To examine ways in which individuals with arthritis manage their employment and health by focusing on the type and determinants of diverse behavioral coping strategies used to manage activity limitations, and to examine the relationship between coping behaviours and participation in employment.
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The study group comprised 492 patients (383 women, 109 men) with osteoarthritis or rheumatoid arthritis. All participants were employed, and all participants were administered an in-depth, structured questionnaire. The study used an inductive approach to analyze coping responses and distinguished among 4 categories of coping behaviors as follows: adjustments to time spent on activities; receipt of help; modification of behaviours; and anticipatory coping.
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Anticipatory coping included exercising, planning, and pacing activities.Fewer coping behaviors were reported at the workplace than outside of the workplace. Anticipatory coping was used most often in the workplace. Workplace activity limitations were related to increased reports of all types of anticipatory coping. Expectations of continued employment were also related to modifications of activities, as was longer disease duration and discussing arthritis with one’s employer. Help from others was associated with talking to an employer and positive job perceptions. Compared with work, reports of a greater number of coping behaviors used at home were associated with changes in overall work participation (e.g., absenteeism).
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These results expand our understanding of the experience of having a chronic illness and working and highlight the ways in which people accommodate to workplace limitations by using a variety of different behavioral coping efforts to remain employed.
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| Behaviours | At home | At work |
|---|---|---|
| Adjustment of time | “I cut back socializing and leisure activities in order to have the energy to do my job.” “At times I forgo the whole activity – end up staying home because I can’t do it – (too much) pain.” | “I have to take time off sometimes.” “I try not to have too many clients in one day.” “My knees are gone so I don’t kneel (at work) anymore.” |
| Help from others | “I hire a landscaper occasionally to work on major tasks.” “I try to travel with someone so they can help lift things like luggage.” “I go to certain grocery store because there is someone who will bring the groceries to the car for you.” | “If I'm having a flare up I take a cab to and from work.” “I ask a coworker to pack materials in small boxes so its easier for me to set up displays.” “I have people come to my desk instead of going to them.” |
| Modifications to activities | “I have car keys with special handles so that I can turn the ignition more easily.” “I brace myself on the arms of the chair or table so that I can push myself up and I don't have to rely on my knees.” “When I tie my shoelaces I put one leg behind the other and bend straight up from the hip, then flex my ankle up.” | “I use the handicapped parking spot to limit my walk from the lot to the building.” “I use a stool to keep my legs up when they get stiff.” “Grasping small objects is hard – sometimes at work to tighten a cylinder valve I use a wrench.” |
| Anticipatory coping | “When buying clothes I look for things that are easy to put on.” “I carefully measure each move to find what movement hurts the least – do what works.” “Before getting out of bed in the morning I try to do some stretching exercises.” | “I try to organize things so I do everything I need at one spot and I don't have to come back later.” “I pace my work so that I get lots of work done at a time when I'm not in too much pain.” “If I sit too long, I will stand up and give myself a break because it will hurt later.” |
This table provides examples of coping behaviours used at home and at the workplace. Adjusting time spent on activities included changes to the frequency, duration, and timing of activities and giving up or limiting activities. Help from others included instrumental help with tasks and discussion of difficulties with others. Modifications to activities included modifying the way in which activities were performed, structure modification to the workplace or home and using devices. Anticipatory coping encompassed planning, caution, movement such as stretching and exercising to minimize symptoms, and alternating rest with activity.
| Coping Behaviours | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Adjust time | Receive help | Modifications | Anticipatory coping | |||||||
| b | ß | b | ß | b | ß | b | ß | |||
| Demographic variable | ||||||||||
| Age | 0.00 | 0.04 | 0.01 | 0.06 | -0.01 | -0.04 | 0.00 | -0.01 | ||
| Sex | 0.09 | 0.03 | 0.02 | 0.08 | -0.14 | -0.03 | -0.77* | -0.14 | ||
| Marital status | ||||||||||
| Widowed/div/sep | 0.11 | 0.01 | 0.05 | 0.02 | 0.34 | 0.08 | -0.11 | -0.02 | ||
| Never married | 0.03 | -0.01 | 0.03 | 0.01 | 0.12 | 0.02 | 0.04 | 0.06 | ||
| Income | ||||||||||
| $39,999 | -0.24 | -0.04 | -0.25 | -0.08 | -0.25 | -0.05 | 0.03 | 0.01 | ||
| $40-69,999 | 0.19 | 0.12 | -0.02 | -0.01 | -0.21 | -0.05 | -0.08 | -0.02 | ||
| $70-99,999 | 0.12 | 0.07 | -0.12 | -0.05 | 0.32 | 0.08 | 0.49 | 0.09 | ||
| R2 change | 0.03 | 0.02 | 0.04 | 0.03 | ||||||
| Illness variable | ||||||||||
| Diagnosis | ||||||||||
| Non-inflammatory | -0.07 | -0.03 | -0.18 | -0.07 | 0.07 | 0.02 | 0.48 | 0.10 | ||
| Both | 0.22 | 0.07 | -0.42† | -0.10 | -0.10 | -0.01 | 0.28 | 0.03 | ||
| Duration | 0.00 | 0.01 | 0.01 | 0.09 | 0.02† | 0.10 | -0.01 | -0.02 | ||
| Symptom severity | -0.04 | -0.10 | -0.05 | -0.09 | -0.08 | -0.10 | -0.10 | -0.10 | ||
| Joints affected | -0.37 | -0.08 | -0.14 | -0.03 | -0.28 | -0.03 | 1.81* | 0.16 | ||
| Fatigue | 0.07 | 0.09 | -0.01 | -0.01 | -0.14 | -0.03 | 0.06 | 0.04 | ||
| Medication | 0.02 | 0.01 | 0.01 | 0.01 | 0.07 | 0.02 | 0.06 | 0.01 | ||
| R2 change | 0.08‡ | 0.07‡ | 0.04† | 0.12‡ | ||||||
| Work context | ||||||||||
| Workplace activity limitations | 0.11‡ | 0.47 | 0.14‡ | 0.53 | 0.23‡ | 0.51 | 0.29‡ | 0.53 | ||
| Employer knows | 0.12 | 0.05 | 0.27† | 0.10 | 0.45† | 0.10 | 0.21 | 0.04 | ||
| Variable hours | -0.01 | -0.01 | -0.14 | -0.06 | 0.21 | 0.05 | 0.29 | 0.06 | ||
| Job perceptions | 0.01 | 0.06 | 0.03* | 0.13 | 0.02 | 0.05 | 0.04 | 0.07 | ||
| Future expectations | 0.06 | 0.01 | 0.08 | 0.02 | -0.66† | -0.11 | -0.81† | -0.11 | ||
| R2 change | 0.15‡ | 0.21‡ | 0.19‡ | 0.20‡ | ||||||
| Total R2 | 0.26‡ | 0.31‡ | 0.26‡ | 0.35‡ | ||||||
This table shows the association of workplace coping efforts to demographic, illness, and work context variables which revealed that, as expected, greater difficulty with workplace activities was consistently associated with reports of more coping. For the most part, demographic variables were not associated with behavioral coping at work, although women were more likely to report anticipatory coping efforts. Similar to other research, illness-related factors were inconsistently associated with coping behaviours. That is, the impact of arthritis on employment is only partly related to the severity of an individual’s condition and can perhaps be better conceived as an interaction between the individual and his or her environment. Job context variables were also related to coping. Participants who had told their employer about their arthritis reported receiving more modifications and help to manage work limitations.
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