Early intervention to preserve employment for people with multiple sclerosis

Approximately 75% of people with MS are unemployed 5 years after diagnosis, although more than 90% of people with MS have a history of employment. People with MS who are working consistently report higher quality of life than those who are unemployed but have similar health status, and people who retire prematurely experience significant financial stress. Fatigue, cognitive changes, and mobility limitations are key factors influencing employment. Interventions to preserve employment have not been notably successful in part due to the time required to participate and in part due to the ambivalence people express with respect to disclosing their MS and requesting accommodations.

In anticipation of a RCT (now in progress) we conducted a pilot study using Motivational Interviewing (MI), a technique that focuses on ambivalence to change and has been widely applied to public health issues ranging from alcohol consumption, smoking cessation, dietary changes, adherence to health promotion or remediate regimes, etc. The MI was delivered by telephone or in person in six monthly 30 minute doses to 8 individuals with MS who are currently working but at risk for leaving employment due to cognitive and/or physical changes. In this study we focused on the ambivalence of subjects to disclose MS to their employer, to acknowledge limitations to themselves, and to request accommodations from their employer and/or make accommodations themselves. Outcomes are measured in changes in employment status and satisfaction with the intervention. Individuals reported satisfaction with the intervention and several resolved ambivalence and successfully requested accommodations.