Work Ability Score Research Articles

Work disability in rheumatic diseases: Baseline results from an inception cohort

We aimed to characterize work disability in patients with newly diagnosed rheumatic diseases and compare work characteristics between patients with rheumatic diseases and controls without rheumatic diseases at diagnosis. Patients with inflammatory arthritis (IA) and osteoarthritis (OA), surrogates for autoimmune and non-autoimmune rheumatic diseases, respectively, and controls of working age were surveyed at diagnosis. Patients with rheumatic diseases who were employed before symptom onset were characterized as having work disability if they reported reduced work ability and productivity while remaining in the same job as before symptom onset, changed to a less demanding job or stopped working/retired. Work characteristics at diagnosis were compared between rheumatic diseases patients and controls. The unemployment rate before symptom onset was lower in patients with IA (20%) compared to patients with OA (32%). Among patients with IA and OA who were employed before symptom onset, 59% and 43% reported work disability, respectively (P=.04). The unemployment rate at diagnosis was comparable in patients with IA (26%) and higher in patients with OA (38%) compared to controls (29%). Employed patients with IA and OA, when compared with controls, reported poorer work ability (score: 37 vs 39 vs 41, P<.01; proportion with poor/moderate work ability: 48% vs 33% vs 21%, P<.01) and greater work productivity loss (score: 32 vs 29 vs 17, P<.01) at diagnosis. Rheumatic diseases impose significant work disability at diagnosis, highlighting the need for identification and interventions targeting work disability early in the course of disease.

Development of self-assessed work ability among middle-aged asthma patients—a 10 year follow-up study

Objective The prevalence of asthma has been growing among working age people over the last decades. In this study, we examine the development of Work Ability Score (WAS) among middle-aged asthmatics in a longitudinal setting, in order to find risk factors for poor development. Methods We followed the development of WAS trends during 10 years in a cohort of 529 middle-aged asthmatics, who were active in working life. Follow-up questionnaires were mailed in years 1, 2, 4, 6, 8, and 10. To study the development of WAS over time, we computed the discrete Frechet distance, which describes the similarity between the shapes of WAS curves. Results Sixty-eight percent of the patients’ WAS remained good or excellent throughout the follow-up period, while 24% of the patients WAS trend remained moderate. However, in 8%, the WAS was poor already in baseline and decreased further throughout the study. Using logistic regression, the moderate/poor development was associated significantly with high body mass index (BMI), pack years, adult onset asthma, physically strenuous work, number of co-morbidities, especially in psychiatric conditions, hypertension, and gastroesophageal reflux disease(GERD). When the model was adjusted for age and gender, adulthood onset of asthma and pack years lost their significance. Based on medication (high dose of inhaled corticosteroids (ICS) and second controller in use), 8% of the patients had severe asthma. Conclusion In the great majority of middle-aged asthma patients WAS remained stable throughout the follow-up period. However, 8% of the patients, who had more severe asthma and multiple co-morbidities, showed significantly poorer outcomes.

Lifestyle, sick leave and work ability among Norwegian employees with asthma-A population-based cross-sectional survey conducted in Telemark County, Norway.

To investigate whether physician-diagnosed asthma modifies the associations between multiple lifestyle factors, sick leave and work ability in a general working population. A cross-sectional study was conducted in Telemark County, Norway, in 2013. A sample of 16 099 respondents completed a self-administered questionnaire. We obtained complete data on lifestyle, work ability and sick leave for 10 355 employed persons aged 18-50 years. We modelled sick leave and work ability using multiple logistic regression, and introduced interaction terms to investigate whether associations with lifestyle factors were modified by asthma status. Several lifestyle risk factors and a multiple lifestyle risk index were associated with sick leave and reduced work ability score among persons both with and without physician-diagnosed asthma. A stronger association between lifestyle and sick leave among persons with asthma was confirmed by including interaction terms in the analysis: moderate lifestyle risk score * asthma OR = 1.4 (95% CI 1.02-2.1); high lifestyle risk score * asthma OR = 1.6 (95% CI 1.1-2.3); very high lifestyle risk score * asthma OR = 1.6 (95% CI 0.97-2.7); obesity * asthma OR = 1.5 (95% CI 1.02-2.1); past smoking * asthma OR = 1.4 (95% CI 1.01-1.9); and current smoking * asthma OR = 1.4 (95% CI 1.03-2.0). There was no significant difference in the association between lifestyle and work ability score among respondents with and without asthma. In the present study, we found that physician-diagnosed asthma modified the association between lifestyle risk factors and sick leave. Asthma status did not significantly modify these associations with reduced work ability score. The results indicate that lifestyle changes could be of particular importance for employees with asthma.

