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Meta-Analysis
. 2014 Nov 6;2014(11):CD010208.
doi: 10.1002/14651858.CD010208.pub2.

Non-pharmacological interventions for preventing job loss in workers with inflammatory arthritis

Jan L Hoving  1 , Diane Lacaille, Donna M Urquhart, Timo J Hannu, Judith K Sluiter, Monique H W Frings-Dresen
Affiliations
Meta-Analysis

Non-pharmacological interventions for preventing job loss in workers with inflammatory arthritis

Jan L Hoving et al. Cochrane Database Syst Rev. .

Abstract

Background: Work participation of patients with inflammatory arthritis (IA) is important not only economically but also for physical and psychological health. There is no Cochrane Review to date on studies of non-pharmacological interventions specifically aimed at preventing job loss in people with IA.

Objectives: To assess the effects of non-pharmacological interventions that aim to prevent job loss, work absenteeism or improve work functioning for employees with IA (rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), other spondylarthritis (SpA) or IA associated with connective tissue diseases, such as Systemic Lupus Erythematosus (SLE)).

Search methods: We searched the following databases from inception up to 30 April 2014; The Cochrane Library (including Cochrane Central Register of Controlled Trials, i.e. CENTRAL and DARE), MEDLINE (PubMed), EMBASE (Embase.com), CINAHL (EbSCOhost), ClinicalTrials.gov and PsycINFO (ProQuest). We did not impose language restrictions in the search.

Selection criteria: We included randomised controlled trials (RCTs) that evaluated interventions aimed at preventing job loss in adults of working age (18 to 65 years) diagnosed with IA, including RA, AS, PsA, SpA or other types of IA. Primary outcomes were job loss and sickness absenteeism and the secondary outcome was work functioning.

Data collection and analysis: Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias in the included RCTs.

Main results: We included three RCTs with a total of 414 participants at risk of job loss. The majority of participants had IA, most with RA and to a lesser degree AS. The interventions aimed to prevent job loss and improve work functioning in several ways: firstly by evaluating work changes or adaptations and secondly by providing any person-directed interventions including vocational counselling, advice or education. Interventions directly targeted at the work environment were minimal and included workplace visits (one trial) or any actions by an occupational physician (one trial). The duration or dose of the interventions varied from two 1.5-hour sessions (one RCT) over five months, two consultation and multidisciplinary treatments during three months (one RCT), to six to eight individual or group sessions over six months (also one RCT). All participants were recruited through rheumatology clinics, both in or outside hospitals. Included trials investigated job loss (n = two RCTs; 382 participants), work absenteeism and work functioning (n = one RCT; 32 participants). Overall, we evaluated the two smaller trials as having a high risk of bias and the large trial as having a low risk of bias. Trials showed marked differences in how they performed on risk of bias items, particularly on performance bias.We assessed the quality of the evidence using the GRADE approach and judged there to be very low quality evidence across the three reported outcomes. Of the two RCTs investigating job loss, the larger one (n = 242 participants) reported a large statistically significant reduction in job loss (relative risk (RR) = 0.35, 95% confidence interval (CI) 0.18 to 0.68) and the other RCT (n = 140) reported similar effects in both groups, although the CI was very wide (RR = 1.05, 95% CI 0.53 to 2.06). The latter one probably suffered from performance bias and we judged it to have a high risk of bias. The one small trial investigating sickness absenteeism found uncertain results at six months' follow-up (MD = -2.42 days, 95% CI -5.03 to 0.19). Finally, in the same small trial investigating work functioning using the Rheumatoid Arthritis-Work Instability Scale (RA-WIS), there was a moderate improvement of intermediate term work functioning (six months; scale range 0 to 23; mean improvement -4.67 points, 95% CI -8.43 to -0.91). We identified no adverse effects in the publications of the three trials.

Authors' conclusions: This Cochrane review of three RCTs found very low quality evidence overall for job loss prevention interventions having an effect on job loss, work absenteeism and work functioning in workers with inflammatory arthritis. While this review highlights that further high quality RCTs are required, the results suggest that these strategies have potential to be effective.

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Conflict of interest statement

Jan Hoving: None known

Diane Lacaille: Prof Lacaille has been awarded a grant by the Canadian Institute of Health Research (CIHR) to evaluate an intervention to improve at work productivity and prevent work disability in people with inflammatory arthritis.

Donna Urquhart: None known.

Timo Hannu: Dr. Timo Hannu owns 150 shares (share class B) of Orion Corporation, a European pharmaceuticals and diagnostics company. In 2011, he received an honorarium of GBP 200 for writing a review titled "Reactive arthritis", which was published in the journal Best Practice & Research Clinical Rheumatology.

Judith Sluiter: None known.

Monique Frings‐Dresen: None known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included trials.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included trial.
1.1
1.1. Analysis
Comparison 1 job loss prevention vs control intervention, Outcome 1 Job loss counts (workers) cumulative 12, 24, 30, 48 months.
1.2
1.2. Analysis
Comparison 1 job loss prevention vs control intervention, Outcome 2 Sickness absenteeism ‐ work days missed per month ‐ six months.
1.3
1.3. Analysis
Comparison 1 job loss prevention vs control intervention, Outcome 3 Work functioning ‐ RA WIS ‐ six months.
1.4
1.4. Analysis
Comparison 1 job loss prevention vs control intervention, Outcome 4 Extra: Job loss or increase in disability pension: counts (participants) ‐ 24 months.
1.5
1.5. Analysis
Comparison 1 job loss prevention vs control intervention, Outcome 5 Extra: Job loss events ‐ permanent and temporary ‐ 48 months.
1.6
1.6. Analysis
Comparison 1 job loss prevention vs control intervention, Outcome 6 Extra: Sickness absenteeism ‐ Workdays missed as proportion of days worked over the past month ‐ six months.
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  • doi: 10.1002/14651858.CD010208

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