scored poorly on the methodological quality assessment. There was 'insufficient evidence' for VR programs for (a)'competitive employment', in altering rates of job retention, changes in employment, improvement in rates of re-entry into the labour force; (b) for altering 'work ability' by improving participants' confidence in the accommodation request process, or employability maturity or job seeking activity. No evidence could be assimilated for changes in proportions of persons in supported employment or on disability pensions, nor for cost-effectiveness.

Authors' conclusions: There was inconclusive evidence to support VR for pwMS. However, the review highlights some of the challenges in providing VR for pwMS. Clinicians need to be aware of vocational issues, and to understand and manage barriers for maintaining employment. Proactive and timely VR programs should incorporate practical solutions to deal with work disability, workplace accommodation and educate employers, and the wider community. Liaison with policy makers is imperative for government initiatives that encourage work focused VR programs. Future research in VR should focus on improving methodological and scientific rigour of clinical trials; on the development of appropriate and valid outcome measures; and on cost effectiveness of VR programs.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 VR of high intensity versus VR of low intensity, Outcome 1 Rate of Employment.
2.1
2.1. Analysis
Comparison 2 VR vs minimal intervention, Outcome 1 Rate of Unemployment.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

LaRocca 1996 {published data only}
    1. LaRocca NG, Kalb RC, Gregg K. A program to facilitate retention of employment among persons with multiple sclerosis. Work 1997;7:37‐46. - PubMed
Rumrill 1998 {published data only}
    1. Rumrill PD, Roessler RT, Cook BG. Improving career re‐entry outcomes for people with multiple sclerosis: a comparison of two approaches. Journal of Vocational Rehabilitation 1998;10(3):241‐52.

References to studies excluded from this review

Lee 2005 {published data only}
    1. Lee RKY, Chan CCH. Factors affecting vocational outcomes of people with chronic illness participating in a supported competitive open employment program in Hong Kong. Work 2005;25:359‐68. - PubMed
Roessler 1997 {published data only}
    1. Roessler RT, Kirk HM, Brown PL. Chronic illness and return to work: a social cognitive perspective. Work 1997;8:189‐96. - PubMed
Rumrill 1997 {published data only}
    1. Rumrill PD, Garnette MR. Career adjustment via reasonable accommodations: the effects of an employee‐empowerment intervention for people with disabilities. Work 1997;9:57‐64. - PubMed