Mediating Factors for the Relationship between Stress and Work Ability over Time in Young Adults.

Stress can affect work ability. The aim of this study was to identify how this pathway is mediated over time in young adults. Participants of the Work Ability in Young Adults cohort were selected. A theoretical framework was built, which lead to a statistical model. Selected dimensions of mediators were recovery, work demands affecting private life, feelings of control over private life, and physical activity in leisure time. A quadruple serial mediation model was built with four mediators. The total effect of stress on work ability was −0.3955, 95% CI [−0.4764, −0.3146]. The total indirect effect amounted to 81% with an effect of −0.3182, 95% CI [−0.3750, −0.2642]. The relationship between stress and Work Ability Score five years later in young adults was mediated by stress five years later, work demands affecting private life, feelings of control over private life and feeling well-rested upon waking. These results indicate that work demands affecting private life and feelings of control over private life are important mediators of the relationship between stress and work ability in young adults. A well-balanced relationship between work and private life can counteract the influence of stress on work ability in this age group.

Normative reference values and physical factors associated with work ability: a cross-sectional observational study

ObjectivesTo establish normative reference values for work ability in healthy Australian adults using the Work Ability Score and investigate the association of physical performance factors.MethodsThe Work Ability Score was collected...

Employment Status and Associations with Workability, Quality of Life and Mental Health after Kidney Transplantation in Austria.

Kidney transplantation (KTx) in end-stage renal disease is associated with a significant increase in quality of life (QoL) and self-perceived health, optimally leading to the maintenance of employment or return to work (RTW) in working-age patients. The aim of this study was to assess individual factors including the QoL and mental health of kidney transplant recipients (KTRs) associated with employment after transplantation. A cross-sectional study including working-age patients with a history of KTx after 2012 was conducted at two Austrian study centers (Vienna and Graz). Brief Symptom Inventory (BSI-18), World Health Organization Quality of Life (WHOQOL-Bref) and Workability Index (WAI) were assessed along with detailed questionnaires on employment status. Out of n = 139 KTRs (43.2 ± 9.07 years; 57.6% male), 72 (51.8%) were employed. Employed patients were more frequently in a partnership (p = 0.018) and had higher education levels (p = 0.01) and QoL scores (<0.001). Unemployed KTRs reported fatigue and mental health issues more often (p < 0.001), and had significantly higher anxiety, depression and somatization scores (BSI-18). In unadjusted logistical regression, workability score (WAS; odds ratio (OR) = 3.39; 95% confidence interval (CI) = 1.97–5.82; p < 0.001), partnership (OR = 5.47; 95% CI 1.43–20.91; p = 0.013) and no psychological counseling after KTx (OR = 0.06; 95% CI = 0.003–0.969; p = 0.048) were independently associated with employment. Self-assessed mental health, workability and QoL were significantly associated with employment status after KTx. Thus, in order to facilitate RTW after KTx in Austria, vocational rehabilitation and RTW programs addressing KTRs should focus on increasing social support and care for their mental health.

Long-term effects on function, health-related quality of life and work ability after structured physiotherapy including a workplace intervention. A secondary analysis of a randomised controlled trial (WorkUp) in primary care for patients with neck and/or back pain

