Session Information
Date: Tuesday, November 7, 2017
Title: Fibromyalgia, Soft Tissue Disorders, Regional and Specific Clinical Pain Syndromes Poster II
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
Disabled status in fibromyalgia (FM) was found to be associated with lower education, higher FM symptom burden, and lower functional status. Less is known about the characteristics of unemployed FM patients who are not receiving any form of disability benefits.
Methods:
Patients diagnosed clinically with fibromyalgia were enrolled and classified according to employment status and compared. Questionnaires used: patient health questionnaire (PHQ-9), general anxiety disorder -7 questionnaire (GAD-7), health assessment questionnaire disability index (HAQ-DI), fibromyalgia impact questionnaire (FIQ), pain disability index, pain catastrophizing scale, polysymptomatic distress scale (PSD) as the sum of widespread pain index (WPI), and the symptom severity scale (SS).
Results:
Of 555 FM patients, 87.2% met the ACR 2010 preliminary FM criteria, 38.4% working full time, 13.3% part time, 11.7% receiving disability, 27.9% unemployed 2.7% students and 5.9% retired. We compared patients who were employed either full or part time and/or student, with unemployed FM patients (Table 1).
Binomial logistic regression was performed to ascertain the effects of BMI, education level, PHQ-9, GAD-7, HAQ-DI, pain related disability, FIQ, pain catastrophizing score, and PSD on the likelihood that FM patients were unemployed. The model explained 49.2% (Nagelkerke R2) of the variance in unemployed status, and correctly classified 82.8% of the cases, sensitivity 77.1%, specificity 86.5%, positive predictive value 79.4%, negative predictive value 84.9% Of the nine predictor variables only three were statistically significant: FIQ, pain catastrophizing score and the pain disability index. Increasing FIQ, pain disability index, and pain catastrophizing were each significantly associated with increasing likelihood of being unemployed.
We also compared unemployed to disabled FM patients, and the only significant dfference observed was that more disabled FM were recipients of Medicare 25.5% vs 4% p=0.001.
Conclusion:
Compared to employed fibromyalgia patients, those who are unemployed have higher BMI, are more depressed and experience higher physical and pain related disability. They also have higher FM severity and distress, measured by FIQ and PSD.
Increasing fibromyalgia severity, pain related disability, and catastrophizing predict unemployment status in patients with FM. This information suggests that in order to prevent unemployment, we need to identify early the subset of FM patients with severe FM, who catastrophize and have high pain related disability scores. This subset of FM patients, may need intensive multidisciplinary interventions that include physical and occupational therapy and psychological interventions that can modify patients’ maladaptive responses to pain.
|
Table 1: Characteristics of employed and unemployed patients with fibromyalgia. Values are the mean (standard deviation) or percentages. |
|||
|
|
EMPLOYED |
UNEMPLOYED |
P |
|
N, % |
302 66.8% |
150 33.2% |
|
|
Age, years |
41.8 (11.1) |
42.9(10.0) |
0.389 |
|
Female sex, % |
82.8% female |
92% female |
0.021 |
|
Ethnicity white % |
79.8% |
78% |
0.774 |
|
Marital status |
|
|
0.222 |
|
Married % |
54.6% |
60% |
|
|
Divorced% |
15.9% |
18.7% |
|
|
Living with partner % |
1.3% |
1.3% |
|
|
Single % |
23.8% |
19.3% |
|
|
Widowed % |
2% |
0% |
|
|
Education level
|
|
|
0.655 |
|
Less than 12th grade |
3.3% |
5.3% |
|
|
High school graduate |
14.6% |
16.7% |
|
|
Some college |
19.5% |
23.3% |
|
|
College graduate |
31.1% |
30% |
|
|
Post graduate |
14.9% |
6.7% |
|
|
BMI |
29.4 (6.9) |
31.7 (9.7) |
0.008 |
|
PHQ-9 |
11.6 (6.1) |
14 (6.2) |
0.0001 |
|
GAD-7 |
8.4 (6.8) |
9.3 (6.3) |
0.213 |
|
WPI |
10.8 (4.5) |
13.7 (15.5) |
0.004 |
|
SS |
8.6 (2.3) |
9.3 (2) |
0.002 |
|
PSD |
19.5 (5.8) |
23.9 (17.6) |
0.002 |
|
Pain catastrophizing score |
22 (13.8) |
23.3 (12.6) |
0.613 |
|
HAQ-DI |
0.8 (1.0) |
1.3 (0.9) |
0.0001 |
|
Pain disability index |
4.6 (2.2) |
6.5 (1.9) |
0.0001 |
|
FIQ total |
52.0 (20.1) |
68.4 (17.1) |
0.0001 |
To cite this abstract in AMA style:
Kinanah Y, Jhala N, Kaouk S, Bork D, Davin S, Rispinto S, Wilke W, Gota CE. Employment Status in Fibromyalgia: Comparison of Employed and Unemployed Patients and Predictors of Unemployed Status [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/employment-status-in-fibromyalgia-comparison-of-employed-and-unemployed-patients-and-predictors-of-unemployed-status/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/employment-status-in-fibromyalgia-comparison-of-employed-and-unemployed-patients-and-predictors-of-unemployed-status/