Work Instability Scale For Rheumatoid Arthritis Research Articles

Psychometric testing of the Rheumatoid Arthritis Work Instability Scale in employed people with fibromyalgia.

The aim of the study was to establish whether the Rheumatoid Arthritis Work Instability Scale (RA-WIS), in its current form, is applicable for use with employed people with fibromyalgia (FM) to identify the risk of work disability and need for work rehabilitation. Content validity was first investigated using cognitive debriefing interviews. Participants completed a postal questionnaire. Construct validity was assessed using Rasch analysis. Concurrent validity included testing between the RA-WIS and work (e.g., Workplace Activity Limitations Scale) and health (FM Impact Questionnaire-Revised (FIQ-R) scales. Two weeks later, participants were mailed a second questionnaire to measure test-retest reliability. Interviews were conducted with 13 participants with FM. All RA-WIS items were considered very or extremely relevant by almost all participants, with only one suggesting other items (anxiety and brain fog). Questionnaire responses were analysed from 156 employed participants: 94% women; 45.71 (SD 10.05) years of age; with time since FM diagnosis 2.99 (4.17) years (symptom duration 8.36 (SD 7.16) years). The RA-WIS mostly satisfied Rasch model requirements and a Rasch transformation scale was created. Concurrent validity was generally good (rs = 0.55-0.66) with work scales and the FIQ-R. Internal consistency (Person Separation Index values) was consistent with group use in FM, not individual level use. Test-retest reliability was excellent, with intraclass coefficient (2, 1)=0.90. The RA-WIS is valid and reliable for group use in employed people with FM. However, further work is needed to develop a WIS for individual use in FM.

Work instability and associated factors among patients with rheumatoid arthritis in Greater Poland.

ObjectivesRheumatoid arthritis (RA) affects patients’ capacity to work. The Rheumatoid Arthritis Work Instability Scale (RA-WIS) is a reliable method to measure work instability (WI) (1–3). We lack data on the relationship between RA and work instability among Polish patients. Our study aimed to assess WI and associated factors among patients with RA.Material and methodsThe authors conducted a multi-centre cross-sectional observational study. 315 patients from three rheumatology centres were enrolled and filled in questionnaires, including demographic and self-reported clinical data, RA-WIS, and the Health Assessment Questionnaire (HAQ). Swollen and tender joint counts (SJC, TJC) were assessed by the attending physician, and current erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were collected. We excluded 41 patients due to an incorrectly filled in form and analysed questionnaires of 274 patients. DAS28 (Disease Activity Score in 28 joints) and DAS28-CRP were calculated. We performed statistical analysis with Statistica v. 13.3 using the Mann-Whitney U test, χ2 test, and Spearman’s correlation.Results140 (51%) patients were currently employed and their characteristics were analysed. In univariable analysis we identified the following risk factors for high risk WI: moderate-to-high disease activity (DAS28 ≥ 3.2 – OR 2.29, 95% CI 1.06–4.96, p = 0.033; DAS28-CRP ≥ 3.2 – OR 2.34, 95% CI 1.04–5.27, p = 0.038), ESR ≥ 30 mm/h in women and ≥ 20 mm/h in men (OR 2.65, 95% CI 1.20–5.89, p = 0.010), CRP ≥ 1 mg/dl (OR 4.02, 95% CI 1.78–9.10, p < 0.001), HAQ-DI > 1.0 (OR 2.23, 95% CI 1.04–4.81, p = 0.037) and at least moderate pain on the visual analogue scale (VAS p ≥ 4.5 cm – OR 5.31, 95% CI 2.36–11.96, p < 0.001).Correlations were moderate between RA-WIS and VASp (RS = 0.59, p < 0.001) and HAQ-DI (RS = 0.52, p < 0.001) but weak with disease activity indices (DAS28 [RS = 0.31, p < 0.001]; DAS28-CRP [RS = 0.28, p < 0.001]).ConclusionsPain and disability are the main factors strongly associated with work instability among patients with RA.

