Lacaille Diane, White Margaret A, Rogers Pam A, Backman Catherine L, Gignac Monique A M, Esdaile John M
University of British Columbia and Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada.
Arthritis Rheum. 2008 Nov 15;59(11):1647-55. doi: 10.1002/art.24197.
Work disability is a common outcome of inflammatory arthritis (IA), yet few services address employment. We conducted a proof-of-concept study of the "Employment and Arthritis: Making It Work" self-management program aimed at preventing work disability and maintaining at-work productivity in employed people with IA.
The program was developed using the precede-proceed model and self-management concepts. Program goals included modifying risk factors for work disability and enhancing self-management of work problems due to IA, as identified in initial focus groups. The program included a self-learning manual, 5 group sessions, and individual visits with an occupational therapist for an ergonomic assessment and a vocational rehabilitation counselor. It was pilot tested in 2 groups (n = 19) and evaluated over 12 months of followup.
Participants consisted of 19 employed women with IA. Process evaluation demonstrated feasibility and excellent attendance and use of the self-learning manual. By 1 year, 80% reported increased confidence in requesting job accommodations, 74% had requested an accommodation, and 71% of requested accommodations were implemented. The occupational therapist and vocational rehabilitation counselor visits resulted in recommendations for change in 100% and 74% of participants, respectively, with implementation of some recommended changes in 89% and 63%, respectively. Improvements were observed in self-confidence in managing problems at work, fatigue interference with work, measures of limitations, and at-work productivity.
We developed a novel intervention to prevent work disability in patients with IA, combining self-management group sessions and professional assessments aimed at job retention, which resulted in people making changes to adapt their work to their arthritis, and improved fatigue, self-efficacy, and at-work productivity.
工作能力丧失是炎性关节炎（IA）的常见后果，但很少有服务机构关注就业问题。我们针对“就业与关节炎：让它发挥作用”自我管理项目开展了一项概念验证研究，该项目旨在预防IA在职患者的工作能力丧失并维持其工作效率。
该项目采用前期-过程-结果模型和自我管理理念开发。项目目标是在最初的焦点小组中确定，项目目标包括改变工作能力丧失的风险因素以及加强对IA所致工作问题的自我管理。该项目包括一本自学手册、5次小组会议，以及与职业治疗师进行的个人面谈以进行人体工程学评估和与职业康复顾问面谈。该项目在2组（n = 19）中进行了试点测试，并在12个月的随访中进行了评估。
参与者包括19名患有IA的在职女性。过程评估表明该项目具有可行性，且自学手册的出勤率和使用率很高。到1年时，80%的人表示在申请工作便利方面更有信心，74%的人申请了便利，且71%的申请便利得到了落实。职业治疗师和职业康复顾问的面谈分别使分别有100%和74%的参与者得到了改变建议，其中分别有89%和63%的建议改变得到了实施。在工作中管理问题的自信心、疲劳对工作的干扰、受限程度指标以及工作效率方面均观察到了改善。
我们开发了一种新的干预措施来预防IA患者的工作能力丧失，将自我管理小组会议和旨在保留工作的专业评估相结合，这使得人们做出改变以使其工作适应关节炎状况，并改善了疲劳、自我效能和工作效率。
