P249 Working with axSpA: a qualitative study using the British Society for Rheumatology Biologics Register
Authors: Hollick Rosemary J 
Published: April 2020

Abstract

Background
We have previously reported that axSpA patients living in rural areas report a greater impact of their disease on work productivity. Whilst rural dwellers were more likely to work in a physical job and work part-time, it is unclear how features of the disease, job type and work environment interact to influence presenteeism (work disability). We aimed to explore experiences of work and factors influencing the ability to work optimally in individuals with axSpA.

Methods
30 semi-structured telephone interviews were conducted from a subset of patients drawn from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis (BSRBR-AS) registry. Individuals were purposively sampled across a range of ages, area of residence (urban and rural), occupations (sedentary and manual), employment status and stage of working life, from diverse geographical regions in the UK. The topic guide explored experiences of living with AxSpA, work, health care and impact of AxSpA on family, financial and social life over time. Interviews were audio-recorded and transcribed. Data was analysed using an iterative thematic approach, supported by NVivo 12 qualitative data analysis software.

Results
Factors influencing presenteeism are considered under three themes; occupation, individual and workplace. Occupation: The extent to which jobs permitted flexibility, in terms of what, when and how tasks were done, was important. Dichotomous classifications of job type as sedentary or manual were unhelpful. Participants, especially in public facing jobs, reported an obligation to attend work even when feeling unwell. Individual: Work was important in terms of self-identity and providing social interactions as well as financial security. However, fatigue, reduced mobility, chronic pain and medication affected physical and mental function at work. Individuals did not discuss work issues with their rheumatologist, who tended to focus on disease management. Workplace: Support from work colleagues and immediate line managers was critically important, over and above organisational policies. However, AxSpA was often misunderstood, for example, as ‘a bad back.’ Flexible working practices e.g. home-working enabled individuals to continue to work, when they would otherwise have been unable to. Adaptations to driving and commuting to work were common. Some employers permitted adjustments to working practices or time off for appointments, whereas others were inflexible. Sickness monitoring procedures were often perceived to be punitive, rather than supportive.

Conclusion
The relationship between job type, work environment and work disability is nuanced and complex. Existing measures of work do not accurately reflect what people actually do, the challenges they face, or the benefits of work. Flexibility in terms of what, when and how tasks are done is important. There is significant variation in support offered by employers. Healthcare professionals can do more to support individuals to work well and educate employers.

Disclosures
R.J. Hollick None.