Impaired Quality of Working Life in Inflammatory Bowel Disease Patients

Sara van Gennep, Nanne K H de Boer, Marieke E Gielen, Svend T Rietdijk, Krisztina B Gecse, Cyriel Y Ponsioen, Marjolijn Duijvestein, Geert R D'Haens, Mark Löwenberg, Angela G E M de Boer, Sara van Gennep, Nanne K H de Boer, Marieke E Gielen, Svend T Rietdijk, Krisztina B Gecse, Cyriel Y Ponsioen, Marjolijn Duijvestein, Geert R D'Haens, Mark Löwenberg, Angela G E M de Boer

Abstract

Background: Work-related aspects are important determinants of health for inflammatory bowel disease (IBD) patients.

Aims: We aimed to describe quality of working life (QWL) in IBD patients and to assess variables that are associated with QWL.

Methods: Employed IBD patients of two tertiary and two secondary referral hospitals were included. QWL (range 0-100) was measured using the Quality of Working Life Questionnaire (QWLQ). Work productivity (WP), fatigue, and health-related quality of life (HRQL) were assessed using the Work Productivity and Activity Impairment questionnaire, Multidimensional Fatigue Inventory, and Short Inflammatory Bowel Disease Questionnaire, respectively. Active disease was defined as a score > 4 for the patient-reported Harvey-Bradshaw index in Crohn's disease (CD) or Simple Clinical Colitis Activity Index in ulcerative colitis patients.

Results: In total, 510 IBD patients were included (59% female, 53% CD, mean age 43 (SD 12) years). The mean QWLQ score was 78 (SD 11). The lowest subscore (54 (SD 26)) was observed for "problems due to the health situation": 63% reported fatigue-related problems at work, 48% agreed being hampered at work, 46% had limited confidence in their body, and 48% felt insecure about the future due to their health situation. Intermediate/strong associations were found between QWL and fatigue (r = - 0.543, p < 0.001), HRQL (r = 0.527, p < 0.001), WP loss (r = - 0.453, p < 0.001) and disease activity (r = - 0.331, p < 0.001). Independent predictors of impaired QWL in hierarchical regression analyses were fatigue (B = - 0.204, p < 0.001), WP loss (B = - 0.070, p < 0.001), and impaired HRQL (B = 0.248, p = 0.001).

Conclusions: IBD-related problems at work negatively influence QWL. Fatigue, reduced HRQL, and WP loss were independent predictors of impaired QWL in IBD.

Keywords: Fatigue; Inflammatory bowel disease; Job satisfaction; Quality of life; Quality of working life; Work performance.

Conflict of interest statement

SG: none; NB: has served as a speaker for AbbVie, Takeda, and MSD. He has served as consultant and principal investigator for Takeda and TEVA Pharma B.V. He has received a (unrestricted) research grant from Dr. Falk, TEVA Pharma B.V, MLDS, and Takeda; MG: none; SR: none; KG: has received consultancy fees and/or speaker’s honoraria from AbbVie, Celltrion, Ferring, Immunic Therapeutics, Janssen, Pfizer, Roche, Sandoz, Samsung Bioepis, Takeda, and Tillotts; CP: has served as a speaker for Takeda, Tillotts, and Roche. He has served as advisor for Takeda, Pliant, and Shire. He has received grant support from Takeda. MD: reports advisory fees from Echo Pharma and Robarts Clinical Trials, Inc., speaker fees from Janssen, Merck & Co., Inc., Pfizer, Takeda and Tillotts Pharma, and nonfinancial support from Dr. Falk. GD: has served as advisor for Abbvie, Ablynx, Amakem, AM Pharma, Avaxia, Biogen, Bristol Meiers Squibb, Boerhinger Ingelheim, Celgene, Celltrion, Cosmo, Covidien, Ferring, DrFalk Pharma, Engene, Galapagos, Gilead, Glaxo Smith Kline, Hospira, Immunic, Johnson and Johnson, Lycera, Medimetrics, Millenium/Takeda, Mitsubishi Pharma, Merck Sharp Dome, Mundipharma, Novonordisk, Pfizer, Prometheus laboratories/Nestle, Protagonist, Receptos, Robarts Clinical Trials, Salix, Sandoz, Setpoint, Shire, Teva, Tigenix, Tillotts, Topivert, Versant and Vifor and received speaker fees from Abbvie, Ferring, Johnson and Johnson, Merck Sharp & Dohme, Mundipharma, Norgine, Pfizer, Shire, Millenium/Takeda, Tillotts and Vifor.; ML: served as speaker and/or principal investigator for Abbvie, Celgene, Covidien, Dr. Falk, Ferring Pharmaceuticals, Gilead, GlaxoSmithKline, Janssen-Cilag, Merck Sharp & Dohme, Pfizer, Protagonist therapeutics, Receptos, Takeda, Tillotts, Tramedico and has received research grants from AbbVie, Merck Sharp & Dohme, Achmea healthcare and ZonMW.; AB: none.

