Abstract

Background: Despite recent advances Work Disability (WD) in rheumatoid arthritis (RA) remains common. WD is frequently preceded by a period of Work Instability characterised by a mis-match between an individual’s functional abilities and job demands. This could raise the risk of WD if not resolved, A Work Instability Scale for RA (the RA-WIS) has been previously 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 was 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 to both cancel out at the test level, and have only a marginal effect on the test score itself.

Conclusion: The RA-WIS has 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.