Additional references

Access Economics 2005
    1. Access Economics. Acting positively: Strategic implications of the economics costs of Multiple Sclerosis in Australia. MS Australia 2005.
Aronson 1997
    1. Aronson KJ. Quality of life among persons with multiple sclerosis and their caregivers. Neurology 1997;48:74‐80. - PubMed
Atlas 2004
    1. Collaborative study between World Health Organization and the World Federation of Neurology. Atlas: country resources for neurological disorders 2004. France: World Health Organization, 2004. [http://www.who.int/mental_health/neurology/neurogy_atlas_lr.pdf]
Beatty 1995
    1. Beatty WW, Blanco CR, Wilbanks SL, Paul RH, Hames KA. Demographic, clinical, and cognitive characteristics of multiple sclerosis patients who continue to work. Journal of Neurologic Rehabilitation 1995;9(3):167‐73.
BRSM 2003
    1. BRSM. Vocational Rehabilitation ‐ The Way Forward. In: Frank, A editor(s). British Society Rehabilitation Medicine (BRSM). 2nd Edition. London: BRSM, 2003.
BSRM 2000
    1. British Society of Rehabilitation Medicine. Vocational rehabilitation: The way forward. London: British Society of Rehabilitation Medicine, 2000.
Catanzaro 1992
    1. Catanzaro M, Weinert C. Economic status of families living with multiple sclerosis. International Journal of Rehabilitation Research 1992;15:209‐18. - PubMed
Crowther 2001
    1. Crowther R, Marshall M, Bond GR, Huxley P. Vocational rehabilitation for people with severe mental illness. Cochrane Database of Systematic Reviews 2001, Issue 2. [DOI: 10.1002/14651858.CD003080; CD003080] - DOI - PMC - PubMed
Dyck 1995
    1. Dyck I. Hidden geographies: the changing lifeworlds of women with multiple sclerosis. Social Science Medicine 1995;40:307‐20. - PubMed
Egger 1998
    1. Egger M, Smith GD. Bias in location and selection of studies. BMJ 1998;316(7124):61‐6. - PMC - PubMed
Fraser 2003
    1. Fraser R, McMahon B, Dancy‐Hawley C. Progression of disability benefits: a perspective on multiple sclerosis. Journal of Vocational Rehabilitation 2003;19(3):173‐9.
Goetzsche 1987
    1. Goetzsche PC. Reference bias in reports of drug trials. BMJ 1987;295:654‐6. - PMC - PubMed
Gronning 1990
    1. Gronning M, Hannisdal E, Mellgren I. Multivariate analysis of factors associated with unemployment in people with multiple sclerosis. Journal of Neurology, Neurosurgery and Psychiatry 1990;53:388‐90. - PMC - PubMed
Hassink 1993
    1. Hassink G, Manegold U, Poser S. Early retirement and occupational rehabilitation of patients with multiple sclerosis. Rehabilitation (Stuttg) 1993;32(2):139‐45. - PubMed
Higgins 2005
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.5 [updated May 2005] 11a. Appendix B. http://www.cochrane.org/resources/handbook/hbook.htm 2005.
ICF 2001
    1. International Classification of Functioning, Disability and Health (ICF). World Health Organization (WHO), Geneva 2001.
Jackson 1991
    1. Jackson MF, Quaal C, Reeves MA. Effects of multiple sclerosis on occupational and career patterns. Axon 1991 1991;Sept:16‐22. - PubMed
Johnson 2004
    1. Johnson K, Amtmann D, Yorkston K, Klasner ER, Kuehn CM. Medical, psychological, social and programmatic barriers to employment for people with multiple sclerosis. Journal of Rehabilitation 2004;70:38‐50.
Jongbloed 1996
    1. Jongbloed L. Factors influencing employment status of women with multiple sclerosis. Canadian Journal of Rehabilitation 1996;9:213‐22.
Khan 2007
    1. Khan F, Turner Stokes L, Ng L, Kilpatrick T. Multidisciplinary rehabilitation for adults with multiple sclerosis. Cochrane Database of Systematic Reviews 2007, Issue 2. [DOI: 10.1002/14651858.CD006036.pub2] - DOI - PMC - PubMed
Khan 2007a
    1. Khan F, Pallant J. Use of International Classification of Functioning, Disability and Health (ICF) to describe patient‐reported disability in Multiple Sclerosis and identification of relevant environmental factors. J Rehab Med 2007;39:63‐70. - PubMed
Khan 2007b
    1. Khan F, Pallant J. Use of the International Classification of Functioning, Disability and Health (ICF) to identify preliminary comprehensive and brief core sets for Multiple Sclerosis. Disability and Rehabilitation 2007;29(16):1241‐60. - PubMed
Kornblith 1986
    1. Kornblith AB, LaRocca NG, Baum HM. Employment in individuals with multiple sclerosis. International Journal of Rehabilitation Research 1986;9(2):155‐65. - PubMed
LaRocca 1985
    1. Rocca N, Kalb R, Scheinberg L, Kendall P. Factors associated with unemployment of patients with multiple sclerosis. Journal of Chronic Diseases 1985;38(2):203‐10. - PubMed
Minden 1993
    1. Minden SL, Marder WD, Harrold LN, Dor A. Multiple Sclerosis, A Statistical Portrait. A Compendium of Data, Demographics, Disability and Health Services Utilization in the United States Prepared for the National Multiple Sclerosis Society by AbtAssociates, Inc 1993.
Morales 2004
    1. Morales‐ Gonzalez JM, Benito Leon J, Rivera Navarro J, Mitchell AJ. A systematic approach to analyse health related quality of life in multiple sclerosis: the GEDMA study. Multiple sclerosis 2004;10:47‐54. - PubMed
Murphy 1998
    1. Murphy N, Confavreux C, Haas J, König N, Roullet E, Sailer M, et al. Economic evaluation of multiple sclerosis in the UK, Germany and France. Pharmacoeconomics 1998;13(5 Pt 2):607‐22. - PubMed
Nair 2008
    1. Nair A, Turner‐Stokes L, Tyerman A. Vocational rehabilitation for acquired brain injury in adults. Cochrane Database of Systematic Reviews 2008, Issue 3. [DOI: 10.1002/14651858.CD006021.pub2; CD006021] - DOI
NSF 2005
    1. The National Service Framework for Long term conditions. The Department of Health 2005.
Pathways 2002
    1. Pathways to work. http://www.jobcentreplus.gov.uk/jcp/customers/programmesandservices/path....
Poser 1983
    1. Poser CM, Paty DW, Scheinberg LC, McDonald WI, Davis FA, Ebers GC, et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Annals of Neurology 1983;13:227‐31. - PubMed
Sirvastava 2005
    1. Sirvastava S, Chaberlain MA. Factors determining job retention and return to work for disabled employees: a questionnaire study of opinions of disabled peoples organizations in the UK. Journal of Rehabilitation Medicine 2005;37:17‐22. - PubMed
Smith 2005
    1. Smith MM, Arnett PA. Factors related to employment changes in individuals with multiple sclerosis. Multiple Sclerosis 2005;11:602‐9. - PubMed
Turner‐Stokes 2005
    1. Turner‐Stokes L, Nair A, Sedki I, Disler PB, Wade DT. Multi‐disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database of Systematic Reviews 2005, Issue 3. [DOI: 10.1002/14651858.CD004170.pub2; CD004170] - DOI - PubMed
Tyerman 2004
    1. Tyerman A, Meehan M. Vocational assessment and rehabilitation after acquired brain injury: interagency guidelines. Vocational assessment and rehabilitation after acquired brain injury: interagency guidelines. London: British Society of Rehabilitation Medicine /JobcentrePlus/Royal College of Physicians, 2004.
van Tulder 2003
    1. Tulder MW, Furlan A, Bombardier C, Bouter L. Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group. Spine 2003;28(12):1290‐9. - PubMed
Waddell 2006
    1. Waddell G, Burton A. Is work good for your health and well being?. Department of Work and Pensions 2006.
Yorkston 2005
    1. Yorkston KM, Johnson KL, Klasner ER. Taking part in life: enhancing participation in multiple sclerosis. Physical Medicine and Rehabilitation Clinics of North America 2005;16:583‐94. - PubMed