Good Work Habits and Adjustments May Help Patients Keep Jobs

The degree to which people with multiple sclerosis (MS) are conscientious — a personality trait that reflects responsibility, organization, and goal-oriented skills — in their work habits can help to predict their employment status in three years, according to a survey of 70 MS patients.

A study based on its results also found that accommodations made in the workplace, like flexible hours and written instructions, are likely to help in preserving their jobs.

The study, “Conscientiousness and deterioration in employment status in multiple sclerosis over 3 years” was published in the Multiple Sclerosis Journal.

Compared with the general population, people with MS are at risk of unemployment. Research has shown that older age, lower education, longer disease duration, and physical and cognitive disability are all risk factors for gainful employment among these patients.

Few studies, however, have analyzed how personality traits can also influence this risk.

Researchers at The State University of New York conducted a survey, called Buffalo Vocational Monitoring Survey (BVMS), to evaluate changes in work status over a three-year period in MS patients relative to healthy individuals.

They followed 70 MS patients and 25 healthy people serving as controls. At the study’s start (baseline), all underwent neurological and neuropsychological tests to assess their cognition and physical abilities.

Conscientiousness — the ability for deliberation, achievement, and order — was also assessed. In recent studies, this trait was shown to predict deterioration in cognition and brain volume in MS patients. Its lack, or a low level of conscientiousness, is also linked to occupational stress in MS.

Conscientiousness was measured using the NEO Five-Factor Inventory (NEO-FFI), a personality trait questionnaire that includes measures of how people accomplish goals, their degree of organization and cleanliness, and their adherence to obligations. Higher scores correspond to higher levels of this trait.

Negative changes in employment over these years, like a move from full-time to part-time work or critical work events, were classified in this study as deteriorating employment status (DES). A classification of stable employment status, called SES, was given when no changes, including improvements, employment were reported.

At the study’s start, 75.7% of the MS patients surveyed were employed full time, 5.7% were full time with reduced hours or responsibilities, and 18.6% worked part time. Among controls, 93.1% worked full time and 6.9% part time.

All healthy participants maintained a stable employment status during the years of follow-up, as did a majority of MS patients.

But employment status declined for 26% of them, with eight patients (44% of this group) moving from full- or part-time employment to being unemployed or formally disabled.

Twenty-four negative work events were reported by MS patients at follow-up. The most frequent was formal criticism (21%), followed by a decrease in working hours, the need for extra hours to fulfill the same goal, and a lowering of job responsibilities due to inadequate performance (17% for each).

” This complete loss of employment within a relatively short period of time highlights the importance of identifying at-risk PwMS [people with MS] and providing timely accommodations or additional clinical attention,” the researchers wrote.

Compared to stably employed patients, those with a deteriorating employment status had a significantly poorer education, lower conscientiousness scores, and greater fatigue as measured by the fatigue severity score (FSS; higher scores indicate more severe fatigue).

MS patients with a deteriorating status also performed worse on neuropsychological tests, including the symbol digit modalities test (SDMT), which measures cognitive processing speed; the brief visuospatial memory test—revised (BVMTR), that assesses visual memory; and the nine-hole peg test (9HPT), a test that evaluates manual dexterity (hand skills).

The most common adjustment was flexible hours (19 patients, 37.3%), followed by personalized written instructions (nine patients, 17.6%). Other adjustments included the ability to work from home and memory aids.

Forty-six working MS patients (88.5%) disclosed their illness to their employers. All had significantly higher conscientiousness scores.

“Low conscientiousness, cognitive impairment, physical impairment, and lower education at baseline predict DES [deteriorating employment status]” in MS, the researchers wrote.

“Conscientiousness may be a useful target for preventing employment loss,” the team added.

According to the National MS Society, “accommodations might help to increase the ability of people with MS to better organize themselves and become more goal-oriented at work,” it stated in a press release.

The Society has several resources to help develop and achieve work goals, including the video series “Employment Matters – Managing MS in the Workplace,” a guide for deciding whether and when to disclose MS to employers, another for identifying and requesting effective accommodations, and “Working with MS” to help consider career options.

Further research is needed to understand how accommodations, compensatory tools, and targeted interventions can help prevent employment loss among people with MS.