Do rheumatologists recognize their patients' work-related problems?

Objective. The question addressed in this pilot study was 'Does the additio n of an occupational health physiotherapist offering early vocational asses sment influence the management of rheumatology patients (clinically and rel ated to the workplace)?' Method. Sequential vocational assessments were offered to 78 subjects with rheumatological complaints of more than 1 yr duration experiencing difficul ties in working. The findings from the vocational assessments were fed back to rheumatologists. Where necessary and acceptable. workplace intervention s were made and the Employment Service's Access to Work scheme was utilized to address the employment problems found. Results. The intervention vocational assessments trebled the number or subj ects seeing a Disability Employment Adviser (17% before the study, a furthe r 37% during it ). High levels of satisfaction were reported for interventi ons made at work. Some important changes to the management of some patients by a few doctors were made, but information from the vocational assessment s did not reach them reliably in a number of cases. Conclusion. An unmet need for advice and workplace aids and equipment was i dentified. Vocational assessment by a practitioner with clinical knowledge, ergonomic and workplace experience proved helpful to patients in this pilo t study. Without vocational assessment. the hospital-based team rarely iden tified what were often remediable. work problems and appeared unaware of th e appropriate referral route for this group of patients. Rheumatologists ma y need to expand their management to include consideration of work issues t o ensure that their patients are referred early for appropriate ergonomic i ntervention when required. Further study is required to help facilitate eas y identification in the clinical setting of patients with problems at work.