Studies Say People with Rheumatic Disease Face Work Challenges

Aleksandar Malivuk; Hryshchyshen Serhii; Iakov Filimonov; Krisha Vishinpir; Russamee; sutlafk; Svitlana Hulko; yangtak / shutterstock.com

EULAR 2020 e-CONGRESS—People with rheumatic diseases have more difficulty than others leading a work life, and researchers are attempting to quantify just how long they are able to remain healthy and working compared with the general population.

This topic is particularly pressing because people are now expected to work for a longer and longer periods of time. In Europe, the pension age has been getting older, and this trend is expected to continue, said Ross Wilkie, MD, a senior lecturer in public health and epidemiology at Keele University, Newcastle, U.K., in a talk at the European e-Congress of Rheumatology.

In the United Kingdom, for example, the pension age was 65 in 2018. It is expected to be 67 by 2028 and 68 sometime between 2037 and 2039, Dr. Wilkie said. For people struggling with the pain associated with such diseases as osteoarthritis and other rheumatic diseases, keeping up that pace is likely to be a challenge.

“It’s unclear whether people will be healthy enough to continue to work for longer, and this is particularly prevalent in people with rheumatic diseases, who are more likely to experience early retirement—more likely to experience work absence, absenteeism—than people who don’t have rheumatic diseases,” he said. “Can people with rheumatic diseases work for longer in line with policies to extend working life?”

Researchers examined two datasets—the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE)—to determine the healthy work-life expectancy of people with rheumatic diseases and explore associated factors. The healthy work-life expectancy, as they defined it, is the number of years that people are healthy and working after age 50, with healthy meaning no physical or mental impairments that inhibit the performance of normal day-to-day activities.

The overall healthy work-life expectancy for people in England, they found, was 9.42 years, meaning those at age 50 can expect to work for about nine-and-half more years. This figure for people with osteoarthritis was just 5.58 years. The study is in press with Lancet Public Health.

Researchers also assessed physical activity and found those with osteo­arthritis (OA) who say they participate in moderate physical activity at least more than once a week have a longer healthy work-life expectancy (just under eight years) than those who do not engage in this activity (just under four years). The healthy work-life expectancy was also longer for those who say they’re physically active among those without OA, Dr. Wilkie said.

“Physical activity can be one factor that can lead to improvements in healthy work-life expectancy,” Dr. Wilkie said.

Dr. Wilkie pointed out the data paint different pictures of healthy working life around countries in Europe. For example, the healthy work-life expectancy in England is similar to that of Denmark and Sweden—two countries combined for the sake of the analysis—at about five years, but higher than Belgium and Spain, which both have a healthy work-life expectancy below four years. The results in Denmark and Sweden show more people are expected to have more years of not being healthy but still working, which could be a sign those countries make arrangements for members of the workforce who are not well so they can continue employment.

“The estimates of healthy work-life expectancy in this study question whether people will be able to extend their working lives to the level that govern­ments would like by increasing state pension age,” Dr. Wilkie said. “This varies by country, but this variation indicates that there are methods that we could be using to maintain, and actually increase, healthy work-life expectancy. But we need further research to be able to indicate what they are.”

Systemic Improvements Needed

Dr. Björk

Mathilda Björk, PhD, pro­fessor of occupational therapy at Linköping University, Sweden, said interviews conducted with patients, employers and other stakeholders show the need for systemic improvements in helping people with chronic pain return to work.

Researchers interviewed 18 patients and 28 others—employers and those with occupational health services, for example—for insights into their experience. The study was done as part of a project called SaMMRA, an effort to understand and correct barriers for people with chronic pain in returning to work.

Research shows that a collaboration among everyone involved in the rehabilitation process is vital in getting people back to work, but “how this intervention should be arranged in this black box of rehabilitation to facilitate the sustainable return to work, we’re not sure about yet,” Dr. Björk said.¹

In the interviews, it became clear that different services and organizations all have their own regulations to follow and that bridging the differences in those regulations was a major challenge. Flexibility, she said, is key, but inflexibility was all too common.

The majority of participants said more knowledge about such things as the health insurance system and about chronic pain itself would help people navigate their way back to employment.

The issue of timing also loomed large, she said. Participants in rehabilitation have to stay motivated and be ready for the different stages, but, Dr. Björk said, “it’s very individual what the right timing is for different patients.”

Overall, there seemed to be no unifying path toward and no one clearly in charge of how to achieve the end goal.

“There is no clear responsibility for keeping together the return-to-work process,” she said. “Different goals, lack of knowledge, responsibilities and coordination make it difficult to create a person-centered rehabilitation process.”

The “crucial point” in the process, Dr. Björk said, appeared to be the point immediately after rehabilitation is complete—when the patient has the skills and knowledge to return to work, but the employer or the system is not flexible enough to adapt to the person’s needs.

When the system did work, flexibility and creativity were ingredients that stood out, Dr. Björk said.

“My overall impression from the studies we conducted, and the clinical experience I have, is that it’s often based on each actor’s good will to create the flexible solution based on the patient’s need,” Dr. Björk said. “To achieve a more effective collaboration, I think we need better consensus, to work more with person-centered efforts and to have clearer structures for how collaboration should be carried out.”

Thomas R. Collins is a freelance writer living in South Florida.

References

1. Fischer MR, Persson E, Stalnacke B, et al. Return to work after interdisciplinary pain rehabilitation: One- and two-year follow-up based on the Swedish Quality Registry for Pain rehabilitation. J Rehabil Med. 2019 Apr 1;51(4):281–289.