title: Work-related problems in multiple sclerosis: a literature review on its associates and determinants.
abstract: OBJECTIVE
  To explore which variables are associated to or determinants of work-related difficulties or unemployment in persons with multiple sclerosis (MS).
  
  
  METHODS
  Papers published between 1993 and February 2015 were included. Quality was judged as poor, acceptable, good or excellent. Determinants were extracted from prospective and retrospective data, associated variables from cross-sectional data; variables were grouped by similarity. Evidence was judged as strong if there were at least two good studies reporting the same results; limited if there was only one good and some acceptable studies.
  
  
  RESULTS
  Forty-two papers were selected, for a total of 31,192 patients (75% females). Work-related difficulties were referred as unemployment, lower amount of worked hours or job cessation. Strong evidence of impact over work-related difficulties was found for a core set of variables, i.e., expanded disability status scale, MS duration, patients' age, fatigue and walking problems. Little evidence exists on the impact of contextual factors.
  
  
  CONCLUSIONS
  Most of the variables identified as associated to or determinants of work-related difficulties can be treated through rehabilitative interventions. It is important that future research addresses not only unemployment issues in MS, but also the amount and severity of problems affecting work-related tasks relying on specific assessment instruments.
  
  
  CONCLUSIONS
  Multiple sclerosis (MS) affects young persons of working age and limitation in work activities is part of MS-related disability, but they are not consistently addressed in MS research: EDSS, MS duration, patients' age, fatigue, walking problems, cognitive and neuropsychological impairments were the factors most commonly found as associated to or determinant of difficulties with work. Evidence exists that rehabilitation interventions are effective for fatigue, cognitive impairment, mobility and walking difficulties. However, research did not address the impact of rehabilitation programmes on vocational outcomes. Rehabilitation researchers should include MS-specific assessment instruments for work-related difficulties to standardised clinical protocols, so that the benefits of rehabilitation on persons' ability to work can be demonstrated directly: in this way, cost-benefit balance analyses can be added to the evaluation of treatment effectiveness.
authors.affiliation: a Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation , Milan , Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Raggi
authors.affiliation: a Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation , Milan , Italy.
authors.forename: Venusia
authors.initials: V
authors.lastname: Covelli
authors.affiliation: a Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation , Milan , Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Schiavolin
authors.affiliation: a Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation , Milan , Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Scaratti
authors.affiliation: a Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation , Milan , Italy.
authors.forename: Matilde
authors.initials: M
authors.lastname: Leonardi
authors.affiliation: a Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation , Milan , Italy.
authors.forename: Michelle
authors.initials: M
authors.lastname: Willems
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000523:psychology*; D004651:Employment; D005221:Fatigue; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009103:Multiple Sclerosis / Q000503:physiopathology / Q000523:psychology*; D011446:Prospective Studies; D012189:Retrospective Studies; D014478:Unemployment; D016138:Walking
keywords: Employment; ICF classification; multiple sclerosis; review; work