Health Outcomes

LAUREN E.
SILVER
EVALUATION OF THE WORK LIMITATIONS QUESTIONNAIRE
Lauren Silver
HPM 564: Health Outcomes
November 19, 29
Lauren Silver Evaluation of the Work Limitations Questionnaire
Health Outcomes November 19, 2009
1.0. BACKGROUND
!he "or# Limitations $uestionnaire %"L$& is a 'eneric, sel()re*orte+ health outcomes instrument that
measures on)the),ob im*act o( chronic *h-sical or emotional health *roblems an+ relate+ treatments on
,ob *er(ormance an+ .or# *ro+uctivit-/
1
0t .as +evelo*e+ b- (acult- at the !u(ts 1niversit- School o(
Me+icine, 2oston, Massachusetts an+ the 1niversit- o( !e3as Houston Health Science 4enter, School o(
Public Health in Houston, !e3as, an+ .as (irst *ublishe+ in 21/
2
2.0. CONCEPTUAL MODEL
!he "L$ measures em*lo-e+ in+ivi+uals5 +i((icult- in meetin' (our t-*es o( ,ob +eman+s: time
mana'ement, *h-sical +eman+s, mental)inter*ersonal +eman+s, an+ out*ut +eman+s/
6
!he time
mana'ement scale assesses in+ivi+uals5 +i((icult- meetin' their at).or# time mana'ement an+
sche+ulin' +eman+s7 the *h-sical +eman+s scale assesses to .hat e3tent in+ivi+uals have +i((icult-
*er(ormin' ,ob (unctions that re8uire bo+- stren'th, movement, en+urance, coor+ination, an+ (le3ibilit-7
the mental)inter*ersonal scale assesses in+ivi+uals5 abilit- to *er(orm co'nitive tas#s an+ carr- out
social interactions .hile at .or#7 an+ the out*ut +eman+s scale assesses in+ivi+uals5 overall on)the),ob
*ro+uctivit-/
4,5
0n measurin' in+ivi+uals5 .or# limitations accor+in' to these (our on)the),ob +eman+s, the
"L$ see#s to measure the overall conce*t o( *resenteeism/
6
Presenteeism9as o**ose+ to absenteeism
9re(ers to the +e'ree that em*lo-ee health *roblems lea+ to .or# limitations an+ re+uce+ on)the),ob
*er(ormance rather than to the amount o( .or# misse+ b- em*lo-ees/
:
More s*eci(icall-, ho. +o
chronic health an+;or emotional con+itions an+ relate+ treatments in(luence on)the),ob *er(ormance
outcomes .hile em*lo-ees are at .or#<
3.0. MEASUREMENT MODEL
!he measurement mo+el o( a health outcomes instrument is the =scale an+ subscale structure, an+ the
*roce+ures (ollo.e+ to create scale an+ subscale scores/>
?
0n a++ition to evi+ence o( reliabilit- an+
vali+it-, the Me+ical Outcomes !rust Scienti(ic @+visor- 4ommittee assesses the a+e8uac- o( a
measurement mo+el base+ on .hether the level o( measurement o( the instrument5s scale or subscales
as .ell as scorin' *roce+ures are =.ell),usti(ie+/>
9

3.1. Scal a!" S#$%cal S&'#c&#'
@s mentione+ above, the ori'inal, 25)item "L$ consists o( (our scales measurin' em*lo-e+
in+ivi+uals5 abilit- to meet (our t-*es o( at).or# +eman+s: time mana'ement %5 items&, *h-sical
+eman+s %6 items&, mental)inter*ersonal +eman+s %9 items&, an+ overall out*ut +eman+s %5 items&/ !he
(our subscales an+ relate+ items .ere chosen +urin' the 8uestionnaire5s +evelo*ment base+ on the
(ollo.in': 1& 4ronbach al*has (or internal consistenc- e3cee+e+ /9 (or each subscale7 2& subscales
e3hibite+ =si'ni(icant correlation .ith *ro+uctivit- variables7> an+ 6& in+ivi+ual items .ithin each
subscale .ere non)+u*licative/
1
@ll items as# res*on+ents the (ollo.in' 8uestion: =Ho. much o( the
time .ere -ou able to +o the (ollo.in' .ithout +i((icult- +ue to *h-sical health or emotional
*roblems<>
11
Aes*on+ents ma- choose amon' 5 res*onse o*tions accor+in' to an or+inal)level Li#ert)
Buster scale that matches a *ercenta'e o( time .ith each *ossible res*onse o*tion: all o( the time
%1C&, a 'reat +eal o( the time, some o( the time %D5C&, a sli'ht bit o( the time, an+ none o( the time
%C&/ Aes*on+ents also ma- in+icate that an- item =+oes not a**l- to m- ,ob/> Eevelo*ers o( the "L$
chose this or+inal)level =+i((icult- 8uestion stem> (or t.o ma,or reasons/
12
First, co'nitive intervie.s in