AB1193 WORK INSTABILITY AMONG POLISH RHEUMATOID ARTHRITIS PATIENTS

Background:Rheumatoid arthritis (RA) affects patients’ capacity to work. Rheumatoid Arthritis Work Instability Scale (RA-WIS) is a reliable method to measure work instability (WI) (1–3). We lack data on relationship between RA and work instability among Polish patients.Objectives:The aim of our study was to assess WI and associated factors among patients with RA.Methods:315 patients from three rheumatology centres were enrolled and filled questionnaires including demographic and self-reported clinical data, RA-WIS, and The Health Assessment Questionnaire (HAQ). Swollen and tender joints count (SJC, TJC) were assessed by attending physician and current erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were collected. We excluded 41 patients due to incorrectly filled form and analysed questionnaires of 274 patients. DAS28 (Disease Activity Score in 28 joints) and DAS28-CRP were calculated. We performed statistical analysis with Statistica v. 13.3 using Mann-Whitney U test, chi-square test and Spearman’s correlationResults:140 (51 %) patients were employed and their characteristics are presented on Table 1. In univariable analysis we identified following risk factors for high risk WI: moderate-to-high disease activity (DAS28≥3.2 – OR 2.29, 95%CI 1.06-4.96, p=0.033; DAS28-CRP≥3.2 – OR 2.34, 95%CI 1.04-5.27, p=0.038), ESR ≥30 mm/h in women and ≥20 mm/h in men (OR 2.65, 95%CI 1.20-5.89, p=0.010), CRP≥1mg/dL (OR 4.02, 95%CI 1.78-9.10 p&lt;0.001), HAQ-DI&gt;1.0 (OR 2.23, 95%CI 1.04-4.81, p=0.037) and at least moderate pain on visual analogue scale (VASp ≥4.5 cm - OR 5.31, 95%CI 2.36-11.96, p&lt;0.001). Correlations were moderate between RA-WIS and VASp (RS=0.59, p&lt;0.001) and HAQ-DI (RS=0.52, p&lt;0.001) whereas weak with disease activity indices (DAS28 - RS=0.31, p&lt;0.001; DAS28-CRP - RS=0.28, p&lt;0.001).Table 1.Demographic and clinical characteristics of employed patients according to work instability risk, N(%) or mean(±SD).CharacteristicRA-WIS scorelow-to-moderate (0-17)high (&gt;17)Patients94 (67.1%)46 (32.9%)Sex, female73 (77.7%)38 (82.6%)Age (years)47.9 (±11.8)50.4 (±9.3)Disease duration (years)13.0 (±8.4)14.0 (±8.7)RF, positive68 (72.3%)34 (73.9%)ACPA, positive59 (62.8%)29 (63.0%)ESR (mm/h)18.3 (±16.0)28.2 (± 21.9)*CRP (mg/dL)0.6 (± 1.0)1.1 (± 1.0)*TJC4.5 (±4.0)7.6(±6.3)*SJC2.7 (±3.0)5.2(±5.5)*HAQ-DI0.7 (±0.5)1.1 (±0.5)*pain - VAS 10 cm3.9 (±1.9)6.5 (± 2.2)*DAS283.5 (±1.2)4.2 (±1.4)*DAS28-CRP3.9 (±1.0)4.3 (±1.2)*WI – work instability, RA-WIS – Rheumatoid Arthritis Work Instability Scale, RF – rheumatoid factor in IgM class, ACPA – anti-citrullinated protein antibodies, ESR – erythrocyte sedimentation rate, CRP – C-reactive protein, TJC – tender joints count, SJC – swollen joints count, HAQ-DI – Heath Assessment Questionnaire Disability Index, VAS – visual analogue scale, DAS28 – Disease Activity Score in 28 joints*p&lt;0.05, Mann-Whitney U testConclusion:Pain and disability are main factors associated with work instability among patients with RA.

