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Fortschr Neurol Psychiatr 2013; 81(2): 95-103
DOI: 10.1055/s-0032-1330286
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Chronisch krank und ohne Arbeit? Eine aktuelle Analyse zur Erwerbstätigkeit bei Multipler Sklerose

Chronically Ill and Unemployed? A Review on Vocational Status in Multiple Sclerosis
S. Kern
,
M. Kühn
,
T. Ziemssen
Further Information

Publication History

Publication Date:
14 February 2013 (online)

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Zusammenfassung

Hintergrund: Multiple Sklerose (MS) ist eine der häufigsten neurologischen Erkrankungen des jungen Erwachsenenalters. Sie ist gekennzeichnet durch einen meist chronisch progredienten Verlauf mit weitreichenden Beeinträchtigungen in privaten und beruflichen Lebensbereichen. Ziel der vorliegenden Arbeit ist eine literaturbasierte Darstellung der aktuellen Arbeitssituation von MS-Patienten unter Berücksichtigung von krankheitsspezifischen, therapeutischen, psychosozialen und sozioökonomischen Einflussfaktoren. Neben der Darstellung der internationalen Datenlage gilt dem aktuellen Forschungsstand in Deutschland ein besonderes Interesse.

Ergebnisse: Laut deutschen und internationalen Untersuchungen sind rund 40 % der MS-Patienten im erwerbsfähigen Alter nicht mehr erwerbstätig. Hauptgründe hierfür sind krankheitsspezifische Faktoren, wie zum Beispiel Einschränkungen im Bereich der Mobilität und der oberen Extremitäten, Fatigue und kognitive Beeinträchtigung. Diese Symptome werden laut dem Deutschen Multiple Sklerose Register (DMSR) noch immer unzureichend behandelt. Bei Patienten mit geringer motorischer Einschränkung (EDSS ≤ 3,0) haben depressive Störungen einen großen Einfluss auf die Erwerbstätigkeit. Eine Zunahme der Progression, ein relativ gesehen höheres Alter bei der Diagnosestellung sowie die Ausübung einer physisch schweren Arbeit gelten im Hinblick auf die Erwerbstätigkeit als prognostisch ungünstig. Nicht krankheitsspezifische Gründe für Einschränkungen der Erwerbstätigkeit sind unter anderem der Mangel an flexiblen Arbeitszeiten, das Fehlen von flexiblen Ruhepausen, Unverständnis am Arbeitsplatz sowie die persönliche Einstellung zur Arbeit.

Schlussfolgerung: Der aktuelle Erkenntnisstand zur Erwerbssituation von MS-Patienten basiert fast ausnahmslos auf internationalen Untersuchungen (Skandinavien, England, USA, Australien, MSIF Survey). Aussagekräftige Daten zur Erwerbssituation von MS-Patienten in Deutschland liegen derzeit lediglich in Form des DMSR vor. Die Daten machen deutlich, dass Symptome wie Fatigue, Ataxie und kognitive Beeinträchtigung noch immer unzureichend behandelt werden. Die Gründe für die unzureichende Versorgung sind vielfältig – nicht zuletzt fehlen jedoch gerade bei der Behandlung von Ataxie, Fatigue und kognitiven Beeinträchtigungen effektive und ausreichend evaluierte Therapieoptionen. Umfassende Studien zu spezifischen Einflussfaktoren auf die Erwerbsfähigkeit von MS-Patienten in Deutschland fehlen.

Abstract

Background: Multiple sclerosis (MS) is one of the most common neurological disorders in young adults. It is characterised by a chronic progressive course with far reaching implications on the patient’s private and professional life. Based on the current literature, employment status is analysed in relation to disease-specific, therapeutic, psychosocial, and socioeconomic factors. A special emphasis is placed on the vocational status of MS patients in Germany.

Results: According national and international studies, around 40 % of all MS patients are currently unemployed. Main reasons for early retirement are disease-specific factors such as impaired mobility, disability in the upper extremities, fatigue, and cognitive impairment. According to the German Multiple Sclerosis Registry (GMSR), these symptoms are still insufficiently treated. In patients with minor motoric impairment (EDSS ≤ 3.0), depressive symptoms seem to have a major impact on employment status. Disease progression, older age at diagnosis, and hard physical work are negative predictors in terms of employment situation. The lack of flexible working hours, the inability to have flexible resting times at work, a lack of understanding from colleagues and employers as well as the personal attitude were main non-disease-specific reasons for early retirement.

Conclusions: The current knowledge on the vocational status in MS is mainly based on international studies (e. g., Scandinavia, England, USA, Australia, MSIF Survey). For Germany, only the GMSR supports significant information on the employment status of MS patients. According to the GMSR, ataxia, fatigue and cognitive dysfunction are still insufficiently treated – a situation that is at least partly due to insufficient treatment options. Comprehensive studies that focus on a broad range of possible influencing factors on vocational status of German MS patients are currently lacking.

Schlüsselwörter

Multiple Sklerose - Erwerbstätigkeit - Arbeitslosigkeit - Berentung - Rente - Behinderung - Lebensqualität

Key words

multiple sclerosis - employment - retirement - disability - quality of life - unemployment
 

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