the *ilot *hase o( the "L$ .ith *atients 1? to 64 -ears ol+ belon'in' to +i((erent con+ition 'rou*s9
res*irator-, 'astrointestinal, an+ *s-chiatric con+itions an+ e*ile*s-9(aile+ to reveal a consistent
res*onse o*tion/
16
Further testin' com*are+ the e3tent to .hich in+ivi+ual res*onses o( 66 res*on+ents
matche+ on three, 9)item alternative res*onse (ormats7 the G+i((icult-5 (orm ha+ the lo.est mismatch rate
an+ more accuratel- re(lecte+ res*on+ent e3*eriences as re*orte+ in the co'nitive intervie.s/
14
Secon+,
the Buster (ormat .as chosen to allo. res*onses to be translate+ into *ercenta'es o( time that
res*on+ents e3*erience .or# limitations, thereb- =(acilitateHin'I (uture economic anal-ses/>
15

3.2. Sc(')!* P'(c"#'%
Jach item .ithin a scale is score+ (rom to 4, +e*en+in' on the amount o( time res*on+ents in+icate
the- e3*erience +i((icult- carr-in' out a s*eci(ic .or# tas# .ithin the s*eci(ie+ recall *erio+ %e/'/, t.o
.ee#s&/ 0tem scores are summe+ an+ +ivi+e+ b- the total number o( items .ithin each scale/ !his
avera'e scale score is then multi*lie+ b- 25, .hich *ro+uces a (inal interval)level scale score ran'in'
(rom to 1/
16
@ scale score o( in+icates a res*on+ent is limite+ none o( the time .hile a score o( 1
+enotes limite+ all o( the time/ 0tems mar#e+ as =+oes not a**l- to m- ,ob> are set to missin' *rior to
scorin'/
+.0. RELIABILIT, - VALIDIT,
Aeliabilit- an+ vali+it- re(er to ho. consistent an+ accurate, res*ectivel-, an instrument is in measurin'
the conce*t%s& it *ur*orts to measure/
+.1. Rl)a$)l)&.
4/1/1/ 0nternal 4onsistenc-/ 0nternal reliabilit-, or internal consistenc-, re(ers to the e3tent that similar
items in a scale are correlate+ .ith each other9i( t.o items in a scale are su**ose+ to measure the same
construct %e/'/, *h-sical .or# +eman+s&, then a res*on+ent5s scores on both items shoul+ be correlate+/
1:
!he MO! states that acce*table reliabilit- coe((icients9usuall- calculate+ as 4ronbach5s K coe((icient
9shoul+ be at least /: (or 'rou* com*arisons an+ /9)/95 (or in+ivi+ual com*arisons/
1?
Aeliabilit-
coe((icients that are too hi'h, ho.ever, ma- su''est that items in a scale are re+un+ant/
19
Eevelo*ers o(
the "L$)25 (irst assesse+ the instrument5s reliabilit- in *atients .ith rheumatoi+ arthritis, chronic +ail-
hea+ache s-n+rome, an+ e*ile*s-, an+ (oun+ that all (our scales +emonstrate+ 'oo+ internal consistenc-
.ith 4ronbach K coe((icients ran'in' (rom /?? to /91/
2
Subse8uent revie.s o( health)relate+ .or#
*ro+uctivit- instruments also +escribe the "L$)25 as internall- consistent/
21,22
More s*eci(icall-, the
"L$)25 +emonstrate+ hi'h internal consistenc- amon' a+ults .ith an3iet- +isor+ers %scale 4ronbach
K5s ran'in' (rom /91)/9:&, amon' em*lo-ees o( a lar'e 1/S/ +urable 'oo+s (irm %scale 4ronbach K5s
o( at least /?4& an+ .hen com*arin' the .or# limitations o( osteoarthritis *atients to a health-
com*arison 'rou* %4ronbach K5s ran'in' (rom /96 to /9:&/
26,24,25
!he latter t.o stu+ies also re*orte+
acce*table item)to)total scale correlations %the +e'ree to .hich sin'le item scores are correlate+ .ith the
total scale score&, ran'in' (rom /56 to /96/ 0n .or#ers .ith musculos#eletal +isor+ers an+ in .or#ers
.ith shoul+er or elbo. +isor+ers, ho.ever, the 16)item "L$ +emonstrate+ a lo.er level o( internal
consistenc-, .ith scale 4ronbach K5s ran'in' (rom /:4 to /96 an+ /41 to /??, res*ectivel-/
26,2:
Save
t.o items (rom the time mana'ement scale in osteoarthritis *atients, item)to)scale correlations in the
"L$)16 in these *o*ulations also e3cee+e+ the recommen+e+ minimum o( /4/
4/1/2/ !est)Aetest Ae*ro+ucibilit-/ !he MO! +e(ines test)retest reliabilit- as =the +e'ree to .hich an
instrument -iel+s stable scores over time amon' res*on+ents .ho are assume+ not to have chan'e+ on
the +omains bein' assesse+/>
2?
