Work participation in patients with systemic sclerosis: a systematic review.

OBJECTIVES: With this systematic review an overview is given of what is known about work participation in patients with systemic sclerosis (SSc). METHODS: The databases Pubmed, Cinahl, Nursing and Allied Health and PsychARTICLES have been checked from 1980 onwards. The search string consisted of all combinations of key words for work participation and SSc. Two investigators evaluated the eligibility for the articles. Reference lists were searched for other studies. RESULTS: Eight quantitative and one qualitative study were scrutinised in depth. The percentage of patients not working ranges from 18% to 61%. A meta-analysis of the percentage patients not working was performed and a weight mean of 37% was found. The following parameters are associated with the work variable in multivariate analysis (number of studies in which the variable was independently associated with the work variable/number of studies in which the variable was multivariately assessed): global disability (4/5), health (3/5), educational level (2/4), disease duration (3/3), skin/lung involvement (1/3), age/fatigue/muscle involvement/hand function (1/2) and having a decreased income/race/social support/physically demanding job (1/1). In the qualitative study, management of the work situation, disclosure of limitations at the work force and adaptation of resources in daily life are discussed. CONCLUSIONS: Most studies concerning work participation are at this very moment quantitative and cross-sectionally designed. Longitudinal studies are needed to assess causality and qualitative research may be opportune to have a more comprehensive view on the topic of work participation in patients with SSc.