Workplace Activity Limitations Scale 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.

Psychometric testing of the British-English Long-Term Conditions Job Strain Scale, Long-Term Conditions Work Spillover Scale and Work-Health-Personal Life Perceptions Scale in four rheumatic and musculoskeletal conditions.

The aims were to validate linguistically British-English versions of the Long-Term Conditions Job Strain Scale (LTCJSS), Long-Term Conditions Work Spillover Scale (LTCWSS) and Work-Health-Personal Life Perceptions Scale (WHPLPS) in rheumatoid arthritis, axial spondyloarthritis, osteoarthritis and fibromyalgia (FM). The three scales were forward translated and reviewed by an expert panel prior to cognitive debriefing interviews. Participants completed a postal questionnaire. Construct validity was assessed using Rasch analysis. Concurrent validity included testing between the three scales and work (e.g., Workplace Activity Limitations Scale [WALS]) and condition-specific health scales. Two weeks later, participants were mailed a second questionnaire to measure test-retest reliability. The questionnaire was completed by 831 employed participants: 68% women, 53.5 (SD 8.9) years of age, with condition duration 7.7 (SD 8.0) years. The LTCJSS, LTCWSS and WHPLPS Parts 1 and 2 satisfied Rasch model requirements, but Part 3 did not. A Rasch transformation scale and Reference Metric equating scales with the WALS were created. Concurrent validity was generally good (rs = 0.41-0.85) for the three scales, except the WHPLPS Part 3. Internal consistency (Person Separation Index values) was consistent with group use in all conditions, and individual use except for the LTCWSS and WHPLSP Parts 1 and 2 in FM. Test-retest reliability was excellent, with intraclass coefficients (2,1) of 0.80-0.96 for the three scales in the four conditions. Reliable, valid versions of the British-English LTCJSS, LTCWSS and WHPLPS Parts 1 and 2 are now available for use in the UK.

Psychometric testing of the British English Workplace Activity Limitations Scale in four rheumatic and musculoskeletal conditions.

The aims were to validate a British English version of the Workplace Activity Limitations Scale (WALS) linguistically, then test this psychometrically in RA, axial spondyloarthritis (axSpA), OA and FM. The WALS was forward translated, reviewed by an expert panel, and cognitive debriefing interviews were conducted. Participants completed a postal questionnaire booklet. Construct (structural) validity was examined by fit to the Rasch measurement model. Concurrent validity included testing between the WALS and the Work Limitations Questionnaire-25 (WLQ-25). Two weeks later, participants were mailed a second questionnaire booklet for test-retest reliability. Minor wording changes were made to the WALS, then 831 employed participants completed questionnaires: 267 men and 564 women; 53.5 (s.d. 8.9) years of age; with condition duration 7.7 (s.d. 8.0) years. The WALS satisfied Rasch model requirements, and a WALS Rasch transformation table was created. Concurrent validity was strong with the WLQ-25 (RA r s = 0.78; axSpA r s = 0.83; OA r s = 0.63; FM r s = 0.64). Internal consistency was consistent with group use (α = 0.80-0.87). Test-retest reliability was excellent, with intraclass correlation coefficient (2,1) at ≥0.90. A reliable, valid British English version of the WALS is now available for use in the UK.

Return to work after medial opening wedge high tibial osteotomy

BackgroundHigh tibial osteotomy (HTO) is frequently performed in young and physically active patients with knee medial compartment osteoarthritis and varus deformity. There is however, limited evidence on the function of patients after returning to work following HTO. The main objective of this study was to evaluate the return to work following medial opening-wedge HTO in our institution. MethodsPatients who underwent medial opening wedge HTO were identified and sent a questionnaire to assess their type of employment, as well as their return to work and function at work following surgery. Work related outcomes were assessed using the Workplace Activity Limitations Scale (WALS), whilst quality of life and satisfaction with surgery was assessed using the EQ-5D and Visual Analogue Scales (VAS). ResultsThere were 42 patients identified in the study. The mean time to return to work was 2.6 months, with 79% of patients returning to work by 3 months. The mean WALS score was 5.4 and the mean EQ-5D was 0.77. The mean VAS for quality of life was 77.9 and mean VAS for satisfaction with surgery was 58.3. In patients with light intensity physical jobs, however, mean satisfaction with surgery increased to 86. Survivorship of HTO was 93% in this series. ConclusionsMedial opening-wedge HTO is an effective treatment method for patients who are still in active employment. The majority of patients return to work within 3 months of surgery and demonstrate good function at work. Patient satisfaction with surgery, however, is higher in less physically demanding jobs.

