Debra Lerner

The Work Limitations Questionnaire.

Objective.The objective of this work was to develop a psychometrically sound questionnaire for measuring the on-the-job impact of chronic health problems and/or treatment (“work limitations”). Research Design.Three pilot studies (focus groups, cognitive interviews, and an alternate forms test) generated candidate items, dimensions, and response scales. Two field trials tested the psychometric performance of the questionnaire (studies 1 and 2). To test recall error, study 1 subjects were randomly assigned to 2 different questionnaire groups, a questionnaire with a 4-week reporting period completed once or a 2-week version completed twice. Responses were compared with data from concurrent work limitation diaries (the gold standard). To test construct validity, we compared questionnaire scores of patients with those of healthy job-matched control subjects. Study 2 was a cross-sectional mail survey testing scale reliability and construct validity. Subjects.The study subjects were employed individuals (18–64 years of age) from several chronic condition groups (study 1, n = 48; study 2, n = 121) and, in study 1, 17 healthy matched control subjects. Measures.Study 1 included the assigned questionnaires and weekly diaries. Study 2 included the new questionnaire, SF-36, and work productivity loss items. Results.In study 1, questionnaire responses were consistent with diary data but were most highly correlated with the most recent week. Patients had significantly higher (worse) limitation scores than control subjects. In study 2, 4 scales from a 25-item questionnaire achieved Cronbach alphas of ≥0.90 and correlated with health status and self-reported work productivity in the hypothesized manner (P ≤0.05). Conclusions.With 25 items, 4 dimensions (limitations handling time, physical, mental-interpersonal, and output demands), and a 2-week reporting period, the Work Limitations Questionnaire demonstrated high reliability and validity.

What Does Research Tell Us About Depression, Job Performance, and Work Productivity?

Objective: To assess the work impact of depression. Methods: A review of research articles published since 2002, reporting on the magnitude and/or nature of depressions impact on work. Results: This research is characterized by the use of three outcome indicators (employment status, absenteeism, and presenteeism metrics) and three research designs (population-based, workplace, and clinical). The literature documents that, compared to non-depressed individuals, those with depression have more unemployment, absences, and at-work performance deficits. Methodological variation makes it difficult to determine the magnitude of these differences. Additionally, the research suggests that the work impact of depression is related to symptom severity and that symptom relief only partly reduces the adverse work outcomes of depression. Conclusions: Research has contributed to knowledge of the multidimensional work impact of depression. Further developing intervention research is an important next step.

The Work Limitations Questionnaire's validity and reliability among patients with osteoarthritis

The 25-item Work Limitations Questionnaire (WLQ) was recently developed to measure health-related decrements in ability to perform job roles among employed individuals. Research has demonstrated its validity and reliability in several populations. We assessed the WLQs performance when administered to patients with osteoarthritis (OA), which is a leading cause of work disability and productivity loss. We recruited a representative sample of 230 employed, confirmed OA patients and a comparison group of 37 healthy employed controls. Subjects completed a mail survey. In tests of the WLQs scale internal reliability, the questionnaire met all established criteria. Additionally, in construct validity tests, the WLQ correctly detected OA vs. control group differences, and correlated significantly with arthritis pain, stiffness, and functional limitation, and self-reported work productivity. The WLQ is an accurate and reliable source of information for assessing the work impact of OA.

Relationship of employee-reported work limitations to work productivity.

Background. Work limitation rates are crucial indicators of the health status of working people. If related to work productivity, work limitation rates may also supply important information about the economic burden of illness. Objective. Our objective was to assess the productivity impact of on-the-job work limitations due to employees’ physical or mental health problems. Research Design. Subjects were asked to complete a self-administered survey on the job during 3 consecutive months. Using robust regression analysis, we tested the relationship of objectively-measured work productivity to employee-reported work limitations. Subjects. We attempted to survey employees of a large firm within 3 different jobs. The survey response rate was 2245 (85.9%). Full survey and productivity data were available for 1827 respondents. Measures. Each survey included a validated self-report instrument, the Work Limitations Questionnaire (WLQ). The firm provided objective, employee-level work productivity data. Results. In adjusted regression analyses (n = 1827), employee work productivity (measured as the log of units produced/hour) was significantly associated with 3 dimensions of work limitations: limitations handling the job’s time and scheduling demands (P = 0.003), physical job demands (P = 0.001), and output demands (P = 0.006). For every 10% increase in on-the-job work limitations reported on each of the 3 WLQ scales, work productivity declined approximately 4 to 5%. Conclusion. Employee work limitations have a negative impact on work productivity. Employee assessments of their work limitations supply important proxies for the economic burden of health problems.

