Reuben Escorpizo

Measuring Worker Productivity: Frameworks and Measures

Worker productivity is a combination of time off work (absenteeism) due to an illness and time at work but with reduced levels of productivity while at work (also known as presenteeism). Both can be gathered with a focus on application as a cost indicator and/or as an outcome state for intervention studies. We review the OMERACT worker productivity groups’ progress in evaluating measures of worker productivity for use in arthritis using the OMERACT filter. Attendees at OMERACT 9 strongly endorsed the importance of work as an outcome in arthritis. Consensus was reached (94% endorsement) for fielding a broader array of indicators of absenteeism. Twenty-one measures of at-work productivity loss, ranging from single item indicators to multidimensional scales, were reviewed for measurement properties. No set of at-work productivity measures was endorsed because of variability in the concepts captured, and the need for a better framework for the measurement of worker productivity that also incorporates contextual issues such as job demands and other paid and unpaid life responsibilities. Progress has been made in this area, revealing an ambivalent set of results that directed us back to the need to further define and then contextualize the measurement of worker productivity.

Assessing the impact of health conditions using the ICF

Purpose. People may suffer from diseases and a variety of health conditions, but a full understanding of the experience of their health condition also requires comprehensive information about the impact of the disease or the health condition on the person. This article operationalises the impacts of health conditions as classified in the International Classification of Diseases (ICD) in terms of the concept of functioning as found in the International Classification of Functioning, Disability and Health (ICF). It identifies a set of ICF categories as the functioning properties – to describe the impact of health conditions generically across health conditions to be jointly used with the ICD. Method. The ICF categories to characterise the functioning properties of any health condition have been selected from three main generic health profile instruments: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), the World Health Survey (WHS) Questionnaire and a list of candidate categories of the generic ICF core set. Results. A set of ICF categories to describe the impact of a health condition is presented according to specific functioning domains. Conclusions. The joint use of the ICD and the ICF through the list of functioning properties and in the context of ICD-11 development captures the valuable synergy of the two classifications. It enhances patient management, intervention design and the reporting of health. It also enables us to distinguish severity of disease from its impacts. The ICD–ICF joint use creates a shared formal representation across the continuum of care for health information system implementation.

Developing a Core Set to Describe Functioning in Vocational Rehabilitation Using The International Classification of Functioning, Disability, and Health (ICF)

Introduction the consequences of accidents, injuries, and health conditions that prevent workers from engaging in employment are prevailing issues in the area of work disability. Vocational rehabilitation (VR) programs aim to facilitate return-to-work process but there is no universal description of functioning for patients who participate in VR. Our objective is to develop a Core Set for VR based on the international classification of functioning, disability, and health (ICF). An ICF Core Set is a short list of ICF categories with alphanumeric codes relevant to a health condition or a health-related event. Methods development process consists of three phases. First is the preparatory phase which consists of four parallel studies: (1) systematic review of the literature, (2) worldwide survey of experts, (3) cross-sectional study, and (4) focus group interview. Patients with various health conditions are to be recruited from five VR centers located in Switzerland and Germany. The second phase is a consensus conference where findings from the preparatory phase will be presented followed by a multi-stage consensus process to determine the ICF categories that will comprise the Core Set for VR. The final phase consists of validation studies in several health conditions and settings. Conclusions we expect the first version of the ICF Core Set for VR to be completed in 2010. The Core Set can serve as a guide in the evaluation of patients and in planning appropriate intervention within VR programs. This Core Set could also provide a standard and common language among clinicians, researchers, insurers, and policymakers in the implementation of successful VR.

