Employment and Multiple Sclerosis: A Meta-analysis of Clinical and Demographic Correlates

Abstract

Background: Individuals with neurodegenerative multiple sclerosis (MS) experience some of the highest rates of unemployment in early adulthood. Although psychological characteristics associated with successful return-to-work have been meta-analysed, the impact of illness and demographic variables remains unclear. Objective: To compare clinical and demographic characteristics of employed persons with MS with peers who are not in the workforce, and to map these differences against the International Classification of Functioning, Disability and Health (ICF). Methods: Twenty-five independent studies (7053 employed, 11043 not employed) were identified from a search of the Embase, PsycINFO and PubMed databases. Standardised mean differences (Hedge’s g) with 95% confidence intervals and p values, fail-safe Ns and heterogeneity statistics were calculated. Effect sizes were categorised according to ICF domains: ‘body functions and structures’, ‘activities and participation’ and ‘personal factors’. Results: Body functions and structures were routinely assessed, with significant medium to large effect sizes observed for MS subtype (gw= 0.80) and fatigue symptoms (gw= -0.51): those employed commonly had a non-progressive illness subtype and were less affected by fatigue. The employed group also reported significantly greater activity and participation levels (i.e. lowered disability gw= -1.16, mobility gw= -2.43), were younger (gw= -0.62) and had a shorter disease duration (gw= -0.63). Gender and pain were not significant factors. Conclusions: Vocational interventions for persons with MS require multidisciplinary input, aimed to improve impairment and disability of those who experience a relapse. Longitudinal data is needed to determine whether clinical and demographic variables remain a barrier to employment over time.