What is new?
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Patients' viewpoints on the sensibility (face/content validity and feasibility) of self-reported outcome measures and their ability to capture “what matters” are rarely investigated. This study provided a head-to-head comparison of the sensibility of five at-work productivity measures—providing a perspective beyond psychometrics.
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Methods to appraise the qualitative attributes of patient-reported outcome measures are scarce in the literature. A novel, quantitative, group-level approach to evaluate the sensibility of work outcome measures from the patients' perspective was applied.
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Variable performance across four key sensibility criteria was found among the five at-work productivity measures compared. Overall, the Workplace Activity Limitations Scale and Work Limitations Questionnaire were most preferred by patients with osteoarthritis or rheumatoid arthritis.
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Users engaged in an evidence-based process to select work outcome measures for application in arthritis should consider sensibility attributes in conjunction with available psychometric evidence to inform their choice(s).
The impact of arthritis on a person's ability to meet work demands is an important concern [1], [2], [3], [4], although the ideal measure(s) to capture the extent of this impact remains unclear. In addition to the traditional indicators of work absenteeism (e.g., days off work), recent studies have emphasized the importance of examining “on-the-job” problems (at-work productivity loss or presenteeism) experienced by workers with arthritis [5], [6], [7]. As more and more individuals with arthritis are able to continue to work given recent advancements in therapies, the need for accurate and precise evaluations of presenteeism has gained importance and research attention. In fact, compared with absenteeism, presenteeism has shown to contribute to an even greater proportion of the indirect economic costs of arthritis [8], [9], giving this concept clear economic relevance. The measures of presenteeism measures are also increasingly used as study outcomes in rheumatology clinical trials [10], [11], [12] as there is an increasing recognition that work issues and potential cost benefits of therapeutic interventions are important to different stakeholders, including patients/workers, employers, industry, and policy makers.
The number of self-report presenteeism measures is on the rise [5], [13], [14], [15], many of which have potential applicability in clinical trials or employment-related research. Some could also be applied to estimate costs associated with health-related productivity loss. For example, the Work Limitations Questionnaire (WLQ-25) [16] assesses the proportion of time workers have difficulty over various work domains. The Workplace Activity Limitations Scale (WALS) [17] takes a different approach as it is aimed at quantifying the degree of difficulty a worker experiences while performing various job-related tasks. Yet, another example is the Work Instability Scale for Rheumatoid Arthritis (RA-WIS) [18], which is designed as a prognostic indicator of future work loss and has potential applicability to help inform vocational decision making (e.g., the need for workplace interventions).
To quantify patient experiences (e.g., symptoms, work, and health-related quality of life), choosing the ideal outcome measure(s) in a given situation may involve not only psychometric considerations but also “sensibility” considerations. Sensibility is a term originally coined by Feinstein [19] to describe the importance for instruments to demonstrate fundamental attributes such as face/content validity and feasibility. Recently, others have also emphasized the need to directly appraise these qualitative attributes (also referred to as clinical utility, practicality, or applicability) from the perspectives of both end users (e.g., researchers/clinicians) and respondents (e.g., patients) [20], [21], [22]. In today's patient-oriented approach to health care, engaging patients in the development/testing of outcome measures are increasingly relevant in rheumatology [23], [24] and also mandated by regulatory agencies, such as the US Food and Drug Administration [25]. When assessing the value of a health intervention, it is important to be able to demonstrate efficacy on outcomes that capture concepts deemed meaningful (i.e., what matters) to the target patient population. Irrespective of its psychometric robustness, if an outcome measure fails to meet conceptual needs, or if it is impractical to apply, it may not be the optimal choice for a given circumstance.
Sensibility appraisals of work outcome measures are relevant for several additional reasons: (1) there is substantial diversity in available perspectives and approaches to quantify the impact of health on work, but specific work concepts (e.g., ability vs. productivity) that resonate most with patients/workers remain unclear [5], [13]; (2) job context can vary considerably among workers; thus, there is a need to examine whether specific work measures are similarly relevant across different occupational sectors; and (3) the evolving nature of the employment and labor market (e.g., change in job demands over time because of technological advancements) entails a need for periodic (re)appraisals of available outcome measures to ensure that they remain optimal for capturing what matters to the present-day worker.
Research that examines the direct comparability of measures in a controlled sample is useful for gaining insights on the measures' relative strengths and limitations [5], [7], [13], [26], [27]. To date, however, most head-to-head studies on work measures have mainly focused on psychometrics [27], [28], [29], [30], [31], [32], [33], [34] as comparisons of sensibility attributes have been rarely evaluated. This study examined and compared the sensibility attributes (comprehensiveness, understandability, length, and suitability of response options) of five at-work productivity measures from the perspective of patients with osteoarthritis (OA) or rheumatoid arthritis (RA).