OP0010 EFFECTIVENESS OF THE MAKING IT WORK™ PROGRAM AT IMPROVING PRESENTEEISM AND WORK CESSATION IN WORKERS WITH INFLAMMATORY ARTHRITIS – RESULTS OF A RANDOMIZED CONTROLLED TRIAL

Background:Arthritis often leads to presenteeism (decreased at-work productivity), missed days from work and permanent work disability, leading to reduced quality of life and high costs to individuals and society. Yet, health services addressing the employment needs of people with arthritis are lacking.Objectives:We evaluated the effectiveness of the Making-it-WorkTM(MiW) program, an online self-management program developed to help people with inflammatory arthritis (IA) deal with employment issues.Methods:A multi-center RCT evaluated the effectiveness of MiW at improving presenteeism and preventing work cessation (WC) over two years. Participants were recruited from rheumatologist practices, consumer organizations and arthritis programs, in three Canadian provinces. Eligibility criteria: diagnosis of IA, employed, age 18-59, and concerned about ability to work. Participants were randomized 1:1 to MiW or usual care plus printed material on workplace tips. MiW consists of five online self-learning modules and group meetings, and individual vocational counselling and ergonomic consultations. Questionnaires were administered every 6 months. Outcomes were presenteeism [Rheumatoid Arthritis Work Instability Scale (RA-WIS)], time to WC ≥ 6 months, and time to WC ≥ 2 months (secondary outcome). Baseline characteristics (age, gender, ethnicity, occupation, education, disease duration and self-employment) were collected. Intention-to-treat (ITT) longitudinal analysis of RA-WIS using linear mixed effect regression models with 2-year comparison as primary endpoint and survival analysis for time to WC using Kaplan-Meier and Cox Proportional Hazard models were performed. Robustness analyses were conducted by using various missing values imputation methods like last observation carried forward, imputation using worse possible outcomes and model-based multiple imputations; using square root transformation of RA-WIS outcome; and adjusting for baseline covariates. SAS version 9.4 was used.Results:A total of 564 participants were recruited, with 478 (84.75%) completing 2-year follow-up. Baseline characteristics were similar between groups. Mean RA-WIS scores were significantly lower in the intervention group from 6 months onwards, with the greatest difference observed at 2 years (-1.78, 95%CI: -2.7, -0.9, p &lt; .0001), yielding a standardized effect size of 32%. Satisfactory robustness was observed. Work cessation occurred less often in intervention than control groups, but only reached statistical significance for WC ≥ 2 months (WC ≥ 6 months: 31 versus 44 events, aHR 0.70, 95%CI: 0.44, 1.11, p = 0.13; WC ≥ 2 months: 39 versus 61 events, aHR: 0.65, 95%CI: 0.43, 0.98, p = 0.04).Conclusion:Results of the RCT reveal the program was effective at improving presenteeism and preventing short-term WC. Effectiveness at preventing long-term work disability will be assessed at 5 years. This program fills one of the most important and costly unmet needs for people with inflammatory arthritis.

Effectiveness of an integrated care intervention on supervisor support and work functioning of workers with rheumatoid arthritis

Purpose: In this manuscript, we evaluated the effectiveness of an intervention programme consisting of integrated care and a participatory workplace intervention on supervisor support, work instability and at-work productivity after 6 months of follow-up among workers with rheumatoid arthritis (RA). Methods: We conducted a randomized controlled trial; we compared the intervention programme to usual care. Eligible patients were diagnosed with RA, had a paid job (> 8 h per week) and who experienced, at least, minor difficulties in work functioning. Supervisor support was measured with a subscale of the Job Content Questionnaire, work instability with the Work Instability Scale for RA, and at-work productivity with the Work Limitations Questionnaire. Data were analyzed using linear regression analyses. Results: A beneficial effect of the intervention programme was found on supervisor support among 150 patients. Analyses revealed no effects on work instability and at-work productivity. Conclusion: We found a small positive effect of the intervention on supervisor support, but did not find any effects on work instability and at-work productivity loss. Future research should establish whether this significant but small increase in supervisor support leads to improved work functioning in the long run. This study shows clinicians that patients with RA are in need of efforts to support them in their work functioning.Implications for RehabilitationRheumatoid arthritis (RA) is a chronic inflammatory disease with a severe impact on work functioning, even when a patient is still working.It is important to involve the workplace when an intervention is put in place to support RA patients in their work participation.Supervisor support influences health outcomes of workers, and it is possible to improve supervisor support by an intervention which involves the workplace and supervisor.

