Skip to main content
SpringerLink
Log in

Employment in multiple sclerosis

Exiting and re-entering the work force

Journal of Neurology volume 255, pages 1354–1360 (2008)Cite this article

Abstract

Multiple sclerosis (MS) is associated with significant economic burden and high rates of unemployment. This investigation evaluated patient and disease characteristics associated with work loss and work initiation using the NARCOMS patient registry. Patient and disease characteristics associated with transitions to unemployment or employment were evaluated cross-sectionally and prospectively over the course of two assessment periods (mean interval of 1.56 ± 0.93 years). Eligible participants included 8,867 patients for the cross-sectional component, and 8,122 for longitudinal analyses. At Time 1 and Time 2 56–58 % of MS patients were not employed. At Time 1, unemployed participants more likely to have a progressive disease course, had a longer symptom duration, greater levels of disability as measured by the PDDS, and greater functional limitations across all domains of the performance scales (p < 0.0001 for all). At Time 2, increasing MS symptoms in the past 6 months increased the odds of becoming unemployed. In addition, specific problems in mobility, hand function, fatigue, and cognitive performance domains were associated with increased odds of becoming unemployed. Less severe problems in similar areas, including mobility, hand function, and cognitive functioning were also predictive of work initiation among patients not employed. MS is associated with high rates of unemployment. Specific physical and mental health limitations confer risk of employment cessation over time, as well as the likelihood of employment initiation. This study has implications for rehabilitation interventions to target specific MS related limitations that place patients at greatest risk for work status changes.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Ariel M, Sara D (2006) Health-related quality of life in multiple sclerosis: the impact of disability, gender and employment status. Qual Life Res V15:259–271

    Google Scholar 

  2. Bauer HJ, Firnhaber W, Winkler W (1965) Prognostic criteria in multiple sclerosis. Ann N Y Acad Sci 122:542–551

    PubMed  CAS  Google Scholar 

  3. Beatty W, Blanco C, Wilbanks S, Paul R, Hames K (1995) Demographic, clinical and cognitive characteristics of multiple sclerosis patients who continue to work. J Neurol Rehabil 9:167–173

    Google Scholar 

  4. Beatty WW, Blanco CR, Wilbanks BS, Paul RH, Hames BA (1995) Demographic, clinical, and cognitive characteristics of multiple sclerosis patients who continue to work. J Neurol Rehabil 9:167–173

    Google Scholar 

  5. Beatty WW, Blanco CR, Wilbanks SL, Paul RH, Hames KA (1995) Demographic, clinical, and cognitive characteristics of multiple sclerosis patients who continue to work. J Neurol Rehabil 9:167–173

    Google Scholar 

  6. Busche KD, Fisk JD, Murray TJ, Metz LM (2003) Short term predictors of unemployment in multiple sclerosis patients. Can J Neurol Sci 30:137–142

    PubMed  CAS  Google Scholar 

  7. Canadian Burden of Illness Group (1998) Burden of illness of multiple sclerosis: part II: quality of life. Can J Neurol Sci 25:31–38

    Google Scholar 

  8. de Croon EM, Sluiter JK, Nijssen TF, Dijkmans BAC, Lankhorst GJ, Frings- Dresen MHW (2004) Predictive factors of work disability in rheumatoid arthritis: a systematic literature review. Ann Rheum Dis 63:1362–1367

    Article  PubMed  CAS  Google Scholar 

  9. Edgley K, Sullivan M, Dehoux E (1991) A survey of multiple sclerosis: determinants of employment status. Can J Rehabil 4:127–132

    Google Scholar 

  10. Freal JE, Kraft GH, Coryell JK (1984) Symptomatic fatigue in multiple sclerosis. Arch Phys Med Rehabil 65:135–138

    PubMed  CAS  Google Scholar 

  11. Genevie L, Kallos JE, Struening EL (1987) Job retention among people with MS. J Neurol Rehabil 1:131–135

    Google Scholar 

  12. Grima DT, Torrance GW, Francis G, Rice G, Rosner AJ, Lafortune L (2000) Cost and health related quality of life consequences of multiple sclerosis. Mult Scler 6:91–98

