title: Adaptations made by rheumatoid arthritis patients to continue working: a pilot study of workplace challenges and successful adaptations.
abstract: OBJECTIVE
  The goals of this pilot study were to use qualitative research techniques in a group of currently employed patients with rheumatoid arthritis (RA) to develop categories of challenges encountered in maintaining employment and categories of successful adaptations made to continue working; and to identify obstacles considered to be persistent threats to continued employment.
  
  
  METHODS
  Patients were interviewed by telephone with a questionnaire composed of structured-response format and open-ended response format questions focusing on specific challenges and adaptations in the workplace.
  
  
  RESULTS
  Of the 22 patients interviewed, 96% were women, mean age was 50 years, 84% were college graduates, and the majority had light physical job demands and high autonomy over their work and hours worked. Patients encountered diverse challenges, such as fatigue, pain, typing, writing, physical requirements, maintaining a pleasant disposition, working overtime, traveling for business, commuting, being on time, not being able to choose rest periods, and environmental issues. Patients also made multiple adaptations to continue working, the most helpful being changing job or altering career path (36%), altering work hours (32%), using more disease-modifying antirheumatic drugs (27%), using car service (23%), sleeping more (18%), and working at home (14%). Patients were not at all confident in their ability to continue working because of RA, and perceived the following persistent threats to continued employment: fatigue (45%), not being able to use hands (45%), not being able to choose rest periods (27%), and commuting problems (18%). In addition, patients confronted psychological stresses, such as dealing with coworkers and supervisors and balancing job and personal roles. These challenges and adaptations included unfavorable work-related occurrences, or "negative work-role events."
  
  
  CONCLUSIONS
  Seemingly successfully employed patients with RA faced multiple challenges and made major adaptations to maintain employment and still perceived their employment to be in jeopardy because of RA. The findings of this study have important implications for screening patients at risk for negative work-role events and for possible work-related and social support interventions aimed at preserving employment.
authors.affiliation: Joan and Sanford I. Weill Medical College of Cornell University, Hospital for Special Surgery, New York, New York, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Mancuso
authors.forename: S A
authors.initials: SA
authors.lastname: Paget
authors.forename: M E
authors.initials: ME
authors.lastname: Charlson
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000517:prevention & control / Q000523:psychology*; D001294:Attitude to Health; D006233:Persons with Disabilities / Q000523:psychology*; D005221:Fatigue / Q000209:etiology; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D016272:Occupational Health; D009790:Occupations / Q000706:statistics & numerical data; D010865:Pilot Projects; D036301:Qualitative Research; D020377:Self Efficacy; D012720:Severity of Illness Index; D012944:Social Support; D011795:Surveys and Questionnaires; D014941:Work Simplification; D016526:Workload