Multiple Sclerosis and Sustainable Employment: How Vocational Rehabilitation Can Help Prevent Job Loss

In this article

• Why MS presents particular challenges at work
• Looking beyond visible symptoms
• Understanding the relationship between symptoms and job demands
• What does the evidence tell us about vocational rehabilitation for MS?
• Lessons from an NHS-based intervention
• Reasonable adjustments and employer engagement
• Making support individual, practical and timely
• What this means for vocational rehabilitation practitioners
• Key takeaways
• Further information and resources
• About the speaker

Key takeaways

• MS can affect working life through physical, cognitive and psychological symptoms, including fatigue and memory difficulties that may not be visible to colleagues or employers.
• Employment difficulties cannot be explained by symptoms alone. Job demands, workplace culture, management attitudes and access to adjustments also influence whether someone can remain at work.
• Research into vocational rehabilitation for people with MS is growing, but the evidence base remains limited. More high-quality research is needed to establish which interventions work best.
• An NHS-based study explored the feasibility of providing individually tailored employment support, including workability assessment, goal setting, fatigue management and reasonable adjustments.
• Employer engagement can help translate an individual's needs into practical workplace changes, provided the person is comfortable with their employer being involved.
• Early support, flexible working arrangements and multidisciplinary collaboration may help address difficulties before they become entrenched.
• The aim is not simply to help someone return to work, but to support their ability to remain in meaningful, sustainable employment.

Multiple sclerosis and sustainable employment: why work needs to be part of the conversation

Multiple sclerosis (MS) is a chronic neurological condition that can affect people during their working lives. For many, remaining in employment is important for financial security, identity, independence and participation in everyday life.

However, continuing to work with MS can present complex challenges. Symptoms may fluctuate, change over time or affect several aspects of functioning simultaneously. The demands of a particular role may become harder to manage, while the support available from an employer or healthcare service can vary considerably.

For vocational rehabilitation (VR) professionals, the question is not simply whether someone with MS can work. It is how the interaction between their health, functional capacity, job demands and workplace environment affects their ability to remain at work.

This was the focus of a recent Vocational Rehabilitation Association (VRA) webinar, in which Blanca de Dios Perez, Senior Research Fellow at the University of Nottingham, explored the evidence for vocational rehabilitation for people with MS and shared findings from research testing an employment-support intervention within the NHS.

Her presentation highlighted both the potential for VR to support job retention and the challenges that still need to be addressed in research, service delivery and workplace practice.

Looking beyond visible symptoms

MS can affect people in different ways. Physical symptoms may be apparent to colleagues, but other difficulties can be much less visible.

Fatigue, cognitive difficulties and psychological effects can all influence how someone manages their work. A person may look well while experiencing significant exhaustion, struggling to concentrate, finding it harder to remember information or needing longer to complete familiar tasks.

This can create a gap between what an employer observes and what the employee is experiencing.

When difficulties are not visible, there is a risk that changes in performance will be interpreted as a lack of motivation, commitment or capability. An employee may also feel reluctant to explain their symptoms or request support, particularly if they are concerned about how their condition will affect their standing at work.

Blanca highlighted fatigue as a particularly important issue. It can affect not only energy levels but also concentration and other aspects of work performance. Cognitive difficulties, such as remembering deadlines or following complex conversations in meetings, can create additional challenges.

These experiences are not uniform. Two people with MS may have different symptoms, different patterns of fluctuation and different support needs, even if their diagnoses or disease courses appear similar.

For VR practitioners, this reinforces the importance of assessing the person's actual experience of work rather than making assumptions based on diagnosis or outward appearance.

The relationship between symptoms and job demands

A central theme of the webinar was that employment outcomes are shaped by more than the individual's health condition.

The nature of the job matters.

A physically demanding role may present different challenges from a desk-based role involving prolonged concentration, complex meetings, frequent interruptions or tight deadlines. Travel requirements, working hours and the availability of breaks may also affect how manageable a job feels.

The workplace environment matters too. Colleagues' attitudes, management responses, organisational culture and the practical availability of adjustments can influence whether an employee is able to continue working.

This is where the concept of work instability becomes useful: difficulties can arise when the demands of a job no longer match an individual's capacity to meet them.

