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Meta-Analysis
. 2013 Sep-Oct;18(5):e94-e100.
doi: 10.1155/2013/829464.

Does pain in individuals with multiple sclerosis affect employment? A systematic review and meta-analysis

Shahnaz Shahrbanian, Mohammad Auais, Pierre Duquette, Katie Andersen, Nancy E Mayo
Meta-Analysis

Does pain in individuals with multiple sclerosis affect employment? A systematic review and meta-analysis

Shahnaz Shahrbanian et al. Pain Res Manag. 2013 Sep-Oct.

Erratum in

  • Pain Res Manag. 2013 Nov-Dec;18(6):328. Anderson, Katie [corrected to Andersen, Katie]

Abstract
in English, French

Background: Individuals with multiple sclerosis (MS) experience some of the highest unemployment rates among all groups of chronic illnesses. Pain has been found to be a common reason for sick leave or early retirement in healthy populations or other groups with chronic illness; however, there is little awareness regarding the effect of pain on the work status of individuals with MS.

Objectives: To estimate the extent to which individuals with pain differ in employment status compared with those without pain among MS patients.

Methods: An extensive systematic review of the scientific literature was performed within the framework of the Cochrane Collaboration to identify studies focusing on the effect of pain on employment in individuals with MS. The following databases were searched: PubMed, EMBASE, PsychInfo, Web of Science, MD Consult and Elsevier, and Science Direct. The methodological quality of studies was assessed using the McMaster Critical Review Form.

Results: Ten articles met the inclusion criteria and were included in the systematic review. Of these studies, five that exhibited clinical, methodological and statistical homogeneity were included in the meta-analysis. The between-groups (pain + versus pain -) pooled random OR of being employed was 0.7 (strong), and was significantly different from unity (95% CI 0.5 to 0.9; P=0.001).

Conclusions: The results of the present study indicated that individuals with MS who experience pain were significantly more likely to report a decreased employment rate than individuals with MS who were pain free.

HISTORIQUE :: Les personnes atteintes de sclérose en plaques (SP) présentent l’un des taux de chômage les plus élevés de tous les groupes de maladie chronique. Il est établi que la douleur est une raison courante de prendre un congé de maladie ou une retraite anticipée dans les populations en santé ou d’autres groupes ayant une maladie chronique. Cependant, on ne sait pas grand-chose de l’effet de la douleur sur le statut d’emploi des personnes atteintes de SP.

OBJECTIFS :: Évaluer dans quelle mesure le statut d’emploi des personnes atteintes de SP qui sont victimes de douleurs diffère de celui des personnes atteintes de SP qui n’en sont pas victimes.

MÉTHODOLOGIE :: Les chercheurs ont effectué une vaste analyse systématique des publications scientifiques dans le cadre de la Collaboration Cochrane afin d’extraire les études portant sur l’effet de la douleur sur l’emploi des personnes atteintes de SP. Ils ont fouillé les bases de données suivantes : PubMed, EMBASE, PsychInfo, Web of Science, MD Consult et Elsevier, ainsi que Science Direct. Ils ont évalué la qualité méthodologique des études au moyen du formulaire d’examen critique McMaster.

RÉSULTATS :: Dix articles respectaient les critères d’inclusion et ont été inclus dans l’analyse systématique. De ce nombre, les cinq qui présentaient une homogénéité clinique, méthodologique et statistique ont fait partie de la méta-analyse. Le risque rapproché aléatoire regroupé des intergroupes (douleur + par rapport à douleur −) à avoir un emploi s’élevait à 0,7 (fort), ce qui différait de manière significative de l’unité (95 % IC 0,5 à 0,9; P=0,001).

CONCLUSIONS :: Selon les résultats de la présente étude, les personnes atteintes de SP victimes de douleurs étaient significativement plus susceptibles de déclarer un taux d’emploi moins élevé que celles qui n’en étaient pas victimes.

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Figures

Figure 1)
Figure 1)
Graphic display of the study selection process (60)
Figure 2)
Figure 2)
Forest plot of the effect of pain on employment status. The far left column lists the names of the studies, in chronological order, and the far right column shows a plot of comparison. For each study, the OR is shown as a square, with area proportional to the sample size. The 95% CI is represented by the horizontal line around each square. The vertical line in the middle is called ‘the line of no effect’, which visually displays the study overall results (42). The bottom line on this plot is marked ‘Random’ and shows the combined effect or difference for the studies (44). The overall OR and 95% CI are plotted by the diamond in the last row of the graph. Because the diamond does not cross the ‘line of no effect’, the calculated difference between groups is considered to be statistically significant (42). The OR falls below 1, indicating that patients with multiple sclerosis pain were less likely to be employed than individuals with multiple sclerosis without pain
Figure 3)
Figure 3)
Funnel plot of the study to assess the presence of possible publication bias. A symmetrical inverted funnel, as shown, implies no publication bias. The dashed vertical line represents the pooled estimate of the pain effect of all included studies
See this image and copyright information in PMC

References

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