Background/Purpose: Rheumatic and musculoskeletal conditions are leading causes of work disability. A previous trial showed a preventive work disability intervention delivered by vocational rehabilitation counselors (VRCs) reduced job loss among people with arthritis; however, VRC services are not readily available to most people with arthritis. Occupational therapists (OTs) and physical therapists (PTs) could implement a similar intervention, yet this has not been evaluated. The aim of this study was to examine the efficacy of a structured work disability prevention program delivered by OTs and PTs on work limitations and unemployment over two years.

Methods: This single-blind, parallel-arm randomized trial enrolled participants age 21-65 who were employed 15 or more hours/week, and reported a doctor-diagnosed rheumatic or musculoskeletal condition and a concern about staying employed due to their health. The intervention consisted of a 1.5 hour meeting, a written action plan, written materials on disability-related employment issues and supports, and telephone calls at 3-weeks and 3-months by trained OTs or PTs. Control group participants received the written materials but had no contact with the interventionists. The primary outcome was work limitations, measured with the Output Job Demand subscale of the Work Limitations Questionnaire (WLQ). The secondary outcome was unemployment: i) permanent and ii) both temporary and permanent. Intent to treat analyses were performed. For the primary analysis, a two-sample t-test was used to assess the effect of the intervention on the 24-month change in the WLQ subscale. As the secondary analysis, we evaluated the intervention effect on time to permanent unemployment using the Kaplan-Meier procedure and the log-rank test. The same approach was also used to evaluate the time to the first job loss (temporary or permanent). ClinicalTrials.gov NCT01387100.

Results: Between October 2011 and January 2014, 652 individuals were assessed for eligibility and 287 participants were randomized: 143 intervention and 144 control participants. 264 participants (92%) completed two year data collection. There was no difference in the mean WLQ change scores from baseline to two year follow-up (-8.6 ± 1.92 intervention vs. -8.33 ± 2.22 control (p=.93)); however, there was an effect on unemployment: 11 (8%) participants experienced permanent job loss at 2-years in the intervention arm and 25 (18%) in the control arm (p=.03) (Figure 1a). 47 (35%) intervention participants and 65 (46%) control participants experienced any unemployment during the follow up period (HR: 0.70 (0.48, 1.01), p = 0.06) (Figure 1b).

Conclusion: The intervention did not have an effect on work limitations but did reduce work cessation.