For example, someone experiencing significant fatigue may struggle with a work pattern that requires sustained activity without sufficient opportunities to rest. The issue may not be that the person has lost the ability to do their job altogether, but that the current arrangement makes it increasingly difficult to meet its demands.

Vocational rehabilitation can help explore whether that mismatch can be reduced.

Possible approaches include changing the organisation of tasks, adjusting working hours, reviewing the balance of responsibilities, introducing assistive technology or improving the way work is planned across the day.

The aim is to identify what can realistically change, rather than assuming that the only options are to continue struggling or leave employment.

What does the evidence tell us about vocational rehabilitation for MS?

Blanca discussed the developing evidence base for interventions intended to help people with MS return to work or remain in employment.

Although interest in this area is increasing, the evidence remains limited. Earlier reviews identified too few eligible studies to draw firm conclusions about the effectiveness of vocational rehabilitation interventions. More recent reviews have brought additional research together, but the overall evidence base still needs strengthening.

This distinction matters.

There is a clear rationale for providing work-focused support to people with MS, and research has identified promising approaches. However, it would be premature to claim that one specific intervention model is proven to work for everyone.

The evidence discussed in the webinar points towards several areas of potential value:

• Workplace accommodations: adjustments are associated with improved employment retention and workability outcomes.
• Individually tailored support: interventions need to reflect the person's circumstances, symptoms, goals and job demands.
• Fatigue management: understanding fluctuations in energy and their impact on work can help inform practical changes.
• Cognitive and psychological support: difficulties with concentration, memory, mood and motivation may need to be considered alongside physical symptoms.
• Employer communication: collaborative discussions can help translate an individual's needs into workplace action.

These findings provide useful direction for practice while underlining the need for further research.

For the VR profession, building a stronger evidence base is important not only for identifying effective approaches, but also for demonstrating the value of employment support and informing future service provision.

Learning from an NHS-based intervention

During the webinar, Blanca described a study in which her team tested an employment-support intervention delivered through NHS neurology services.

The study was designed primarily to explore whether the intervention could be delivered in practice and whether it showed promising changes in areas such as fatigue, work instability and progress towards vocational goals. It was a feasibility study, rather than a definitive trial of effectiveness.

The intervention included a workability assessment to explore each participant's aspirations, preferences, employment difficulties and priorities. Participants could then identify up to three goals and receive individually tailored support over a three-month period.

The amount of support varied according to need, with between one and ten hours available to each participant.

Support could include work-focused discussions with the individual, help identifying reasonable adjustments, fatigue management, strategies for cognitive difficulties and liaison with employers or other healthcare professionals where appropriate.

This flexible approach recognised that not everyone needs the same level or type of intervention.

One person might need help preparing to request a specific adjustment. Another might require more extensive support to understand fluctuating fatigue, address workplace difficulties and coordinate input from other professionals.

The study found that the intervention was acceptable to participants, and most support was delivered remotely. This was particularly relevant given the fatigue experienced by many participants: avoiding travel and the additional demands of attending appointments in person made support easier to fit around work and home life.

However, the study also encountered implementation challenges, including difficulties identifying suitable professionals to deliver the intervention and recruiting participants through busy NHS services.

The findings therefore offer useful learning about feasibility and service delivery, while leaving questions about effectiveness and wider implementation for future research.

Reasonable adjustments: turning understanding into action

A significant proportion of the intervention described by Blanca focused on reasonable adjustments.

Participants had experienced difficulties obtaining workplace changes, even when those changes were intended to help them manage their symptoms and remain in employment.

One challenge was the perception that providing an adjustment to one employee might be unfair to other members of the team. For example, a manager might be reluctant to allow an employee to work from home because they fear other colleagues will expect the same arrangement.

However, an adjustment made in response to an individual's disability-related needs is not simply a workplace perk. Where the legal duty applies, employers must consider and make reasonable adjustments to avoid disabled workers being placed at a substantial disadvantage.

The practical question is what change is appropriate to the individual and their role.

Depending on the person's needs, this might involve:

• Flexible working hours or a change to the distribution of hours across the week.
• Hybrid or home working where suitable for the role.
• Adjustments to workload, task sequencing or deadlines.
• Planned breaks and opportunities to manage fluctuating energy.
• Assistive technology or changes to working methods.
• Clearer communication or practical support with remembering and organising tasks.
• Reviewing responsibilities as symptoms or work demands change.

