Article

PURPOSE: To explore which variables are associated to or determinants of
work-related difficulties or unemployment in persons with multiple sclerosis
(MS). METHOD: Papers published between 1993 and February 2015 were included.
Quality was judged as poor, acceptable, good or excellent. Determinants were
extracted from prospective and retrospective data, associated variables from
cross-sectional data; variables were grouped by similarity. Evidence was judged
as strong if there were at least two good studies reporting the same results;
limited if there was only one good and some acceptable studies. RESULTS:
Forty-two papers were selected, for a total of 31 192 patients (75% females).
Work-related difficulties were referred as unemployment, lower amount of worked
hours or job cessation. Strong evidence of impact over work-related difficulties
was found for a core set of variables, i.e. expanded disability status scale, MS
duration, patients' age, fatigue and walking problems. Little evidence exists on
the impact of contextual factors. DISCUSSION: Most of the variables identified as
associated to or determinants of work-related difficulties can be treated through
rehabilitative interventions. It is important that future research addresses not
only unemployment issues in MS, but also the amount and severity of problems
affecting work-related tasks relying on specific assessment instruments.
Implications for Rehabilitation Multiple sclerosis (MS) affects young persons of
working age and limitation in work activities is part of MS-related disability,
but they are not consistently addressed in MS research: EDSS, MS duration,
patients' age, fatigue, walking problems, cognitive and neuropsychological
impairments were the factors most commonly found as associated to or determinant
of difficulties with work. Evidence exists that rehabilitation interventions are
effective for fatigue, cognitive impairment, mobility and walking difficulties.
However, research did not address the impact of rehabilitation programmes on
vocational outcomes. Rehabilitation researchers should include MS-specific
assessment instruments for work-related difficulties to standardised clinical
protocols, so that the benefits of rehabilitation on persons' ability to work can
be demonstrated directly: in this way, cost-benefit balance analyses can be added
to the evaluation of treatment effectiveness.

Langue : ANGLAIS