语境因素影响接受依那西普治疗的强直性脊柱炎在职患者的工作结局：AS@Work 的 2 年结果。

Contextual factors influence work outcomes in employed patients with ankylosing spondylitis starting etanercept: 2-year results from AS@Work.

机构信息

Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands.

Caphri Research Institute, Maastricht University, Maastricht, The Netherlands.

出版信息

Rheumatology (Oxford). 2018 May 1;57(5):791-797. doi: 10.1093/rheumatology/kex476.

DOI:10.1093/rheumatology/kex476

PMID:29373701

Abstract

OBJECTIVES

The aim was to determine changes over time in work outcomes and investigate the predictive value of baseline personal and work-related factors on the evolution of work outcomes among employed patients with AS initiating etanercept.

METHODS

Employment status, absenteeism and presenteeism were assessed using the Work Productivity and Activity Impairment for AS questionnaire in a 24-month open-label, observational study (NCT01421303). The potential effect of baseline factors on work outcomes was analysed using predictive modelling (Cox regression and linear mixed models).

RESULTS

After 24 months, 11/75 (14.7%) patients had permanently withdrawn from employment (seven because of AS). Absenteeism and presenteeism decreased significantly within 6 months of etanercept treatment and remained stable thereafter. Predictive modelling indicated that male sex (hazard ratio = 0.18; 95% CI: 0.04, 0.85), (log) number of working hours per week (hazard ratio = 0.13; 95% CI: 0.03, 0.51) and the possibility of developing skills (hazard ratio = 0.42; 95% CI: 0.19, 0.91) positively influenced time in employment. Over time, lower absenteeism was significantly associated with the quality of contact with colleagues [coefficient (s.e.): -0.35 (0.10)] and importance of the job for quality of life [-0.49 (0.17)], and higher absenteeism with current smoking [1.66 (0.44)] and change in job because of illness [1.51 (0.66)]. Over time, lower presenteeism was associated with male sex [-14.5 (2.64)], the possibility of postponing work [-6.60 (2.73)], quality of contact with colleagues [-2.04 (0.96)] and >50 workers in the company [-7.65 (2.76)], and higher presenteeism with manual profession [8.41 (2.72)].

CONCLUSION

Contextual factors influence work outcomes over time and should not be ignored when aiming to improve work outcomes in patients with AS.

TRIAL REGISTRATION

ClinicalTrials.gov, http://clinicaltrials.gov, NCT01421303.

摘要

目的

旨在确定接受依那西普治疗的 AS 患者工作结果随时间的变化，并探讨基线个人和工作相关因素对工作结果演变的预测价值。

方法

在一项为期 24 个月的开放标签、观察性研究（NCT01421303）中，使用 AS 工作生产力和活动障碍问卷评估就业状况、缺勤和工作效率下降。使用预测模型（Cox 回归和线性混合模型）分析基线因素对工作结果的潜在影响。

结果

24 个月后，75 例患者中有 11 例（14.7%）永久性退出工作（7 例因 AS）。依那西普治疗后 6 个月内缺勤和工作效率下降显著，此后保持稳定。预测模型表明，男性（危险比=0.18；95%可信区间：0.04，0.85）、每周工作时间（log）（危险比=0.13；95%可信区间：0.03，0.51）和发展技能的可能性（危险比=0.42；95%可信区间：0.19，0.91）正向影响就业时间。随着时间的推移，较低的缺勤率与同事间的接触质量呈显著负相关[系数（标准误）：-0.35（0.10）]和工作对生活质量的重要性呈负相关[-0.49（0.17）]，而较高的缺勤率与当前吸烟呈正相关[1.66（0.44）]和因病换工作呈正相关[1.51（0.66）]。随着时间的推移，较低的工作效率与男性呈负相关[-14.5（2.64）]、工作可推迟呈负相关[-6.60（2.73）]、与同事的接触质量呈负相关[-2.04（0.96）]和公司员工超过 50 人呈负相关[-7.65（2.76）]，而与手工职业呈正相关[8.41（2.72）]。