These are possibilities to explore, not a standard package to apply to everyone with MS.

An adjustment that helps one person may be unnecessary or unsuitable for another. The process needs to begin with understanding the individual's difficulties and the demands of their work, followed by discussion about what could make a meaningful difference.

Fatigue management needs to reflect the working day

Fatigue is particularly important because it can affect several aspects of work and may fluctuate over the course of a day.

Blanca described the use of fatigue diaries to help people understand these patterns and consider how their work schedules could be adapted.

This illustrates the value of looking beyond a general statement such as "I am tired at work".

A more useful assessment explores questions such as:

• At what points during the day does fatigue become most difficult?
• Which tasks require the greatest physical or cognitive effort?
• Are there predictable periods when concentration or energy declines?
• How do meetings, travel, interruptions or competing deadlines affect fatigue?
• Are breaks available when they are needed?
• Could demanding tasks be scheduled at a more manageable time?
• What happens to the person's energy after work, and how does this affect recovery?

For example, someone who needs to complete a high volume of calls and then write detailed notes may find that completing all the calls before beginning the documentation is difficult to sustain. Exploring whether tasks can be broken into smaller blocks, with recovery time between them, may identify a more workable pattern.

This is not about lowering expectations automatically. It is about examining how work is organised and whether changes could enable the person to meet the essential demands of their role more sustainably.

Fatigue management may also need to consider its relationship with cognitive difficulties, mood and other symptoms. These factors can interact, making a holistic assessment particularly important.

Employer engagement: helping support reach the workplace

The study also explored whether participants wanted their employers involved in the intervention.

Employer involvement was limited, but those who participated were generally keen to understand how they could support their employees.

This highlights an important distinction between providing advice to an individual and helping create the conditions needed for that advice to work in practice.

A practitioner may help someone identify an adjustment that could make their job more manageable. However, if the adjustment requires a change to working arrangements, task allocation or management expectations, the employer may need to be involved to make it happen.

Employer engagement can help clarify:

• The essential demands of the role.
• The employee's current difficulties and priorities.
• Potential adjustments and how they could be implemented.
• How performance and progress will be reviewed.
• Whether further input from occupational health or other professionals is needed.

The individual's wishes and confidentiality remain central. Employer involvement should be discussed with the person, including what information they are comfortable sharing and what they hope to achieve through the conversation.

Blanca noted that some people may initially be reluctant to involve their employer because they fear the process will focus on what they cannot do. Building trust and explaining the purpose of vocational rehabilitation can help address these concerns.

The emphasis should be on enabling the person to remain at work, not presenting a list of limitations.

Why timing matters

Another important lesson from the webinar was the value of addressing work-related difficulties before they become entrenched.

Blanca highlighted the challenges of providing support when workplace relationships have already deteriorated, performance concerns have continued for a long period or formal disciplinary processes are under way.

At that stage, it may be much harder to rebuild trust and agree on a workable plan.

Early intervention does not necessarily mean intervention immediately after diagnosis. People will have different priorities and levels of readiness, and a new diagnosis can bring many questions about health, treatment and the future.

Rather, the aim is to create opportunities to discuss work before difficulties become unmanageable.

This may involve raising employment as part of conversations about living with MS, identifying early signs of work instability, or providing access to advice when someone first notices that their symptoms are affecting their job.

Early support can create space to explore adjustments and options while the person remains connected to their workplace.

It can also help prevent a situation in which leaving work appears to be the only remaining option.

Individually tailored goals and multidisciplinary support

The intervention described by Blanca used goal setting to help structure support, but the goals were not always conventional, narrowly defined performance targets.

Some participants wanted help disclosing their MS to a manager or colleagues. Others wanted to understand how to manage fatigue or reduce the number of days each week on which fatigue affected them at work. Cognitive difficulties and other practical employment concerns also featured.

This is a useful reminder that progress in vocational rehabilitation may look different for each person.

The relevant goal might be to request an adjustment, understand a pattern of fatigue, improve confidence in a workplace conversation or identify how to manage a particular task. These outcomes may be important steps towards maintaining employment, even if they do not immediately translate into a measurable change in performance.

Support may also require input from several disciplines.

Depending on the individual's needs, this could include occupational therapists, physiotherapists, psychologists, neurologists, occupational health professionals and other relevant specialists.

