Impact of Unmet Workplace Accommodation Needs on Work Productivity in Those with Systemic Sclerosis Gastrointestinal Involvement

Objectives Systemic sclerosis (SSc) is a systemic autoimmune rheumatic disease with gastrointestinal manifestations that may restrict participation in the workplace. Our objectives were to study work factors, unmet workplace accommodations and association with work productivity between those with and without SSc-associated gastrointestinal symptoms.

Methods A cross-sectional study was conducted in individuals 16 years or older with SSc, who were employed or had been employed in the last 5 years. Demographics, disease manifestations including patient reported outcomes, frequency of disease flares, specific limitations at work, and the need, availability and use of various workplace supports were collected. Regression models were used to evaluate the unadjusted and adjusted relationship between unmet accommodation needs and workplace outcomes (absenteeism, job disruption and presenteeism; respectively) between participants with and without SSc-associated GI involvement. A p-value of <0.05 was considered statistically significant.

Results We report 217 participants (175 (80.6%) women, 42 (19.4%) men) where 129 (59.4%) had gastrointestinal symptoms and 88 (40.6%) did not have any GI symptoms related to SSc. Those with GI involvement scored lower on self-related health outcomes (p<0.0001), have greater amounts of pain (p<0.0003) and fatigue (p<0.0001), have worse patient-reported health overall (p<0.0001), more health variability (p<0.0001), and more disease flares (p<0.0004). Participants with SSc-associated GI symptoms needed more workplace accommodations than those without GI symptoms, including flexible hours or flex time (65.9% vs 46.6%), extended health benefits (84.1% vs 68.2%), breaks and rest periods (58.7% vs 33.3%), special equipment (62.1% vs 44.8%), modified job duties (48.8% vs 26.1%), altered work schedule (54.9% vs 33.3%), and the need to work from home on occasion (56.4% vs 37.4%) (Table 1). Participants with SSc-GI manifestations were 3.68 times more likely to have unmet workplace accommodations than those without GI manifestations; this did not change when the subjects disclosed their diagnosis to their supervisors. Those with GI involvement had higher job disruption scores (on average, 1.2 scores higher) and reported greater disease-related impairment in job productivity (on average, 2.3 scores higher) than those without GI involvement; this is also true when adjusted for biological sex and age.

Conclusion The presence of GI symptoms poses a significant burden on productive employment in individuals with SSc. This study lays the groundwork for where SSc- specific efforts in workplace policies and practices should be directed.