    PubMed  CAS  Google Scholar 

  13. Gronning M, Hannisdal E, Mellgren SI (1990) Multivariate analyses of factors associated with unemployment in people with multiple sclerosis. J Neurol Neurosurg Psychiatry 53:388–390

    Article  PubMed  CAS  Google Scholar 

  14. Hadjimichael O, Kerns RD, Rizzo MA, Cutter G, Vollmer T (2007) Persistent pain and uncomfortable sensations in persons with multiple sclerosis. Pain 127(1–2):35–41

    Article  PubMed  Google Scholar 

  15. Hammond SR, McLeod JG, Macaskill P, English DR (1996) Multiple sclerosis in Australia: socioeconomic factors. J Neurol Neurosurg Psychiatry 61:311–313

    PubMed  CAS  Google Scholar 

  16. Jackson MF, Quaal C, Reeves MA (1991) Effects of multiple sclerosis on occupational and career patterns. Axone 13:16–17, 20–12

    PubMed  CAS  Google Scholar 

  17. Jacobs LD, Wende KE, Brownscheidle CM, Apatoff B, Coyle PK, Goodman A, Gottesman MH, Granger CV, Greenberg SJ, Herbert J, Krupp L, Lava NS, Mihai C, Miller AE, Perel A, Smith CR, Snyder DH (1999) A profile of multiple sclerosis: the New York State Multiple Sclerosis Consortium. Mult Scler 5:369–376

    PubMed  CAS  Google Scholar 

  18. Julian L, Merluzzi NM, Mohr DC (2007) The relationship among depression, subjective cognitive impairment, and neuropsychological performance in multiple sclerosis. Mult Scler 13:81–86

    Article  PubMed  CAS  Google Scholar 

  19. Kornblith AB, La Rocca NG, Baum HM (1986) Employment in individuals with multiple sclerosis. Int J Rehabil Res 9:155–165

    Article  PubMed  CAS  Google Scholar 

  20. Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444–1452

    PubMed  CAS  Google Scholar 

  21. Larocca N, Kalb R, Scheinberg L, Kendall P (1985) Factors associated with unemployment of patients with multiple sclerosis. J Chronic Dis 38:203–210

    Article  PubMed  CAS  Google Scholar 

  22. LaRocca N, Kalb R, Scheinberg L, Kendall P (1985) Factors associated with unemployment of patients with multiple sclerosis. J Chronic Dis 38:203–210

    Article  PubMed  CAS  Google Scholar 

  23. Lovera J, Bagert B, Smoot KH, Wild K, Frank R, Bogardus K, Oken BS, Whitham RH, Bourdette DN (2006) Correlations of Perceived Deficits Questionnaire of Multiple Sclerosis Quality of Life Inventory with Beck Depression Inventory and neuropsychological tests. J Rehabil Res Dev 43:73–82

    Article  PubMed  Google Scholar 

  24. Marrie RA, Chelune GJ, Miller DM, Cohen JA (2005) Subjective cognitive complaints relate to mild impairment of cognition in multiple sclerosis. Mult Scler 11:69–75

    Article  PubMed  Google Scholar 

  25. Marrie RA, Cutter G, Tyry T, Hadjimichael O, Campagnolo D, Vollmer T (2005) Changes in the ascertainment of multiple sclerosis. Neurology 65:1066–1070

    Article  PubMed  CAS  Google Scholar 

  26. Marrie RA, Cutter G, Tyry T, Vollmer T, Campagnolo D (2006) Does multiple sclerosis-associated disability differ between races? Neurology 66:1235–1240

    Article  PubMed  CAS  Google Scholar 

  27. McCabe MP, De Judicibus M (2003) Multiple sclerosis and economic wellbeing: role of health, age, and duration of illness. J Clin Psychol Med Settings 10:139–147

    Article  Google Scholar 

  28. Midgard R, Riise T, Nyland H (1996) Impairment, disability, and handicap in multiple sclerosis. A cross-sectional study in an incident cohort in More and Romsdal County, Norway. J Neurol 243:337–344

    Article  PubMed  CAS  Google Scholar 

  29. Miller DM, Rudick RA, Cutter G, Baier M, Fischer JS (2000) Clinical significance of the multiple sclerosis functional composite: relationship to patient- reported quality of life. Arch Neurol 57:1319–1324

