Facilitating Participation: Work Instability

1
Facilitating Participation Work Instability

• Gill Gilworth
• Senior Research Fellow,
• Academic Unit of Musculoskeletal and
  Rehabilitation Medicine, University of Leeds

2
The importance of work

• Far and away the best prize that life offers is
  the chance to work hard at work worth doing
• Theodore Roosevelt 1903
• I need to go to work to keep me mentally
  stimulated,.. if I dont work Ill go crazy
• Patient with RA

3
The importance of work (2)

• In addition to the obvious monetary rewards
  work also has a number of wider benefits
• sense of worth and identity
• social contacts outside the household
• participation in a wider collective purpose
• ability to work has been linked to improved
  quality of life (Pettifer 1993, Grahn,
  Ekdahl Borgquist 1992, Jahoda 1982)

4
Traditionally research focuses are

• Work Disability
• Factors relating to job loss
• Sickness Absence
• Anecdotal evidence
• Too often people wait until their job is under
  threat before seeking help

5
Work Disability/Instability in RA

• Work Disability rates in RA remain high
• WD is commonly preceded by a period of WI
• Early identification of those experiencing WI is
  the key to early intervention aimed at job
  retention both at work and early aggressive
  treatment
• Early identification requires reliable, robust
  measures

6
The concept of Work Instability

• the impact in the workplace of any health problem
  or disability must relate to the individuals
  work demands
• describes the extent of any mismatch between
  functional (in)capasity and work demands
• its potential impact, on efficiency/productivity
  and ultimately on job retention/security if not
  addressed

7
A definition

• Work Instability can be defined as
• a state in which the consequences of a
  mis-match between an individuals functional (and
  cognitive) abilities and the demands of their job
  can threaten continuing employment if not
  resolved

8
Recognising and addressing Work Instability is
important for

• Individuals financial and psychosocial costs,
  undermining of independence and general health as
  result of not being able to participate in the
  economy.
• Society as a whole higher unemployment and
  disability benefits lower tax revenues.
• Employers who lose staff with valuable
  experience, may incur additional expenses for
  covering the work of absent staff, additional
  costs for pensions and in the recruitment and
  training of new staff.

9
Development of the RA-WIS

• Qualitative interviews
• Cognitive de-briefing (face validity)
• Main postal survey
• (draft RA-WIS plus other measures)
• Gold Standard Assessments (criterion validity)
• Rasch Analysis
• Test re-test postal survey

10
Development of the RA-WIS

• Qualitative Interviews n45
• To explore the concept of Work Instability in RA
  
• Item generation
• Items generated from the interview transcripts,
  each chosen to be generic, relevant to the
  construct and simple capturing a single
  concept.
• Field tested to test face validity

11
Item Selection

• Items should be
• Relevant to the construct to be measured
• Applicable to all potential respondents
  (irrespective of age, gender and occupation)
• Reflect a single idea
• Unambiguous, simple language, not colloquial
• jargon free

12
Transcript Items

• I have to get up earlier for a start because
  Ive found that if I have a hot bath and allow
  time for the drugs to kick in I manage
• its more stressful than the job I used to do
  and stress is another thing that brings on
  flares...

13
Resulting items

• I'm getting up earlier because of my condition
• The stress of my job makes my arthritis flare

14
RA-WIS Methods (continued)

• Rasch analysis (Rasch 1980)
• Item Response Theory used to examine the scaling
  properties of the RA-WIS and consider
  Differential Item Functioning on data from the
  postal survey
• Gold standard of expert vocational assessment
• for criterion validity
• Test re-test postal survey

15
Scores on the 23 item Work Instability Scale
indicate level of risk of Work Disability/job
retention problems
16
Conclusion of RA-WIS project

• This project produced a simple true/not true
  questionnaire which allows clinicians to screen
  for, and monitor Work Instability from onset of
  disease so facilitating work retention.

17
Cross-cultural adaptation of the RA-WIS

• EULAR funded project (Standing Committee for
  Allied Health Professionals)
• French, Dutch and German versions being developed
• Method based on published guidelines
• (Beeton et al SPINE 2000)

18
Future Work

• Further translation work with other WI scales
• Item banking - evidence is emerging of common
  items on the construct of WI but also unique
  components to all scales developed to date
• New scales are planned for
• Office workers
• Manual workers
• Workers where tasks predominately involve use of
  the upper limbs

19
Acknowledgements

• Other members of the research team including
• Alan Tennant, Bipin Bhakta, Anne Chamberlain,
  Sophie Eyres, Amy Carey, Glyn Smyth
• and Jacqui Smith.

• The Arthritis Research Campaign (funders of
  RA-WIS project)
• The cross-cultural adaptation is being funded by
  EULAR

20
Extending Working Life research programme at the
University of Leeds

• Rheumatoid Arthritis-Work Instability Scale
  (RA-WIS)
• Work Instability Scale for mild to moderate TBI
• Epilepsy-Work Instability Scale (WISE)
• MS-Work Instability Scale
• Understanding musculoskeletally related sickness
  absence and job loss in Nurses and development of
  a Nurse-Work Instability Scale
• In the future ? Back pain, Diabetes, other
  occupational groups