Journal of Occupational Rehabilitation

, Volume 24, Issue 4, pp 747–754 | Cite as

Work Ability Index as Tool to Identify Workers at Risk of Premature Work Exit

  • Corné A. M. RoelenEmail author
  • Martijn W. Heymans
  • Jos W. R. Twisk
  • Jac J. L. van der Klink
  • Johan W. Groothoff
  • Willem van Rhenen


Purpose To investigate the Work Ability Index (WAI) as tool for identifying workers at risk of premature work exit in terms of disability pension, unemployment, or early retirement. Methods Prospective cohort study of 11,537 male construction workers (mean age 45.5 years), who completed the WAI at baseline and reported their work status (employed, unemployed, disability pension, or retired) after mean 2.3 years of follow-up. Associations between WAI scores and work status were investigated by multinomial logistic regression analysis. The ability of the WAI to discriminate between workers at high and low risk of premature work exit was analyzed by the area (AUC) under the receiver operating characteristic curve. Results 9,530 (83 %) construction workers had complete data for analysis. At follow-up, 336 (4 %) workers reported disability pension, 125 (1 %) unemployment, and 255 (3 %) retirement. WAI scores were prospectively associated with the risk of disability pension at follow-up, but not with the risk of unemployment and early retirement. The WAI showed fair discrimination to identify workers at risk of disability pension [AUC = 0.74; 95 % confidence interval (CI) 0.70–0.77]. The discriminative ability decreased with age from AUC = 0.78 in workers aged 30–39 years to AUC = 0.69 in workers ≥50 years of age. Discrimination failed for unemployment (AUC = 0.51; 95 % CI 0.47–0.55) and early retirement (AUC = 0.58; 95 % CI 0.53–0.61). Conclusions The WAI can be used to identify construction workers <50 years of age at increased risk of disability pension and invite them for preventive interventions.


Discriminative ability Prognostic research ROC curve Sensitivity and specificity WAI 