Objective: To study the long-term effects of a workplace intervention in addition to structured physiotherapy regarding self-reported measures in patients with acute/subacute neck and/or back pain.Design: WorkUp – a cluster-randomised controlled trial in 32 primary care centers in Sweden, from January 2013 through December 2014 (ClinicalTrials.gov ID: NCT02609750).Intervention: Structured physiotherapy with the workplace dialogue ‘Convergence Dialogue Meeting’ (CDM), conducted by the treating physiotherapist as an add-on. Reference group received structured physiotherapy.Subjects: Adults, 18–67 years (mean 43.7, standard deviation (SD) 12.2), 65.3% women with acute/subacute neck and/or back pain who had worked ≥4 weeks past year, considered at risk of sick leave or were on short-term sick leave (≤60 days) were included (n = 352).Outcome measures: Self-reported function, functional rating index (FRI), health-related quality of life (EQ-5D-3L) and work ability (Work Ability Score, WAS) at 12 months follow-up.Results: The mean differences in outcomes between intervention and reference group were; −0.76 (95% confidence interval (CI): −2.39, 0.88; FRI), 0.02 (95% CI: −0.04, 0.08; EQ-5D-3L) and −0.05 (95% CI: −0.63, 0.53; WAS). From baseline to 12 months, the intervention group improved function from 46.5 (SD 19.7) to 10.5 (SD 7.3) on FRI; health-related quality of life from 0.53 (SD 0.29) to 0.74 (SD 0.20) on EQ-5D and work ability from 5.7 (SD 2.6) to 7.6 (SD 2.1) on WAS.Conclusion: Despite a clinically relevant improvement over time, there were no significant differences in improvement between groups, thus we conclude that CDM had no effect on self-reported measures in this study.Key pointsIn earlier analysis of the primary outcome (work ability measured by absenteeism) in this trial, a positive effect was found when the workplace intervention ‘Convergence Dialogue Meeting’ (CDM) was added to structured physiotherapy for patients with neck or back pain.By contrast, in this new analysis of secondary outcomes (self-reported function, health and perceived work ability), there was no added effect of CDM above structured physiotherapy alone, although patients in both the intervention and reference group improved over time.The addition of CDM to physiotherapy is therefore justified by its specific effect on behavior (work absence) rather than any effect on clinical outcomes.

Interrelated Factors for Return to Work of Sick-Listed Employees in Sweden

Abstract Purpose: Long-term sickness absence is a significant human and economic cost in many countries, including Sweden making research on factors which impact on return to work (RTW) relevant. This study has two aims: (1) provide an overview of factors that impact RTW expectations in a national sample of Swedish workers on long-term sickness absence; and (2) gain an understanding of the interrelationships among these factors using a socioecological framework and decision tree analysis. Method: A survey, designed to capture information about demographic variables, health and work ability, workplace contact, supervisor support and expectations of return to work, was mailed to 1,112 randomly selected sick-listed people in Sweden and completed by 534, representing a response rate of 48%. Results: The most important factors affecting RTW expectations were work ability and burnout. Employees reporting high levels of work ability were more likely to expect to RTW compared to those reporting low levels, and this was dependent on their relative burnout score. Those with a high burnout score were less likely to expect to RTW, while for those with a low burnout score RTW expectations were dependent on age, country of birth, and supervisor support. For young employees reporting low work ability and low burnout score, RTW expectations were lower. Conclusions: Our results suggest a more nuanced approach to delivery of RTW services is required, whereby practitioners need to understand the socioecology of the range of factors that impact RTW expectations. The use of decision tree analysis facilitates this understanding by describing the interrelationships between these factors.

Personal and Societal Impact of Low Back Pain: The Groningen Spine Cohort.

Cross-sectional study. The aim of this study was to study the personal and societal impact of low back pain (LBP) in patients admitted to a multidisciplinary spine center. The socioeconomic burden of LBP is very high. A minority of patients visit secondary or tertiary care because of severe and long-lasting complaints. This subgroup may account for a major part of disability and costs, yet could potentially gain most from treatment. Currently, little is known about the personal and societal burden in patients with chronic complex LBP visiting secondary/tertiary care. Baseline data were acquired through patient-reported questionnaires and health insurance claims. Primary outcomes were LBP impact (Impact Stratification, range 8-50), functioning (Pain Disability Index, PDI; 0-70), quality of life (EuroQol-5D, EQ5D; -0.33 to 1.00), work ability (Work Ability Score, WAS; 0-10), work participation, productivity costs (Productivity Cost Questionnaire), and healthcare costs 1 year before baseline. Healthcare costs were compared with matched primary and secondary care LBP samples. Descriptive and inferential statistics were applied. In total, 1502 patients (age 46.3 ± 12.8 years, 57% female) were included. Impact Stratification was 35.2 ± 7.5 with severe impact (≥35) for 58% of patients. PDI was 38.2 ± 14.1, EQ5D 0.39 (interquartile range, IQR: 0.17-0.72); WAS 4.0 (IQR: 1.0-6.0) and 17% were permanently work-disabled. Mean total health care costs (&OV0556;4875, 95% confidence interval [CI]: 4309-5498) were higher compared to the matched primary care sample (n = 4995) (&OV0556;2365, 95% CI: 2219-2526, P < 0.001), and similar to the matched secondary care sample (n = 4993) (&OV0556;4379, 95% CI: 4180-4590). Productivity loss was estimated at &OV0556;4315 per patient (95% CI: 3898-4688) during 6 months. In patients seeking multidisciplinary spine care, the personal and societal impact of LBP is very high. Specifically, quality of life and work ability are poor and health care costs are twice as high compared to patients seeking primary LBP care. 3.

