To investigate factors associated with fulfilment of expectations towards paid employment after total hip/knee arthroplasty (THA/TKA). Cohort study including preoperatively employed patients aged... Show moreTo investigate factors associated with fulfilment of expectations towards paid employment after total hip/knee arthroplasty (THA/TKA). Cohort study including preoperatively employed patients aged 18-64 scheduled for THA/TKA. Expectations were collected preoperatively, and 6 and 12 months postoperatively with the paid employment item of the Hospitalfor-Special-Surgery Expectations Surveys (back-to-normal = 1; large improvement = 2; moderate improvement = 3; slight improvement = 4; not applicable = 5). Patients scoring not applicable were excluded. Fulfilment was calculated by subtracting preoperative from postoperative scores (< 0: unfulfilled; = 0: fulfilled). Multivariable logistic regression analyses were conducted separately for THA/TKA at 6 and 12 months postoperatively. Six months postoperatively, 75% of THA patients (n = 237/ n = 316) and 72% of TKA patients (n = 211/n = 294) had fulfilled expectations. Older age (TKA:OR 1.08, 95% CI 1.01-1.15) and better postoperative physical functioning (THA:OR 1.10, 95% CI 1.06-1.14; TKA:OR 1.03, 95% CI 1.01-1.06) increased the likelihood of fulfilment. Physical work tasks (THA:OR 0.12, 95% CI 0.03-0.44), preoperative sick leave (TKA:OR 0.33, 95% CI 0.17-0.65), and difficulties at work (THA:OR 0.10, 95% CI 0.03- 0.35; TKA:OR 0.41, 95% CI 0.17-0.98) decreased the likelihood of fulfilment. Twelve months postoperatively similar risk factors were found. Three out of four working-age THA/TKA patients had fulfilled expectations towards paid employment at 6 months postoperatively. Preoperative factors associated with fulfilment were older age, mental work tasks, no sick leave, postoperative factors were better physical functioning, and no perceived difficulties at work. Show less
This thesis focuses on health inequity in Spondyloarthritis (SpA) and potential drivers for this. The general lack of evidence on the role of socioeconomic factors, mainly at the level of the... Show moreThis thesis focuses on health inequity in Spondyloarthritis (SpA) and potential drivers for this. The general lack of evidence on the role of socioeconomic factors, mainly at the level of the individual, but also at the wider societal level, on disease outcomes in SpA, stimulated the undertaking of the individual studies described in the thesis. The possibility to study socioeconomic factors give a unique dimension to the analyses presented and provide more insights that complement the existing body of evidence. The studies presented also highlight much unmet need in our understanding of disease and in particular the intricate relationships between biological and non-biological factors that drive adverse outcomes in SpA. Many of these relationships are naturally complex and the observed effects on outcomes, multifactorial in origin. The thesis has three overarching aims, all pertaining to better understanding the role of socioeconomic factors in SpA, from different angles, both at the individual as well as the country-level and the impact on outcomes, namely imaging and work outcomes. Show less
Brakema, E.A.; Tabyshova, A.; Kleij, R.M.J.J. van der; Sooronbaev, T.; Lionis, C.; Anastasaki, M.; ... ; FRESH AIR Collaborators 2019
Working gainfully is a major activity of adult life, providing income, structure, social interaction and an opportunity to learn and practice skills, and a source of self-esteem. In people with... Show moreWorking gainfully is a major activity of adult life, providing income, structure, social interaction and an opportunity to learn and practice skills, and a source of self-esteem. In people with chronic arthritis work disability is common, having a major impact upon individuals as well as society. In the Netherlands, rheumatic diseases account for about 15% of the costs due to work disability payments. Given this significance, work retention issues have been identified as one of the aims of the management of chronic arthritis. Apart from the optimization of medical treatment, in many countries structured vocational rehabilitation programs are being offered to patients with chronic arthritis, with the aim of preventing the loss of paid employment or enhancing return to work. The aim of the present thesis was to describe the evidence regarding the effectiveness of vocational rehabilitation programs in patients with chronic arthritis. Moreover, this thesis includes an evaluation of a multidisciplinary job retention vocational rehabilitation program aimed at the prevention of work disability in patients with chronic arthritis who were at risk for job loss. In addition, the co-operation between rheumatologists and occupational physicians in the process of vocational rehabilitation was evaluated. Show less
