Chiropractic + Naturopathic Doctor

Newly adopted productivity measures help people with arthritis stay at work

By Institute for Work and Health   

Features Clinical Patient Care

Oct. 8, 2014 – Rheumatoid arthritis is a very painful and tiring condition and, not long ago, being diagnosed with it usually meant having to leave the workforce. But improvements in treatment mean more people can now remain at work in spite of their rheumatoid arthritis.

Though their productivity levels at work may lag, especially during
flare-ups, it’s common today to see people with this condition cycle
through phases of missing work, struggling through work, and being fully
functional and symptom-free.

For researchers and clinicians,
this change in arthritis management has led to a need for new tools to
measure the condition’s impact on patients’ working lives. When studying
the effectiveness of a drug or a treatment program, it’s no longer
enough to measure the extent to which people take days off or leave the
workforce. Loss of productivity at work must also be taken into account.


this year, a team of international researchers led by Institute for
Work & Health (IWH) senior scientist Dr. Dorcas Beaton unveiled a
set of measures for productivity-at-work outcomes that have met
international standards. The five tools for measuring the impact of
arthritis on worker productivity include these questions:

•    Assume that your
work ability at its best has a value of 10 points. How many points would
you give your current work ability? (Item 1 from Work Ability Index)

During the past seven days, how much did the specific health problem
affect your productivity while you were working? (Item 5 from Work
Productivity and Activity Impairment)

•    In the last month, how
much has arthritis interfered with your work productivity outside the
home? (Item 4 from Work Productivity Survey-Rheumatoid Arthritis)

In the past two weeks, how much of the time did your physical health or
emotional problems make it difficult for you to concentrate on your
work? (Sample item from 25-item Work Limitations Questionnaire-25)

How much difficulty do you have with the pace of work that your job
requires? (Sample item from 12-item Workplace Activity Limitations

These five measures, which have been put through a
rigorous validation process, were presented in May in Budapest at a
consensus conference of Outcome Measures in Rheumatology (OMERACT). Also
involved in the project from IWH are senior scientists Dr. Monique
Gignac and Dr. Claire Bombardier, as well as doctoral student Ken Tang.

is an important role for adults for many reasons, and it is just as
important in the lives of persons with arthritis,” says Beaton. “These
measures of worker productivity will allow more attention to be paid to
patients’ ability to get back to work.”

Getting the thumbs up for
these tools at the OMERACT meeting was a significant milestone for the
research team. Formed in 1992, OMERACT is a global network striving to
establish uniform standards for measuring outcomes for arthritis and
other diseases of the joints, muscles and bones. At the time, scientists
doing clinical trials around the world were using very different scales
and measures for assessing health outcomes. As a result, it was
difficult to pull out clear messages from the findings.

scientists use a rigorous and time-consuming process for developing and
adopting outcome measures. It’s a process driven by data, built on
consensus and heavily informed by stakeholders. Developing measures that
pass muster at OMERACT typically takes many years. To get approval at
OMERACT, researchers have to get buy-in from a vast range of
stakeholders, from researchers, clinicians and pharmaceutical companies
to regulators and patients.

The need for measures on worker
productivity emerged about eight years ago, voiced in part by the
patients and consumer groups involved in arthritis research. At the
time, more than 20 measures of worker productivity were being used.
However, many were measuring different things or had not been tested for
people with arthritis.

In defining worker productivity, the
research group combined two perspectives. One is the level of work
output, often described in hours and dollars. The second is the ease
with which a person does his or her job.

“We presented separate
measures for these different ways of thinking about productivity because
we wanted to capture the quality of work life from the patients’
perspectives—as well as a cost and productivity orientation,” says
Beaton. “Both are important.”

However, a worker’s productivity
has to be understood in context. How much control do patients have over
their schedules or worksites? Are their workloads heavy or light? Can a
co-worker help now and then? These core contextual factors could affect
the scores obtained on the measures, and the work to incorporate them is

The road to creating and presenting an evidence-based
set of productivity measures has been a long but important one, says
Beaton: “Individual workers and their clinicians need to know how much
impact the condition has on their ability to work and whether
accommodations or treatments are helping. Likewise, workplaces benefit
from knowing whether an intervention such as changing a workstation
brings up a worker’s productivity.”

“OMERACT was an excellent
place to engage people in our work,” she adds. “Researchers can now
select from a set of tools and include work outcomes in their
musculoskeletal research.”

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