How Successful is the Outcome of SE for People with Arthritis?

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How Successful is the Outcome of SE for People with Arthritis?

Category:  30 Health services research

Diane Lacaille1, Margaret White1, Adam2

1Arthritis Research Centre of Canada; University of British Columbia,

Vancouver, BC, Canada2 Pack Arthritis Treatment Program, Vancouver, BC,

Canada

Presentation Number: 139

Poster Board Number: 139

Keywords: work disability, self-employment, arthritis and musculoskeletal

conditions

Background & objectives. Arthritis and MSK conditions are the leading cause

of work disability (WD) in Canada and the US. Self-employment (SE)

potentially offers a number of advantages to individuals wishing to remain

employed. High physical demand at work, low job autonomy, difficulty

commuting, low support from co-workers and supervisors, are all known risk

factors for WD that can be modified in SE. Yet, SE places demands that may

make it difficult for people with arthritis. The objective of this study was

to describe the outcome of SE in people with arthritis and related

conditions. This has never been described before.

Methods. Subjects were recruited from all patients having used the services

of a province wide Arthritis Treatment Program, in 1999 & 2000. Screening

letters were sent to 4414 individuals, screening for eligibility and

inviting participation. Of these, 1695 (38%) responded. 442 (26%) reported

SE experience, of which 247 (56%) agreed to participate and completed a

postal survey about SE.

Methods. Participants had a mean age of 51 yrs, 75% were women. OA and RA

were the main condition in appr. 1/3 of the sample ea; FM, PsA, a CTD and

spondylitis in 6-11% of the sample ea; and non-inflammatory BP and other

types of inflammatory arthritis in less than 2% ea. Mean disease duration

was 11.2 yrs. Subjects reported, on average, a moderately high degree of

pain and disease activity (mean VAS of 5.3 cm & 5.9 cm resp.) and a mean HAQ

score of 1.3. At the time of survey, 37% had stopped SE, 14% bcse of

arthritis, 8% for financial reasons and 15% for unrelated reasons. 54% of

those who had stopped SE stated they would consider SE again. Duration of

self-employed work while having arthritis was analyzed using survival

analysis. Whether people began SE before or after arthritis onset influenced

survival. In people who began SE before arthritis onset (49%), survival

(calculated as the time from arthritis onset to business cessation) was 95%

at 2 yrs, 91% at 5 yrs and 86% at 10 yrs. For people who began SE after

arthritis onset, survival (calculated as the time from initiation to

cessation of business), was less: 88% at 2 yrs, 75% at 5 yrs and 66% at

10yrs. Nonetheless these survival rates are as good as, if not better than

reported rates for the general pop. 66% rated their SE experience as

successful, 11% as unsuccessful and 23% were neutral. 66% had a home-based

business. 64% felt they had control over the pace of their work at least

most of the time, and 75% over the time of starting/stopping work. 54%

agreed their job required lots of physical effort. 67% had ergonomically

adapted their work environment.

Conclusion. People with arthritis do very well in SE, despite the demands

inherent to both SE & arthritis. They rate their experience favorably and

the survival of their SE is excellent compared to reported rates in the

general pop. Their rating of modifiable work conditions that are risk

factors for WD was better than reported figures in paid employment, but

still not ideal.