One Year Effects of a Workplace Integrated Care Intervention for Workers with Rheumatoid Arthritis: Results of a Randomized Controlled Trial

Purpose To evaluate the effectiveness of a workplace integrated care intervention on at-work productivity loss in workers with rheumatoid arthritis (RA) compared to usual care. Methods In this randomized controlled trial, 150 workers with RA were randomized into either the intervention or control group. The intervention group received an integrated care and participatory workplace intervention. Outcome measures were the Work Limitations Questionnaire, Work Instability Scale for RA, pain, fatigue and quality of life (RAND 36). Participants filled out a questionnaire at baseline, and after 6 and 12 months. We performed linear mixed models to analyse the outcomes. Results Participants were on average 50 years of age, and mostly female. After 12 months, no significant intervention effect was found on at-work productivity loss. We also found no significant intervention effects on any of the secondary outcomes. Conclusions We did not find evidence for the effectiveness of our workplace integrated care intervention after 12 months of follow up. Future studies should focus on investigating the intervention in groups of workers with severe limitations in work functioning, and an unstable work situation.

Reliability and Validity of the Work Instability Scale for Rheumatoid Arthritis

ObjectiveThe objective was to evaluate the psychometric properties of the Rheumatoid Arthritis-Work Instability Scale (RA-WIS) in a clinical trial setting. MethodsSecondary analyses were conducted using data from a 56-week, randomized controlled trial of patients with early rheumatoid arthritis (RA). Patient-reported outcome measures included the RA-WIS, the Health Assessment Questionnaire (HAQ), the Rheumatoid Arthritis Quality of Life Questionnaire, and the Global Assessment of Disease Activity and Pain, data for which were collected at baseline and at weeks 12, 16, 24, and 56. Data were analyzed for reliability, validity, and responsiveness. ResultsAmong 148 patients whose data were analyzed, more than half were women (56.1%) with a mean age of 46.8 years. On average, patients experienced RA symptoms for 8.7 months; the mean 28-Joint Disease Activity Score (DAS28) was 5.9, and the mean HAQ – Disability Index was 1.3. The RA-WIS demonstrated excellent internal consistency and test-retest reliability (α = 0.89 and intraclass correlation coefficient = 0.91, respectively). At baseline and week 24, moderate to strong correlations were seen between RA-WIS total scores and the HAQ, the Global Assessment of Disease Activity, and the Pain Rheumatoid Arthritis Quality of Life Questionnaire, ranging from 0.47 to 0.81 (all P < 0.0001). Mean RA-WIS total scores and work disability risk levels discriminated between clinical severity scores on the DAS28, the HAQ – Disability Index, and the Physician Global Assessment of Disease Activity (all P < 0.05). Mean baseline to week 24 RA-WIS total change scores were significantly different among American College of Rheumatology responder groups (P ≤ 0.0001) and between DAS28 remission status groups (P < 0.001). ConclusionsThese findings provide evidence supporting the reliability, validity, and responsiveness of the RA-WIS for evaluating work disability in patients with RA in a clinical trial setting.

Non-pharmacological interventions for preventing job loss in workers with inflammatory arthritis.

