Motivational Interviewing as Early Vocational Intervention in MS.
|Title||Motivational Interviewing as Early Vocational Intervention in MS.|
|Publication Type||Journal Article|
|Authors||Hunter C, Johnson KL, Fraser RT|
|Journal||International Journal of MS Care|
People with multiple sclerosis (MS) experience physical, cognitive, environmental, social, and psychosocial barriers that lead to difficulties in maintaining employment. Even though 90% of people with MS have a history of employment, only 20–30% will be employed 5–15 years from diagnosis. Successful interventions need to take into account the complex interaction between functional limitations and programmatic barriers. Various vocational rehabilitation interventions have been tried to help people with MS retain employment but with mixed results. It was found that many people with MS did not participate in interventions designed to preserve employment until they experienced a work-related crisis because of fatigue, concern about disclosure, or preference to not anticipate future problems. We have identified motivational interviewing (MI) as a potential alternative intervention to assist in preserving employment. MI is a brief, client-centered, directive counseling approach that enhances intrinsic motivation to change by exploring and resolving ambivalence. The efficacy of MI to promote change across various populations for health behaviors ranging from substance abuse to fitness has been demonstrated. Given the complex barriers that confront people with MS seeking to preserve employment, MI may be a valuable tool in that effort. The University of Washington MS Rehabilitation Research and Training Center is providing brief telephone MI sessions to individuals with MS to explore the costs, benefits, and ambivalence of study participants toward making accommodations at work in efforts to stay employed through the progression of the disease. Based on a review of our pilot data, we believe MI has the potential to be a useful tool in preserving employment and have advanced to a randomized clinical trial with 60 subjects. We describe and/or demonstrate the intervention and review the qualitative results of the pilot work.