Background Several single-item global measures are available to explore at-work productivity loss (presenteeism) in patients with rheumatic diseases. However, large variations in results are seen with differences manifesting in the varying concepts used, recall periods, disease attribution and reference points.
Objectives To identify from a patient's perspective, difficulties and differences in the comprehension of 5 global presenteeism measures in patients with inflammatory arthritis (IA) and osteoarthritis (OA) across 7 countries.
Methods As part of the EULAR-PRO/OMERACT initiative, 70 patients diagnosed with IA or OA in paid employment were recruited from 7 countries across Europe and Canada. Patients provided baseline clinical and occupational characteristics after which a cognitive debriefing interview, known also as “think out loud” technique took place. Patients were randomly allocated to be interviewed on 3/5 measures (Work Productivity Scale–Rheumatoid Arthritis (WPS-RA), Work Productivity and Activity Impairment Questionnaire (WPAI), Work Ability Index (WAI), Quality and Quantity questionnaire (QQ) and WHO Health and Performance Questionnaire (HPQ)), with the WPAI being asked for all patients as a standard measure of comparison between countries and patients. All 5 measures were also given to the patients with the requirement of stating which measure was most applicable to them. NVivo was used to code the data into 4 themes: concepts, time period, reference and attribution.
Results 57% of the study population was female; mean age 45.6 (SD 10.7) years and median symptom duration 13.5 [IQR 5-19] years. Between countries, discrepancies were found for the interpretation of the word “performance”, with Romania and Sweden interpreting performance to relate to sports rather than work (table). Difficulties in the interpretation of terminology accountable for problems with scoring were found for the word 'productivity' (WPAI) which was regarded as relating to producing products. 70% of patients said 7 days (WPAI) was an accurate representation of how their condition affects work productivity. 58% reported the today time period (QQ) to be inaccurate as many patients had not yet or were not attending work that day. The “compared to normal” reference (QQ) caused difficulty due to the ambiguous nature of the word normal, as did the comparison to colleagues (HPQ) as many felt uncomfortable and considered it unfair to make comparisons to the performance of healthy co-workers. Overall, 29% of patients said the WPAI was the most relevant to them making it the most favoured measure, whilst the WAI was the least favoured with 12% of votes.
Conclusions The lack of consensus and difficulties expressed with the measures reinforces the need for a universally accepted and language applicable measure. This would facilitate comparisons of presenteeism results across studies and countries, a task currently difficult to undertake.
Disclosure of Interest None declared