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Cross-Cultural Adaptation of the Work Rehabilitation Questionnaire (WORQ) to French: A Valid and Reliable Instrument to Assess Work Functioning


Purpose The Work Rehabilitation Questionnaire (WORQ) is a patient-reported instrument to assess work related functioning in vocational rehabilitation (VR) and work, based on the International Classification of Functioning, Disability and Health (ICF) core set for VR. The objective of this study was to cross-culturally adapt WORQ to French and to evaluate its psychometric properties. Methods The cross-cultural adaptation followed a dual-panel approach. Psychometrics was examined in one VR-centre in the French speaking part of Switzerland. Test–retest reliability was analyzed with intraclass correlation coefficient (ICC), internal consistency was assessed with Cronbach’s alpha. Construct validity was determined by convergence to the self-reported general functioning scale and the Hospital Anxiety and Depression Scales (HADS). The association of patient’s return-to-work expectation within 6-months and having a case manager was examined. The usability of WORQ-French was tested in 10 VR patients. Results Eighty-nine patients with musculoskeletal injuries were included. WORQ-French showed excellent internal consistency (0.968) and a high test–retest reliability (0.935). WORQ-French was positively associated with self-reported general functioning (r = 0.662) and both HADS scales (r = 0.56–0.57). Neither the patient’s return-to-work expectation nor having a case manager were significantly correlated with WORQ-French. Usability in terms of understandability of questions and response options was found to be good. Seven patients rated the length of WORQ-French as good, while two found the instrument a little too long and one found it too long. Conclusions WORQ French is a valid, reliable, and easy to administer instrument to assess self-reported work functioning given our study setting and sample characteristics.

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  1. 1.

    International Labour Organization, editor. ILO vocational rehabilitation and employment (disabled persons) convention (no. 159) and recommendation (no. 168): United Nations convention on the rights of persons with disabilities. Geneva: ILO; 2008.

  2. 2.

    Seing I, MacEachen E, Stahl C, Ekberg K. Early-return-to-work in the context of an intensification of working life and changing employment relationships. J Occup Rehabil. 2015;25(1):74–85.

    Article  PubMed  Google Scholar 

  3. 3.

    Marzolini S, Oh PI, Alter D, Stewart DE, Grace SL. Musculoskeletal comorbidities in cardiac patients: prevalence, predictors, and health services utilization. Arch Phys Med Rehabil. 2012;93(5):856–862.

    Article  PubMed  Google Scholar 

  4. 4.

    Ervasti J, Vahtera J, Pentti J, Oksanen T, Ahola K, Kivekas T, et al. The role of psychiatric, cardiometabolic, and musculoskeletal comorbidity in the recurrence of depression-related work disability. Depress Anxiety. 2014;31(9):796–803.

    Article  PubMed  Google Scholar 

  5. 5.

    Finger ME, Glassel A, Erhart P, Gradinger F, Klipstein A, Rivier G, et al. Identification of relevant ICF categories in vocational rehabilitation: a cross sectional study evaluating the clinical perspective. J Occup Rehabil. 2011;21(2):156–166.

    Article  PubMed  Google Scholar 

  6. 6.

    Schmidt C, Bernert S, Spyra K. [Concerning the impact of psychological comorbidity for chronic back pain: frequency, reduced earning capacity pension and rehabilitation aftercare in the course of the rehabilitation cohorts 2002–2009]. Rehabilitation (Stuttg). 2014;53(6):384–389.

    Article  CAS  Google Scholar 

  7. 7.

    Catalina-Romero C, Ruilope LM, Sanchez-Chaparro MA, Valdivielso P, Cabrera-Sierra M, Fernandez-Labandera C, et al. Factors influencing return-to-work after cerebrovascular disease: the importance of previous cardiovascular risk. Eur J Prev Cardiol. 2015;22(9):1220–1227.

    Article  PubMed  Google Scholar 

  8. 8.