    Article  PubMed  CAS  Google Scholar 

  30. Mitchell JN (1981) Multiple sclerosis and the prospects for employment. J Soc Occup Med 31:134–138

    Article  PubMed  CAS  Google Scholar 

  31. O’Connor RJ, Cano SJ, Ramio i Torrenta L, Thompson AJ, Playford ED (2005) Factors influencing work retention for people with multiple sclerosis: cross-sectional studies using qualitative and quantitative methods. J Neurol 252:892–896

    Article  PubMed  Google Scholar 

  32. Patricia AF, Usha S (2004) Employment and Disability: Evidence from the 1996 Medical Expenditures Panel Survey. J Occupational Rehabil V14:1–11

    Google Scholar 

  33. Preiningerova J, Hadjimichael O, Vollmer T, Rizzo MA (2003) Validation of patient-reported disease descriptors in the NARCOMS patient registry. International Journal of MS Care (serial online) 5:126

    Google Scholar 

  34. Rao SM, Leo GJ, Ellington L, Nauertz T, Bernardin L, Unverzagt F (1991) Cognitive dysfunction in multiple sclerosis. II. Impact on employment and social functioning (see comments). Neurology 41:692–696

    PubMed  CAS  Google Scholar 

  35. Rodriguez M, Siva A, Ward J, Stolp- Smith K, O’Brien P, Kurland L (1994) Impairment, disability, and handicap in multiple sclerosis: a populationbased study in Olmsted County, Minnesota. Neurology 44:28–33

    PubMed  CAS  Google Scholar 

  36. Rozin R, Schiff Y, Kahana E, Soffer D (1975) Vocational status of multiple sclerosis patients in Israel. Arch Phys Med Rehabil 56:300–304

    PubMed  CAS  Google Scholar 

  37. Rune M, Trond R, Harald N (1996) Impairment, disability and handicap in multiple sclerosis A cross-sectional study in an incident cohort in Møre and Romsdal County, Norway. J Neurol V243:337–344

    Google Scholar 

  38. Salomone PR, O’Connell KR (1988) The impact of disability on career development of people with multiple sclerosis. Journal of Career Development 25(1):65–81

    Google Scholar 

  39. Schwartz CE, Vollmer T, Lee H (1999) Reliability and validity of two selfreport measures of impairment and disability for MS. North American Research Consortium on Multiple Sclerosis Outcomes Study Group. Neurology 52:63–70

    PubMed  CAS  Google Scholar 

  40. Smith MM, Arnett PA (2005) Factors related to employment status changes in individuals with multiple sclerosis. Mult Scler 11:602–609

    Article  PubMed  Google Scholar 

  41. Verdier-Taillefer MH, Sazdovitch V, Borgel F, Cesaro P, Kurtz A, Millet MF, Roullet E, Marteau R (1995) Occupational environment as risk factor for unemployment in multiple sclerosis. Acta Neurol Scand 92:59–62

    Article  PubMed  CAS  Google Scholar 

  42. Vollmer T, Ni W, Stanton S, Hadjimichael O (1999) The NARCOMS Patient Registry: a resource for investigators. Int J MS Care (serial online)

  43. Vollmer TL, Hadjimichael O, Preiningerova J, Ni W, Buenconsejo J (2002) Disability and treatment patterns of multiple sclerosis patients in United States: a comparison of veterans and nonveterans. J Rehabil Res Dev 39:163–174

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Suite 270, 3333 California Street, 94143-0920, San Francisco, CA, USA

    L. J. Julian PhD

  2. Veterans Administration Medical Center, San Francisco, CA, USA

    L. Vella MPH

  3. Barrow Neurological Institute, Phoenix, AZ, USA

    T. Vollmer MD

  4. Yale University School of Medicine, New Haven, CT, USA

    O. Hadjimichael MPH

  5. Northwestern University, Evanston, USA

    D. C. Mohr PhD

Authors
  1. L. J. Julian PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Vella MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Vollmer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. O. Hadjimichael MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. C. Mohr PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. J. Julian PhD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Julian, L.J., Vella, L., Vollmer, T. et al. Employment in multiple sclerosis. J Neurol 255, 1354–1360 (2008). https://doi.org/10.1007/s00415-008-0910-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-008-0910-y

Key words

search

Navigation