Workplace Activity Limitations 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.

How Does Job Insecurity and Workplace Activity Limitations Relate to Rheumatic Disease Symptom Trajectories in Young Adulthood? A Longitudinal Study.

Workplace and labor market conditions are associated with the health of the working population. A longitudinal study was conducted among young adults with rheumatic disease to examine workplace activity limitations and job insecurity and their relationship with disease symptom trajectories. Three online surveys were administered to young adults with rheumatic disease over 27 months. Self-reported data on pain, fatigue, and disease activity were collected. Workplace activity limitations and job insecurity were measured. Group-based discrete mixture models determined pain, fatigue, and disease activity trajectory groups. Robust Poisson regression models were fitted to examine the relationship among workplace activity limitations, job insecurity, and trajectory group membership. In total, 124 participants (mean ± SD age 29 ± 4.5 years) with rheumatic disease were recruited. At baseline, participants reported considerable workplace activity limitations (10.35 ± 5.8), and 36% of participants indicated experiencing job insecurity. We identified 2 latent rheumatic disease symptom trajectory groups. The first group had high persistent pain, fatigue, or disease activity; the second group had low persistent disease symptoms over time. Greater workplace activity limitations were associated with an increased relative risk (RR) of being in the high persistent severe pain (RR 1.02 [95% confidence interval (95% CI) 1.01, 1.03]), fatigue (RR 1.02 [95% CI 1.01, 1.03]), and disease activity trajectory groups (RR 1.02 [95% CI 1.01, 1.03]). Job insecurity was associated with an increased RR of membership in the high persistent pain (RR 1.14 [95% CI 1.04, 1.25]) and disease activity trajectory groups (RR 1.11 [95% CI 1.00, 1.22]). Workplace activity limitations and job insecurity represent working conditions that are associated with the health of young adults with rheumatic disease and should be examined as potential targets for intervention.

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.

Unmet Workplace Support Needs and Lost Productivity of Workers With Systemic Sclerosis: A Path Analysis Study.

Few studies have examined how workplace support can address work productivity loss among individuals with systemic sclerosis (SSc). The objective was to 1) examine the relationship between unmet workplace support needs and work productivity loss among workers with SSc, and 2) determine whether SSc symptom severity, fatigue, active disease periods, and workplace activity limitations mediate the relationship between unmet workplace support needs and work productivity loss. A cross-sectional survey was conducted of employed individuals with SSc who were recruited through rheumatology clinics. Information on work productivity loss (i.e., absenteeism, presenteeism, job disruptions) and the need, availability, and use of workplace supports was collected. SSc symptom severity (e.g., workplace activity limitations, active disease periods, fatigue, and overall SSc symptom severity) and demographic, health, and work context characteristics were collected. Three Bayesian path models examined the association between unmet workplace support needs and each work productivity loss outcome. SSc symptom severity variables were examined as mediators in each model. A total of 110 employed participants were recruited (mean ± SD ages 49 ± 12.9 years). More than three-fourths of participants were female (77%) and worked full-time (77%). The most needed workplace supports included extended health benefits (84%), special equipment (63%), and flextime (59%). Additionally, 61% reported unmet workplace support needs. Path models indicated that indirect relationships between unmet workplace support needs and work productivity loss were significant. For all models, workplace activity limitations mediated the relationship between unmet workplace support needs and productivity loss. To foster productive employment of individuals with SSc, interventions need to address symptom severity and meet workplace support needs.

The Role of Sex, Gender, Health Factors, and Job Context in Workplace Accommodation Use Among Men and Women with Arthritis.

BackgroundWith the aging of populations in many countries, workers are expected to remain employed longer but may struggle with the onset of common, chronic conditions like arthritis. To date, few studies have examined workplace policies and practices that could help accommodate individuals with arthritis, and fewer still have used a sex and gender-based approach to explore similarities and differences between women and men.ObjectivesThis study compared the health and work contexts of workers aged ≥50 years to better understand similarities and differences between women and men in accommodation availability, need, use, and unmet needs.MethodsA cross-sectional survey of men and women with osteoarthritis (OA), inflammatory arthritis (IA), or both OA and IA was administered online or by telephone and assessed demographics (e.g. age, education), health (e.g. pain, fatigue, workplace activity limitations), work context factors (e.g. job sector, full/part-time work, job control), and workplace accommodations (e.g. health benefits, flexible hours, special equipment/adaptations, modified duties). Sex and gender-based analyses examined similarities and differences between men and women and included descriptive statistics, multivariable multinomial analyses, and nested regression analyses.ResultsThere was a 58.9% response rate and final sample of 463 participants (women, n = 266; men, n = 197; OA = 59.0%; IA/both IA and OA = 23.7%; unsure = 17.3%). Women and men were significantly different in a number of health (e.g. fatigue, health variability, workplace activity limitations) and work context factors (e.g. job sector, part-time work, job stress). However, in other respects, they were similar (e.g. pain, job involving physical demands, size of organization, shift work, union membership, job control). There were no differences between men and women in the availability or use of workplace accommodations. However, women reported significantly more accommodation needs and had greater unmet needs. Multivariable multinomial analyses found male/female as a binary variable did not explain differences in accommodation need, use, and unmet need. Nested analyses highlighted that differences in health variables explained male/female differences in accommodation need, while work context differences explained male/female differences in whether needs were met.ConclusionsThe findings highlight that women and men draw on a range of existing accommodation policies and practices to help manage their arthritis and that most have their accommodation needs met. Decomposing the context within which men and women with arthritis work suggests that women may face health and work context challenges that differ from men and that are related to greater accommodation needs and unmet need. This highlights potential vulnerabilities in the work of women that need to be addressed.

