What Interventions Are Effective in Supporting People with Multiple Sclerosis to Return to Work - Literature review Example

Running Head: What interventions are effective in supporting people with MS to return to work? Name Tutor Name Course Date Introduction Multiple sclerosis is a life-threatening degenerative disease that affects the psychological, economic, physical and social aspects of an individual’s capacity to participate meaningfully at work (Bishop, Tschopp and Muvihill, 2000). Further, its unpredictable nature implies that an individual’s career faces an uncertain future as patients may end up losing employment. Despite this, there is a lack of substantive literature on return-to-work (RTW) interventions for MS patients. These calls for a need to investigate the effective interventions that people with MS to return to work hence the research question: What interventions are effective in supporting people with MS to return to work? This research question based on the premise that MS interventions are three-fold: management of the medical symptoms, role management and emotional management. Normally, the interventions primarily involve managing the symptoms associated with MS. Generally, the interventions have similarities, ranging from promoting episodic, crisis, fragmented and symptomatic intervention to an increased focus on the quality of care delivered to the MS patient to support him to return to work. With, workplace-based return-to-work interventions, behaviour change of MS patient to increase seek and maintain work is expected. People with MS are also expected to participate in the workplace meaningfully (Roessler and Rumrill, 2003). Method The criteria for reviewing the article included searching for controlled articles and randomized controlled trials that examined variables that make return-to-work interventions effective. The reviewer independently extracted data from such study that met the criteria. Library research was conducted with the reviewer focusing on analysis of documents and summarizing them in the table (See Table 1), to include details on the methods, level of research, results and limitations. Only articles documented in English language were considered. Four databases were searched, including MEDLINE, CINAHL, Google Scholar and Rehabilitation Reference Centre. The keywords used to search the articles included: "people with MS",” return to work" and" intervention". In all, twelve articles are surveyed that explored multiple sclerosis interventions.’ Four articles are directly related to the research question. A key research barrier faced included the concern that few empirical researches have explored the ‘return to work interventions for MS’. The alternative solution was to explore articles on vocational rehabilitation. The findings were later related to in an effort to answer the research question. Table 1: Summary of Reviewed Literature Author & date Purpose Design Sample Findings LOE Limitations Bishop, Tschopp & Muvihill (2000) Examines features of episodic neurological illneses and the best practices for rehabilitation Descriptive study (Survey) 44 articles For return to work interventions to be effective, they should have an insight on the problems that people with MS 2a - Failure to rationally relate multiple sclerosis and epilepsy RTW interventions -Not generalisable, focus on employed - No follow up interview conducted. Berglind & Gerner (2002) Examine factors for effective return to work and among people with MS. Direct Approach & Unstructured Surveys (mail questionnaire) 185 Motivation of clients can make return to work interventions effective 2a -Small sample size. -lacks generalizability -Failure to examine theoretical perspectives on motivation Khan & TurnerStokes (2009) Evaluate effectiveness of VR programs in comparison to workability of people with MS Randomized controlled trials (RCTs) 80 (78 completers) - Contextual factors such as environmental issue, employment policy and transport issues are crucial for the success of the intervention programs 2b - Small sample size. -Lacks generalizability -Differences in approach and philosophy between the trials made pooling data from the two trials difficult Fraser, Johnson, Clemmons, Getter, Johnson and Gibbons (2003 examine occupational characteristics of people with MS Structured Survey (Questionnaires) 79 - Financial subsidies and group or individual psychotherapy effectively assists in the RTW interventions 1a -- Small sample size. -Lacks generalizability Limited review of cognitive concerns MS population . Roessler, Rumrill, Hennessey, Vierstra, Pugsley and Pittman (2003) Examine the issue affecting job acquisition and retention of people with MS Unstructured survey (Participatory Action Research (PAR) 1,310 - Review of work policies and practices can promote career development of people with MS. 2b -Unbalanced sample as most of the respondents were white -Small geographic location increasing bias. Roessler and Rumrill (2003) Examine the barriers to effective return to work interventions Descriptive study (Survey) 37 Articles - Effective interventions are those that are the product of consultation with the people with MS themselves . 