Coronel Institute

Quality of Life and illness representation in chronic RSI patients:

does work status matter?

Dr. Judith K. Sluiter, PhD, Associate Prof.Prof.dr Monique H.W. Frings-Dresen

Coronel Institute of Occupational Health,Academic Medical Center, Amsterdam, Netherlands

j.sluiter@amc.uva.nl

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Background: RSI

• known since 1700 in Bernardino Ramazzini’s “De Morbis Artificum Diatriba”

• most registred occupational disease in The Netherlands• lot of studies: focus on short-term complaints somewhere in

upper extremity in working populations• lack of studies in larger groups of chronic RSI patients

• lack of knowledge about what may be important for the ability to work with these complaints

• RSI Dutch patient association: 1700 members in 1999, 3250 members in 2005

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Objective

to study differences between the perspectives of

working and sick-listed Dutch chronic RSI patients’

with respect to indices of quality of life and illness

representation

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Methods

• data from questionnaire study 2005• N= 1121; members of the RSI patient association• demographics • work-status (working or presently sick-listed)• complaint-related variables: type, severity, duration, extent• cause of RSI

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Methods: dependent and independent variables

• quality of life (QoL): – SF-36 subscales– current work-ability compared to best ever (0-10) – percentual complaint-related QoL deterioration calculated through two

VAS-scales that asked to rate QoL with respect to1) current general health (0-100) and

2) general health before the RSI-complaints existed (0-100)

• illness representation: brief illness perception questionnaire (B-IPQ) (Broadbent et al., 2006)

• comparison between working and sick-listed patients

(statistical and in terms of clinically relevant differences)

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Results (1): demographics

work-status: working

(n=745)

sick-listed

(n=376)

Sex (proportion females)* 2/3 3/4

Age (yrs)* 40 42

Education (proportion high)* 3/4 2/3

*= p-values <0,01 (Sluiter & Frings-Dresen, submitted)

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work-status*: working (%) sick-listed (%)

long-term over exertion during work

71 75

short-term over exertion during work

5 2

more than one cause 17 15

over exertion in off-work time 2 2

Main cause RSI complaints?RSI working (n=745), sick-listed (n=376)

* = p-values > 0,05

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Location of complaints? 8 regionsChronic RSI-patients (n=1121)

53%

61%

53%

58%

33%

70%

58%

27%

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work-status: working sick-listed

duration complaints (yrs) 5,6 6,2

extent pain (0-16 regions)* 5,7 7,7

severity pain (0-100 devastating)* 36 52

severity other complaints (0-100)* 34 46

Duration, extent and severity of complaintsRSI working (n=745), sick-listed (n=376)

*= p-values <0,01 (Sluiter & Frings-Dresen, submitted); Clinical relevant differences in extent and severity of complaints

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QoL(1): SF-36 domains (higher scores are better QoL)

pp= physical functioning

prp= physical role

p= pain

vt=vitality

sf=social functioning

erp=emotional role

mh=mental health

All p<0,01 except for Social functioning (p=0,44) (Sluiter & Frings-Dresen, submitted)

Quality of Life [SF-36 score: 0=bad - 100=good]

0

10

20

30

40

50

60

70

80

90

100

pp prp p vt sf erp mh

subscales

me

an

sc

ore

SF36 Ned SF36 RSI working SF36 RSI sick-listed = Clinical relevant differences

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QoL (2): current estimated work-ability compared to best ever(10)

Current work-ability

0 1 2 3 4 5 6 7 8 9 10

RSI working

RSI sick-listed

Gro

up

means score (0-10 best)

P=0,000 and clinically relevant (Sluiter & Frings-Dresen, submitted)

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Decrease in QoL because of RSI complaints

p<0,01 between groups and clinically relevant present difference (Sluiter & Frings-Dresen, submitted)

Decrease in QoL because of RSI complaints

0

10

20

30

40

50

60

70

80

90

100

KvL voor klachten KvL nu

Estimate before complaints started and current

Me

an

Qo

L (

0 b

ad

-10

0 g

rea

t)

RSI working RSI sick-listed

Percentual decrease:

Working: 31%

Sick-listed: 49%

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Clinically relevant differences in illness representation

• Consequences: how much does your illness affect your life (not at all, to severely)

• Treatment control: how much do you think your treatment can help your illness? (not at all, to extremely helpful)

• Identity: how much do you experience symptoms from your illness? (no symptoms at all, to many severe symptoms)

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Conclusions• sick-listed RSI patients reported a greater number and more severe complaints

than working RSI patients; severity and extent of complaints may be usable as prognostic factors to decide on timely interventions for work resumption

• quality of life deterioration due to the RSI complaints is greater for sick-listed compared to working RSI patients

• illness representation differs with work status at almost all dimensions, but clinically relevant on consequences, treatment control, and identity ; this could be used in informational treatment strategies