Are non-pharmacological interventions effective in the management of work disability in rheumatic conditions?

man with checklist

In recent years workforce participation among individuals with rheumatic diseases has received considerable research attention, particularly with an ageing population who will be expected to stay at work longer. Therefore, a review by Gignac et al (2012) in Best Practice and Research Clinical Rheumatology on the effectiveness of a range of non-pharmacological interventions in managing work disability in rheumatological conditions is timely.

Here’s what they did

The authors sought studies that examined the effect of non-pharmacological work interventions aimed at individuals with rheumatic conditions, e.g. rheumatoid arthritis [RA], osteoarthritis [OA], ankylosing spondylitis, lupus, and fibromylagia, and included studies evaluating outcomes such as work retention, workplace difficulties, return to work or job satisfaction. Interventions could be clinically based, work-based, or evaluate work policies or services. MEDLINE, EMBASE and PsycInfo databases were searched for references published between 1980 and February 2012. All studies needed to have as an explicit aim the improvement of work retention or amelioration of work difficulties and needed to assess work outcomes.

Here’s what they found

The initial literature search resulted in 4081 references, and after the application of the inclusion criteria 20 studies evaluating 15 interventions remained that were reviewed. The interventions, which varied widely in the content they offered, included medical assessments, rehabilitation services, exercise, psychological counselling, disease self-management and education, workplace counselling and information about accommodations, benefits and legal rights and responsibilities.

Six of the 15 interventions (40.0%) focussed primarily on workplace issues, six combined disease, psychological and/or work components (40.0%) and two (13.3%) were exercise only.There was variability in the duration and intensity of the interventions. They ranged from a one-time mailing of information about job options to a 1-year long intervention.

The authors concluded

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“Early diagnosis and treatment may not be enough to keep people at work, working well, or help those not working return to their jobs – there is a need for interventions aimed at employment.”

Due to the variability in the interventions, i.e. their intensity and their target samples, appraising the effectiveness of interventions was difficult for the authors. In general, most reported being effective on some level with significant changes in primary or secondary work-related outcomes. 

There appeared to be a tendency for interventions that did not use diverse strategies for managing employment but included only clinical, rehabilitation, exercise, or disease-related counselling to be less effective in reducing absenteeism or returning individuals to work.

The Musculoskeletal Elf’s view

The Musculoskeletal Elf

The findings from this review emphasise the importance of the Consensus Statement for Work and Health that was signed in 2008 by all the main healthcare professional bodies in the UK agreeing that they would do all that they can to help individuals enter, remain in and return to work. Therefore, it is important to take on board the review authors’ recommendations for the consistent inclusion of behavioural and psychological outcome measures of treatment, such as absenteeism, presenteeism, return-to-work, support, work stress and job satisfaction.

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Gignac, M.A.M., Jetha, A., Bowring, J., Beaton, D.E. & Badley, E.M. 2012, “Management of work disability in rheumatic conditions: A review of non-pharmacological interventions”, Best practice & research clinical rheumatology, Vol. 26, no. 3, pp. 369-386. [PubMed abstract]

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