2c -No follow up interviews -Strictly included people with RRMS -Not generalizable. Pack and Szirony (2009) Determine whether willingness to return to work can be an effective indicator of actual return to work Structured Survey (Questionnaires) 1310 - Self-efficacy is a significant component for effective return to work intervention 2c - Lacks generalisability: -only respondents currently unemployed -Most of sample was Caucasian Rumrill (2009) Investigates into most predominant challenges that face people with MS in the modern-day employment scene. Time-series design 1,180 - Physiological symptoms, socioeconomic status, age, course and disease progression and cognitive dysfunction are critical for effective RTW strategy activity. 3b Date from ne geographical regions – lacks generalisability. -No results given. Bishop, Frain, Rumrill and Rymond (2009) Explore the correlation between return to work interventions (such as self-management among people with MS) and the employment status Structured Survey (Questionnaires) 250 - impact of multiple sclerosis on effective RTW depends on financial, functional, personal and psychosocial factors 2a - No follow up interview -Lacks generalisability- All participants from one geographic location Chiu, Chan, Bishop, Cardoso and O'Neil (2013) Establish the role that vocational rehabilitation (VR) or intervention play in ensuring that people with MS maintain their employments. Qualitative methodological design (Case study) 1920 - State vocational rehabilitation agencies help individuals with MS seek employment. III - Failure to offer the severity of MS dysfunctions or symptoms - Failure to deduce causality -Lacks generalisability- All participants from one geographic location Rumrill, Koch and Wohford (2013) Examine how people with MS frequently face barriers to job retention and the strategies that can be integrated to make an intervention effective. Pre-post study 31 - Elliptical exercise training does significantly improve fatigue and quality of life ratings. 3b - No study design or sampling method stated. -No follow up interview Koch, Rumill, Fraser, Johnson, Clemmons, Getter and Gibbons (2003) Examine demographic of people with MS who seek vocational services and the perceived psychosocial functioning of relevant variables Pre-post study 26 - profiling the MS patients before recommending pertinent interventions can be helpful in making the interventional programs effectives. 3b - No follow up interview -Lacks generalisability- All participants from one geographic location Discussion Review of the literature, based on the findings of the 12 reviewed articles, reveals the critical components that make up for an effective return to work interventions or people with MS. This is since people with MS constantly and significantly experience higher rate of underemployment and unemployment compared to the general population (Chiu et al, 2013). Several factors contributed to the effectiveness of return to work interventions for people with MS (Berglind and Gerner, 2002; Bishop, Tschopp and Muvihill, 2000; Roessler and Rumrill, 2003). Therefore, effective RTW interventions need multifaceted approaches. This is since the impact of multiple sclerosis on employment is irreducible to any single factor. Rather, it represents a multifarious interaction of variables such as financial, functional, personal and psychosocial (Bishop, Frain, Rumrill and Rymond, 2009). Effective interventions are those that are the product of consultation with the people with MS themselves, since this will enable employees with MS to create work environment that is employee-friendly to people with MS (Roessler and Rumrill, 2003). Therefore, people with MS need to be profiled to determine what kinds of interventions are appropriate for their needs. Koch et al (2003) found that profiling the MS patients before recommending pertinent interventions can be helpful in making the interventional programs effectives. These findings can be related to Bishop, Tschopp and Muvihill’s (2000) discussion that affective RTW interventions can be achieved through a review of the problems that people with MS face. According to Berglind and Gerner (2002) motivation is also a critical factor that enables intervention, rehabilitation or return to work effectively. Indeed, self-efficacy is a significant factor. It relates to the research question in that it implies that an effective return to work intervention is that that informs people with MS that they should “believe they need” to work, otherwise they will never try to work (Pack and Szirony, 2009). Therefore, readiness to work can be assimilated to an individual’s beliefs regarding returning to work. Fraser et al (2003) also examine the motivational factors accounting for effective RTW interventions for people with MS. Fraser et al (2003) observed that aside from the financial subsidies, group therapy or individual psychotherapy can effectively assist in the return to work interventions. Issues that affect job acquisition and retention of people with MS can also contribute to what makes an RTW intervention effective (Roessler et al, 2003). For instance, a review of strengths and weaknesses in work policies and practices and the possible interventions can promote career development of people with MS. Enabling the interventions to address the problems faced by people with MS can enable the RTW interventions to be effective. Based on Roessler and Rumrill’s (2003) perspective, for return-to-work interventions to be effective, the barriers standing in the way to effective interventions should be understood and minimised. The researchers use Hershenson’s systemic model of rehabilitation and counseling to identify the barriers. In which case, for an effective approach to improvement of employment outcomes for persons with MS is to address the workplace barriers (Roessler and Rumrill, 2003). Rumrill (2009) investigates