© 2020. The Author(s).

Figures

Fig. 1
Fig. 1
Quality of working life in inflammatory bowel disease patients. Mean (SD) total Quality of Working Life Questionnaire (QWLQ) score and subscores of the total IBD cohort
Fig. 2
Fig. 2
Associations between quality of working life and fatigue, IBD-specific health-related quality of life, and work productivity loss. a Association between quality of working life (quality of working life questionnaire (QWLQ) score) and health-related quality of life (short inflammatory bowel disease questionnaire (SIBDQ) score). b Association between quality of working life (QWLQ score) and fatigue (Multidimensional Fatigue Inventory (MFI) score). c Association between quality of working life (QWLQ score) and overall work productivity loss due to IBD in the past week (percentage of work productivity (WP) loss). B unstandardized regression coefficient, r Pearson’s correlation coefficient
Fig. 3
Fig. 3
Quality of working life according to the presence of disease activity, arthralgia and corticosteroid use. Mean (SD) total Quality of Working Life Questionnaire (QWLQ) scores compared between the absence and presence of clinical disease activity (p-HBI or p-SCCAI > 4), arthralgia and corticosteroid use at the time of completing the questionnaire. *p < 0.0001; **p = 0.018

References

    1. Spekhorst LM, Oldenburg B, van Bodegraven AA, et al. Prevalence of- and risk factors for work disability in Dutch patients with inflammatory bowel disease. World J Gastroenterol. 2017;23:8182–8192. doi: 10.3748/wjg.v23.i46.8182.
    1. Büsch K, da Silva SA, Holton M, Rabacow FM, Khalili H, Ludvigsson JF. Sick leave and disability pension in inflammatory bowel disease: a systematic review. J Crohns Colitis. 2014;8:1362–1377. doi: 10.1016/j.crohns.2014.06.006.
    1. Williet N, Sarter H, Gower-Rousseau C, et al. Patient-reported outcomes in a French nationwide survey of inflammatory bowel disease patients. J Crohns Colitis. 2017;11:165–174. doi: 10.1093/ecco-jcc/jjw145.
    1. Zand A, van Deen WK, Inserra EK, et al. Presenteeism in inflammatory bowel diseases: a hidden problem with significant economic impact. Inflamm Bowel Dis. 2015;21:1623–1630. doi: 10.1097/MIB.0000000000000399.
    1. van Gennep S, Evers SW, Rietdijk ST, et al. High disease burden drives indirect costs in employed inflammatory bowel disease patients: the WORK-IBD study. Inflamm Bowel Dis. 2020 doi: 10.1093/ibd/izaa082.
    1. Paulides E, Gearry RB, de Boer NKH, Mulder CJJ, Bernstein CN, McCombie AM. Accommodations and adaptations to overcome workplace disability in inflammatory bowel disease patients: a systematic review. Inflamm Intest Dis. 2019;3:138–144. doi: 10.1159/000495293.
    1. Mosadeghrad AM. Quality of working life: an antecedent to employee turnover intention. Int J Heal Policy Manag. 2013;1:43–50. doi: 10.15171/ijhpm.2013.07.
    1. Arnold AE, Coffeng JK, Boot CRL, et al. The relationship between job satisfaction and productivity-related costs: a longitudinal analysis. J Occup Environ Med. 2016;58:874–879. doi: 10.1097/JOM.0000000000000831.
    1. Dür M, Sadloňová M, Haider S, et al. Health determining concepts important to people with Crohn’s disease and their coverage by patient-reported outcomes of health and wellbeing. J Crohn’s Colitis. 2014;8:45–55. doi: 10.1016/j.crohns.2012.12.014.
    1. de Jong M, Tamminga SJ, van Es RJJ, Frings-Dresen MHW, de Boer AGEM. The quality of working life questionnaire for cancer survivors (QWLQ-CS): factorial structure, internal consistency, construct validity and reproducibility. BMC Cancer. 2018;18:66. doi: 10.1186/s12885-017-3966-1.
