Employment in multiple sclerosis Exiting and re-entering the work force
Employment in multiple sclerosis Exiting and re-entering the work force
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DOI：
10.1007/s00415-008-0910-y
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发表时间：
2008-09-01
影响因子：
6
通讯作者：
Mohr, David C.
中科院分区：
文献类型：
--
作者：
Julian, Laura J.;Vella, Lea;Mohr, David C.
多发性硬化症（MS）与严重的经济负担和高失业率有关。本研究使用NARCOMS患者注册表评估与工作损失和工作开始相关的患者和疾病特征。在两个评估期（平均间隔为1.56 +/- 0.93年）内，对与失业或就业过渡相关的患者和疾病特征进行横断面和前瞻性评估。符合条件的参与者包括8,867例横断面分析患者和8,122例纵向分析患者。在时间1和时间2时，56- 58%的MS患者没有工作。在时间1，失业参与者更有可能有一个渐进的病程，有更长的症状持续时间，更大的残疾水平（由PDDS测量），更大的功能限制在所有领域的表现量表（p < 0.0001）。在时间2，在过去的6个月里，多发性硬化症症状的增加增加了失业的几率。此外，行动能力、手功能疲劳和认知能力领域的特定问题与失业几率增加有关。类似领域的不太严重的问题，包括行动能力、手功能和认知功能，也预示着没有工作的患者开始工作。多发性硬化症与高失业率有关。随着时间的推移，特定的身心健康限制带来了失业的风险，也带来了开始就业的可能性。这项研究对针对特定NIS相关限制的康复干预具有启示意义，这些限制使患者处于工作状态改变的最大风险中。
Multiple sclerosis (MS) is associated with significant economic burden and high rates of unemployment. This investigation evaluated patient and disease characteristics associated with work loss and work initiation using the NARCOMS patient registry. Patient and disease characteristics associated with transitions to unemployment or employment were evaluated cross-sectionally and prospectively over the course of two assessment periods (mean interval of 1.56 +/- 0.93 years). Eligible participants included 8,867 patients for the cross-sectional component, and 8,122 for longitudinal analyses. At Time I and Time 2 56-58 % of MS patients were not employed. At Time 1, unemployed participants more likely to have a progressive disease course, had a longer symptom duration, greater levels of disability as measured by the PDDS, and greater functional limitations across all domains of the performance scales (p < 0.0001 for all). At Time 2, increasing MS symptoms in the past 6 months increased the odds of becoming unemployed. In addition, specific problems in mobility, hand function) fatigue, and cognitive performance domains were associated with increased odds of becoming unemployed. Less severe problems in similar areas, including mobility, hand function, and cognitive functioning were also predictive of work initiation among patients not employed. MS is associated with high rates of unemployment. Specific physical and mental health limitations confer risk of employment cessation over time, as well as the likelihood of employment initiation. This study has implications for rehabilitation interventions to target specific NIS related limitations that place patients at greatest risk for work status changes.