Journal of Occupational Rehabilitation

, Volume 19, Issue 2, pp 142–154 | Cite as

Comparison of the Psychometric Properties of Four At-Work Disability Measures in Workers with Shoulder or Elbow Disorders

  • Kenneth Tang
  • Shanley Pitts
  • Sherra Solway
  • Dorcas Beaton


Introduction To better capture the extent of work disability following an occupational injury, clinical researchers are beginning to recognize the importance of considering not only levels of absenteeism, but also disabilities experienced while “at-work”. Although at-work disability measures are available in the literature, currently there is little insight on the selection of specific measures that may be best suited for a given population or situation. The objective of this study is to assess and compare the measurement properties of four self-report at-work disability measures in workers with shoulder or elbow disorders. Methods Study sample consisted of 80 patients attending a shoulder and elbow specialty clinic operated by the Worker Safety Insurance Board of Ontario. Internal consistency reliability, validity, and patient preference of four at-work disability measures were compared in a cross-sectional design. Selected measures included the work module of the Disabilities of the Arm, Shoulder and Hand Outcome Measure, Work Limitations Questionnaire (WLQ-16), Work Instability Scale for Rheumatoid Arthritis (RA-WIS), and Stanford Presenteeism Scale. Results All four measures demonstrated evidence of internal consistency reliability (alpha = 0.76–0.90) and construct validity, although only modest correlations against work-oriented constructs (r = 0.37–0.60) were observed. The RA-WIS was most preferred by respondents (44.6%) over the other measures. Conclusions Although no single scale stood out as clearly superior, the WLQ-16 was considered the best overall performer. Variable performance between the scales suggests some divergence in the way these measures conceptualize “at-work disability”, which may be important to consider when selecting instruments for future studies.


Measurement Reliability and validity Upper extremity At-work disability Presenteeism 



This study was supported by St. Michael’s Hospital. Dr. Dorcas Beaton is supported by the Canadian Institutes of Health Research (CIHR) New Investigator’s Award. The authors would like to extend our utmost appreciation and thanks to Taucha Inrigt and Elaine Harniman for their hard work and dedication to this project. We would also like to thank Sonia Pagura and Jeff Hewer at the Shoulder and Elbow Specialty Clinic for their support and assistance throughout the course of this study.