The role of VR is to maintain a focus on work and coordinate appropriate support around the person's goals, recognising when additional clinical or specialist input is required.

What this means for vocational rehabilitation practitioners

The webinar reinforces several practical principles for VR practice.

1. Start with the person's experience

Explore how MS affects the individual in their specific role. Do not assume that the diagnosis, apparent disability or symptom list tells the whole story.

2. Assess the person, the job and the environment

Consider functional capacity alongside job demands, working arrangements, workplace culture, relationships and the support available.

3. Make fatigue and cognitive difficulties discussable

People may find it difficult to explain invisible or fluctuating symptoms. Use practical questions about the working day to help identify patterns and possible changes.

4. Turn assessment into workplace action

Where appropriate and with the person's agreement, work collaboratively with employers to explore and implement adjustments. Recommendations need a realistic route into practice.

5. Tailor the intervention and the goals

Some people will need a small amount of targeted advice; others may need more sustained, coordinated support. Goals should reflect what matters to the individual and what is feasible in their circumstances.

6. Consider timing and readiness

Look for opportunities to address difficulties before workplace relationships and employment options become more limited, while recognising that people need time to understand their situation and consider their choices.

7. Review and adapt

MS can affect people differently over time. A plan that works now may need to change as symptoms, capacity or job demands change. Review is therefore part of sustainable support, not simply a final check.

These principles are consistent with a biopsychosocial, work-focused approach to vocational rehabilitation: understanding the whole person, collaborating with relevant stakeholders and adapting support to help people remain in or return to meaningful work.

Strengthening the evidence and the availability of support

Blanca's presentation also highlighted a wider challenge for the profession.

Although employment is important to many people with MS, access to specialist vocational rehabilitation can be limited, and NHS services may face capacity constraints and waiting lists. Research is still needed to understand which intervention components are most effective, how support can be delivered at scale and how people can be reached before workplace difficulties become complex.

The feasibility study provides useful learning about how a targeted intervention might operate within NHS services and how employment support could be delivered in a flexible, individually tailored way.

It also underlines the importance of connecting research with practice. Evidence needs to inform service design, while real-world experience can help researchers understand what is practical, acceptable and useful for people with MS and the professionals supporting them.

For vocational rehabilitation, this is an ongoing opportunity: to build the evidence, strengthen collaboration between healthcare and employment, and demonstrate the value of addressing work as part of living well with a long-term condition.

Final thought

MS does not affect every person in the same way, and the challenges someone experiences at work cannot be understood through their diagnosis alone.

The demands of the role, the organisation of work, workplace attitudes and access to appropriate support all influence whether employment remains manageable.

Blanca de Dios Perez's presentation highlighted the potential for vocational rehabilitation to help people identify practical changes, work towards individual goals and involve employers where appropriate. It also showed why timely support and further research are important.

The aim is not simply to help someone keep a job at any cost. It is to help them find a sustainable way to participate in work, with support that reflects their needs, their goals and the realities of their working life.

Further information and resources

Multiple Sclerosis Society

The MS Society provides information and support for people affected by MS, including resources about work and employment.

Website: https://www.mssociety.org.uk/

MS Trust

The MS Trust provides information about MS, its symptoms and practical support for people living with the condition.

Website: https://mstrust.org.uk/

Acas – Reasonable adjustments

Acas provides UK workplace guidance on reasonable adjustments, including how employers and workers can discuss and agree appropriate support.

Website: https://www.acas.org.uk/reasonable-adjustments

Access to Work

The UK Government's Access to Work scheme may provide practical support for eligible people with a disability or health condition to start or remain in work.

Website: https://www.gov.uk/access-to-work

About the speaker

Blanca de Dios Perez is a Senior Research Fellow at the University of Nottingham and a psychologist by background. Her research focuses on vocational rehabilitation, particularly the evidence for interventions that support people with multiple sclerosis to remain in paid employment.

In the VRA webinar, Blanca shared research exploring employment outcomes for people with MS and the feasibility of delivering an individually tailored employment-support intervention within NHS neurology services. Her presentation highlighted practical considerations for vocational rehabilitation, including fatigue management, reasonable adjustments, employer engagement and early support.

We thank Blanca for sharing her research and insights with the VRA community.

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