Ammatillinen kuntoutus nivelreumassa

Markku Hakala

Näytön aste: B

Ammatillinen kuntoutus turvaa työkykyä todennäköisimmin silloin, kun kyseessä on työkyvyttömyyden uhka tai työkyvyttömyys on ollut tilapäistä.

This randomized controlled trial «Allaire SH, Li W, LaValley MP. Reduction of job lo...»1 with 48 months of follow up was undertaken to determine the efficacy of vocational rehabilitation provided to persons with rheumatic diseases while they are still employed, but at risk for job loss.


A total of 242 patients with rheumatic diseases residing in Massachusetts were recruited through their rheumatologists for study. Participants were randomly assigned to the experimental group (n = 122) or the control group (n = 120). Subjects in the experimental group received two 1.5-hour sessions of vocational rehabilitation; those in the control group received print materials about disability employment issues and resources by mail. The main outcome assessed was the time to first job loss. Job losses were defined as permanent disability, premature retirement, or a period of unemployment. All analyses were conducted on an intent-to-treat basis.


Job loss was delayed in the experimental group compared with the control group (P = 0.03 by log rank test). After adjustment for confounders, participation in the experimental group was found to be protective against job loss (odds ratio 0.58; 95 % confidence interval 0.34–0.99, P = 0.05 by pooled logistic regression).


Vocational rehabilitation delivered to patients at risk for job loss, but while they were still employed, delayed job loss. Such an intervention has the potential to reduce the high indirect costs, as well as the personal impact, of rheumatic diseases.

  • Tutkimuksen laatu: tasokas
  • Sovellettavuus suomalaiseen väestöön: hyvä

Kommentti: Puututtiin jo silloin kun henkilö oli työssä, mutta hänellä oli työkyvyttömyyden uhka.

This randomized controlled trial «de Buck PD, le Cessie S, van den Hout WB ym. Rando...»2 was planned to investigate the effectiveness of a multidisciplinary job-retention vocational rehabilitation (VR) program in patients with a rheumatic condition who were at risk for job loss.


A total of 140 patients with a chronic rheumatic condition (70 with RA) were randomly assigned to either a multidisciplinary job-retention VR program (n = 74) or usual outpatient care (UC) (n = 66). Patients in the VR group were assessed and guided by a multidisciplinary team, whereas patients in the UC group received care as initiated by their rheumatologist, supplemented with written information. The main outcome measure was the occurrence of job loss (complete work disability or unemployment); additional outcome measures included job satisfaction, pain, functional status, emotional status, and quality of life.


There was no difference between the 2 groups regarding the proportion of patients having lost their job at any time point, with 24 % and 23 % of the patients in the VR and UC groups, respectively, having lost their job after 24 months. Over the total period of 24 months, patients in the VR group had a significantly greater improvement of the fatigue visual analog scale and of emotional status (all P values < 0.05).


A job-retention VR program did not reduce the risk of job loss but improved fatigue and mental health in patients with chronic rheumatic diseases at risk for job loss.

  • Tutkimuksen laatu: tasokas
  • Sovellettavuus suomalaiseen väestöön: kohtalainen

Yleiskommentti: Ammatillisesta kuntoutuksesta on niukalti satunnaistettuja kontrolloituja tutkimuksia. Kansalliset erot terveydenhuoltojärjestelmissä ja sosiaalivakuutuksessa heikentävät tulosten sovellettavuutta.


  1. Allaire SH, Li W, LaValley MP. Reduction of job loss in persons with rheumatic diseases receiving vocational rehabilitation: a randomized controlled trial. Arthritis Rheum 2003;48:3212-8 «PMID: 14613285»PubMed
  2. de Buck PD, le Cessie S, van den Hout WB ym. Randomized comparison of a multidisciplinary job-retention vocational rehabilitation program with usual outpatient care in patients with chronic arthritis at risk for job loss. Arthritis Rheum 2005;53:682-90 «PMID: 16208658»PubMed