Work in the picture? The reporting of and effects on work outcomes in exercise therapy trials in people with rheumatoid arthritis or axial spondyloarthritis: a systematic review

Abstract

Objective: Many people with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) face limitations in societal participation, including work. Supervised exercise therapy improves symptoms and physical functioning, but its impact on work outcomes is unclear. This systematic review aims to examine the reporting of and effects on work outcomes in exercise therapy trials. Method: Eight databases were searched up to February 2024 for randomized controlled trials (RCTs) evaluating the (cost-)effectiveness of supervised exercise therapy interventions in adults with RA/axSpA. The reporting of work and other social participation outcomes, the content of the exercise therapy intervention, and their effects on work outcomes were extracted. Within- and between-group results on work outcomes were summarized. Results: In total, 41 (22 RA, 19 axSpA) RCTs on supervised exercise therapy were included, none of which was specifically targeted at work. Two RCTs in people with RA included work outcomes (absenteeism and employment hours). None of the RCTs in axSpA reported work outcomes. A work-related item or subscale was reported in 6/22 of the RA and 7/19 of the axSpA trials. Outcomes on societal participation (including work) were reported in 13/22 of the RA and 18/19 of the axSpA trials. Effects on work were reported on different outcomes and results were inconclusive. Conclusion: Work outcomes are rarely reported in exercise therapy trials in people with RA/axSpA. To determine the effects of supervised exercise therapy on work, future studies should include work outcomes. International consensus on which outcome to use could increase the comparability of results.