Background/Purpose: It is increasingly recognized that contextual factors (either environmental or personal) play a role in the magnitude in which the disease influences work participation. However, no summary data exist on which factors might be relevant. Therefore, we reviewed the literature on contextual factors in relation to work outcomes in patients with Ankylosing Spondylitis (AS).

Methods: Medline, EMBASE, PsyINFO and Cinahl as well as references of selected articles were searched systematically up to June 2012. Articles were eligible if reporting original data on the influence of contextual factors (CF) on work disability, sick leave or presenteeism in patients with AS. Assessment of risk of bias and extraction of data were performed by two independent persons. CF were grouped in environmental and personal factors according to the framework proposed by OMERACT (1).. Analyses were marked as ‘high quality’ if the CF was significantly contributing to work outcome in multivariable analyses, after adjustment for disease activity and physical function in a study that had a sufficient samples size for a multivariable analyses.

Results: Out of 1165 studies, 19 met the inclusion criteria of which one was added by hand search (seventeen cross-sectional and two longitudinal); 17 studies addressed employment/WD, three sick leave and 2 presenteeism. For work disability (n=11 studies), there was high quality evidence for the adverse influence of higher age (n= 4), (absence of) work accommodations (n=2), nature of work (n=1), (absence of) workplace support (n=1), (absence of) non-workplace support (n=1), avoidant coping (n=1) and being unmarried (n=1). Evidence was conflicting for gender and education. For sick leave and presenteeism there was no high level evidence for the role of any contextual variable.

Conclusion: Depending on the threshold used to decide whether evidence of the association between a CF and work-outcome can be considered as ‘high quality’, age, work accommodations, nature of work, workplace support and coping/ are candidate variables to be included as important contextual factors of work outcome in addition to disease related variables (function and disease activity). It should be noted all these studies reported cross-sectional associations.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/which-contextual-factors-have-an-important-influence-on-work-outcome-in-patients-with-ankylosing-spondylitis-a-systematic-literature-review/