Job Accommodations Availability and Utilization Among People With Lupus: An Examination of Workplace Activity Limitations and Work Context Factors.

The aim of this study was to examine the availability of diverse job accommodations (or flexible working arrangements) and to describe their use among people with systemic lupus erythematosus (lupus), as well as to examine factors associated with the use of job accommodations. A mail survey was sent to adult lupus patients receiving care from a lupus clinic based in Toronto, Canada. The survey assessed demographic information, self-reported disease activity, work history, workplace activity limitations, job strain, and the availability and use of job accommodations. Standard multivariable linear regression analysis was used to examine factors associated with the use of job accommodations. We received 362 responses of 604 mailed surveys (60% response rate). Participants who were employed within the last 5 years, but who were not currently working, were less likely than currently employed participants to report having had job accommodations available to them at their last place of employment. The use of job accommodations was reported by 70% of currently employed respondents and by 72% of those not currently employed. The most common job accommodation used was sick leave days. Factors positively associated with the use of job accommodations among those who were employed included higher levels of education, being diagnosed with fibromyalgia, at least 1 episode of short-term work disability, not belonging to a union, greater workplace activity limitations, and greater job strain. The use of job accommodations among people with lupus is common. Work context factors, such as workplace activity limitations and job strain, are the main factors associated with the use of job accommodations.

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.

Availability, need for, and use of work accommodations and benefits: are they related to employment outcomes in people with arthritis?

To examine the availability, need, and use of workplace policies for workers with osteoarthritis (OA) and inflammatory arthritis (IA) and their association with employment outcomes. Participants (n = 219) were employed, ages ≥25 years, and diagnosed with OA or IA. They were recruited through community advertising and rheumatology clinics in 2 Canadian provinces. Respondents completed a 35-45-minute telephone interview assessing demographics (age, sex), health (diagnosis, pain, activity limitations), work context (job control), employment outcomes (workplace activity limitations, absenteeism, productivity losses, reduced hours), benefits (extended health, short-term leaves), and accommodations (flexible hours, modified schedules, special equipment/adaptations, work-at-home arrangements). Regression analyses examined differences in benefit/accommodation need and use. Many participants reported that arthritis impacted their work. But with the exception of extended health benefits, ∼50-65% of participants reported not needing each individual benefit/accommodation, although only 7.3% of respondents reported needing no benefits or accommodations at all. Greater job control and education were associated with greater perceived need and use of benefits/accommodations. Need was also associated with greater activity limitations, and disclosure of arthritis was related to use of benefits/accommodations. Participants needing but not using workplace policies often had significantly poorer employment outcomes compared to those using benefits/accommodations. Findings are relevant to workers with arthritis and to employers. Results suggest that individuals with arthritis are unlikely to be a drain on workplace resources. Many individuals do not use benefits/accommodations until needed, and among those using them, there were generally positive relationships with diverse employment outcomes.

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.

Transitioning to employment with a rheumatic disease: the role of independence, overprotection, and social support.

To examine perceived independence, overprotection, and support, and their association with the employment participation of young adults with rheumatic disease. One hundred and forty-three young adults, ages 18 to 30 years, with systemic lupus erythematosus (54.5%) and juvenile arthritis (45.5%) completed a 30-min online questionnaire of their work and education experiences. Information collected was demographic, health (e.g., pain, fatigue, disease activity), work context (e.g., career satisfaction, helpfulness of job accommodation/benefits, and workplace activity limitations), and psychosocial (e.g., independence, social support, and overprotection). Log-Poisson regression analysis examined factors associated with employment status. Over half of respondents were employed (59%) and 26% were enrolled in school. Respondents reported moderate to high perceptions of independence and social support. However, 27% reported that "quite a bit" to "a great deal" of overprotection characterized their relationships with those closest to them. At the bivariate level, employed participants and those indicating greater perceived independence reported greater social support and less overprotection. Multivariable analysis revealed that being employed was associated with older age, more job accommodations/benefits perceived as being helpful, and greater perceived independence. This is one of the first studies examining the employment of young adults with rheumatic diseases. Findings highlight the importance of psychosocial perceptions such as independence and overprotection, in addition to support related to working. Additional research is needed to better understand the role of those close to young adults with rheumatic diseases in supporting independence and encouraging employment.

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...

Striking a Balance: Work-Health-Personal Life Conflict in Women and Men with Arthritis and its Association with Work Outcomes

Purpose To examine men and women’s perceptions of inter-role balance/imbalance in work, arthritis, and personal roles and its association with demographic, health and employment factors, including job stress, career satisfaction, job disruptions, absenteeism and perceived productivity losses. Methods Participants were employed, aged ≥40 years and diagnosed with osteoarthritis or inflammatory arthritis. They were recruited through community advertising and rheumatology clinics in two Canadian provinces. Respondents completed a 35–45 min telephone interview and a 20-min self-administered questionnaire assessing role perceptions [(arthritis negatively impacts work (A → W); work/personal life negatively impact arthritis (W/P → A); work as a positive role (W +))], demographic, health and work context information. Analyses included exploratory factor analysis and multivariate regressions. Results Findings revealed similarities between men (n = 104) and women (n = 248) in health, work and role perceptions, although women reported more benefits of working with arthritis (W+) than men. Some gender differences were found in factors associated with inter-role perceptions highlighting the importance of children, fatigue, unpredictable work hours, job control, and workplace activity limitations. Role perceptions were associated with work outcomes but only one perception, W/P → A, interacted with gender. Among men, greater perceptions that work and personal demands interfered with managing arthritis were associated with more job disruptions. Conclusions This study revealed negative and positive inter-role perceptions related to working with a chronic illness and associations with work outcomes. It highlights potentially modifiable factors that could assess risk and inform interventions to improve role balance and working experiences.

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.