    Hasselhorn MH. Work ability—concept and assessment. In: Weber VM, Warr N, editors. Achieving business excellence—health, well-being and performance. Bielefeld: Bertelsmann Stiftung, BKK Bundesverband; 2008.

  9. 9.

    Power P. A guide to vocational assessment. 5 ed. Austin: Pro-Ed; 2013.

    Google Scholar 

  10. 10.

    Breeding RR. The utility of proactive vocational assessment in advancing consumer empowerment. Vocat Eval Career Assess Prof J. 2005;2(2):39–56.

    Google Scholar 

  11. 11.

    Homa D, DeLambo D. Vocational assessment and job placement: chapter 8. In: Escorpizo R, Brage S, Homa D, Stucki G, editors. Handbook of vocational rehabilitation and disability evaluation. New York: Springer; 2015. pp. 161–187.

    Chapter  Google Scholar 

  12. 12.

    World Health Organization (WHO). International classification of functioning, disability and health. Geneva: WHO; 2001.

    Google Scholar 

  13. 13.

    Saltychev M, Kinnunen A, Laimi K. Vocational rehabilitation evaluation and the international classification of functioning, disability, and health (ICF). J Occup Rehabil. 2013;23(1):106–114.

    Article  PubMed  Google Scholar 

  14. 14.

    Finger ME, Escorpizo R, Glassel A, Gmunder HP, Luckenkemper M, Chan C, et al. ICF core set for vocational rehabilitation: results of an international consensus conference. Disabil Rehabil. 2012;34(5):429–438.

    Article  PubMed  Google Scholar 

  15. 15.

    Finger ME, Escorpizo R, Bostan C, De Bie R. Work Rehabilitation Questionnaire (WORQ): development and preliminary psychometric evidence of an ICF-based questionnaire for vocational rehabilitation. J Occup Rehabil. 2014;24(3):498–510.

    PubMed  Google Scholar 

  16. 16.

    Finger ME, Selb M, De Bie R, Escorpizo R. Using the international classification of functioning, disability and health in physiotherapy in multidisciplinary vocational rehabilitation: a case study of low back pain. Physiother Res Int. 2015;20(4):231–241.

    Article  PubMed  Google Scholar 

  17. 17.

    Portmann Bergamaschi R, Escorpizo R, Staubli S, Finger ME. Content validity of the work rehabilitation questionnaire-self-report version WORQ-SELF in a subgroup of spinal cord injury patients. Spinal Cord. 2014;52(3):225–230.

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    Swiss Federal Statistical Office. Languages declared as main languages, 2015. Accessed 21 Nov 2017.

  19. 19.

    Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25(24):3186–3191.

    Article  CAS  Google Scholar 

  20. 20.

    Hagell P, Hedin PJ, Meads DM, Nyberg L, McKenna SP. Effects of method of translation of patient-reported health outcome questionnaires: a randomized study of the translation of the rheumatoid arthritis quality of life (RAQoL) instrument for Sweden. Value Health. 2010;13(4):424–430.

    Article  PubMed  Google Scholar 

  21. 21.

    World Health Organization (WHO). WHODAS-II—disability assessment schedule training manual: a guide to administration. Geneva: WHO; 2004.

    Google Scholar 

  22. 22.

    O’Connor J, McCaughan D, McDaid C, Booth A, Fayter D, Rodriguez-Lopez R, et al. Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis. Health Technol Assess. 2016;20(55):1–262.

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Glassel A, Finger ME, Cieza A, Treitler C, Coenen M, Escorpizo R. Vocational rehabilitation from the client’s perspective using the international classification of functioning, disability and health (ICF) as a reference. J Occup Rehabil. 2011;21(2):167–178.

    Article  PubMed  Google Scholar 

  24. 24.

    Haasper C, Junge M, Ernstberger A, Brehme H, Hannawald L, Langer C, et al. [The Abbreviated Injury Scale (AIS). Options and problems in application]. Unfallchirurg. 2010;113(5):366–372.