OMERACT Filter Evidence Supporting the Measurement of At-work Productivity Loss as an Outcome Measure in Rheumatology Research.

Indicators of work role functioning (being at work, and being productive while at work) are important outcomes for persons with arthritis. As the worker productivity working group at OMERACT (Outcome Measures in Rheumatology), we sought to provide an evidence base for consensus on standardized instruments to measure worker productivity [both absenteeism and at-work productivity (presenteeism) as well as critical contextual factors]. Literature reviews and primary studies were done and reported to the OMERACT 12 (2014) meeting to build the OMERACT Filter 2.0 evidence for worker productivity outcome measurement instruments. Contextual factor domains that could have an effect on scores on worker productivity instruments were identified by nominal group techniques, and strength of influence was further assessed by literature review. At OMERACT 9 (2008), we identified 6 candidate measures of absenteeism, which received 94% endorsement at the plenary vote. At OMERACT 11 (2012) we received over the required minimum vote of 70% for endorsement of 2 at-work productivity loss measures. During OMERACT 12 (2014), out of 4 measures of at-work productivity loss, 3 (1 global; 2 multiitem) received support as having passed the OMERACT Filter with over 70% of the plenary vote. In addition, 3 contextual factor domains received a 95% vote to explore their validity as core contextual factors: nature of work, work accommodation, and workplace support. Our current recommendations for at-work productivity loss measures are: WALS (Workplace Activity Limitations Scale), WLQ PDmod (Work Limitations Questionnaire with modified physical demands scale), WAI (Work Ability Index), WPS (Arthritis-specific Work Productivity Survey), and WPAI (Work Productivity and Activity Impairment Questionnaire). Our future research focus will shift to confirming core contextual factors to consider in the measurement of worker productivity.

Work disability among workers with osteoarthritis of the knee: risks factors, assessment scales, and interventions.

The prevalence of knee osteoarthritis (OA) among individuals active in the workforce will increase considerably in the next generation and a significant percentage of these individuals are expected to experience work disability because of this disease. The aim of this review was to summarize the existing knowledge on the following: (a) work disability risk factors; (b) reliable and valid work disability assessment tools; and (c) efficient interventions to reduce work disability in individuals with knee OA. An electronic document search using key words and MeSH terms was performed with various databases. Two independent investigators were tasked with the screening of articles and quality assessment. A critical appraisal of what is known was performed and recommendations for clinical practice and future research were formulated. The database search yielded 61 references. One article on risk factors, three related to assessment tools, and two on interventions were retained. Age and previous work absence episodes were found to be risk factors of workplace disability. The Work Limitation Questionnaire, the Work Instability Scale for Rheumatoid Arthritis, and the Workplace Activity Limitations Scale were psychometrically sound for the population studied. Education-based interventions seem to be more effective than conventional interventions in helping individuals with knee OA return to work faster, reduce the number of days absent from work, and improve their overall well-being. This review is the first to summarize the evidence on work disability risk factors, assessment tools, and interventions for this growing population and to show a critical gap in the existing knowledge.

Work factors are associated with workplace activity limitations in systemic lupus erythematosus.

The objective of this study was to examine the extent of workplace activity limitations among persons with lupus and to identify factors associated with activity limitations among those employed. We conducted a cross-sectional study using a mailed survey and clinical data of persons with lupus who attended a large lupus outpatient clinic. Data were collected on demographics, health, work factors and psychosocial measures. The workplace activity limitations scale (WALS) was used to measure difficulty related to different activities at work. Multivariable analysis examined the association of health, work context, psychosocial and demographic variables with workplace activity limitations. We received 362 responses from 604 (60%) mailed surveys. Among those not employed, 52% reported not working because of lupus. A range of physical and mental tasks were reported as difficult. Each of the physical, cognitive and energy work activities was cited as difficult by more than one-third of participants. Among employed participants, 40% had medium to high WALS difficulty scores. In the multivariable analysis, factors significantly associated with workplace activity limitations were older age, greater disease activity, fatigue, poorer health status measured by the 36-item Short Form Health Survey, lower job control, greater job strain and working more than 40 h/week. People with lupus experience limitations and difficulty at work. Determinants of workplace activity limitations are mainly those related to workplace and health factors.

