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A neuropsychologically based employment intervention for women with multiple sclerosis: A quasi-randomized controlled trial

Published online by Cambridge University Press:  05 September 2022

Marnina B. Stimmel Open the ORCID record for Marnina B. Stimmel [Opens in a new window] ,
Jenna N. Cohen ,
Elizabeth K. Seng ,
Shaina Shagalow  and
Frederick W. Foley
Marnina B. Stimmel*
Affiliation:
Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
Jenna N. Cohen
Affiliation:
Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
Elizabeth K. Seng
Affiliation:
Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
Shaina Shagalow
Affiliation:
Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
Frederick W. Foley
Affiliation:
Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA Multiple Sclerosis Comprehensive Care Center, Holy Name Medical Center, Teaneck, NJ, USA
*
Corresponding author: Marnina B. Stimmel, email: marninas@gmail.com
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Abstract

Objective:

Job loss is common in multiple sclerosis (MS) and frequently associated with depression, fatigue, and cognitive dysfunction. Identifying these modifiable risk factors and providing “at-risk” women with a neuropsychologically-based intervention may improve employment outcomes. Our study seeks to investigate the utility of a neuropsychologically-based intervention with varying levels of treatment and follow-up, and evaluate treatment and employment outcomes among groups.

Method:

In this longitudinal, quasi-randomized controlled trial, employed women with MS meeting criteria on screening measures were considered “at-risk” for job instability and randomized to one of two neuropsychological testing interventions (standard-care group received testing and phone feedback of results and recommendations; experimental group received testing and in-person feedback with subsequent care-coordinator calls from a nurse to help coordinate recommendation completion). Participants who did not meet criteria were considered “low-risk” and only followed over time.

Results:

56 women in the treatment groups (standard-care = 23; experimental = 33) and 63 women in the follow-only group were analyzed at 1 year. Rates of decreased employment were similar between standard-care (17.4%) and experimental (21.2%) groups (OR = .782, 95% CI .200–3.057). However, the experimental group completed significantly more treatment recommendations, t(53) = −3.237, p = .002. Rates of decreased employment were also similar between the “low-risk” (17.5%) and “at-risk” groups (19.6%), (OR = .721, 95% CI .285–1.826).

Conclusion:

Employment outcomes were similar at 1 year between treatment groups receiving differing levels of a neuropsychologically-based intervention, however treatment adherence significantly improved in the experimental group. Treatment groups also had similar employment outcomes as compared to a “low-risk,” no intervention group, suggesting that engaging in either neuropsychological intervention may have impacted job stability.

Keywords

multiple sclerosiscognitive impairmentfatiguedepressionemployment interventionneuropsychologytreatment adherencevocational rehabilitation
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 29 , Issue 4 , May 2023 , pp. 388 - 396
Copyright
Copyright © INS. Published by Cambridge University Press, 2022

