This project will evaluate whether vocational rehabilitation (VR) provided to employed persons with rheumatic disorders improves their ability to remain employed.
The specific aims are: 1) to recruit and characterize a study sample consisting of employed rheumatology patients by the following baseline variables: a) sociodemographic characteristics; b) disease and health status; c) job characteristics; d) employment related self-efficacy; e) limitations in ability to work; and f) job accommodation seeking behaviors, and 2) to perform a randomized control trial with two intervention arms, job retention services provided by professional VR counselors versus provision of written information about arthritis-related employment issues and resources for help. Work disability frequently results from the effects of rheumatic disorders, including osteoarthritis, rheumatoid arthritis and systemic lupus erythematosus. Job retention VR services may prevent, or delay, this work loss, but this is not known. These VR services target important rheumatic disorder work disability risk factors by reducing the barriers posed by functional limitations and symptoms through job modification, promotion of future career planning, and the establishment of an alliance with the main resource for VR assistance. The study is a randomized control trial conducted with patients recruited from the practices of community-based rheumatologists. 120 experimental subjects will receive job retention services provided by VR counselors. 120 control subjects will receive literature about employment related help. The primary outcome is rate of work instability events, including work loss; secondary outcomes are self- efficacy, work limitations, and job accommodation seeking behaviors. Work instability events will be assessed at 6 month intervals over 24 to 36 months post intervention. Rates of these events among experimental and control subjects will be analyzed with adjustment for covariates through Poisson regression. The remaining outcomes will be assessed at baseline and at 6 and 24 months post intervention. Analysis of co-variance and categorical methods will be used to compare the groups on these outcomes. The results of the study will evaluate the efficacy of job retention services in forestalling work instability in this population.
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