Measuring the Impact of Arthritis on Worker Productivity: Perspectives, Methodologic Issues, and Contextual Factors

Leading up to the Outcome Measures in Rheumatology (OMERACT) 10 meeting, the goal of the Worker Productivity Special Interest Group (WP-SIG) was to make progress on 3 key issues that relate to the application and interpretation of worker productivity outcomes in arthritis: (1) to review existing conceptual frameworks to help consolidate our intended target and scope of measurement; (2) to examine the methodologic issues associated with our goal of combining multiple indicators of worker productivity loss (e.g., absenteeism <—> presenteeism) into a single comprehensive outcome; and (3) to examine the relevant contextual factors of work and potential implications for the interpretation of scores derived from existing outcome measures. Progress was made on all 3 issues at OMERACT 10. We identified 3 theoretical frameworks that offered unique but converging perspectives on worker productivity loss and/or work disability to provide guidance with classification, selection, and future recommendation of outcomes. Several measurement and analytic approaches to combine absenteeism and presenteeism outcomes were proposed, and the need for further validation of such approaches was also recognized. Finally, participants at the WP-SIG were engaged to brainstorm and provide preliminary endorsements to support key contextual factors of worker productivity through an anonymous “dot voting” exercise. A total of 24 specific factors were identified, with 16 receiving ≥ 1 vote among members, reflecting highly diverse views on specific factors that were considered most important. Moving forward, further progress on these issues remains a priority to help inform the best application of worker productivity outcomes in arthritis research.

Content Comparison of Worker Productivity Questionnaires in Arthritis and Musculoskeletal Conditions Using the International Classification of Functioning, Disability, and Health Framework

Background Worker productivity outcome is essential in examining the rehabilitation of workers with arthritis and other musculoskeletal conditions. There is great variation in the contents of worker productivity questionnaires. The International Classification of Functioning Disability and Health (ICF) offers the possibility to serve as a reference to describe and compare the contents of these questionnaires. Methods A literature review identified published self-report worker productivity questionnaires. All meaningful concepts were identified and linked to the corresponding ICF category according to established rules. Results Eighteen questionnaires were identified which contained a total of 519 meaningful concepts and which were linked to 64 unique 2nd level ICF categories. All questionnaires addressed Activities and Participation, thirteen (72%) addressed Body Functions, seven (39%) addressed Environmental Factors, seven (39%) addressed Personal Factors and only one questionnaire (6%) for Body Structures component. Overall, Work Role Functioning (WRF) questionnaire addressed the most number of different categories while Quantity and Quality method contained only one ICF category. The Rheumatoid Arthritis-Work Instability Scale had the highest number of categories for Body Functions, the Work Activity Limitations Scale and WRF had the most number of categories for Activities and Participation. The Health and Labour Questionnaire had the highest number of categories referring to unpaid work participation. The Health and Work Questionnaire was the only that included contextualization of both Environmental and Personal Factors. Conclusion Self-report worker productivity questionnaires differed largely in their contents. This content analysis study could guide us in selecting an appropriate questionnaire for a specific study question.

Harmonizing WHO’s International Classification of Diseases (ICD) and International Classification of Functioning, Disability and Health (ICF): importance and methods to link disease and functioning

BackgroundTo understand the full burden of a health condition, we need the information on the disease and the information on how that disease impacts the functioning of an individual. The ongoing revision of the International Classification of Diseases (ICD) provides an opportunity to integrate functioning information through the International Classification of Functioning, Disability and Health (ICF).DiscussionPart of the ICD revision process includes adding information from the ICF by way of “functioning properties” to capture the impact of the disease on functioning. The ICD content model was developed to provide the structure of information required for each ICD-11 disease entity and one component of this content model is functioning properties. The activities and participation domains from ICF are to be included as the value set for functioning properties in the ICD revision process.SummaryThe joint use of ICD and ICF could create an integrated health information system that would benefit the implementation of a standard language-based electronic health record to better capture and understand disease and functioning in healthcare.

People with Spinal Cord Injury in the United States.

EPIDEMIOLOGY OF SPINAL CORD INJURY IN THE UNITED STATES The incidence of traumatic spinal cord injury (SCI) in the United States is estimated to be 40.1 cases per million, indicating approximately 12,500 new SCI occur each year. The prevalence of SCI is estimated to be 906 cases per million, or 276,000 individuals. Males are more likely to experience an SCI than females at a ratio of 2.25:1 and are estimated to account for 80% of all traumatic SCI cases. Between 1993 and 2012, there was an estimated decrease in incidence of SCI from 144 to 87 cases per million in younger males aged 16 to 24 years. Vehicular accidents are the leading cause of SCI in the United States, accounting for approximately 39.08% of all SCIs between 2005 and 2015. Unintentional falls (29.54%) ranked second, followed by acts of violence (14.41%; 13.01% from gunshot wounds) and sports/recreational activities (8.39%). The average life expectancy for an individualwith SCI has not changed since the 1980s and is significantly lower than an individual without SCI. The leading cause of mortality in SCI individuals is disease of the respiratory system, such as pneumonia, accounting for 21.6% of all deaths. Between 1997 and 2012, there was a significant increase in the incidence of acute traumatic SCIs as a result from unintentional falls. Incidence and prevalence of SCI in individuals older than 60 years have increased, with prevalence increasing at a slower rate because of higher mortality rates in this age group.