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References

Amato, M. P., Portaccio, E., Goretti, B., Zipoli, V., Iudice, A., Pina, D. D., Malentacchi, G., Sabatini, S., Annuziata, P., & Falcini, M. (2010). Relevance of cognitive deterioration in early relapsing-remitting MS: A 3-year follow-up study. Multiple Sclerosis Journal, 16, 1474–1482.CrossRefGoogle Scholar
Bøe Lunde, H. M., Telstad, W., Grytten, N., Kyte, L., Aarseth, J., Myhr, K.-M., & Bø, L. (2014). Employment among patients with multiple sclerosis-a population study. PLoS ONE, 9, e103317.CrossRefGoogle ScholarPubMed
Benedict, R. H., Cookfair, D., Gavett, R., Gunther, M., Munschauer, F., Garg, N., & Weinstock-Guttman, B. (2006). Validity of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS). Journal of the International Neuropsychological Society: JINS, 12, 549.CrossRefGoogle ScholarPubMed
Charvet, L., Serafin, D., & Krupp, L. B. (2014). Fatigue in multiple sclerosis. Fatigue: Biomedicine, Health & Behavior, 2, 3–13 Google Scholar
Flachenecker, P., Kümpfel, T., Kallmann, B., Gottschalk, M., Grauer, O., Rieckmann, P., Trenkwalder, C, & Toyka, K. (2002). Fatigue in multiple sclerosis: A comparison of different rating scales and correlation to clinical parameters. Multiple Sclerosis Journal, 8, 523–526.CrossRefGoogle ScholarPubMed
Grytten, N., Skår, A. B., Aarseth, J. H., Assmus, J., Farbu, E., Lode, K., Nyland, H. I., Smedal, T., & Myhr, K. M. (2017). The influence of coping styles on long-term employment in multiple sclerosis: A prospective study. Multiple Sclerosis Journal, 23, 1008–1017.CrossRefGoogle ScholarPubMed
Hansson, M., Chotai, J., Nordstöm, A., & Bodlund, O. (2009). Comparison of two self-rating scales to detect depression: HADS and PHQ-9. British Journal of General Practice, 59, e283–e288.CrossRefGoogle ScholarPubMed
Hubbard, G., Gray, N. M., Ayansina, D., Evans, J. M., & Kyle, R. G. (2013). Case management vocational rehabilitation for women with breast cancer after surgery: A feasibility study incorporating a pilot randomised controlled trial. Trials, 14, 1–14.CrossRefGoogle ScholarPubMed
Jackson, M., Quaal, C., & Reeves, M. (1991). Effects of multiple sclerosis on occupational and career patterns. Axone, 13, 16–20.Google ScholarPubMed
Johnson, K. L., Yorkston, K. M., Klasner, E. R., Kuehn, C. M., Johnson, E., & Amtmann, D. (2004). The cost and benefits of employment: A qualitative study of experiences of persons with multiple sclerosis. Archives of Physical Medicine and Rehabilitation, 85, 201–209.CrossRefGoogle ScholarPubMed
Julian, L. J., Vella, L., Vollmer, T., Hadjimichael, O., & Mohr, D. C. (2008). Employment in multiple sclerosis. Journal of Neurology, 255, 1354–1360.CrossRefGoogle ScholarPubMed
Khan, F., & Amatya, B. (2017). Rehabilitation in multiple sclerosis: A systematic review of systematic reviews. Archives of Physical Medicine and Rehabilitation, 98, 353–367.CrossRefGoogle ScholarPubMed
Khan, F., Ng, L., & Turner-Stokes, L. (2009). Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis. Cochrane Database of Systematic Reviews, 2009, CD007256.Google ScholarPubMed
Kornblith, A. B., La Rocca, N. G., & Baum, H. M. (1986). Employment in individuals with multiple sclerosis. International Journal of Rehabilitation Research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue Internationale de Recherches de Readaptation, 9, 155–165.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefGoogle ScholarPubMed
Krupp, L. B., LaRocca, N. G., Muir-Nash, J., & Steinberg, A. D. (1989). The fatigue severity scale: Application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of Neurology, 46, 1121–1123.CrossRefGoogle ScholarPubMed
LaRocca, N. G., Kalb, R. C., & Gregg, K. (1996). A program to facilitate retention of employment among persons with multiple sclerosis. Work, 7, 37–46.CrossRefGoogle ScholarPubMed
Matute-Blanch, C., Montalban, X., & Comabella, M. (2018). Multiple sclerosis, and other demyelinating and autoimmune inflammatory diseases of the central nervous system. Handbook of Clinical Neurology, 146, 67–84.CrossRefGoogle Scholar
