Persons with arthritis confirm that work provides not only financial income and in some cases access to health benefits, but work provides a sense of social belonging, role functioning, and meaning. When faced with time off work because of their disease activity, people with arthritis are often actively seeking ways to return to this meaningful part of their lives.
If our goal as clinicians is to track what matters most to patients, and to see if our treatments are supporting those parts of the patients' lives, we ought to be considering more than “return to work: yes/no” when we talk to them or each other about their work. Worker productivity or work role functioning provides a more comprehensive framework for considering the interplay between work and health.
The purpose of this presentation will be to provide a framework and our groups experience with the measurement of worker productivity as an outcome and the information that you might need to know in order to bring this into clinical practice. This talk will be divided into three parts.
1) What is it that we are trying to measure? The first step in choosing an outcome instrument is to clarify what exactly it is that you want to measure. The Sandqvist group in 2004 presented a conceptual framework that depicts a worker's productivity as the overlap of the person's capacity to work, and the demands of the job. This balance can of course change by altering a person's ability or the jobs demands (through accommodations physically, socially or psychologically). Measures can focus on an amount of difficulty that someone has had in their job or a level of productive output they are able to achieve. Other measures focus on the distress and instability experienced because of mismatched ability and demands. Which to use is a choice that needs to be made ahead of time. Contextual factors must also be considered, particularly things would be likely to define whether a person of a given ability would be able to be productive at work or not.
2) How should we measure it? Over 26 instruments exist to measure worker productivity. In this portion of the presentation will review the approach we took guided by the OMERACT Filter 2.0. The filter directs us to review conceptual match and practical considerations under “feasibility”. Then to move towards truth (can the numbers coming from this tool adequately represent our desired construct?), and discrimination where we focus on the ability to detect change when it has occurred (and no change when it has not).
3) Practically speaking, how do we make use of these scores in clinical practice? In this portion of the talk the approach used in the OMERACT process for determining the meaning of small but important changes in score, and benchmarking of scale scores will be discussed. Ways to integrate work productivity into clinical practice will be discussed including charting over time, and the use of graphs to depict ways of adjusting job or person to enable high productivity.
Worker productivity, by its very nature, is a complex outcome. It reflects not only the person's capacity but does so within the context of a given job situation. That said, it is an important part of the lives of many adults living with arthritis, and is currently under-represented in our research and clinical discourse.
Disclosure of Interest None declared