  1. 1.
    Organisation for Economic Co-operation and Development. Maintaining prosperity in an ageing society. Accessed 05 Feb 2014.
  2. 2.
  3. 3.
    Bureau of Labor Statistics 2008. Older workers: are there more older people in the workplace? Accessed 20 Dec 2013.
  4. 4.
    Organisation for Economic Co-operation and Development. Older workers: living longer, working longer. Accessed 05 Feb 2014.
  5. 5.
    Kooij D, De Lange A, Jansen P, Dikkers J. Older workers’ motivation to continue to work: five meanings of age. A conceptual review. J Manag Psychol. 2008;23:364–94.CrossRefGoogle Scholar
  6. 6.
    Ilmarinen J. Aging workers. Occup Environ Med. 2001;58:546–52.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Charness N. Aging and human performance. Hum Factors. 2008;50:548–55.PubMedCrossRefGoogle Scholar
  8. 8.
    Kenny GP, Yardley JE, Martineau L, Jay O. Physical capacity in older adults: implications for the aging worker. Am J Ind Med. 2008;51:610–25.PubMedCrossRefGoogle Scholar
  9. 9.
    Schuring M, Burdorf L, Kunst A, Mackenbach J. The effects if ill health on entering and maintaining paid employment: evidence in European countries. J Epidemiol Community Health. 2007;61:597–604.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Sluiter JK. High-demand jobs: age-related diversity in work ability? Appl Ergon. 2006;37:429–40.PubMedCrossRefGoogle Scholar
  11. 11.
    Ilmarinen J, Tuomi K. Work ability of ageing workers. Scand J Work Environ Health. 1992;18(Suppl 2):8–10.PubMedGoogle Scholar
  12. 12.
    Ilmarinen J. Toward a longer worklife: ageing and the quality of worklife in the European Union. Helsinki: Finnish Institute of Occupational Health; 2005.Google Scholar
  13. 13.
    Tengland PA. The concept of work ability. J Occup Rehabil. 2011;21:275–85.PubMedCrossRefGoogle Scholar
  14. 14.
    Tuomi K, Ilmarinen J, Jahkola A, Katajarinne L, Tulkki A. Work ability index, second revised version. Helsinki: Finnish Institute of Occupational Health; 1998.Google Scholar
  15. 15.
    Van den Berg TI, Elders LA, de Zwart BC, Burdorf A. The effects of work-related and individual factors on the Work Ability Index: a systematic review. Occup Environ Med. 2009;66:211–20.PubMedCrossRefGoogle Scholar
  16. 16.
    Tuomi K, Ilmarinen J, Martikainen R, Aalto L, Klockars M. Aging, work, life style and work ability among Finnish municipal workers. Scand J Work Environ Health. 1997;23(Suppl 1):58–65.PubMedGoogle Scholar
  17. 17.
    Ilmarinen J, Tuomi K, Klockars M. Changes in the work ability of active employees over an 11-year period. Scand J Work Environ Health. 1997;23(Suppl 1):49–57.PubMedGoogle Scholar
  18. 18.
    Pohjonen T. Perceived work ability of home care workers in relation to individual and work-related factors in different age groups. Occup Med. 2001;51:209–17.CrossRefGoogle Scholar
  19. 19.
    Monteiro MS, Ilmarinen J, Corrêa Filho HR. Work ability of workers in different age groups in a public health institution in Brazil. Int J Occup Saf Ergon. 2006;12:417–27.PubMedGoogle Scholar
  20. 20.
    Safari S, Akbari J, Kazemi M, Mououdi MA, Mahaki B. Personnel’s health surveillance at work: effect of age, body mass index, and shift work on mental work load and work ability index. J Environ Public Health. 2013;28:94–8.Google Scholar
  21. 21.
    Alavinia SM, de Boer AGEM, van Duivenbooden JC, Frings-Dresen MH, Burdorf A. Determinants of work ability and its predictive value for disability. Occup Med. 2009;59:32–7.CrossRefGoogle Scholar
  22. 22.
    Sell L, Bültmann U, Rugulies R, Villadsen E, Faber A, Søgaard K. Predicting long-term sickness absence and early retirement pension from self-reported work ability. Int Arch Occup Environ Health. 2009;82:1133–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Salonen P, Arola H, Nygård CH, Huhtala H, Koivisto AM. Factors associated with premature departure from working life among ageing food industry employees. Occup Med. 2003;53:65–8.CrossRefGoogle Scholar
  24. 24.
    Liira J, Matikainen E, Leino-Arjas P, Malmivaara A, Mutanen P, Rytkönen H, Juntunen J. Work ability of middle-aged Finnish construction workers—a follow-up study in 1991–1995. Int J Ind Ergon. 2000;25:477–81.CrossRefGoogle Scholar
  25. 25.
    Organisation for Economic Co-operation and Development. Sickness and disability schemes in the Netherlands. Accessed 20 Dec 2013.
  26. 26.
    Van Oorschot W. Narrowing pathways to early retirement in the Netherlands. Policy Press. 2007;15:247–55.Google Scholar