    1. Ciwit BV. Castor electronic data capture. Amsterdam: Ciwit B.V; 2018.
    1. Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics. 1993;4:353–365. doi: 10.2165/00019053-199304050-00006.
    1. Smets EM, Garssen B, Bonke B, De Haes JC. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 1995;39:315–325. doi: 10.1016/0022-3999(94)00125-O.
    1. Irvine EJ, Zhou Q, Thompson AK. The Short Inflammatory Bowel Disease Questionnaire: a quality of life instrument for community physicians managing inflammatory bowel disease. CCRPT Investigators. Canadian Crohn’s Relapse Prevention Trial. Am J Gastroenterol. 1996;91:1571–1578.
    1. Bennebroek Evertsz’ F, Nieuwkerk PT, Stokkers PCF, et al. The patient simple clinical colitis activity index (P-SCCAI) can detect ulcerative colitis (UC) disease activity in remission: a comparison of the P-SCCAI with clinician-based SCCAI and biological markers. J Crohns Colitis. 2013;7:890–900. doi: 10.1016/j.crohns.2012.11.007.
    1. Bennebroek Evertsz’ F, Hoeks CCMQ, Nieuwkerk PT, et al. Development of the patient Harvey Bradshaw index and a comparison with a clinician-based Harvey Bradshaw index assessment of Crohn’s disease activity. J Clin Gastroenterol. 2013;47:850–856. doi: 10.1097/MCG.0b013e31828b2196.
    1. Tamminga SJ, de Jong M, Frings-Dresen MHW, de Boer AGEM. The Quality of Working Life Questionnaire for Cancer Survivors: sufficient responsiveness for use as a patient-reported outcome measurement. Eur J Cancer Care (Engl) 2018;27:e12910. doi: 10.1111/ecc.12910.
    1. Van Laar D, Edwards JA, Easton S. The work-related quality of life scale for healthcare workers. J Adv Nurs. 2007;60:325–333. doi: 10.1111/j.1365-2648.2007.04409.x.
    1. de Jong M, Tamminga SJ, de Boer AGEM, Frings-Dresen MHW. Quality of working life of cancer survivors: development of a cancer-specific questionnaire. J Cancer Surviv. 2016;10:394–405. doi: 10.1007/s11764-015-0485-4.
    1. De Boer AGEM, Bennebroek Evertsz’ F, Stokkers PC, et al. Employment status, difficulties at work and quality of life in inflammatory bowel disease patients. Eur J Gastroenterol Hepatol. 2016;28:1130–1136. doi: 10.1097/MEG.0000000000000685.
    1. de Jong M, Tamminga SJ, Frings-Dresen MHW, de Boer AGEM. Quality of Working Life of cancer survivors: associations with health- and work-related variables. Support Care Cancer. 2017;25:1475–1484. doi: 10.1007/s00520-016-3549-8.
    1. Le Berre C, Peyrin-Biroulet L, Buisson A, et al. Impact of inflammatory bowel diseases on working life: a French nationwide survey. Dig Liver Dis. 2019;51:961–966. doi: 10.1016/j.dld.2019.01.024.
    1. Borren NZ, van der Woude CJ, Ananthakrishnan AN. Fatigue in IBD: epidemiology, pathophysiology and management. Nat Rev Gastroenterol Hepatol. 2019;16:247–259. doi: 10.1038/s41575-018-0091-9.
    1. van Andel EM, Koopmann BDM, Crouwel F, et al. Systematic review of development and content validity of patient-reported outcome measures in Inflammatory Bowel Disease: do we measure what we measure? J Crohns Colitis. 2020 doi: 10.1093/ecco-jcc/jjaa057.
    1. Jones J, Loftus EV, Panaccione R, et al. Relationships between disease activity and serum and fecal biomarkers in patients with Crohn’s disease. Clin Gastroenterol Hepatol. 2008;6:1218–1224. doi: 10.1016/j.cgh.2008.06.010.
    1. Cellier C, Sahmoud T, Froguel E, et al. Correlations between clinical activity, endoscopic severity, and biological parameters in colonic or ileocolonic Crohn’s disease. A prospective multicentre study of 121 cases. The Groupe d’Etudes Thérapeutiques des Affections Inflammatoires Digestives. Gut. 1994;35:231–235. doi: 10.1136/gut.35.2.231.

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