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 have now explored the aspect 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 qualitative study (Shukla et al., 2017) found that participants had discussed their diagnosis and symptoms to varying levels with employers, family members, friends and healthcare professionals. They had decided on the level of disclosure after assessing the risks and potential benefits. On a positive note, they were able to find support from work colleagues and family but this was sometimes riddled with challenges. In addition, the specialist physiotherapy team were able to offer much needed physical and psychological support. However, despite disclosing their diagnosis, participants remained fearful of stigmatisation especially at work, resulting in psychological distress, which was amplified by the lack of awareness about the condition.
We would recommend that employers, healthcare professionals and family members should not underestimate the challenges faced by individuals when deciding whether to disclose this ‘hidden disability’. Offering support and encouragement to empower individuals with AS/Axial SpA to successfully disclose their diagnosis should they choose to should be taken into account as a routine element of clinical care.
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
Employees' 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.
Changes to sickness certification were introduced with a view to facilitate return to work (RTW). In 2010 the sick note was replaced with a Fit Note. Although departure from the old statement was generally welcomed by the key stakeholders (GPs, employees and 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 from the GP to the employer - who play a pivotal role in the process. In fact, very little is known about employees’ perspectives on communication with their GP during sickness certification, and whether the Fit Note does indeed facilitate RTW discussions with the employer.
Of the studies that have explored employees’ perceptions of the Fit Note, the majority have failed to disaggregate employees’ views of the Fit Note by their health condition, occupation, etc. It is therefore unknown if the perceived utility of the Fit Note varies depending on employee characteristics or if certain employee groups find it more useful than others. Previous studies have also failed to explore employees’ perspectives on the actual use of their Fit Note during discussions with employers. This study will aim to address this gap and seek to answer the following research questions:
- What do employees expect from the GP during the sickness certification process?
- What do employees report on communication about return to work with their GP?
- What are employees’ views on the outcome of their discussions about return to work with GPs and employers?
These questions will be answered through a mixed method study of employed adults recently issued with a Fit Note and residing in Lancashire and Cumbria. The participants will be identified at three GP practices, contacted by post and asked to complete a questionnaire about their Fit Note consultation. A sub-sample will be then selected for individual interviews. The interviews will be conducted after the participant has returned to work (or at least has had the chance to talk to their employer about their return). The findings from this work will help gain a better understanding of employees’ perspectives on sickness certification, including on their communication about health and work with GPs and employers. The findings will also help explore how the Fit Note system can be improved for the employees in the future.
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.