  1. 1.
    Escorpizo R, Bombardier C, Boonen A, Hazes JM, Lacaille D, Strand V, et al. Worker productivity outcome measures in arthritis. J Rheumatol. 2007;34:1372–80.PubMedGoogle Scholar
  2. 2.
    Loeppke R, Hymel PA, Lofland JH, Pizzi LT, Konicki DL, Anstadt GW, et al. Health-related workplace productivity measurement: general and migraine-specific recommendations from the ACOEM expert panel. J Occup Environ Med. 2003;45:349–59. doi:10.1097/01.jom.0000063619.37065.e2.PubMedCrossRefGoogle Scholar
  3. 3.
    Lofland JH, Pizzi L, Frick KD. A review of health-related workplace productivity loss instruments. PharmacoEconomics. 2004;22:165–84. doi:10.2165/00019053-200422030-00003.PubMedCrossRefGoogle Scholar
  4. 4.
    Collins JJ, Baase CM, Sharda CE, Ozminkowski RJ, Nicholson S, Billotti GM, et al. The assessment of chronic health conditions on work performance, absence, and total economic impact for employers. J Occup Environ Med. 2005;47:547–57. doi:10.1097/01.jom.0000166864.58664.29.PubMedCrossRefGoogle Scholar
  5. 5.
    Li X, Gignac MA, Anis AH. The indirect costs of arthritis resulting from unemployment, reduced performance, and occupational changes while at work. Med Care. 2006;44:304–10. doi:10.1097/01.mlr.0000204257.25875.04.PubMedCrossRefGoogle Scholar
  6. 6.
    Koopman C, Pelletier KR, Murray JF, Sharda CE, Berger ML, Turpin RS, et al. Stanford presenteeism scale: health status and employee productivity. J Occup Environ Med. 2002;44:14–20. doi:10.1097/00043764-200201000-00004.PubMedCrossRefGoogle Scholar
  7. 7.
    Prasad M, Wahlqvist P, Shikiar R, Shih YC. A review of self-report instruments measuring health-related work productivity: a patient-reported outcomes perspective. PharmacoEconomics. 2004;22:225–44. doi:10.2165/00019053-200422040-00002.PubMedCrossRefGoogle Scholar
  8. 8.
    Lynch W, Riedel J. Measuring employee productivity: a guide to self-assessment tools. Scottsdale: Institute for Health & Productivity Management & William Mercer; 2001.Google Scholar
  9. 9.
    Ozminkowski RJ, Goetzel RZ, Chang S, Long S. The application of two health and productivity instruments at a large employer. J Occup Environ Med. 2004;46:635–48. doi:10.1097/01.jom.0000131797.52458.c8.PubMedCrossRefGoogle Scholar
  10. 10.
    Lerner D, Amick BC 3rd, Rogers WH, Malspeis S, Bungay K, Cynn D. The work limitations questionnaire. Med Care. 2001;39:72–85. doi:10.1097/00005650-200101000-00009.PubMedCrossRefGoogle Scholar
  11. 11.
    Beaton DE, Kennedy CA. Beyond return to work: testing a measure of at-work disability in workers with musculoskeletal pain. Qual Life Res. 2005;14:1869–79. doi:10.1007/s11136-005-3865-9.PubMedCrossRefGoogle Scholar
  12. 12.
    Amick BC 3rd, Habeck RV, Ossmann J, Fossel AH, Keller R, Katz JN. Predictors of successful work role functioning after carpal tunnel release surgery. J Occup Environ Med. 2004;46:490–500. doi:10.1097/01.jom.0000126029.07223.a0.PubMedCrossRefGoogle Scholar
  13. 13.
    Lerner D, Reed JI, Massarotti E, Wester LM, Burke TA. The work limitations questionnaire’s validity and reliability among patients with osteoarthritis. J Clin Epidemiol. 2002;55:197–208. doi:10.1016/S0895-4356(01)00424-3.PubMedCrossRefGoogle Scholar
  14. 14.
    Endicott J, Nee J. Endicott work productivity scale (EWPS): a new measure to assess treatment effects. Psychopharmacol Bull. 1997;33:13–6.PubMedGoogle Scholar
  15. 15.
    Gilworth G, Chamberlain MA, Harvey A, Woodhouse A, Smith J, Smyth MG, et al. Development of a work instability scale for rheumatoid arthritis. Arthritis Rheum. 2003;49:349–54. doi:10.1002/art.11114.PubMedCrossRefGoogle Scholar
  16. 16.
    Gilworth G, Bhakta B, Eyres S, Carey A, Anne Chamberlain M, Tennant A. Keeping nurses working: development and psychometric testing of the nurse-work instability scale (Nurse-WIS). J Adv Nurs. 2007;57:543–51. doi:10.1111/j.1365-2648.2006.04142.x.PubMedCrossRefGoogle Scholar
  17. 17.
    Brouwer WB, Koopmanschap MA, Rutten FF. Productivity losses without absence: measurement validation and empirical evidence. Health Policy (Amsterdam). 1999;48:13–27. doi:10.1016/S0168-8510(99)00028-7.Google Scholar
  18. 18.
    Lavigne JE, Phelps CE, Mushlin A, Lednar WM. Reductions in individual work productivity associated with type 2 diabetes mellitus. PharmacoEconomics. 2003;21:1123–34. doi:10.2165/00019053-200321150-00006.PubMedCrossRefGoogle Scholar
  19. 19.
    Meerding WJ, IJzelenberg W, Koopmanschap MA, Severens JL, Burdorf A. Health problems lead to considerable productivity loss at work among workers with high physical load jobs. J Clin Epidemiol. 2005;58:517–23. doi:10.1016/j.jclinepi.2004.06.016.PubMedCrossRefGoogle Scholar
  20. 20.
    Turpin RS, Ozminkowski RJ, Sharda CE, Collins JJ, Berger ML, Billotti GM, et al. Reliability and validity of the Stanford presenteeism scale. J Occup Environ Med. 2004;46:1123–33. doi:10.1097/01.jom.0000144999.35675.a0.PubMedCrossRefGoogle Scholar
  21. 21.
    Sanderson K, Tilse E, Nicholson J, Oldenburg B, Graves N. Which presenteeism measures are more sensitive to depression and anxiety? J Affect Disord. 2007;101:65–74. doi:10.1016/j.jad.2006.10.024.PubMedCrossRefGoogle Scholar
  22. 22.
    Workplace Safety & Insurance Board (WSIB). WSIB specialty clinics. (2002). Accessed 23 July 2008.
  23. 23.
    Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the disabilities of the arm, shoulder and hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001;14:128–46.PubMedGoogle Scholar
  24. 24.
    Institute for Work & Health. Scoring the DASH. (1997). Accessed 5 July 2008.
  25. 25.
    Walker N, Michaud K, Wolfe F. Work limitations among working persons with rheumatoid arthritis: results, reliability, and validity of the work limitations questionnaire in 836 patients. J Rheumatol. 2005;32:1006–12.PubMedGoogle Scholar
  26. 26.
    McHorney CA, Tarlov AR. Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res. 1995;4:293–307. doi:10.1007/BF01593882.PubMedCrossRefGoogle Scholar
  27. 27.
    Streiner D, Norman G. Health measurement scales: a practical guide to their development and use. 2nd ed. Oxford: Oxford Medical Publications; 1996.Google Scholar
  28. 28.
    Nunnally J, Bernstein I. Psychometric theory. 3rd ed. New York: McGraw-Hill; 1994.Google Scholar
  29. 29.
    Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60:34–42. doi:10.1016/j.jclinepi.2006.03.012.PubMedCrossRefGoogle Scholar
  30. 30.
    Burton WN, Chen CY, Conti DJ, Pransky G, Edington DW. Caregiving for ill dependents and its association with employee health risks and productivity. J Occup Environ Med. 2004;46:1048–56. doi:10.1097/01.jom.0000141830.72507.32.PubMedCrossRefGoogle Scholar
  31. 31.
    Lerner D, Adler DA, Chang H, Lapitsky L, Hood MY, Perissinotto C, et al. Unemployment, job retention, and productivity loss among employees with depression. Psychiatr Serv (Washington DC). 2004;55:1371–8. doi:10.1176/ Scholar
  32. 32.
    Wolfe F, Michaud K, Choi HK, Williams R. Household income and earnings losses among 6,396 persons with rheumatoid arthritis. J Rheumatol. 2005;32:1875–83.PubMedGoogle Scholar
  33. 33.
    Mattke S, Balakrishnan A, Bergamo G, Newberry SJ. A review of methods to measure health-related productivity loss. Am J Manag Care. 2007;13:211–7.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Kenneth Tang
    • 1
  • Shanley Pitts
    • 2
  • Sherra Solway
    • 3
  • Dorcas Beaton
    • 1
    • 2
  1. 1.Mobility Program Clinical Research UnitSt. Michael’s HospitalTorontoCanada
  2. 2.Department of Occupational Science and Occupational TherapyUniversity of TorontoTorontoCanada
  3. 3.Toronto Rehabilitation InstituteTorontoCanada

Personalised recommendations