McCabe, M. P., & De Judicibus, M. (2003). Multiple sclerosis and economic well-being: Role of health, age, and duration of illness. Journal of Clinical Psychology in Medical Settings, 10, 139–147.CrossRefGoogle Scholar
Miller, A., & Dishon, S. (2006). Health-related quality of life in multiple sclerosis: The impact of disability, gender and employment status. Quality of Life Research, 15, 259–271.CrossRefGoogle ScholarPubMed
Milo, R., & Kahana, E. (2010). Multiple sclerosis: Geoepidemiology, genetics and the environment. Autoimmunity Reviews, 9, A387–A394.CrossRefGoogle ScholarPubMed
Moghadasi, A. N., Pourmand, S., Sharifian, M., Minagar, A., & Sahraian, M. A. (2016). Behavioral neurology of multiple sclerosis and autoimmune encephalopathies. Neurologic Clinics, 34, 17–31.CrossRefGoogle ScholarPubMed
Murray, T. J. (2004). Multiple sclerosis: The history of a disease. Demos Medical Publishing.Google ScholarPubMed
O’Connor, A. A., & Daley, R. (2016). Enhanced vocational rehabilitation for veterans with mild traumatic brain injury and mental illness: Pilot study. Journal of Rehabilitation Research and Development, 53, 307.CrossRefGoogle ScholarPubMed
Patten, S. B., Burton, J. M., Fiest, K. M., Wiebe, S., Bulloch, A. G., Koch, M., Dobson, K. S., Metz, L .M., Maxwell, C .J., & Jetté, N. (2015). Validity of four screening scales for major depression in MS. Multiple Sclerosis Journal, 21, 1064–1071.CrossRefGoogle ScholarPubMed
Patten, S. B., Marrie, R. A., & Carta, M. G. (2017). Depression in multiple sclerosis. International Review of Psychiatry, 29, 463–472.CrossRefGoogle ScholarPubMed
Povolo, C. A., Blair, M., Mehta, S., Rosehart, H., & Morrow, S. A. (2019). Predictors of vocational status among persons with multiple sclerosis. Multiple Sclerosis and Related Disorders, 36, 101411.CrossRefGoogle ScholarPubMed
Ruet, A., Deloire, M., Hamel, D., Ouallet, J.-C., Petry, K., & Brochet, B. (2013). Cognitive impairment, health-related quality of life and vocational status at early stages of multiple sclerosis: A 7-year longitudinal study. Journal of Neurology, 260, 776–784.CrossRefGoogle ScholarPubMed
Salter, A., Thomas, N., Tyry, T., Cutter, G., & Marrie, R. A. (2017). Employment and absenteeism in working-age persons with multiple sclerosis. Journal of Medical Economics, 20, 493–502.CrossRefGoogle ScholarPubMed
Schiavolin, S., Leonardi, M., Giovannetti, A. M., Antozzi, C., Brambilla, L., Confalonieri, P., Mantegazza, R., & Raggi, A. (2013). Factors related to difficulties with employment in patients with multiple sclerosis: A review of 2002–2011 literature. International Journal of Rehabilitation Research, 36, 105–111.CrossRefGoogle ScholarPubMed
Simioni, S., Ruffieux, C., Bruggimann, L., Annoni, J., & Schluep, M. (2007). Cognition, mood and fatigue in patients in the early stage of multiple sclerosis. Swiss Medical Weekly, 137, 496–501.Google ScholarPubMed
Simmons, R. D., Tribe, K. L., & McDonald, E. A. (2010). Living with multiple sclerosis: Longitudinal changes in employment and the importance of symptom management. Journal of Neurology, 257, 926–936.CrossRefGoogle ScholarPubMed
Smith, A. (1982). Symbol digit modalities test. Western Psychological Services.Google Scholar
Stimmel, M. B., Cohen, J. N., Schneider, S. J., Portnoy, J. G., Seng, E. K., & Foley, F. W. (2020). A neuropsychologically-based intervention with increased follow-up support for employed women with multiple sclerosis: A pilot randomized controlled trial. Clinical Rehabilitation, 34, 1292–1302.CrossRefGoogle ScholarPubMed
Sweetland, J. (2012). Vocational rehabilitation for people with multiple sclerosis. University College London.Google ScholarPubMed
Uccelli, M. M., Specchia, C., Battaglia, M. A., & Miller, D. M. (2009). Factors that influence the employment status of people with multiple sclerosis: A multi-national study. Journal of Neurology, 256, 1989–1996.CrossRefGoogle Scholar
Van Schependom, J., D’hooghe, M., Cleynhens, K., D’hooge, M., Haelewyck, M.-C., De Keyser, J., & Nagels, G. (2014). The symbol digit modalities test as sentinel test for cognitive impairment in multiple sclerosis. European Journal of Neurology, 21, e1219–e1272.CrossRefGoogle ScholarPubMed
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.CrossRefGoogle ScholarPubMed