Work productivity: What are the key issues for people with ankylosing spondylitis?

Ankylosing spondylitis (AS) is a chronic inflammatory condition affecting the skeleton. It affects approximately 200,000 people in the UK with the main symptom being back pain. It typically affects people from a young age, often having a detrimental impact on health and wellbeing, and is associated with significant risk of limiting work productivity over the life course. 

Relatively little attention has been paid to issues regarding work productivity in AS. Consequently, there is an urgent need not only to understand better the different perspectives of people with AS, of health professionals, of health service managers, and of employers, but also to embed issues pertinent to work productivity as a routine element of healthcare.

One major issue is that people with AS may face uncertainty as to whether to disclose to family, friends and or work colleagues that they are suffering from back pain due to a fear of stigmatization. We are therefore planning to explore all aspects of disclosure, especially within the work place, to help develop a better understanding of the experiences that people with AS face in sharing their diagnosis. Our current understanding of these issues is based on previous research that has looked at concerns surrounding disclosure of arthritis at work, but this has not been explored specifically in the context of people with AS.

We are conducting in depth interviews with people who have AS to identify their experiences regarding the process of disclosure to employer, colleagues, family and healthcare professionals. We are also looking at factors which influence the problems around disclosure.  Interviews will be completed by the end of 2015, and the data will be analysed during early 2016.


Research Team

Dr Rudresh Shukla, Academic Clinical Fellow in Rheumatology, Lancaster University
Dr Jane Martindale, Extended Scope Physiotherapist and Therapy Research Lead, Wrightington, Wigan and Leigh NHS Foundation Trust; and Honorary Researcher, Lancaster University
Dr Paula Holland, Lecturer in Public Health, Lancaster University
Professor John Goodacre, Director, Lancaster Health Hub


Citizens' journey through sickness absence: from certification back to work

Sickness absence is an event that occurs to the vast majority of working people at some stage of their career.  

Recent evidence suggests that work is generally good for health and citizens need not be fully fit in order to work. In recognition of this fact, major changes to sickness certification have taken place with a view to enhance discussions about work during GP consultations and to facilitate return to work (RTW) of citizens who suffer from health conditions. As a result, the ‘sick note’ was replaced with a new ‘Statement of fitness for work (fit note)’. Although departure from the old statement was generally welcomed by the key stakeholder groups (GPs, citizens and their employers), previous research has largely focused on GPs’ and employers’ experiences of the fit note.

There is a paucity of studies that have explored the perspectives of ‘the certified’ and it is them (as transmitters of information between their GP and their employer) who play a pivotal role in the process. In fact, very little is known about citizens’ perspectives on communication about work with their GP and whether the advice citizens receive (including the contents of the fit note) helps them discuss RTW with their employers. Of the studies that explored employees’ views on the fit note, the majority were conducted at a single point in time and thus failed to cover the complete journey of an individual through the process of sickness absence. This study aims to address this gap and seeks to identify citizens’ views of both their sickness certification and the discussions about work they had with their employers as a result of being issued with a fit note.

The findings from this work will help gain a better understanding of how citizens’ communicate about work with their GPs and employers and will inform the design of a prototype measures (tool) to support the use of the fit note by the citizens.

The research is funded by the ARUK/MRC Centre for Musculoskeletal Health and Work and findings from this study will make an important contribution to the work of the Centre. 


Research Team

Maciek Dobras, PhD Candidate, Lancaster University
Dr Paula Holland, Lecturer in Public Health, Lancaster University
Professor John Goodacre, Director, Lancaster Health Hub