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Iakova M, Ballabeni P, Erhart P, Seichert N, Luthi F, Deriaz O. Self perceptions as predictors for return to work 2 years after rehabilitation in orthopedic trauma inpatients. J Occup Rehabil. 2012;22(4):532–540.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Rashid M, Kristofferzon ML, Nilsson A, Heiden M. Factors associated with return to work among people on work absence due to long-term neck or back pain: a narrative systematic review. BMJ Open. 2017;7(6):e014939.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Steenstra IA, Munhall C, Irvin E, Oranye N, Passmore S, Van Eerd D, et al. Systematic review of prognostic factors for return to work in workers with sub acute and chronic low back pain. J Occup Rehabil. 2017;27(3):369–381.

    Article  PubMed  Google Scholar 

  28. 28.

    Opsahl J, Eriksen HR, Tveito TH. Do expectancies of return to work and Job satisfaction predict actual return to work in workers with long lasting LBP? BMC Musculoskelet Disord. 2016;17(1):481.

    Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    O’Donnell ML, Varker T, Holmes AC, Ellen S, Wade D, Creamer M, et al. Disability after injury: the cumulative burden of physical and mental health. J Clin Psychiatry. 2013;74(2):e137–e143.

    Article  PubMed  Google Scholar 

  30. 30.

    Carriere JS, Thibault P, Sullivan MJ. The mediating role of recovery expectancies on the relation between depression and return-to-work. J Occup Rehabil. 2015;25(2):348–356.

    Article  PubMed  Google Scholar 

  31. 31.

    Ferdiana A, Post MW, Finger M, Bultmann U, Escorpizo R. Assessment of health-related quality of life of clients in vocational rehabilitation: association with depressive symptoms and type of services. Eur J Phys Rehabil Med. 2014;50(3):343–353.

    CAS  PubMed  Google Scholar 

  32. 32.

    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–370.

    Article  CAS  PubMed  Google Scholar 

  33. 33.

    Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155–163.

    Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res. 2005;19(1):231–240.

    PubMed  Google Scholar 

  35. 35.

    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(1):34–42.

    Article  PubMed  Google Scholar 

  36. 36.

    Brown JD. Standard error vs. Standard error off measurement. JALT Testing & Evaluation SIG Newsletter [Internet]. 1999;3(1). Accessed 14 Dec 2017.

  37. 37.

    Tighe J, McManus IC, Dewhurst NG, Chis L, Mucklow J. The standard error of measurement is a more appropriate measure of quality for postgraduate medical assessments than is reliability: an analysis of MRCP(UK) examinations. BMC Med Educ. 2010;10(1):40.

    Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Donoghue D, Stokes EK. How much change is true change? The minimum detectable change of the Berg Balance Scale in elderly people. J Rehabil Med. 2009;41(5):343–346.

    Article  PubMed  Google Scholar 

  39. 39.

    Field A. Exploring assumptions. In: Field A, editor. Discovering statistics using SPSS. 3 ed. London: SAGE; 2009. pp. 131–196.

    Google Scholar 

  40. 40.

    George D, Mallery P. Bivariate correlation. In: George D, Mallery P, editors. SPSS for windows 23 step by step: a simple guide and reference. 14 ed. New York: Taylor & Francis; 2016. pp. 139–148.

    Chapter  Google Scholar 

  41. 41.

    RStudio (2015). RT. RStudio: Integrated development environment for R. RStudio, Inc. Boston, MA. Accessed 15 Oct 2016.

  42. 42.

    Stekhoven DJ, Bühlmann P. MissForest—non-parametric missing value imputation for mixed-type data. Bioinformatics. 2012;28(1):112–118.

    Article  CAS  PubMed  Google Scholar 

  43. 43.

    IBM SPSS Statistics for Windows. 24.0 ed: IBM; 2016.

  44. 44.

    Epstein J, Osborne RH, Elsworth GR, Beaton DE, Guillemin F. Cross-cultural adaptation of the Health Education Impact Questionnaire: experimental study showed expert committee, not back-translation, added value. J Clin Epidemiol. 2015;68(4):360–369.

