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

https://doi.org/10.1016/j.jclinepi.2012.12.009Get rights and content

Abstract

Objective

To 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 Setting

Workers 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.

Results

The 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.

Conclusion

Sensibility 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.

Introduction

What is new?

  • 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.

  • 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.

  • 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.

  • 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).

Section snippets

Participants

Study participants were workers with arthritis (n = 250) recruited by convenience sampling from three sites: two tertiary-level rheumatology clinics in urban teaching hospitals (n = 142) in Toronto, Ontario, Canada, and an outpatient arthritis treatment program providing multidisciplinary services (n = 108) in Vancouver, British Columbia, Canada. Inclusion criteria were (1) attendance at an outpatient rheumatology clinic with a rheumatologist diagnosis of either OA or RA (Toronto) or attendance

Results

The study sample consisted of 250 workers with either OA (n = 130) or RA (n = 120); the majority of whom were female (82.7%). Mean age was 50.6 years [standard deviation (SD), 9.2; range, 19–65]. Workers were employed in various occupational sectors: “business, finance, and administration” (44.1%), “health, science, art, and sports” (31.1%), “sales and services” (17.6%), and “trades, transport, and equipment operators” (7.2%). At the time of survey, most respondents were engaged in either

Discussion

This study examined the comparability of five at-work productivity measures from a fundamentally important yet often overlooked perspective of sensibility. According to patients with arthritis, key sensibility criteria were generally met by all measures—four of which were developed fairly recently (between 2001 and 2004) with one dating back to 1997 (EWPS). Positive ratings for comprehensiveness (70.0–92.8% endorsement) provided perhaps the clearest indication that these measures (continue to)

Acknowledgments

The authors acknowledge the participating institutions for this study: the Mount Sinai Hospital (Toronto, Ontario, Canada), Martin Family Centre for Arthritis Care and Research at St. Michael's Hospital (Toronto, Ontario, Canada), and Mary Pack Arthritis Program (Vancouver, British Columbia, Canada). The authors also thank the Institute for Work & Health and Arthritis Community Research & Evaluation Unit for providing in-kind support.

In addition to the list of authors, investigators of the

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    Funding: Funding for this study was provided by a research grant from the Canadian Arthritis Network (part of the Networks of Centres of Excellence) in partnership with The Arthritis Society of Canada and also by an unrestricted grant from Abbott. Mr. K.T. is a recipient of a Canadian Institutes of Health Research (CIHR) PhD Fellowship, Canadian Arthritis Network Graduate Award, and Syme Fellowship from the Institute for Work & Health. Dr. D.E.B. was supported by a CIHR New Investigators award during the conduct of this study. Dr. D.L. holds the Mary Pack Chair in Arthritis Research from the University of British Columbia and The Arthritis Society of Canada. Dr. C.B. is a recipient of a Canada Research Chair in Knowledge Transfer for Musculoskeletal Care and a Pfizer Chair in Rheumatology (Division of Rheumatology, Faculty of Medicine, University of Toronto).

    Conflict of interest statement: All authors declare no financial or intellectual conflicts of interest. We declare that all sources of funding support had no direct role in the study design, data collection, analysis and interpretation of the data; writing of the article; approval of article content; or in the decision to publish this work. Neither the submission nor publication of this article was contingent on the approval of Abbott.

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