Spotlight on Research for 2004

March 2004 (historical)

Vocational Rehabilitation Improves Job Retention for People with Rheumatic Diseases

Vocational rehabilitation improves job retention for patients with rheumatic diseases who are at risk for job loss, according to a team of scientists from Boston University School of Medicine.

The researchers, led by Saralynn Allaire, Sc.D., and supported by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, found that job loss was delayed and reduced in overall incidence for individuals receiving vocational rehabilitation. Job loss was reduced 49 percent for individuals receiving intervention compared with those receiving no intervention. These results, viewed in the context of government spending for disability versus rehabilitation services, point to the potential for rehabilitation to reduce the societal and personal costs of rheumatic diseases.

Health care providers, say the authors, should refer patients with health-related employment problems to public vocational rehabilitation programs. They also recommend evaluating the cost effectiveness of short-term vocational rehabilitation delivered within the community.

Government spending for disability income support programs, say the scientists, is over 25 times that for vocational rehabilitation. In addition, the portion of the U.S. job force aged 55 and over is increasing, and the incidence of many rheumatic diseases rises substantially for people over age 50. Previous studies have found that health professionals do not usually recommend vocational counseling. When they do, however, patients are more likely to have a successful outcome.

For this four-year study, 242 patients with rheumatic diseases, who had self-identified as "at risk for job loss," were randomly assigned to one of two groups. The experimental group received three hours of vocational rehabilitation services that focused on job accommodation, vocational counseling, education and self-advocacy. The control group received no counseling, but received print materials about disability employment issues and resources through the mail. Telephone interviews throughout the study tracked each participant's employment status.

Health-related job loss is associated with loss of self-esteem, life satisfaction and perceived health status. In patients with rheumatic diseases, job loss is also associated with higher levels of depression and pain.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is part of the U.S. Department of Health and Human Services' National Institutes of Health, the leading Federal agency in biomedical and behavioral research. The mission of NIAMS is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases. For more information about NIAMS, call the information clearinghouse at (301) 495-4484 or (877) 22-NIAMS free call) or visit the NIAMS Web site at www.niams.nih.gov.

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Allaire S, Li W, LaValley M. Reduction of job loss in persons with rheumatic diseases receiving vocational rehabilitation. Arthritis and Rheumatism, 2003;48(11):3212-3218.