Association Between General Physical Debilitation and Competitive Integrated Employment Outcome among Vocational Rehabilitation Clients with Arthritis, Cancer, Multiple Sclerosis, and Parkinson's Disease

Background Fatigue, pain, and weakness are common across chronic conditions and may restrict employment; however, their relationship to employment outcomes remains unclear. Objective To examine the association between general physical debilitation (GPD) and competitive integrated employment (CIE) among vocational rehabilitation (VR) clients with chronic conditions. Method We analyzed 2019 U.S. Rehabilitation Services Administration (RSA-911) data for clients with arthritis, cancer, multiple sclerosis, or Parkinson's disease. Propensity score matching balanced covariates between GPD groups, and generalized estimating equations estimated associations with CIE. We conducted exploratory stratified analyses after a significant GPD × disease group interaction. Results Among 5,921 participants, GPD was not associated with CIE overall (OR = 1.00; 95% CI, 0.86 to 1.16). However, an interaction between GPD and disease group indicated heterogeneity. Among individuals with cancer, GPD was associated with lower employment (adjusted RD = −9.0%; 95% CI, −18.0% to −1.0%). Negative trends were observed for multiple sclerosis (RD = −2.0%) and Parkinson's disease (RD = −13.0%), whereas arthritis showed a trend toward higher employment (RD = 4.0%). Conclusion The association between GPD and CIE may differ across disease groups, suggesting that physical symptom burden does not uniformly influence employment outcomes and may depend on clinical and workplace contexts.