    Article  PubMed  Google Scholar 

  45. 45.

    Harkness J, Bilgen I, Córdova Cazar A, Hu M, Huang L, Lee S, et al. Questionnaire design. Guidelines for best practice in cross-cultural surveys. Accessed 15 Sept 2016.

  46. 46.

    Boot CR, Hogg-Johnson S, Bultmann U, Amick BC 3rd, van der Beek AJ. Differences in predictors for return to work following musculoskeletal injury between workers with and without somatic comorbidities. Int Arch Occup Environ Health. 2014;87(8):871–879.

    Article  PubMed  Google Scholar 

  47. 47.

    Cieza A, Geyh S, Chatterji S, Kostanjsek N, Ustun BT, Stucki G. Identification of candidate categories of the international classification of functioning disability and health (ICF) for a generic ICF core set based on regression modelling. BMC Med Res Methodol. 2006;6(1):36.

    Article  PubMed  PubMed Central  Google Scholar 

  48. 48.

    Voutilainen A, Pitkaaho T, Kvist T, Vehvilainen-Julkunen K. How to ask about patient satisfaction? The visual analogue scale is less vulnerable to confounding factors and ceiling effect than a symmetric Likert scale. J Adv Nurs. 2016;72(4):946–957.

    Article  PubMed  Google Scholar 

  49. 49.

    Rausch M, Zehetleitner M. A comparison between a visual analogue scale and a four point scale as measures of conscious experience of motion. Conscious Cogn. 2014;28:126–140.

    Article  PubMed  Google Scholar 

  50. 50.

    Martins PC, Couto TE, Gama AC. Auditory-perceptual evaluation of the degree of vocal deviation: correlation between the Visual Analogue Scale and Numerical Scale. Codas. 2015;27(3):279–284.

    Article  PubMed  Google Scholar 

  51. 51.

    Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, et al. Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manag. 2011;41(6):1073–1093.

    Article  Google Scholar 

  52. 52.

    van Kampen DA, Willems WJ, van Beers LW, Castelein RM, Scholtes VA, Terwee CB. Determination and comparison of the smallest detectable change (SDC) and the minimal important change (MIC) of four-shoulder patient-reported outcome measures (PROMs). J Orthop Surg Res. 2013;8(1):40.

    Article  PubMed  PubMed Central  Google Scholar 

  53. 53.

    Jakobsen K, Lillefjell M. Factors promoting a successful return to work: from an employer and employee perspective. Scand J Occup Ther. 2014;21(1):48–57.

    PubMed  Google Scholar 

  54. 54.

    Proper KI, van den Heuvel SG, De Vroome EM, Hildebrandt VH, Van der Beek AJ. Dose-response relation between physical activity and sick leave. Br J Sports Med. 2006;40(2):173–178.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. 55.

    Huijnen IP, Verbunt JA, Peters ML, Seelen HA. Is physical functioning influenced by activity-related pain prediction and fear of movement in patients with subacute low back pain? Eur J Pain. 2010;14(6):661–666.

    Article  PubMed  Google Scholar 

  56. 56.

    Wand BM, Chiffelle LA, O’Connell NE, McAuley JH, Desouza LH. Self-reported assessment of disability and performance-based assessment of disability are influenced by different patient characteristics in acute low back pain. Eur Spine J. 2010;19(4):633–640.

    Article  PubMed  Google Scholar 

  57. 57.

    Tankumpuan T, Utriyaprasit K, Chayaput P, Itthimathin P. Predictors of physical functioning in postoperative brain tumor patients. J Neurosci Nurs. 2015;47(1):E11–E21.

    Article  PubMed  Google Scholar 

  58. 58.

    Rasmussen MU, Amris K, Rydahl-Hansen S, Danneskiold-Samsoe B, Mortensen EL, Christensen R, et al. Are the changes in observed functioning after multi-disciplinary rehabilitation of patients with fibromyalgia associated with changes in pain self-efficacy? Disabil Rehabil. 2017;39(17):1744–1752.

