Clinical considerations to maximize job retention for people with multiple sclerosis.

Goal: Provide practical guidance to clinicians to identify patients in the clinic at risk for changes in employment status, and recommend interventions. Background: Employment plays an important role in perceived quality of life for people with multiple sclerosis (MS), including maintenance of identity, physical and emotional health, financial security, and health care benefits. Changes in employment status can have a significant negative impact on the individual and family. Evaluating Risk: Questions to evaluate risk with respect to changes in employment status will be presented, such as inquiry about increased errors, longer work hours to accomplish job tasks, increased perceived employment stress, negative feedback from employers, and probation or termination support. The importance of careful wording in medical documentation to protect patients who may seek to continue employment and support patients who may seek disability insurance benefits will be described. Interventions: Collaborative interdisciplinary approaches will be recommended, including neuropsychological evaluation; cognitive, physical, occupational, and speech therapy; and interaction with rehabilitation counseling and vocational service providers. Employment interventions related to use of compensatory strategies, job modification and accommodation, and assistive technologies will be described. Employment and disability- related resources will be provided.