The Work Instability Scale for rheumatoid arthritis predicts arthritis-related work transitions within 12 months

Authors

  • Kenneth Tang,

    1. St. Michael's Hospital, University of Toronto, and Institute for Work & Health, Toronto, Ontario, Canada
    Search for more papers by this author
  • Dorcas E. Beaton,

    Corresponding author
    1. St. Michael's Hospital, University of Toronto, and Institute for Work & Health, Toronto, Ontario, Canada
    • Mobility Program Clinical Research Unit, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada, M5B 1W8
    Search for more papers by this author
  • Monique A. M. Gignac,

    1. University of Toronto, University Health Network, and Arthritis Community Research & Evaluation Unit, Toronto, Ontario, Canada
    Search for more papers by this author
  • Diane Lacaille,

    1. Arthritis Research Centre of Canada and University of British Columbia, Vancouver, British Columbia, Canada
    Search for more papers by this author
    • Dr. Lacaille is the Nancy and Peter Paul Saunders Scholar

  • Wei Zhang,

    1. Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
    Search for more papers by this author
  • Claire Bombardier

    1. University of Toronto, Institute for Work & Health, University Health Network, and Mount Sinai Hospital, Toronto, Ontario, Canada
    Search for more papers by this author
    • Dr. Bombardier has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Schering, Roche, Biogen Idec, and PESI Healthcare, and (more than $10,000 each) from Wyeth, Abbott Canada, and Abbott International.


Abstract

Objective

Among people with arthritis, the need for work transitions may signal a risk for more adverse work outcomes in the future, such as permanent work loss. Our aim was to evaluate the ability of the Work Instability Scale for Rheumatoid Arthritis (RA-WIS) to predict arthritis-related work transitions within a 12-month period.

Methods

Workers with osteoarthritis or rheumatoid arthritis (n = 250) from 3 clinical sites participated in self-administered surveys that assessed the impact of health on employment at multiple time points over 12 months. Multivariable logistic regressions were conducted to assess the ability of the RA-WIS (range 0–23, where 23 = highest work instability) to predict 4 types of work transition: reductions in work hours, disability leaves of absence, changes in job/occupation, or temporary unemployment, assembled as a composite outcome. Covariates assessed include age, sex, education, marital status, income, pain intensity, disease duration, and the Health Assessment Questionnaire. Areas under the receiver operating characteristic curves (AUROCCs) were also assessed to further examine the predictive ability of the RA-WIS and to determine optimal cut points for predicting specific work transitions.

Results

After 12 months, 21.7% (n = 50 of 230) of the participants had indicated at least one arthritis-related work transition. Higher baseline RA-WIS was predictive of such an outcome (relative risk [RR] 1.05 [95% confidence interval (95% CI) 1.00–1.11]), particularly at >17 (RR 2.30 [95% CI 1.11–4.77]). The RA-WIS cut point of >13 was found to be most accurate for prediction (AUROCC 0.68 [95% CI 0.58–0.78]).

Conclusion

The RA-WIS demonstrated the ability to predict arthritis-related work transitions within a short timeframe, and could be a promising measurement candidate for risk prognostication where work disability outcomes are of concern.

Ancillary