  27. 27.
    Euwals R, van Vuuren D, Wolthoff R. Early retirement behaviour in the Netherlands: evidence from a policy reform. Economist. 2010;158:209–36.CrossRefGoogle Scholar
  28. 28.
    Ilmarinen J. The work ability index (WAI). Occup Med. 2007;57:160.CrossRefGoogle Scholar
  29. 29.
    Nübling M, Hasselhorn HM, Seitsamo J, et al. Comparing the use of the short and the long disease list in the Work Ability Index Questionnaire. In: Proceedings of the second international symposium on work ability. Verona: ICOH; 2004. p. 74.Google Scholar
  30. 30.
    Ilmarinen J, Tuomi K. Past, present and future of work ability. In: Ilmarinen J, Lehtinen S, editors. People and work—research reports 65. Helsinki: Finnish Institute of Occupational Health; 2004.Google Scholar
  31. 31.
    De Zwart BCH, Frings-Dresen MCH, van Duivenbooden JC. Test-retest reliability of the Work Ability Index questionnaire. Occup Med. 2002;52:177–81.CrossRefGoogle Scholar
  32. 32.
    Radkiewich P, Widerszal-Bazyl M. Psychometric properties of work ability index in the light of comparative survey study. In: International congress series 1280. Amsterdam: Elsevier; 2005. p. 304–9.Google Scholar
  33. 33.
    Steyerberg EW, Vickers AJ, Cook NR, et al. Assessing the performance of prediction models. Epidemiology. 2010;21:128–38.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Biesheuvel CJ, Vergouwe Y, Steyerberg EW, Grobbee DE, Moons KGM. Polytomous logistic regression analysis could be applied more often in diagnostic research. J Clin Epidemiol. 2008;61:125–34.PubMedCrossRefGoogle Scholar
  35. 35.
    Harrell FE. Regression modeling strategies. Accessed 20 Dec 2013.
  36. 36.
    Tuomi K, Toikkanen J, Eskelinen L, et al. Mortality, disability and changes in occupation among aging municipal employees. Scand J Work Environ Health. 1991;17(Suppl 1):58–66.PubMedGoogle Scholar
  37. 37.
    Etter JF, Perneger TV. Analysis of non-response bias in a mailed health survey. J Clin Epidemiol. 1997;50:1123–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Fisher RJ, Katz JE. Social-desirability bias and the validity of self-reported values. Psychol Mark. 2000;17:105–20.CrossRefGoogle Scholar
  39. 39.
    Svedberg P, Ropponen A, Lichtenstein P, Alexanderson K. Are self-report of disability pension and long-term sickness absence accurate? Comparisons of self-reported interview data with national register data in a Swedish twin cohort. BMC Public Health. 2010;10:763.PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Gould R, Ilmarinen J, Järvisalo J, et al. Dimensions of work ability. Helsinki: Finnish Centre for Pensions; 2008.Google Scholar
  41. 41.
    Proper KI, Staal BJ, Hildebrandt VH, van der Beek AJ, van Mechelen W. Effectiveness of physical activity programs at worksites with respect to work-related outcomes. Scand J Work Environ Health. 2002;28:75–84.PubMedCrossRefGoogle Scholar
  42. 42.
    Kuoppala J, Lamminpaa A, Husman P. Work health promotion, job well-being, and sickness absences—a systematic review and meta-analysis. J Occup Environ Med. 2008;50:1216–27.PubMedCrossRefGoogle Scholar
  43. 43.
    Rongen A, Robroek SJW, van Lenthe FJ, Burdorf A. Workplace health promotion: a meta-analysis of effectiveness. Am J Prev Med. 2013;44:406–15.PubMedCrossRefGoogle Scholar
  44. 44.
    Bethge M, Radoschewski FM, Gutenbrunner C. The work ability index as a screening tool to identify the need for rehabilitation: longitudinal findings from the second German sociomedical panel of employees. J Rehabil Med. 2012;44:980–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Corné A. M. Roelen
    • 1
    • 2
    • 3
    Email author
  • Martijn W. Heymans
    • 2
    • 4
  • Jos W. R. Twisk
    • 2
    • 4
  • Jac J. L. van der Klink
    • 3
  • Johan W. Groothoff
    • 3
  • Willem van Rhenen
    • 1
    • 5
  1. 1.ArboNed Occupational Health ServiceUtrechtThe Netherlands
  2. 2.Division Methodology and Applied Biostatistics, Department of Health SciencesVU UniversityAmsterdamThe Netherlands
  3. 3.Division Community and Occupational Medicine, Department of Health Sciences, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  4. 4.EMGO+ Institute for Health and Care ResearchVU University Medical CenterAmsterdamThe Netherlands
  5. 5.Center for Leadership and Management DevelopmentBusiness University NyenrodeBreukelenThe Netherlands

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