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Physical Disability, Executive Functioning Predict Employment Status in Patients With MS

Christina Mattina
The likelihood of patients with multiple sclerosis (MS) maintaining their employment status in 2 years can be predicted by their levels of physical disability and executive functioning, but not by other measures of cognition, according to new study findings.
The likelihood of patients with multiple sclerosis (MS) maintaining their employment status in 2 years can be predicted by their levels of physical disability and executive functioning, but not by other measures of cognition, according to new study findings.

Participation in the workforce is difficult for many patients with chronic diseases, including MS, and this often leads to reduced hours, presenteeism, time missed from work, and unemployment. Both physical impairment and cognitive difficulties can make working difficult for patients with MS, but few studies have focused on cognitive functioning and its longitudinal relationship with work participation among these patients. The current study, published in Neurological Sciences, aimed to determine whether cognitive functioning at baseline can predict changed employment status after 2 years, taking into account mood, fatigue, and disability.

Investigators recruited adult patients with relapsing-remitting MS from 16 MS outpatient clinics in the Netherlands, as well as a healthy control group. Participants in both groups had to be currently employed or within 3 years of their last job. Data were gathered via neuropsychological examinations at baseline and answers to online questionnaires. The questionnaires asked about demographics, work participation, empathy, self-reported cognitive and neuropsychiatric functioning, fatigue, and mood. Patients with MS also had a neurological examination at baseline, in which a neurologist assessed their levels of physical disability.

Patients and healthy controls were not significantly different in terms of their gender, age, educational attainment, or job type; for instance, 87.9% of patients with MS and 81.7% of the healthy controls were engaged in white-collar work. However, the patients worked a mean of 26.2 hours per week, which was significantly lower than the 33.4 hours per week worked by the control group (P <.001). On the neurocognitive tests, the patients with MS scored significantly lower than the healthy controls in the domains of complex attention, perceptual motor functioning, and learning and memory.

After 2 years of follow-up, 97 patients with MS were categorized into the stable employment status (SES) group, based on their responding that their work hours had stayed the same or increased since baseline; 27 patients were considered part of the deteriorated employment status (DES) group because they had either stopped working or reduced their work hours by at least 20% due to MS.

Looking retrospectively at baseline, the groups had similar demographic characteristics, employment type and hours, and some measures of neurocognition, but the DES group had greater physical disability and fatigue, lower complex attention and executive functioning, and more self-reported cognitive problems and depression symptoms at baseline.

In a logistic regression analysis, the researchers determined that lower executive functioning (P = .03) and greater physical disability (P = .01) were the only independent predictors of DES after 2 years. They wrote that these findings support those of cross-sectional studies finding associations between work participation and both physical disability and executive functioning.

Despite finding these factors to be predictors of employment status, the authors noted that they are responsible for only a small amount of the variation in work outcomes. For example, patients with MS may be more likely to maintain their work hours if their employers provide flexibility in terms of work schedules or workload accommodations.

“We should keep in mind that work participation in [patients with MS] is a multifactorial problem,” the study authors concluded. “Besides disease-related factors, it might be of great interest to investigate personal- and work-related factors more extensively.”


van Gorp DAM, van der Hiele K, Heerings MAP, et al. Cognitive functioning as a predictor of employment status in relapsing-remitting multiple sclerosis: a 2-year longitudinal study [published online July 19, 2019]. Neurol Sci. doi: 10.1007/s10072-019-03999-w.

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