Disability evaluation, social security, and the international classification of functioning, disability and health: the time is now.

Objective: To present the International Classification of Functioning, Disability and Health (ICF) as a standard in disability evaluation and to discuss the usefulness and challenges of the ICF when applied in disability evaluation. Conclusions: Disability evaluation can be described and measured using the ICF and ICF-related tools such as the Generic Set, ICF Core Sets specific to health conditions or settings, and measurement instruments that have been linked to the ICF. Wide implementation of the ICF in disability evaluation, specifically in work disability and social security, is needed along with education on the ICF of those in occupational medicine, work rehabilitation, disability adjudication, policy and legislation, and government agencies. The ICF can be used to provide disability criteria in determining functional and work capacity and as a reference framework and a language of disability to help facilitate a common ground of understanding.

A case study on the application of International Classification of Functioning, Disability and Health (ICF)-based tools for vocational rehabilitation in spinal cord injury.

OBJECTIVES Vocational rehabilitation (VR) plays a key role in bringing persons with acquired disabilities back to work, while encouraging employment participation. The purpose of this case study is to illustrate the systematic application of International Classification of Functioning, Disability, and Health (ICF)-based documentation tools by using ICF Core Sets in VR shown with a case example of a client with traumatic spinal cord injury (SCI). PARTICIPANT The client was a 26-year-old male with paraplegia (7th thoracic level), working in the past as a mover. METHODS This case study describes the integration of the ICF Core Sets for VR into an interdisciplinary rehabilitation program by using ICF-based documentation tools. RESULTS Improvements in the clients impairments, activity limitations, and participation restrictions were observed following rehabilitation. Goals in different areas of functioning were achieved. CONCLUSION The use of the ICF Core Sets in VR allows a comprehensive assessment of the clients level of functioning and intervention planning. Specifically, the Brief ICF Core Set in VR can provide domains for intervention relevant to each member of an interdisciplinary team and hence, can facilitate the VR management process in a SCI center in Switzerland.

Modifiable and non-modifiable factors associated with employment outcomes following spinal cord injury: A systematic review.

Abstract Context Employment rates in individuals with spinal cord injury (SCI) are approximately 35%, which is considerably lower than that of the general population. In order to improve employment outcomes a clear understanding of what factors influence employment outcomes is needed. Objective To systematically review factors that are consistently and independently associated with employment outcomes in individuals with SCI, and to understand the magnitude of their influence. Methods Through an electronic search of MEDLINE/PubMed, EMBASE, CINAHL, PsycINFO, Social Science Abstracts and Social Work databases, we identified studies published between 1952–2014 that investigated factors associated with employment outcomes following SCI. Exclusion criteria included: (1) reviews (2) studies not published in English (3) studies not controlling for potential confounders through a regression analysis, or (4) studies not providing an effect measure in the form of OR, RR, or HR. Data were categorized based on the International Classification of Functioning, Disability and Health framework, with each domain sub-categorized by modifiability. First author, year of publication, sample size, explanatory and outcome variables, and effect measures were extracted. Results Thirty-nine studies met the inclusion criteria. Twenty modifiable and twelve non-modifiable factors have been investigated in the context of employment following SCI. Education, vocational rehabilitation, functional independence, social support, and financial disincentives were modifiable factors that have been consistently and independently associated with employment outcomes. Conclusion A number of key modifiable factors have been identified and can inform interventions aimed at improving employment outcomes for individuals with SCI. Future research should focus on determining which factors have the greatest effect on employment outcomes, in addition to developing and evaluating interventions targeted at these factors.