AB1072 Work Disability, Productivity, Presenteeism and Absenteeism in Rheumatic Patients

BackgroundWork capacity is primarily assessed by absenteeism and rheumatic patients may experience decreased productivity as well as presenteeism due to their health problems as well as its costs consequences.ObjectivesTo evaluate...

Return to work and workplace activity limitations following total hip or knee replacement

Total hip (THR) and knee (TKR) replacements increasingly are performed on younger people making return to work a salient outcome. This research evaluates characteristics of individuals with early and later return to work following THR and TKR. Additionally, at work limitations pre-surgery and upon returning to work, and factors associated with work limitations were evaluated. 190 THR and 170 TKR of a total 931 cohort participants were eligible (i.e., working or on short-term disability pre-surgery). They completed questionnaires pre-surgery and 1, 3, 6 and 12 months post-surgery that included demographics, type of occupation, and the Workplace Activity Limitations Scale (WALS). 166 (87%) and 144 (85%) returned to work by 12 months following THR and TKR, respectively. Early (1 month) return to work was associated with, male gender, university education, working in business, finance or administration, and low physical demand work. People with THR returned to work earlier than those with TKR. For both groups, less pain and every day functional limitations were associated with less workplace activity limitations at the time return to work. The majority of individuals working prior to surgery return to work following hip or knee replacement for osteoarthritis (OA) and experience fewer limitations at work than pre-surgery. The changing workforce dynamics and trends toward surgery at younger ages mean that these are important outcomes for clinicians to assess. Additionally, this is important information for employers in understanding continued participation in employment for people with OA.

Sensibility of five at-work productivity measures was endorsed by patients with osteoarthritis or rheumatoid arthritis

ObjectiveTo examine and compare the sensibility attributes (face/content validity and feasibility) of five at-work productivity measures from the perspective of patients with osteoarthritis (OA) or rheumatoid arthritis (RA). Study Design and SettingWorkers with OA or RA (n = 250) completed a survey that includes five at-work productivity (presenteeism) measures and questions asking about their comprehensiveness, understandability, length, and suitability of response options. A final question asked respondents which single measure was considered “best” overall. Measures compared included the Workplace Activity Limitations Scale (WALS), Stanford Presenteeism Scale, Endicott Work Productivity Scale, Work Instability Scale for Rheumatoid Arthritis (RA-WIS), and Work Limitations Questionnaire (WLQ-25). Sensibility performance was assessed quantitatively (% respondent endorsement) and qualitatively via written feedback. ResultsThe WLQ-25 was considered most comprehensive (endorsed by 92.8%), the WALS performed best in terms of understandability (97.6%) and suitability of response options (97.9%), and the RA-WIS was favored in terms of length (91.6%). Consistent sensibility performance between OA and RA was found. The WALS (32.6%) and WLQ-25 (30.0%) were moderately preferred in the final overall appraisal. ConclusionSensibility criteria were generally met by all five at-work productivity measures. Variable endorsement levels across specific sensibility attributes were also revealed across the measures compared.

Return to work and work activity limitations following total hip and knee replacement

