Dr Suzan Verstappen has blogged for us on the impact of Rheumatoid and Musculoskeletal Disease (RMD) on the workforce. Here, she outlines how her research, in association with a number of national research projects, aims to furnish the evidence base by which the extent of the RMD challenge to both workforce health and workplace design can be understood by policymakers.

• Rheumatic and Musculoskeletal Disease (RMDs) have a significant impact on the workplace, both through absences, unemployment related to health conditions, and reduced capacity among workers with RMD
• Over recent years, Dr Verstappen has been involved in a wide range of research projects, both as Principal Investigator and as collaborator, designed to build an evidence base for understanding the true extent of this challenge
• Only once we have the clearest possible idea of the types and scale of RMD impacts in the workplace, can policymakers begin to design effective interventions to help those affected and, as a result, mitigate the billions of pounds lost every year as a result of these conditions

Rheumatic and Musculoskeletal Diseases (RMDs) and mental health problems are the two most common reasons for people of working age to have poorer work outcomes such as increased number of sick days or loss of work because of their disease.  In Europe, RMDs affect more than 4 million people with an estimated societal cost of 0.5 to 2% of the gross domestic product. In the UK it has been estimated that 30.6 million sick leave days are lost due to RMDs annually.

In Greater Manchester the percentage of persons with a long term conditions such as RMDs in employment is lower than in England.  It is thus not surprising that at international, national and local level new interventions and policies are developed to prevent long-term sick leave and work disability or early retirement due to ill health.  From the perspective of a person with a RMD remaining in paid employment is important and increases self-worth and self-esteem.  People will also retain their economic independence and feel part of the society which will likely result in better health outcomes.  For employers retaining experienced personnel may be more cost-beneficial than recruiting and training new personnel.

In addition to the impact of RMDs on absenteeism mentioned above, people with RMDs may also have problems at work whilst at work with ill health or reduced ability (i.e. presenteeism). People may transition between presenteeism and absenteeism, depending on their health status and other personal (e.g. financial, travel to work) circumstances and environmental factors (e.g. support from colleagues, flexible working hours, job type).

When developing interventions or policies to prevent or reduce presenteeism and absenteeism it is important to gain a better understanding about the association between these health, personal and environmental factors and presenteeism and absenteeism.  Furthermore, to sustain in employment it is essential gain a better understanding of the perceived balance people with RMDs have across their personal life, health and work (work-life-balance).

Understanding Presenteeism and Absenteeism as a result of RMD

I am investigating the impact of RMDs, with a special focus on chronic inflammatory auto-immune diseases such as rheumatoid arthritis, on presenteeism and absenteeism.  The peak age of onset of rheumatoid arthritis is ~50 years or earlier, meaning that the majority of the patients are still in employment when diagnosed with their chronic disease.

It is not always visible for other people, including colleagues and employers, that people have rheumatoid arthritis.  Also the disease fluctuates over time and some people may have more problems one day compared to the next day.  It is therefore often difficult for employers and colleagues to understand what the needs are in this group of people or in other group of patients with other chronic fluctuating diseases.  My previous and current research on the impact of RMDs on work includes:

Gaining a better understanding of presenteeism and changes in presenteeism over time: In recent years some of the focus on work outcomes has shifted from absenteeism to presenteeism, because prevention of presenteeism is likely to reduce absenteeism and future work loss. In an international follow-up study including people with inflammatory arthritis and osteoarthritis we are measuring presenteeism using different measures and are comparing the validity of these measures.  This information will inform future studies/interventions which measures is the best available measure to use in certain circumstances. This work is also part of the Outcome Measures in Rheumatology (OMERACT) Worker Productivity group of which I am the Chair. This study will also allow us to gain a better understanding about the changes in presenteeism and absenteeism over time and the association between health, personal and environmental factors and these work outcomes.

Investigating the effect of treatment in patients with rheumatoid arthritis on presenteeism and absenteeism. There has been a major shift in how people with rheumatoid arthritis are treated since 2000. I am investigating the effect of treatment response on absenteeism and presenteeism in patient populations treated according to these more aggressive treatment strategies using data from two large observational studies within the Centre for Musculoskeletal Research.

In collaboration with the National Rheumatoid Arthritis Society (NRAS) a survey was conducted in adults with rheumatoid arthritis and juvenile idiopathic arthritis and the impact of their disease on work. This survey contains a large amount of information in patients currently employed or in those who stopped working due to ill health which can inform future prevention strategies or return to work programmes.  For example advantages to continue work included:  financial security, sense and purpose and achievement, reasonable adjustments, understanding employer, accessible and comfortable working environment.  Challenges to remain in work included:  demanding role of job, disease related symptoms, no reasonable adjustments, commute to work and lack of understanding employer and/or colleagues.  Some of these adjustments are relatively easy to make. Providing people with RMDs and employers with easy accessible guidance on how to implement and fund these changes might increase the uptake of these interventions and decrease short-term and long-terms work related consequences.

In collaboration with the Fit for Work UK coalition we sought to gain a better understanding about the conversations people would like to have with their healthcare professionals around work. A focus group was convened and a survey was conducted in >500 people with RMDs.  The survey highlighted that many people see their GP as the first port of call to discuss work related problems.  However, it was also acknowledged that the GP may lack the right knowledge and should be able to direct people to the relevant support services.  It is important to gain a better understanding where people with seek help for their health related problems in order to develop strategies with these professionals or provide better training.

As part of the Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, we are evaluating the quantification of presenteeism. This information can be used to assess the impact of future workplace interventions.

People with RMDs often develop other co-morbidities (e.g. cardiovascular disease) and many people with RMDs struggle with mental health issues (NRAS survey). When developing interventions it is therefore important to have an integrated approach in preventing presenteeism and absenteeism and not just focus on one health condition.

Policy implications – an evidence base for workplace reform 

My research in RMDs and the impact on work outcomes and barriers and facilitators to remain in work.

This research will help provide the evidence base that will be crucial if we are to successfully inform local, national and international policy makers to develop strategies for healthier workplaces and thus reduce the socio-economic impact from both a patient’s and a societal perspective.

We will also be able to provide estimates of absenteeism and presenteeism in people with RMDs. This data set will be essential to properly understanding the extent of the challenge in the modern workplace.