Occupational Therapy Interventions for Job Retention for Individuals with Multiple Sclerosis: A Case Study

Background: In the United States, while about 66% of individuals with MS are working at the time of their diagnosis, only about 20% are employed 10 years after their diagnosis. Approximately 75% of individuals with MS voluntarily leave work before symptoms make them incapable of work. Research shows that individuals with MS who are unemployed experience higher levels of perceived stress than their employed counterparts. There is inconclusive evidence to support vocational rehabilitation (VR) for individuals with MS, highlighting gaps in traditional VR services. Nevertheless, studies highlight the importance of multidisciplinary care to keep this population in the workforce.

The unemployment trends for individuals with MS showcases the need to address both functional and psychological aspects of returning to and/or maintaining employment. Occupational therapy practitioners (OTPs) can support individuals with MS in navigating the common barriers to employment including acquiring reasonable work accommodations, understanding workplace protections under the Americans with Disabilities Act (ADA), training clients in strategies to manage physical symptoms secondary to MS, self-advocacy, and processing socioemotional concerns with symptom management in the workplace.

Objectives: Describe the delivery of interventions to support job retention in patients with MS and provide a case study with clinical outcomes to demonstrate how these interventions can be integrated into an occupational therapy (OT) plan of care.

Methods: The case study subject participated in 7 sessions during their OT plan of care. The following interventions were used to support work engagement: symptom management training, education regarding ADA protections, reasonable work accommodations, and addressing socioemotional concerns with symptom management in the workplace. The Canadian Occupational Performance Measure (COPM) was administered at pre- and post-intervention to capture perceived performance and satisfaction in areas of occupational performance deficit.

Results: Clinically significant improvement occurred in the COPM performance (+3.0) and satisfaction (+5.0) scores for the work-specific domain. Additionally, the subject showed clinically significant improvement in the aggregate scores, with a 3.2-point increase in performance and 4.4-point increase in satisfaction. Qualitatively, the subject reported increased self-efficacy with work and job retention, and improved management of symptoms in the work context.

Conclusions: This case study highlights interventions OTPs can utilize to address the occupational domain of work, and contributes to the literature supporting OT involvement in supporting job retention for individuals living with MS.