The association between changes in functional capacity and work ability among unemployed individuals

PurposeUnemployment has multidimensional effects. This study investigated how the changes in functioning are associated with the changes in perceived work ability among unemployed people.MethodsThe participants were clients in projects funded by the European Social Fund (ESF) targeted for unemployed individuals. They answered a questionnaire covering work ability (Work Ability Score) and functioning (cognitive, psychological and social functioning, physical condition and everyday activities) and perceived health at the beginning and at the end of the project (mean follow-up 173 days). The study included data from unemployed respondents (N = 502) aged 19–64 years.ResultsOverall, during the follow-up, both work ability and different aspects of functioning improved, excluding physical condition. Changes in cognitive and psychological functioning, physical condition and everyday activities were significantly associated with the changes in work ability. The physical condition had the strongest association with the changes in work ability. Short unemployment time and especially good perceived health improved WAS over time. Age, gender and follow-up time were not associated with changes in work ability.ConclusionsMaintaining or improving health and functioning and shortening the length of unemployment appeared to be important issues in enhancing work ability and thus increasing re-employability potential.

Work ability, functional exercise capacity and prevalence of obesity in perimenopausal and postmenopausal women with non-manual employment

Objective. This study aimed to evaluate work ability and functional exercise capacity, and their correlation to each other and to obesity, in perimenopausal and postmenopausal women with non-manual employment. Materials and methods. The study included 300 women aged 44–66 years. The following measures were used: work ability index (WAI), 6-min walk test (6MWT), body mass index (BMI), waist–hip ratio (WHR) and adipose tissue accumulation. Regression models of the WAI and distance in the 6MWT were estimated. Results. The examined women obtained WAI 39.0 ± 5.0, BMI 26.2 ± 4.6, WHR 0.819 ± 0.060 and adipose tissue accumulation 30.1 ± 6.1%, on average. About 19% of women obtained a very good work ability score, 55% good, 23% medium and 3% poor. About 17% of women were obese, 39% overweight and 44% normal body mass, 29% had abdominal obesity, 19% had elevated accumulation of adipose tissue and 21% had high accumulation of adipose tissue. These results did not differ significantly between perimenopausal and postmenopausal women The postmenopausal women obtained a significantly lower functional exercise capacity score than perimenopausal women. Conclusion. Work ability correlates positively to functional exercise capacity, which correlates negatively to adipose tissue accumulation in perimenopausal women with non-manual employment, but not in postmenopausal cases.

Finnish Trial on Practices of Anterior Cervical Decompression and Fusion (FACADE): a protocol for a prospective randomised non-inferiority trial comparing outpatient versus inpatient care

IntroductionAlthough a great majority of patients with cervical radiculopathy syndrome can successfully be treated non-operatively, a considerable proportion experience persistent symptoms, severe enough to require neurosurgical intervention. During the past...