Work participation of patients with inflammatory arthritis (IA) is important not only economically but also for physical and psychological health. There is no Cochrane Review to date on studies of non-pharmacological interventions specifically aimed at preventing job loss in people with IA. To assess the effects of non-pharmacological interventions that aim to prevent job loss, work absenteeism or improve work functioning for employees with IA (rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), other spondylarthritis (SpA) or IA associated with connective tissue diseases, such as Systemic Lupus Erythematosus (SLE)). We searched the following databases from inception up to 30 April 2014; The Cochrane Library (including Cochrane Central Register of Controlled Trials, i.e. CENTRAL and DARE), MEDLINE (PubMed), EMBASE (Embase.com), CINAHL (EbSCOhost), ClinicalTrials.gov and PsycINFO (ProQuest). We did not impose language restrictions in the search. We included randomised controlled trials (RCTs) that evaluated interventions aimed at preventing job loss in adults of working age (18 to 65 years) diagnosed with IA, including RA, AS, PsA, SpA or other types of IA. Primary outcomes were job loss and sickness absenteeism and the secondary outcome was work functioning. Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias in the included RCTs. We included three RCTs with a total of 414 participants at risk of job loss. The majority of participants had IA, most with RA and to a lesser degree AS. The interventions aimed to prevent job loss and improve work functioning in several ways: firstly by evaluating work changes or adaptations and secondly by providing any person-directed interventions including vocational counselling, advice or education. Interventions directly targeted at the work environment were minimal and included workplace visits (one trial) or any actions by an occupational physician (one trial). The duration or dose of the interventions varied from two 1.5-hour sessions (one RCT) over five months, two consultation and multidisciplinary treatments during three months (one RCT), to six to eight individual or group sessions over six months (also one RCT). All participants were recruited through rheumatology clinics, both in or outside hospitals. Included trials investigated job loss (n = two RCTs; 382 participants), work absenteeism and work functioning (n = one RCT; 32 participants). Overall, we evaluated the two smaller trials as having a high risk of bias and the large trial as having a low risk of bias. Trials showed marked differences in how they performed on risk of bias items, particularly on performance bias.We assessed the quality of the evidence using the GRADE approach and judged there to be very low quality evidence across the three reported outcomes. Of the two RCTs investigating job loss, the larger one (n = 242 participants) reported a large statistically significant reduction in job loss (relative risk (RR) = 0.35, 95% confidence interval (CI) 0.18 to 0.68) and the other RCT (n = 140) reported similar effects in both groups, although the CI was very wide (RR = 1.05, 95% CI 0.53 to 2.06). The latter one probably suffered from performance bias and we judged it to have a high risk of bias. The one small trial investigating sickness absenteeism found uncertain results at six months' follow-up (MD = -2.42 days, 95% CI -5.03 to 0.19). Finally, in the same small trial investigating work functioning using the Rheumatoid Arthritis-Work Instability Scale (RA-WIS), there was a moderate improvement of intermediate term work functioning (six months; scale range 0 to 23; mean improvement -4.67 points, 95% CI -8.43 to -0.91). We identified no adverse effects in the publications of the three trials. This Cochrane review of three RCTs found very low quality evidence overall for job loss prevention interventions having an effect on job loss, work absenteeism and work functioning in workers with inflammatory arthritis. While this review highlights that further high quality RCTs are required, the results suggest that these strategies have potential to be effective.

Work instability in rheumatoid arthritis patients from Argentina: prevalence and associated factors.

To determine the prevalence of and associated factors to work instability (WI) in rheumatoid arthritis (RA) Argentinean patients. Observational cross-sectional study that assessing employment status in currently working RA patients. They answered the validated version of RA work instability scale (RA-WIS). High-risk WI was considered when RA-WIS was ≥17. Factors associated with high-risk WI were examined by univariable and multivariable analysis. Four-hundred and fifty RA patients were enrolled; of these, 205 patients were currently employed, but only 172 have completed questionnaires required [RA-WIS and health assessment questionnaire (HAQ-A)]. Their mean age was 49.3 ± 10.8 years; 81.3 % were female; and their mean disease duration was 8.1 ± 7.2 years. Fifty-two percent of patients were doing manual work. The mean RA-WIS score was 11.4 ± 6.8, and 41 % of patients had a high-risk WI. High-risk WI was associated with radiographic erosions (p < 0.001) and HAQ-A >0.87 (p < 0.001) in the univariable analysis, whereas in the multivariable logistic regression analysis the variables associated with a high-risk WI were as follows: HAQ-A >0.87 [odds ratio (OR) 12.31; 95 % CI 5.38-28.18] and the presence of radiographic erosions (OR 4.848; 95 % CI 2.22-10.5). In this model, having a higher monthly income (OR 0.301; 95 % CI 0.096-0.943) and a better functional class (OR 0.151; 95 % CI 0.036-0.632) were protective. Forty-one percent of RA working patients had high-risk WI. The predictors of high RA-WIS were HAQ-A ≥0.87 and radiographic erosions, whereas having a better functional class and have higher incomes were protective.

OP0084-HPR Do Occupational Therapy Services Fulfil the Work Related Needs of Rheumatology Patients in the Uk?