into the most predominant challenges that face people with MS in the modern-day employment scene. In which case, an effective return to work intervention should take into consideration the factors contributing to the high unemployment rate for the people with MS, such as physiological symptoms, socioeconomic status, age, course and disease progression and cognitive dysfunction (Rumrill 2009). People with MS face numerous barriers to employment retention, which when understood may facilitate setting up an effective vocational rehabilitation intervention (Bishop, Frain, Rumrill and Rymond, 2009). Rumrill, Koch and Wohford (2013) examine how people with MS frequently face barriers to job retention and the strategies that can be integrated to make an intervention effective. Demographics, ill- and work-related factors can inhibit job retention for people with MS. Khan and Turner-Stokes (2011) also evaluated the effectiveness of vocational rehabilitation programs in comparison to workability of people with MS and care as usual return to work. The researchers found that contextual problems factors such as environmental issue, employment policy and transport issues are crucial for the success of the intervention programs. In which case, for the return-to-work interventions to be effective, they require multidisciplinary approach -- such as considering environment, employment policy and transport issues – that extend beyond the normal delimitation or borderline of health and social care (Khan and Turner-Stokes, 2011). In all, early intervention, on the job accommodation and active participation of the employers are some of the elements that can make effective return-to-work and employment retention (Rumrill, Koch and Wohford, 2013). Conclusion A survey of literature indicates that for interventions to be effective in supporting people with MS to return to work, they should have a number of features. First, effective interventions are those that have an insight into the problems that people with MS face. Second, effective interventions for return to work should motivate the clients to return to work. They should also have financial subsidies, group therapy or individual psychotherapy factors. Further, effective interventions are those that leverage on the strengths and weaknesses in work policies and practices to set out possible interventions that can promote career development of people with MS. A review of literature also reveals that an effective return-to-work intervention takes into consideration the factors contributing to the high unemployment rate for the people with MS, such as physiological symptoms, socioeconomic status, age, course and disease progression and cognitive dysfunction. Also, an effective return-to-work intervention is that that takes a multidisciplinary approach -- such as considering environment, employment policy and transport issues – that extend beyond the normal delimitation or borderline of health and social care. References Berglind, H. H., & Gerner, U. U. (2002). “Motivation and return to work among the long-term sicklisted: an action theory perspective.” Disability & Rehabilitation, 24(14), 719-726. Bishop, M., Frain, M. P., Rumrill, P. D., & Rymond, C. (2009). “The relationship of self-management and disease modifying therapy use to employment status among adults with multiple sclerosis.” Journal Of Vocational Rehabilitation, 31(2), 119-127. doi:10.3233/JVR-2009-0480 Bishop, M., Tschopp, M., & Mulvihill, M. (2000). “Multiple sclerosis and epilepsy: vocational aspects and the best rehabilitation practices.” Journal Of Rehabilitation, 66(2), 50-55. Chiu, C., Chan, F., Bishop, M., da Silva Cardoso, E., & O’Neill, J. (2013). “State vocational rehabilitation services and employment in multiple sclerosis.” Multiple Sclerosis Journal, 19(12), 1655-1664. doi:10.1177/1352458513482372 Khan, F., Ng, L., & Turner-Stokes, L. (2009). “Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis.” Cochrane Database of Systematic Reviews, (1), doi:10.1002/14651858.CD007256.pub2 Koch, L. C., Rumill, J. D., Fraser, R. T., Johnson, E. K., Clemmons, D. C., Getter, A. A., & ... Gibbons, L. L. (2003). “Vocational rehabilitation in multiple sclerosis (MS): A profile of clients seeking services.” Work, 21(1), 69-76 Pack, T., & Szirony, G. (2009). “Predicting readiness to return to work in a population with multiple sclerosis.” Journal Of Vocational Rehabilitation, 31(2), 91-105. doi:10.3233/JVR-2009-0478 Roessler, R., & Rumrill, P. r. (2003). “Multiple sclerosis and employment barriers: a systemic perspective on diagnosis and intervention.” Work, 21(1), 17-23. Retrieved: Rumill, J. D., Roessler, R. T., Hennessey, M. L., Vierstra, C., Pugsley, E., & Pittman, A. (2003). “Perceived strengths and weaknesses in employment policies and services among people with multiple sclerosis: Results of a national survey.” Work, 21(1), 25-36. Rumrill Jr., P., Koch, L., & Wohlford, S. (2013). „Job retention strategies for individuals with multiple sclerosis.” Journal Of Vocational Rehabilitation, 39(2), 127-135. doi:10.3233/JVR-130650Journal Of Vocational Rehabilitation, 39(2), 85-90. doi:10.3233/JVR-130646 Rumrill, P. D., Fraser, R. T., & Johnson, K. L. (2013). “Employment and workplace accommodation outcomes among participants in a vocational consultation service for people with multiple sclerosis.” Rumrill, J. (2009). “Challenges and opportunities related to the employment of people with multiple sclerosis.” Journal Of Vocational Rehabilitation, 31(2), 83-90. doi:10.3233/JVR-2009-0477 Read More