Influence of Obesity on Work Ability, Respiratory Symptoms, and Lung Function in Adults with Asthma

Background: Asthma is defined by variable respiratory symptoms and lung function, and may influence work ability. Similarly, obesity may contribute to respiratory symptoms, affect lung function, and reduce work ability. Thus, assessment of the influence of obesity on work ability, respiratory symptoms, and lung function in adults with asthma is needed. Objectives: We hypothesized that patients with obesity and asthma have more respiratory symptoms and reduced work ability and lung function compared with normal-weight patients with asthma. Methods: We examined 626 participants with physician-diagnosed asthma, aged 18–52 years, recruited from a cross-sectional general population study using a comprehensive questionnaire including work ability score, the asthma control test (ACT), height and weight, and spirometry with reversibility testing. Results: Participants with a body mass index (BMI) ≥30 kg/m² (i.e., obese) had a higher symptom score (OR 1.78, 95% CI 1.14–2.80), current use of asthma medication (1.60, 1.05–2.46), and incidence of ACT scores ≤19 (poor asthma control) (1.81, 1.03–3.18) than participants with BMI ≤24.9 kg/m² (i.e., normal weight). Post-bronchodilator forced vital capacity (FVC) as a percentage of predicted (β coefficient –4.5) and pre-bronchodilator forced expiratory volume in 1 s as a percentage of predicted (FEV₁) (β coefficient –4.6) were negatively associated with BMI ≥30 kg/m². We found no statistically significant association of BMI >30 kg/m² (compared to BMI <24.9 kg/m²) with sick leave (1.21, 0.75–1.70) or reduced work ability (1.23, 0.74–2.04). Conclusions: There were indications that patients with obesity had a higher symptom burden, poorer asthma control, higher consumption of asthma medication, and reduced lung function, in particular for FVC, compared with normal-weight patients.

Workplace-Based Exercise Intervention Improves Work Ability in Office Workers: A Cluster Randomised Controlled Trial.

Neck pain is a burden to employers and employees amenable to improvement with neck/shoulder strengthening exercises. However, the benefits of such interventions on office workers’ work ability remains unknown. This study evaluated the effects of a 12-week combined ergonomics and neck/shoulder strengthening exercise intervention (EET, n = 177, mean age 41.7 years, 26% female), versus a 12-week combined ergonomics and health promotion intervention (EHP, n = 173, mean age 43 years, 29% female) on work ability among office workers. Work ability was measured by a single question. Differences in the work ability score were analyzed using the intention-to-treat (ITT) and per-protocol (i.e., adherence ≥70%) analyses for between- and within-group differences at baseline, 12 weeks, and 12 months. A sub-group analysis was performed for neck cases, defined as reporting neck pain as ≥3 (out of 10). No significant between-group differences for work ability were observed in the general population, and subgroup of neck cases. A significant group-by-time interaction effect at 12 weeks and the trend for significance at 12 months favored the EET group in the per-protocol analysis of the neck cases. EET was effective in increasing work ability post-intervention and potentially, in the long-term, in symptomatic participants with ≥70% adherence to the intervention. However, EET was not superior to EHP.

Cross-cultural adaptation and psychometric properties of the Dutch version of the Hand Function Sort in patients with complaints of hand and/or wrist

BackgroundMusculoskeletal complaints of arm, neck, and shoulder (CANS) can lead to loss of work productivity. To assess the functional consequences of impairments in work, patient-reported outcomes can be important. The Hand Function Sort (HFS) is a 62-item pictorial questionnaire that focuses on work task performance. The aims of this study were the cross-cultural adaptation of HFS into HFS-Dutch Language Version (HFS-DLV) (Part I) and determining construct validity, internal consistency, test-retest reliability, responsiveness and floor/ceiling effects of HFS-DLV (Part II).MethodsI: Translation into Dutch using international guidelines. II: Construct validity was assessed with Spearman’s correlation coefficients between the HFS-DLV and the Dutch version of the QuickDASH, PRWHE, PDI, RAND-36, NRS-pain, and work ability score. Internal consistency was assessed using Cronbach’s α and reliability by a test-retest procedure. A global rating scale of change was used after 4–8 weeks of hand therapy to determine responsiveness.ResultsI: Forty patients were included, and no items were changed. II: 126 patients with hand, wrist, and/or forearm disorders classified as specific or nonspecific CANS. Six predefined hypotheses (50%) were confirmed. Cronbach’s α: 0.98. Test-retest reliability: ICC of 0.922. AUC of 0.752. There were no floor/ceiling effects.ConclusionsI: Translation process into the HFS-DLV went according to plan. II: For construct validity, the presumed direction of correlations was correct, but less than 75% of hypotheses were confirmed. Internal consistency was high, suggesting redundancy. Reliability and responsiveness of the HFS-DLV were good. HFS-DLV can be used in research or clinical practice for Dutch patients with CANS, to evaluate self-reported functional work ability.

