Determinants of early working impairments in multiple sclerosis

Abstract

IntroductionUnemployment can directly affect social status and identity. Assessing and adjusting determinants of early working impairments in a chronic disease can thus reduce its long-term burden. Hereby, we aim to evaluate differences in occupational history and early working impairments between people with multiple sclerosis (MS) and healthy workers.MethodsThis is a cross-sectional study comparing 71 workers with MS [age 41.7 ± 9.4 years; females 59.1%; EDSS 2.0 (1.0–6.0)] and 71 controls (age 42.6 ± 11.9 years; females 33.8%). All participants filled in Work Ability Index (WAI), Work Productivity and Activity Impairment (WPAI), European Questionnaire for Quality of Life (EuroQoL), Beck Depression Inventory II (BDI-II), and Pittsburgh Sleep Quality Index (PSQI). In MS, we further collected expanded disability status scale (EDSS), MS Questionnaire for Job difficulties (MSQ-Job), Fatigue severity scale (FSS), and the Brief International Cognitive Assessment for MS (BICAMS).ResultsWorkers with MS were more working disabled (p < 0.01), less exposed to workplace risks (p < 0.01), and more limited in fitness to work (p = 0.01), compared with controls. On linear regression models adjusted by age, sex, education, and type of contract, people with MS had worse WAI (Coeff=−5.47; 95% CI = −7.41, −3.53; p < 0.01), EuroQoL (Coeff = −4.24; 95% CI = −17.85, −6.50; p < 0.01), BDI-II (Coeff = 3.99; 95% CI = 2.37, 7.01; p < 0.01), and PSQI (Coeff = 4.74; 95% CI = 3.13, 7.61; p < 0.01), compared with controls, but no differences in WPAI (p = 0.60). EuroQoL, BDI-II, and PSQI were equally associated with both WAI and WPAI in MS and controls (all p< 0.01). In MS, worse MSQJob was associated with higher EDSS (Coeff = 5.22; 95% CI = 2.24, 7.95; p < 0.01), progressive disease (Coeff = 14.62; 95% CI = 5.56, 23.69; p < 0.01), EuroQoL (Coeff = 4.63; 95% CI = 2.92, 6.35; p < 0.01), FSS (Coeff = 0.55; 95% CI = 0.38, 0.72; p < 0.01), and cognitive impairment (Coeff = 4.42; 95% CI = 0.67, 8.22; p = 0.02).DiscussionEarly factors associated with working difficulties in MS include disability, fatigue, depression, and cognitive dysfunction. Early identification of clinical features potentially causing working difficulties should be considered to enhance job retention, along with targeted prevention and protection measures.

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“…By comparing both disorders, the similarities in the cognitive characteristics and the severity of deficits contribute to contextualizing the cognitive dysfunction in PCC. In this regard, our findings suggest that cognitive deficits in PCC are almost as pronounced and prevalent as in MS, and fatigue is even more severe, supporting the mounting evidence that fatigue and cognitive dysfunction are associated with occupational issues and socioeconomic consequences 45 , 46 .…”

Clinical variables influencing the perception of fatigue in people with Multiple Sclerosis: a cross-sectional study using FSIQ-RMS

“…Regarding working status, our work con rmed the strong impact of unemployment on the increased perception of fatigue. As already known from the literature on this topic, PwMS are more likely to be unemployed or limited in tness to work (35). Moreover, fatigue is often considered the single most disabling symptom of MS and may be the main driver for loss of employment.…”

The Work Ability Index (WAI) in the Healthcare Sector: A Cross-Sectional/Retrospective Assessment of the Questionnaire

“…Despite the amount of research conducted with this tool, few critical evaluations have associated the administration of the questionnaire with objective data (e.g., the registration of absences due to illness [ 5 ] or clinical assessments of workers [ 6 , 7 , 8 ]) to verify the correspondence between subjective answers and objective information. This aspect is very important for a company’s occupational doctor, who must take the necessary measures to protect the health of workers and must therefore know whether subjective declarations correspond with objective data.…”