BackgroundBefore becoming work disabled, people with inflammatory arthritis (IA) experience work instability, which threatens employment. Thus, many employed people with IA are at risk of losing their job. Rheumatology Occupational...

Work instability and financial loss in early inflammatory arthritis

Inflammatory arthritis is associated with a high degree of work instability and financial burden. In this study, we examine the extent of work instability and financial loss as well as their association with disease characteristics during the first 18 months of inflammatory arthritis. One hundred and four patients in the early phase (more than 6 weeks, < 18 months) of inflammatory arthritis were recruited from a larger early inflammatory arthritis registry. Questionnaires recorded sociodemographic data and disease characteristics, including pain assessed using the Short Form McGill Pain Questionnaire (MPQ) and physical functioning measured with the Medical Outcomes Study Short Form 36 (SF-36) physical functioning score. The Rheumatoid Arthritis Work Instability Scale (RA-WIS) was used to measure patient-perceived functioning in the workplace and the Financial Loss Questionnaire (FLQ) measured the impact on family finances. Participants' mean age was 56 years, 70.2% were female and 49.0% were working. Average yearly household income was < 60 000 Canadian dollars (CAD) for 38.5% of the sample. Of our working patients, 43% had a medium or high risk of work loss as measured by the RA-WIS and 35% reported a financial loss. On multivariate analysis, MPQ and SF-36 contributed to the dependent variable work instability, while age and SF-36 contributed to financial loss. This study identifies pain and physical dysfunction as potential modifiable risk factors for negative socioeconomic repercussions of illness in early inflammatory arthritis.

The relationships between adult juvenile idiopathic arthritis and employment

The chronicity of juvenile idiopathic arthritis (JIA) into adulthood and attendant potential disability may adversely influence educational attainment and the ability to secure and maintain gainful employment. We undertook this study to investigate the effects of patient- and disease-specific factors on education and employment outcomes in a group of adult patients with JIA. We performed a cross-sectional study of 103 consecutive adults attending a JIA continuity clinic, and patients who consented completed questionnaires relating to educational achievement, employment status, and functional disability (the Health Assessment Questionnaire disability index [HAQ DI]), and, for those who were employed, the rheumatoid arthritis Work Instability Scale. We used the structural equation modeling technique to study key patient and disease variables for employment in adults with JIA. The median age of patients was 24 years (range 17-71 years) with median disease duration of 19 years (range 7-67 years). Functional disability (the mean HAQ DI score) was significantly lower in patients who were employed (P = 0.03) and in those with oligoarticular JIA (t = 2.29, P = 0.02). Educational achievement was not influenced by JIA subtype (F = 1.18, P = 0.33). Educational achievement measured by General Certificate of Secondary Education (GCSE) grades had a positive effect on the type of job achieved in later life (F = 11.63, P = 0.001), with greater success leading to more professional or managerial posts. In the complex structural equation model, job stability was influenced positively by educational achievement measured by GCSE grades and negatively by the HAQ DI score (t = 10.94, P = 6.36 × 10(-16) ). Educational attainment is key to successful employability and is influenced by functional disability rather than by JIA subtype. These findings have implications for choice of occupation and delivery of career advice to aid decision making by young people with JIA.

Reliability, validity, and responsiveness of five at‐work productivity measures in patients with rheumatoid arthritis or osteoarthritis

Arthritis often impacts a worker's ability to be productive while at work. However, the ideal approach to measuring arthritis-attributable at-work productivity loss remains unclear. Our objective was to evaluate the relative strengths and weaknesses of 5 measures aimed at quantifying health-related at-work productivity loss and to determine the best available instrument for this population. In a 12-month longitudinal design, the psychometric properties (reliability, validity, and responsiveness) of 5 self-reported measures of at-work productivity were compared in workers with either rheumatoid arthritis (RA) or osteoarthritis (OA). We tested the Workplace Activity Limitations Scale (WALS), 6-item Stanford Presenteeism Scale (SPS-6), Endicott Work Productivity Scale (EWPS), RA Work Instability Scale (WIS), and Work Limitations Questionnaire (WLQ). Across all measures, participants (n = 250, 120 with RA and 130 with OA) consistently reported mild losses of at-work productivity. The Cronbach's alpha of the scales ranged from 0.71 (for SPS-6) to 0.94 (for EWPS), indicating some concerns over the internal consistency of the SPS-6. The RA WIS demonstrated the strongest construct validity (|r| = 0.54-0.74), whereas the WALS was most responsive to perceived changes in work ability. Despite its increasing popularity and potential application for costing analysis, the WLQ did not compare favorably with the other scales, possibly due to psychometric concerns with its physical demands subscale. Measures revealed unique conceptualization of at-work disability, but no single scale emerged as clearly superior. However, current results slightly favor the WALS and RA WIS as superior instruments for measuring at-work productivity loss in workers with arthritis.