A Review of Health-Related Work Outcome Measures and Their Uses, and Recommended Measures

Despite the growing recognition that work can contribute to the development of musculoskeletal disorders, there are almost no data on whether and how physicians investigate the contribution of work to patients’ health status or the influence of health status on work performance. This is particularly true of primary care, where much of the medical care for patients with work-related low back pain is provided. As more patients with musculoskeletal injuries show up in primary care settings, it will become important to document health-related work outcomes and incorporate into practice outcome tools that enable the physician to obtain a quick and accurate accounting of needed information about patients’ work. Health-related work outcomes relate to a person’s labor market status: Is a person working or not working? How well is he or she working? Did the person return to a job of pay and skill comparable to the preinjury job? Outcomes can incorporate time: How long has a person been out of work? How many hours, days, or weeks has a person been reported absent? Is the person working fullor part-time? How many hours does the person perform at full effectiveness? Finally, health-related work outcomes can capture the interplay between a person’s health status and work role performance: How difficult is it for a person with a given health status to perform work activities? Typically, health-related work outcomes have not specifically referred to unpaid work activities, such as volunteer work or household labor. The authors support the importance of capturing both paid and unpaid work outcomes, but in this article, paid work is the focus. Multiple publications in the literature contribute conceptually and methodologically to the health-related work outcomes field. These range from industrial psychology and labor economics to health services research, epidemiology, and pharmacoeconomics. In this paper, a window into health-related work outcomes research is created by considering the reasons for measuring these outcomes and briefly reviewing and illustrating several classes of measures. The advantages and limitations of each measure will be discussed, as the authors draw examples from own work. Although prior work has focused on upper extremity musculoskeletal disorders, the general principles for using health-related work outcomes are similar for researchers studying back injuries and disorders. In addition, a new work-related health outcome tool for measuring successful return to work (RTW) is discussed to illustrate a new class of measures. Hereafter, health-related work outcomes as are referred to as work outcomes.

The cost of poor sleep: workplace productivity loss and associated costs.

Objective: To assess the impact of sleep disturbances on work performance/productivity. Methods: Employees (N = 4188) at four US corporations were surveyed about sleep patterns and completed the Work Limitations Questionnaire. Respondents were classified into four categories: insomnia, insufficient sleep syndrome, at-risk, and good sleep. Employer costs related to productivity changes were estimated through the Work Limitations Questionnaire. Performance/productivity, safety, and treatment measures were compared using a one-way analysis of variance model. Results: Compared with at-risk and good-sleep groups, insomnia and insufficient sleep syndrome groups had significantly worse productivity, performance, and safety outcomes. The insomnia group had the highest rate of sleep medication use. The other groups were more likely to use nonmedication treatments. Fatigue-related productivity losses were estimated to cost

The clinical and occupational correlates of work productivity loss among employed patients with depression.

1967/employee annually. Conclusions: Sleep disturbances contribute to decreased employee productivity at a high cost to employers.

Productivity losses related to the common cold.

Employers who are developing strategies to reduce health-related productivity loss may benefit from aiming their interventions at the employees who need them most. We determined whether depression’s negative productivity impact varied with the type of work employees performed. Subjects (246 with depression and 143 controls) answered the Work Limitations Questionnaire and additional work questions. Occupational requirements were measured objectively. In multiple regression analyses, productivity was most influenced by depression severity (P < 0.01 in 5/5 models). However, certain occupations also significantly increased employee vulnerability to productivity loss. Losses increased when employees had occupations requiring proficiency in decision-making and communication and/or frequent customer contact (P < 0.05 in 3/5 models). The Work Limitations Questionnaire can help employers to reduce productivity loss by identifying health and productivity improvement priorities.

A national survey of health-related work limitations among employed persons in the United States

Learning ObjectivesCompare the contributions of absenteeism and on-the-job loss of productivity to total work loss in employed persons who get a cold, taking comorbidity into account.Describe how both personal factors and illness-related factors influence loss of productivity from colds.Discuss the economic consequences of the common cold and the respective costs of absenteeism and on-the-job loss of productivity.Health-related productivity assessments typically focus on chronic conditions; however, acute conditions, particularly colds, have the potential to cause substantial health-related productivity losses because of their high prevalence in working-age groups. This article presents the findings of a study conducted to estimate productivity loss due to cold by using a telephone-administered survey that measured three sources of loss: absenteeism, on-the-job productivity, and caregiver absenteeism. Each cold experienced by a working adult caused an average of 8.7 lost work hours (2.8 absenteeism hours; 5.9 hours of on-the-job loss), and 1.2 work hours were lost because of attending to children under the age of 13 who were suffering from colds. We conclude that the economic cost of lost productivity due to the common cold approaches

A randomized control trial of cardiac rehabilitation

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