Short summary

Despite the development of new pharmacological and surgical treatments, persons with inflammatory arthritis (IA) experience problems with pain, fatigue, reduced mobility and psychological distress in their everyday lives and suffer from low work ability. The aim of this study is to develop and feasibility test a context specific work rehabilitation (WR) offer, to maintain or increase work ability, work productivity and quality of life (QoL), through three studies: 1) Interviews with persons with IA to explore needs and perspectives on WR, 2) Development of a new WR offer and 3) Feasibility test of the developed WR among persons with IA. 

Rationale

In Denmark, approximately 50.000 persons are diagnosed with rheumatoid arthritis  and about 30.000 with Psoriatic arthritis or Axial spondyloarthritis. In the following, these diagnoses are referred to as inflammatory arthritis (IA). Despite the constant development of new pharmacological and surgical treatments, many persons with IA still experience problems with pain, fatigue, reduced mobility and psychological distress in their everyday lives, especially if the disease activity is not treated quickly and effectively. Furthermore, 20-30% of persons with IA do not tolerate or do not have sufficient effect from the pharmacological treatment. 

The diseases have substantial economic consequences for the individual and the society in the form of direct and indirect costs, primarily because of expensive medication and reduced capacity to work. The concept of work ability is complex, but is often used to describe a persons' resources in relation to the needs and requirements on the labour market, while work disability may result in reduced productivity. Constraints like organizational policies (e.g. strict absence policies), job insecurity, personal financial difficulties, and difficulties in finding appropriate job functions, may lead to presenteeism. The terms absenteeism and presenteeism are used to describe consequences of work disability. Absenteeism is described in terms of sick absence and presenteeism as the degree of reduced productivity while at work. Low presenteeism is common in persons with IA, and contributes to negative economic effects for the patient as well as for the workplace. In general, persons with IA have a higher level of absenteeism than those without IA and up to 38% lose their job during the first years after being diagnosed.

A continued connection to the labour market holds great importance for the everyday lives and quality of life (QoL) among persons with IA. Paid work bears great importance for the sense of identity, everyday normality, social relations, the sense of belonging, to feel worthy and to be able to fulfil societal expectations among persons with IA. Persons with IA struggle to find a balance between paid work and demands from their everyday lives in general. 

A healthy lifestyle, adjustments at the workplace and flexibility in planning tasks, are important elements to ensure that the person can continue to work despite their IA. A Cochrane review by Hoving et al. (2014) aiming to assess the effectiveness of occupational therapeutic non-pharmacological interventions to prevent job loss for employees with IA, concluded that education, advice and visits at the workplace did not have any significant effect on job loss, absenteeism and work functioning among persons with IA. The review was based on three randomized controlled trials (RCT) of low quality, due to bias and baseline differences, and the conclusion was that different strategies have potential, but there is a lack of RCTs of high quality regarding WR for persons with IA. Therefore, the overall aim of this PhD study is to develop and test the feasibility of a context specific WR aiming to maintain or increase work ability, work productivity and QoL among persons with IA. 

Description of the cohort

Study 1: 20 outpatients from Danish Hospital for Rheumatic Diseases with reumathoid arthritis, psoriatic arthritis or axial spondyloarthritis, in paid job (full - or part time), >18 years.

Study 2: Four workshops inspired by research circles including the research group including main supervisor, co-supervisors, representatives from cooperating municipalities, Job centers and center for health promotion, General practitioners, the Research unit for General Practice at SDU, representatives from Danish Hospital for Rheumatic Diseases and representatives from secondary care, both from the involved hospitals and patient representatives as well as their relatives and a couple of employers. In total, 15 participants are invited to attend each workshop. The participants should have experience with job-retention, rehabilitation or treatment of persons with IA. 

Study 3: 20 outpatients from Danish Hospital for Rheumatic Diseases >18 years of age with a diagnosis of reumathoid arthritis, psoriatic arthritis or axial spondyloarthritis, in paid work (full- or part time) who are willing to try out the new WR. Healthcare professionals employed at Danish Hospital for Rheumatic Diseases and employees from the cooperating municipalities who have participated in study 2, will perform the WR

Data and biological material

Study 1: Interview data.

Study 2: Observational data, ethnographic field notes, transscriptions from workshops. 

Study 3: Data from questionnaires and interviews. 

Publications associated with the project

Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark

• Professor, MD, PhD, Head of Research, Jens Søndergaard,