Functional and work outcomes improve in patients with rheumatoid arthritis who receive targeted, comprehensive occupational therapy

Work disability is a serious consequence of rheumatoid arthritis (RA). We conducted a 6-month, prospective randomized controlled trial comparing assessments of function, work, coping, and disease activity in employed patients with RA receiving occupational therapy intervention versus usual care. Employed patients with RA with increased perceived work disability risk were identified by the RA Work Instability Scale (WIS; score >or=10). Patients were stratified into medium- (score >or=10 and <17) and high-risk (>or=17) groups, then randomized into occupational therapy or usual care groups. Assessments were conducted at baseline and 6 months. The primary outcome was the Canadian Occupational Performance Measure (COPM), a standardized patient self-report of function. Other outcomes included the disability index (DI) of the Health Assessment Questionnaire (HAQ); Disease Activity Score in 28 joints (DAS28); RA WIS; EuroQol Index; visual analog scales (VAS) for pain, work satisfaction, and work performance; and days missed/month. Independent sample t-tests and Mann-Whitney U tests were used. We recruited 32 employed patients with RA. At baseline the groups were well matched. At 6 months the improvement in the occupational therapy group was significantly greater than that in the usual care group for all functional outcomes (COPM performance P < 0.001, COPM satisfaction P < 0.001, HAQ DI P = 0.02) and most work outcomes (RA WIS [P = 0.04], VAS work satisfaction [P < 0.001], VAS work performance [P = 0.01]). Additionally, Arthritis Helplessness Index (P = 0.02), Arthritis Impact Measurement Scales II pain subscale (P = 0.03), VAS pain (P = 0.007), EuroQol Index (P = 0.02), EuroQol global (P = 0.02), and DAS28 (P = 0.03) scores significantly improved. Targeted, comprehensive occupational therapy intervention improves functional and work-related outcomes in employed RA patients at risk of work disability.

Adaptation and cross-cultural validation of the rheumatoid arthritis work instability scale (RA–WIS)

Background:Despite recent advances, work disability in rheumatoid arthritis (RA) remains common. Work disability is frequently preceded by a period of work instability characterised by a mismatch between an individual’s functional...

Content Comparison of Worker Productivity Questionnaires in Arthritis and Musculoskeletal Conditions Using the International Classification of Functioning, Disability, and Health Framework

Worker productivity outcome is essential in examining the rehabilitation of workers with arthritis and other musculoskeletal conditions. There is great variation in the contents of worker productivity questionnaires. The International Classification of Functioning Disability and Health (ICF) offers the possibility to serve as a reference to describe and compare the contents of these questionnaires. A literature review identified published self-report worker productivity questionnaires. All meaningful concepts were identified and linked to the corresponding ICF category according to established rules. Eighteen questionnaires were identified which contained a total of 519 meaningful concepts and which were linked to 64 unique 2nd level ICF categories. All questionnaires addressed Activities and Participation, thirteen (72%) addressed Body Functions, seven (39%) addressed Environmental Factors, seven (39%) addressed Personal Factors and only one questionnaire (6%) for Body Structures component. Overall, Work Role Functioning (WRF) questionnaire addressed the most number of different categories while Quantity and Quality method contained only one ICF category. The Rheumatoid Arthritis-Work Instability Scale had the highest number of categories for Body Functions, the Work Activity Limitations Scale and WRF had the most number of categories for Activities and Participation. The Health and Labour Questionnaire had the highest number of categories referring to unpaid work participation. The Health and Work Questionnaire was the only that included contextualization of both Environmental and Personal Factors. Self-report worker productivity questionnaires differed largely in their contents. This content analysis study could guide us in selecting an appropriate questionnaire for a specific study question.

