1. Coronel Institute Quality of Life and illness representation in chronic RSI patients: does work status matter? Dr. Judith K. Sluiter, PhD, Associate Prof. Prof.dr Monique H.W. Frings-Dresen Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, Netherlands j.sluiter@amc.uva.nl

2. Coronel Institute Background: RSI known since 1700 in Bernardino Ramazzini’s “De Morbis Artificum Diatriba” most registred occupational disease in The Netherlands lot of studies: focus on short-term complaints somewhere in upper extremity in working populations lack of studies in larger groups of chronic RSI patients lack of knowledge about what may be important for the ability to work with these complaints RSI Dutch patient association: 1700 members in 1999, 3250 members in 2005

3. Coronel Institute Objective to study differences between the perspectives of working and sick-listed Dutch chronic RSI patients’ with respect to indices of quality of life and illness representation

4. Coronel Institute Methods data from questionnaire study 2005 N= 1121; members of the RSI patient association demographics work-status (working or presently sick-listed) complaint-related variables: type, severity, duration, extent cause of RSI

5. Coronel Institute Methods: dependent and independent variables quality of life (QoL): –SF-36 subscales –current work-ability compared to best ever (0-10) –percentual complaint-related QoL deterioration calculated through two VAS-scales that asked to rate QoL with respect to 1)current general health (0-100) and 2)general health before the RSI-complaints existed (0-100) illness representation: brief illness perception questionnaire (B-IPQ) (Broadbent et al., 2006) comparison between working and sick-listed patients (statistical and in terms of clinically relevant differences)

6. Coronel Institute Results (1): demographics work-status:working (n=745) sick-listed (n=376) Sex (proportion females)*2/33/4 Age (yrs)*4042 Education (proportion high)*3/42/3 *= p-values <0,01 (Sluiter & Frings-Dresen, submitted)

7. Coronel Institute work-status*:working (%)sick-listed (%) long-term over exertion during work 7175 short-term over exertion during work 5 2 more than one cause1715 over exertion in off-work time 2 2 Main cause RSI complaints? RSI working (n=745), sick-listed (n=376) * = p-values > 0,05

8. Coronel Institute Location of complaints? 8 regions Chronic RSI-patients (n=1121) 53% 61% 53% 58% 33% 70% 58% 27%

9. Coronel Institute work-status:workingsick-listed duration complaints (yrs)5,66,2 extent pain (0-16 regions)*5,77,7 severity pain (0-100 devastating)*3652 severity other complaints (0-100)*3446 Duration, extent and severity of complaints RSI working (n=745), sick-listed (n=376) *= p-values <0,01 (Sluiter & Frings-Dresen, submitted); Clinical relevant differences in extent and severity of complaints

10. Coronel Institute QoL(1): SF-36 domains (higher scores are better QoL) pp= physical functioning prp= physical role p= pain vt=vitality sf=social functioning erp=emotional role mh=mental health All p<0,01 except for Social functioning (p=0,44) (Sluiter & Frings-Dresen, submitted) = Clinical relevant differences

11. Coronel Institute QoL (2): current estimated work-ability compared to best ever(10) P=0,000 and clinically relevant (Sluiter & Frings-Dresen, submitted)

12. Coronel Institute Decrease in QoL because of RSI complaints p<0,01 between groups and clinically relevant present difference (Sluiter & Frings-Dresen, submitted) Percentual decrease: Working: 31% Sick-listed: 49%

13. Coronel Institute

14. Clinically relevant differences in illness representation Consequences: how much does your illness affect your life (not at all, to severely) Treatment control: how much do you think your treatment can help your illness? (not at all, to extremely helpful) Identity: how much do you experience symptoms from your illness? (no symptoms at all, to many severe symptoms)

15. Coronel Institute Conclusions sick-listed RSI patients reported a greater number and more severe complaints than working RSI patients; severity and extent of complaints may be usable as prognostic factors to decide on timely interventions for work resumption quality of life deterioration due to the RSI complaints is greater for sick-listed compared to working RSI patients illness representation differs with work status at almost all dimensions, but clinically relevant on consequences, treatment control, and identity ; this could be used in informational treatment strategies