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Participation in paid and unpaid work by adults with rheumatoid arthritis Backman, Catherine L.


This study explored factors associated with participation in paid and unpaid work by adults with rheumatoid arthritis (RA). Up to 50% of people with RA stop employment prematurely because of their illness. Performance of unpaid work, such as household work, home maintenance, care-giving, and volunteering, has been given little attention. A cross-sectional mailed survey was designed in consultation with working age adults with RA. Participation in paid and unpaid work was defined as self-reported number of hours worked "last week." Test-retest reliability coefficients (ICC) for the measures of paid and unpaid work were .99 and .90. Concurrent validity, assessed using a 24-hour diary, was r = .96 for paid work and r = .75 for unpaid work. Potential explanatory factors, conceptually organized as attributes of the person, environment, or occupation, included health and functional status, social support, type of work and work demands. Participants were recruited by written invitation from their rheumatologist (n = 239, 40% of those invited). They were 18 to 66 years old (mean = 50), had RA for an average of 13 years, and 81% were female. They reported an average of 47 hours of work in the week prior to survey date, 19 paid and 28 unpaid hours. Using regression analyses, more hours of paid work were associated with psychologically demanding work, higher social function, less pain, being male, managerial job type, and lower ratings of occupational balance (R² = .25). More hours of unpaid work were associated with more children in the household, more physically and psychologically demanding work, social support from family, and having a post-secondary education (R² = .43). Satisfaction with work performance was associated with higher self-efficacy, greater occupational balance, more skill discretion in one's work, and smaller household size. Seventy-three participants were working less because of their arthritis. Lower functional status, more pain, less psychologically demanding work, and being a household worker were associated with this work limitation due to RA. Study results may influence the content of rehabilitation and education programs aimed at helping people with RA maintain or return to productive occupations, by suggesting some functional and psychosocial factors linked to paid and unpaid work.

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