An Examination of Work Instability, Functional Impairment, and Disease Activity in Employed Patients with Rheumatoid Arthritis

To evaluate the relationship between the Disease Activity Score 28-joint count (DAS28), Health Assessment Questionnaire (HAQ), and Rheumatoid Arthritis-Work Instability Scale (RAWIS); and to define thresholds for clinical assessments associated with moderate to high RA-WIS. Employed patients with RA were evaluated using DAS28, HAQ, and RA-WIS during routine clinics. Relationships between these assessments were evaluated by simple correlation. Multiple linear regression modeling was performed using RA-WIS as an outcome variable and HAQ, DAS28, age, sex, occupation, and disease duration as input variables. Receiver-operating characteristic curves were then formulated to determine optimal DAS28, and HAQ cutoff points for RA-WIS >or= 10, along with the odds ratio (OR). Ninety patients with RA completed the RA-WIS, which was moderately correlated with DAS28 (r =0.53) and HAQ (r = 0.66). Fifty-four percent of RA-WIS was explained by DAS28 (p = 0.002), HAQ (p = 0.001), and sex (p = 0.04). A DAS28 of 3.81 and HAQ of 0.55 were clinically important thresholds. High DAS28 and HAQ were associated with high RA-WIS (OR(DAS) 14.17, OR(HAQ) 25.13, OR(DAS+HAQ) 29.9). Functional impairment and disease activity significantly and independently contributed to patient-perceived work instability risk.

Effect of the early use of the anti–tumor necrosis factor adalimumab on the prevention of job loss in patients with early rheumatoid arthritis

To compare work disability and job loss in early rheumatoid arthritis (RA) patients receiving adalimumab plus methotrexate (adalimumab + MTX) versus MTX alone. In this multicenter, randomized, controlled trial, patients with RA for <2 years who had never taken MTX and who self-reported work impairment were randomized to adalimumab + MTX or placebo + MTX for 56 weeks. Primary outcome was job loss of any cause and/or imminent job loss at or after week 16. Secondary outcomes included disease activity, function (Health Assessment Questionnaire [HAQ] score), and RA quality of life (RAQoL) questionnaire score. Work was evaluated with work diaries and the RA Work Instability Scale. Although job loss during the 56-week study was significantly lower with adalimumab + MTX (14 of 75 patients) compared with MTX alone (29 of 73 patients; P=0.005), the primary end point was not met (12 of 75 versus 20 of 73 patients; P=0.092), likely owing to early drop out in the MTX group. There were significant improvements in American College of Rheumatology 20% response criteria, 28-joint Disease Activity Score, DeltaHAQ, DeltaRAQoL, and working time lost in the adalimumab + MTX group. Twenty-four serious adverse events were reported in 17 participants, with no differences between groups. Adalimumab + MTX reduced job loss and improved productivity in early RA when compared with MTX alone, which supports the early use of anti-tumor necrosis factor therapy and suggests its cost efficacy.

Measures of adult work disability: The Work Limitations Questionnaire (WLQ) and the Rheumatoid Arthritis Work Instability Scale (RA-WIS)

Measures of adult work disability: The Work Limitations Questionnaire (WLQ) and the Rheumatoid Arthritis Work Instability Scale (RA-WIS)

Development of a work instability scale for rheumatoid arthritis.

To explore the concept of work instability (WI), a state in which the consequences of a mismatch between an individual's functional abilities and the demands of his or her job could threaten continuing employment if not resolved, in people with rheumatoid arthritis (RA). To develop the Work Instability Scale (WIS). WI in people with RA was explored through qualitative interviews, which were then used to generate items for the WIS. Through Rasch analysis and validation against a gold standard of expert vocational assessment, a short 23-item, self administered, RA WIS was developed. The WIS can be scored in 3 bands indicating low, medium, and high risk of work disability.