Purpose: Total hip (THR) and knee (TKR) replacement increasingly are performed in middle-aged individuals making return to work (RTW) a salient outcome. This research describes the characteristics of individuals with early and later return to work following THR and TKR. Additionally, at work limitations pre-surgery and upon returning to work and factors associated with workplace limitations were evaluated. Methods: 190 THR (males = 100; female = 90; mean age = 56 yrs, sd=9.9) and 170 TKR (males = 72; female = 98; mean age = 57 yrs, sd=7.2) of a total 931 cohort participants were eligible for the study (i.e., those working or on short-term disability pre-surgery). They completed questionnaires pre-surgery and one, three, six and twelve months post-surgery that included socio-demographics (age, sex, BMI, education, marital status and job status i.e., full- or part-time, short-term disability), job sector (business/administration, health/science/arts, sales and service, and trades/transportation/manufacturing), occupational physical demand (low, high and unable to determine), and the Workplace Activity Limitations Scale (WALS), a 12-item measure where respondents rate how much difficulty they experience carrying out work-related activities unassisted (score range 0-36 with lower scores indicating few limitations). Additionally, the WOMAC pain and function subscales were completed. THR and TKR were analyzed separately and all standardized measures were recoded, as necessary, so that lower scores represented no problems. In addition to descriptive statistics for the sample, the proportion of people working was calculated for each time interval. The association of age, sex, BMI, education, job sector and job demands with early (1 month) versus later (6 and 12 month) RTW was examined using ANOVA for continuous variables and polychoric correlations for categorical data. Results: 166 (87%) and 144 (85%) respondents RTW by twelve months following THR and TKR, respectively. Overall, people with THR (34%) returned to work earlier than those with TKR (23 %). Early RTW was associated with older age, male gender, university education, working in business/administration, and low physical demand work. For both groups, work limitations were significantly less than pre-surgery by one-year follow-up (pre-surgery: THR 12.6, TKR = 13.3; one-year post-surgery: THR=4.14, TKR=5.90). In THR, limitations upon RTW were similar irrespective of time of RTW, while for TKR, those with later return reported fewer limitations than those who returned early. WOMAC pain and function scores were associated with the WALS with Pearson r ranging from 0.53 to 0.78 for THR and from 0.53 to 0.75 for TKR. Conclusions: Overall, a high proportion of individuals, including workers in older age groups, return to work following THR or TKR although time of return is slightly later in TKR. Information on factors associated with time of return and the types of limitations experienced is valuable for clinicians in educating patients about the course of recovery.

Measures of work disability and productivity: Rheumatoid Arthritis Specific Work Productivity Survey (WPS‐RA), Workplace Activity Limitations Scale (WALS), Work Instability Scale for Rheumatoid Arthritis (RA‐WIS), Work Limitations Questionnaire (WLQ), and Work Productivity and Activity Impairment Questionnaire (WPAI)

Measures of work disability and productivity: Rheumatoid Arthritis Specific Work Productivity Survey (WPS‐RA), Workplace Activity Limitations Scale (WALS), Work Instability Scale for Rheumatoid Arthritis (RA‐WIS), Work Limitations Questionnaire (WLQ), and Work Productivity and Activity Impairment Questionnaire (WPAI)

Examination of arthritis-related work place activity limitations and intermittent disability over four-and-a-half years and its relationship to job modifications and outcomes

To examine the type, degree, and episodic nature of arthritis-related work place activity limitations and the consistency of the relationship of activity limitations to job modifications and work place outcomes. Using an interviewer-administered structured questionnaire, individuals with osteoarthritis (OA) or inflammatory arthritis (IA) were interviewed at 4 time points, 18 months apart. At baseline, all participants (n = 490; 381 women, 109 men) were employed. Respondents were recruited using community advertising and from rheumatology and rehabilitation clinics. The Workplace Activity Limitations Scale (WALS) assessed arthritis-related disability with job tasks. Job modifications/accommodations (e.g., scheduling changes), work place outcomes (e.g., absenteeism), demographics, illness, and work context were also measured. Repeated cross-sectional logistic regressions examined levels of WALS disability with job modifications and outcomes at each time point. Similar levels of activity limitations were found comparing OA and IA with fewer difficulties with global aspects of work (e.g., scheduling) than with specific tasks (e.g., working with hands). Three-quarters of the participants had episodic or intermittent WALS difficulty over time. Medium and high levels of work place activity limitations were significantly associated with job modifications, and high WALS difficulty was consistently related to negative work outcomes. Many individuals with arthritis report some difficulty with work place activities. However, these difficulties are often intermittent and may not result in changes to work productivity until they are consistently high. This is important for designing work place interventions and for employers, insurers, and the government to understand to avoid viewing individuals with arthritis as a permanent drain on work place and health resources.

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.

Reye's syndrome associated with respiratory syncytial virus infection.

An upper respiratory tract infection in a 22-month-old boy was followed by rapid loss of consciousness, hypoglycaemia, uraemia, and death. Necropsy examination showed fatty change of liver and kidneys, severe cerebral oedema, bronchiolitis, and endocardial fibroelastosis affecting the left ventricle. Immunofluorescence staining showed infection with respiratory syncytial virus (RSV). The clinical and pathological findings were those of Reye's syndrome, not previously reported accompanying RSV infection.