    Article  PubMed  Google Scholar 

  59. 59.

    Giovannetti AM, Schiavolin S, Brenna G, Brambilla L, Confalonieri P, Cortese F, et al. Cognitive function alone is a poor predictor of health-related quality of life in employed patients with MS: results from a cross-sectional study. Clin Neuropsychol. 2016;30(2):201–215.

    Article  PubMed  Google Scholar 

  60. 60.

    Sun Y, Shigaki CL, Armer JM. Return to work among breast cancer survivors: a literature review. Support Care Cancer. 2017;25(3):709–718.

    Article  PubMed  Google Scholar 

  61. 61.

    Bush EJ, Hux K, Guetterman TC, McKelvey M. The diverse vocational experiences of five individuals returning to work after severe brain injury: a qualitative inquiry. Brain Inj. 2016;30(4):1–15.

    Article  Google Scholar 

  62. 62.

    Waszkowska M, Szymczak W. Return to work after myocardial infarction: a retrospective study. Int J Occup Med Environ Health. 2009;22(4):373–381.

    Article  PubMed  Google Scholar 

  63. 63.

    Nieuwenhuijsen K, Cornelius LR, de Boer MR, Groothoff JW, Frings-Dresen MHW, van der Klink JJL, et al. Predicting improvement of functioning in disability claimants. J Occup Rehabil. 2014;24(3):410–418.

    CAS  PubMed  Google Scholar 

  64. 64.

    de Vries G, Koeter MW, Nieuwenhuijsen K, Hees HL, Schene AH. Predictors of impaired work functioning in employees with major depression in remission. J Affect Disord. 2015;185:180–187.

    Article  PubMed  Google Scholar 

  65. 65.

    Cancelliere C, Kristman VL, Cassidy JD, Hincapie CA, Cote P, Boyle E, et al. Systematic review of return to work after mild traumatic brain injury: results of the international collaboration on mild traumatic brain injury prognosis. Arch Phys Med Rehabil. 2014;95(3 Suppl):S201–S209.

    Article  PubMed  Google Scholar 

  66. 66.

    Kuijer PP, Gouttebarge V, Wind H, van Duivenbooden C, Sluiter JK, Frings-Dresen MH. Prognostic value of self-reported work ability and performance-based lifting tests for sustainable return to work among construction workers. Scand J Work Environ Health. 2012;38(6):600–603.

    Article  PubMed  Google Scholar 

  67. 67.

    Levesque JF, Haggerty J, Beninguisse G, Burge F, Gass D, Beaulieu MD, et al. Mapping the coverage of attributes in validated instruments that evaluate primary healthcare from the patient perspective. BMC Fam Pract. 2012;13(1):20.

    Article  PubMed  PubMed Central  Google Scholar 

  68. 68.

    Howell D, Liu G. Can routine collection of patient reported outcome data actually improve person-centered health? Healthc Pap. 2011;11(4):42–47 (discussion 55–48).

    Article  PubMed  Google Scholar 

  69. 69.

    Gagnier JJ. Patient reported outcomes in orthopaedics. J Orthop Res. 2017;35(10):2098–2108.

    Article  PubMed  Google Scholar 

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The authors would like to thank Olivier Dériaz, Dominique Monnin and Carolina Fellinghauer for their help with the cross-cultural adaptation. We would also like to thank Wolfgang Segerer for providing technical consultation and Christina Ehrmann for statistical support. This project was funded by a research grant from the Swiss Accident Insurance Company (suva).

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Correspondence to Monika E. Finger.

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Finger, M.E., Wicki-Roten, V., Leger, B. et al. Cross-Cultural Adaptation of the Work Rehabilitation Questionnaire (WORQ) to French: A Valid and Reliable Instrument to Assess Work Functioning. J Occup Rehabil 29, 350–360 (2019).

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  • Vocational rehabilitation
  • Work
  • WORQ
  • Functioning
  • ICF
  • Psychometrics