Future Prospects

F

We all know that un controlled MS influences you future prospects for divorce and unemployement. This study looks at some of the factors and find some that make small influences. Relapses are often dismissed as being important to the outcome but here there are subtle effects. Being female is better for stability, but we know that females are more likely to exhibit relapsing MS and disability accumulation is less good

Zarghami A, van der Mei I, Hussain MA, Claflin SB, Bessing B, Simpson-Yap S, Ponsonby AL, Lechner-Scott J, Broadley S, Blizzard L, Taylor BV; AusLong Investigator Group. Long-term trajectories of employment status, workhours and disability support pension status, after a first episode of CNS demyelination. Mult Scler. 2022 May 13:13524585221089900. doi: 10.1177/13524585221089900

Background: People with multiple sclerosis face significant employment-related challenges, with little known of the drivers of these outcomes.

Objective: We examined prospective trajectories of employment-related outcomes up to 11 years following a first episode of central nervous system (CNS) demyelination (FCD).

Methods: Participants were aged 18-59 years, at FCD, with at least two observations and were employed at study entry or anytime during follow-up (n = 207). Outcomes were employment status (full-time, part-time and unemployed), average workhours per week and disability support pension (DSP; receiving/not receiving). We used group-based trajectory modelling to identify groups with common trajectories. Factors associated with trajectory membership were explored using log-multinomial regression.

Results: Distinct trajectories were identified for employment (4), workhours (4) and DSP (2). Compared with stable full-time, female sex was strongly associated with being in the stable part-time trajectory (risk ratio (RR): 5.35; 95% confidence interval (CI) = 2.56-11.20; p < 0.001). A greater level of disability at 5-year review (RR: 1.35; 95% CI = 1.19-1.53) and having more than two comorbidities at baseline (RR: 2.77; 95% CI = 1.37-5.64) were associated with being in early and late deteriorated employment trajectories, respectively. Compared with the increased part-time trajectory, every additional relapse during the 5 years post-FCD was associated with a 10% increased risk of being in the reduced part-time trajectory (RR = 1.10; 95%CI = 1.00-1.22). For every additional EDSS point at 5-year review, the risk of being in the DSP trajectory increased (RR = 1.21; 95% CI = 1.05-1.41).

Conclusion: These trajectories indicate substantial heterogeneity and the complex impact of MS on employment from its earliest timepoints. Understanding these trends could enable better targeting of interventions to facilitate workforce retention, particularly for females, those with a higher number of comorbidities, more frequent relapses and greater rate of disability accrual.

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MouseDoctor

6 comments

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  • Ahh! Something on the psycho-social side. I’ve seen similar trains of thought that tend to view things from a sterile point of view. Obviously, as one’s MS gets worse, completing tasks and therefore employment, becomes more difficult. I’d like to see someone delve more deeply some day into the nasty side of things. As in- In a competitive work environment (or marriage I suppose?), having your MS used against you. People splitting hairs, making things more difficult, failing to accommodate and making stuff up. Yes, there are laws against that, but I had to fight and then sue. Would have been great if back then there were some pointers on how to prep for and deal with the upcoming situations, which many will have. And then, how to live happily after disability?

  • Proof is in the pudding. I can only access abstract. But I speak bitterly having worked my butt off to get diplomas, and throw myself into my career before MS claimed it. I worked full time sporadically 5 of the past 15 years and have little savings. The wake left behind by US LTD insurers who terminate pwms unable to work is largely ignored. Evidence of pwms being more impoverished 15 years after diagnosis should demonstrate disabled pwms are not malingerers seeking disability funds, that is of course if they “qualify” for disability. Better rehab techniques, strength maintenance protocols, and compensatory cognitive strategies for working professionals would likely lead to longer workforce retention. Wouldn’t The benefit to pwms outweigh the cost of these interventions??? sadly, the issue doesn’t stop at this. In real world dynamics, getting hired is a barrier to pwms because employers want reliability and, in US, not to increase their health carrier pool risk. (There is a reason job descriptions for desk jobs require ability to lift 40 lbs, stoop, bend, stand, work additional hours as needed.) Keeping a job for pwms is an even a larger obstacle, physical and cognitive deficits aside, ignorance by co-workers and supervisors of the variability of MS symptoms often causes distrust and questions of the pwms’s veracity because the pwms “looks so good”. I find it interesting that generally Studies struggle to look at “context” of reasons that pwms are unemployed, but such variables are not so unknown: the cumulative effect of working with domestic responsibilities at home, time/manner of commute to work, inflexible employer, and lack of advocate, atty, or Union to help pwms get reasonable accommodations. This hits so close to home, I have spent time and money to retrain vocationally twice, I feel I have so much to offer others yet here I am constrained to posting on blogs with a moniker. Best log off. Peace out.

    • Suebee,

      It hurts my heart to read your story and learn of the struggles you have endured. While many pwms have similar experiences, it does not diminish one’s own unique story nor does it make it easier or less painful.

      Many government jobs (USA) offer good benefits, are more open and willing to accommodate, and are mostly unionized, which many people do not know.

      For example, I am the union shop steward at my government job, so I came make sure to advocate, and have been able to successfully get a few (not all) accommodations approved. My agency offers an option of early disability retirement including a small pension and continued access to low cost healthcare plans. So I feel extremely lucky to have these benefits, very lucky.

      Now, I am not saying that I have not experienced hurtles, just not as many and not as high, than one might experience in the private sector.

      I also benefit from being a veteran, so that does give certain individuals advantages over non-veterans when applying for government jobs.

      I am not sharing this information in a boasting manner, I just wanted you and others to know there is hope and options.

      However, we should not have to push so hard to be afforded the same benefits and employment opportunities as so called “healthy” individuals.

      Hope you find some balance. Sending you positivity and well wishes.

  • Marriage is overrated anyway. I’m in my 40’s with financial assets, so it’s tricky for me to consider marriage now at my age.
    Divorce is common and now with the no blame change in divorce law, it probably will become even more common. Just saying.

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