Preventing job loss for people with Multiple Sclerosis

Multiple Sclerosis (MS) is the most common chronic neurological condition affecting young adults. Many people are diagnosed with MS while they are of working age, and many leave the workplace prematurely. Vocational Rehabilitation (VR) aims to support those with illness or disability to find new employment, remain in or return to work (RTW). The effectiveness of VR for people with MS is inconclusive. This thesis aimed to develop, implement, and evaluate a job retention VR intervention for employed people with MS. The VR intervention was developed following the Medical Research Council Framework for developing and evaluating complex interventions and the person-based approach (PBA). The first study was a systematic review to identify VR interventions implemented to support people with MS to find new employment, remain in or RTW. Fourteen studies met the inclusion criteria describing thirteen interventions. There was considerable variability across the interventions and no clear conclusion about the most effective intervention characteristics or components was reached due to the poor reporting of the interventions. The second study was a qualitative study to explore the experiences of people with MS who work, their needs for VR, and perceived barriers and facilitators to implementing the intervention. I conducted 20 semi-structured interviews with people with MS, healthcare professionals, and employers. Analysis was informed by the framework method and interviews were underpinned by theoretical frameworks. I identified nine themes reflecting the main MS symptoms (e.g., cognition, fatigue), difficulties at work, and support received (e.g., change of working hours). Providing tailored support and early intervention were seen as important attributes for the intervention. The main barrier identified to delivering VR support referred to lack of resources. Having flexibility in the intervention delivery was seen as a facilitator to receiving VR. The findings were combined following the PBA to develop the intervention's guiding principles, logic model, and a job retention intervention. The feasibility and acceptability of the intervention were tested using a mixed-methods single case study design. Secondary objectives included determining whether receiving this intervention was associated with changes in quality of life, fatigue, functional outcomes, and goal attainment. The intervention was tested between June 2020 and January 2021. I recruited 15 participants with MS, 3 employers and 4 healthcare professionals. On average the participants with MS received 8.36 (SD=4.48) hours of intervention and the employers received 1.94 (SD=0.38) hours. The most common topics addressed were managing cognitive problems, fatigue management, and reasonable accommodations. The intervention was only delivered remotely due to the Covid-19 pandemic. It was feasible to deliver the intervention, but it had no impact on quality of life, fatigue, and functional outcomes. However, it had a positive impact on goal attainment. Compared to baseline, the paired t-test showed a significant difference on goal attainment at the post-intervention assessment (t(14)=7.44, p=.0001, d=1.9), three (t(13)=4.81, p=.0001, d=1.28), and six (t(11)= 4.45, p=.001, d=1.28) months follow-up. Participants reported that the intervention was acceptable in the post-intervention interviews. Four themes were derived from the post-intervention interviews regarding the (1) context, (2) the employer, (3) empowerment, and (4) intervention components and attributes. Future research should focus on understanding how VR interventions can be embedded within existing healthcare services.