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Extended report
Adaptation and cross-cultural validation of the rheumatoid arthritis work instability scale (RA–WIS)
  1. G Gilworth1,
  2. P Emery1,
  3. L Gossec2,
  4. T P M Vliet Vlieland3,
  5. F C Breedveld3,
  6. A J Hueber4,
  7. G Schett4,
  8. A Tennant1
  1. 1
    Department of Musculoskeletal and Rehabilitation Medicine, (Faculty of Medicine and Health), University of Leeds, Leeds, UK
  2. 2
    Paris Descartes University, Medicine Faculty ; UPRES-EA 4058; APHP, Rheumatology B Department, Cochin Hospital, Paris, France
  3. 3
    Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  4. 4
    Department of Internal Medicine 3, University of Erlangen-Nuremberg, Nuremberg, Germany
  1. Correspondence to Mrs G Gilworth, Department of Musculoskeletal and Rehabilitation Medicine, University of Leeds, D Floor, Martin Wing, Leeds General Infirmary, Leeds LS1 3EX, UK; gilworths{at}


Background: Despite recent advances, work disability in rheumatoid arthritis (RA) remains common. Work disability is frequently preceded by a period of work instability characterised by a mismatch between an individual’s functional abilities and job demands. This could raise the risk of work disability if not resolved. A work instability scale for RA (RA–WIS) has previously been developed to screen for this risk. The objective of this study was the adaptation of this scale into French, Dutch and German.

Method: Different language versions of the RA–WIS were produced through a process of forward and back translations. The new scales were tested for face validity. English data from the original developmental study was pooled with data generated through postal surveys in each country. The internal construct and cross-cultural validity of the new scales were assessed using Rasch analysis, including differential item functioning (DIF) by culture.

Results: The pooled data showed good fit to the Rasch model and demonstrated strict unidimensionality. DIF was found to be present for six items, but these appeared both to cancel out at the test level and have only a marginal effect on the test score itself.

Conclusions: The RA–WIS was shown to be robust to adaptation into different languages. Data fitted Rasch model expectations and strict tests of unidimensionality. This project and the continuing work on further cross-cultural adaptations have the potential to help ensure clinicians across Europe are able to support RA patients to achieve their potential in work through early identification of those most at risk.

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  • Funding The project was funded by the Standing Committee for Allied Health at EULAR.

  • Competing interests None.

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  • Miscellaneous
    BMJ Publishing Group Ltd and European League Against Rheumatism