Lifestyle and work ability in a general working population in Norway: a cross-sectional study

ObjectivesThe aim of this study was to investigate the association between multiple lifestyle-related risk factors (unhealthy diet, low leisure-time physical activity, overweight/obesity and smoking) and self-rated work ability in a...

Using the Work Ability Index to identify workplace hazards.

The workforce is ageing. While those in relatively sedentary occupations may be largely unaffected, for those employed in more physically demanding occupations, and the organizations who employ them, this poses a challenge. In this cross-sectional survey of outdoor council workers in South Australia we sought to address the challenge of an ageing workforce demographic by examining the association between a range of workplace risks and hazards with work ability scores. 155 workers from five groups of outdoor workers in a large metropolitan council participated in the research. Questionnaires were administered during staff meetings. The survey instrument included questions on demographic and employment characteristics, physical and psychosocial risk factors and the Work Ability Index. Those with excellent or good work ability scores comprised 43% of workers each. Those categorized as having moderate work ability scores comprised 14% of workers. There were no workers with poor work ability scores. Associations with work ability scores were found for age, pain and discomfort, perceptions of health and safety at work, as well as a range of psychosocial and physical risk factors. The results confirm a link between work ability and a range of physical and psychosocial risk factors, which if addressed, may improve the longevity of the workforce.

Work ability and work functioning: measuring change in individuals recently returned to work

PurposeTo assess: (1) whether work ability and work-functioning instruments can detect relevant changes in their respective parameters following a return to work (RTW) and (2) what proportion of those returning to work show changes in their work ability and work functioning.MethodsA total of 1073 workers who returned to work after at least 2 weeks of sick leave were invited to fill out three questionnaires in the first 8 weeks after RTW. These consisted of an appraisal of general, physical, and mental/emotional work ability (scores 0–10) and a work-functioning questionnaire (scores 0–100). Minimal Important Change (MIC) was defined to determine the proportion of people, whose scores had changed at weeks 5 and 8 following RTW. The Smallest Detectable Change (SDC) was determined to put the MIC in perspective of measurement error.ResultsOf all participants, 235 were eligible for the analysis. All MIC values were below the SDC and thus not suitable for use. The SDC for work ability was 2.2 and 19.9 for work functioning. In the first 5 weeks after RTW, 10–15% showed a relevant, measurable improvement in work ability, and work functioning based on the SDC margins.ConclusionsBoth instruments were unable to identify change after RTW adequately. We can conclude that 10–15% of individuals showed improvement in work ability and work functioning in the first 5 weeks after RTW when SDC is used.

Can the STarT Back Tool predict health-related quality of life and work ability after an acute/subacute episode with back or neck pain? A psychometric validation study in primary care

ObjectivesThe predictive ability of the STarT Back Tool (SBT) has not yet been examined among acute/subacute back and/or neck pain in a primary care setting in respect to health-related quality...

Edmonton Obesity Staging System (EOSS) and Work Ability in the Evaluation of Workers Affected by Obesity: A Preliminary Report.

Obesity and work-ability may be influenced by reduced performance, associated diseases, and obesogenic environment. Two hundred seventy-six male (46.7 ± 10.6 years; BMI 33.3 ± 4.4 kg/m) and 658 female (48.4 ± 9.7 years; BMI 33.6 ± 5.4 kg/m) were enrolled. They were classified by Edmonton Obesity Staging System (EOSS) and interviewed for "perceived" work-ability. Total work ability score was 1.3 ± 2.1 in EOSS 0, 1.2 ± 1.5 in EOSS 1, 1.8 ± 2 in EOSS 2, 2.0 ± 2.2 in EOSS 3. Work-ability, in relation to EOSS adjusted for sex, age, work categories referred to EOSS 0, was highest in EOSS stage 3 (P < 0.001 for trend) and with reference to Administration; Industries showed the worst score (P < 0.001) followed by Health (P = 0.001) and Service (P = 0.01). The relation between EOSS and work-ability empowers clinical decision-making and helps to assess the impact of overweight on health and fitness for work.