One metho+ (or assessin' test)rest reliabilit- is b- calculatin' the
intraclass correlation coe((icient %044&, .hich *rovi+es in(ormation on the e3tent to .hich re*eate+
a+ministrations o( the same test un+er the same con+itions *ro+uce the same scores (or the same
in+ivi+uals/
29
"hile un+er +evelo*ment, the test)retest reliabilit- o( the "L$)25 .as assesse+ in
*atients .ith 'astrointestinal, *s-chiatric, an+ res*irator- +iseases, an+ in e*ile*s- *atients/ @ll (our
scales o( the "L$)25 met the +evelo*ers5 minimum 044 stan+ar+ o( /: .hen a+ministere+ to *atients
over both t.o) an+ (our).ee# recall *erio+s/ Ho.ever, subse8uent anal-ses reveale+ that the most
recent .ee# o( re*ortin' ten+e+ to best *re+ict *atients5 "L$ scores, thus, the +evelo*ers recommen+ a
t.o).ee# recall *erio+, but +o not a+vise a'ainst a (our).ee# recall *erio+ since the instrument
*er(orme+ =satis(actoril-> in this case/
6
+.2. Val)")&.
4/2/1/ 4ontent Lali+it-/ 4ontent vali+it- re(ers to .hether an instrument5s scales ca*ture the (ull e3tent
o( the constructs the- inten+ to measure/ !o ensure (ull an+ accurate covera'e o( ho. .or# *er(ormance
ma- be im*acte+ b- health an+ emotional *roblems, +evelo*ers o( the "L$ con+ucte+ (ocus 'rou*s
an+ co'nitive intervie.s .ith *atients (rom (our +i((erent con+ition 'rou*s9res*irator-,
'astrointestinal, an+ *s-chiatric +isor+ers an+ e*ile*s-/ Focus 'rou* an+ co'nitive intervie. *artici*ants
ran'e+ in a'e (rom 1? to 64 -ears ol+ an+ .or#e+ (or at least 2 hours *er .ee#/ Partici*ants i+enti(ie+
*otential content (or the instrument, resultin' in : at).or# +eman+ +imensions %e/'/, time +eman+s,
mental +eman+s, in(ormation *rocessin', etc/& consistin' o( : .or# limitation items %e/'/, =start on
.or# soon a(ter arrivin',> =thin# clearl-,> =.or# aroun+ noise;activit-,> etc/&/
61
Ne3t, co'nitive
intervie.s .ere a+ministere+ .ith a +i((erent sam*le o( *atients to i+enti(- a++itional relevant to*ics
an+ to retain items least li#el- to be misinter*rete+ an+ most relevant/ Five .or# limitations +imensions
an+ 4 items remaine+ that un+er.ent a++itional anal-ses, resultin' in the (inal 4)+imension, 25)item
"L$/
4/2/2/ 4onstruct Lali+it-/ 4onstruct vali+it- can be assesse+ b- e3aminin' .hether an instrument
+emonstrates the h-*othesiMe+ relationshi*s bet.een the outcomes it is su**ose+ to measure an+
variation bet.een 'rou*s sus*ecte+ to +i((er .ith re'ar+ to those outcomes/
62
@ number o( stu+ies have
+emonstrate+ that the "L$)25 can +istin'uish bet.een 'rou*s o( in+ivi+uals .ith a chronic health or
emotional *roblem versus health- controls as .ell as bet.een in+ivi+uals .ith var-in' levels o( +isease
severit- accor+in' to +i((erences in .or# im*airment/ !he "L$)25 has been use+ to sho. that sta'e 1)
6 breast cancer survivors, em*lo-ees .ith three +i((erent (orms o( clinical +e*ression, an+ osteoarthritis
*atients e3*erience+ statisticall- si'ni(icantl- more .or# limitations than health- controls/
66,64,65
Furthermore, sta'e breast cancer survivors .ere statisticall- si'ni(icantl- less li#el- to in+icate on)the)
,ob im*airment than sta'e 1 an+ sta'e 2 breast cancer survivors7 a+ults .ith more severe an3iet- .ere
statisticall- si'ni(icantl- more li#el- to re*ort more +i((icult- meetin' *h-sical, mental)inter*ersonal,
an+ overall out*ut +eman+s at .or# than their less)an3ious counter*arts7 em*lo-ees e3hibitin' onl-
+-sth-mia .ere statisticall- si'ni(icantl- less im*aire+ at .or# than em*lo-ees .ith ma,or +e*ression
or +ouble +e*ression7 an+ *atients .ith more severe osteoarthritis in+icate+ statisticall- si'ni(icantl-
more limitations on the time mana'ement, mental)inter*ersonal +eman+s, an+ out*ut +eman+s scales
than those .ith mil+er osteoarthritis/
66,6:,6?,69

4onstruct vali+it- also ma- be assesse+ b- e3aminin' an instrument5s conver'ent vali+it-, or the
e3tent that scores on more than one instrument inten+e+ to measure the same or similar constructs
correlate .ith one another/
4
!he "L$)25 has +emonstrate+ statisticall- si'ni(icant correlations .ith
other role)(unctionin' scales, inclu+in' the SF)66 role)*h-sical an+ role)emotional scales an+ the
Sheehan Eisabilit- Scale in a+ults .ith an3iet- as .ell as the "estern Ontario an+ McMaster 1niversit-
@rthritis 0n+e3 an+ a *atient 'lobal assessment o( arthritis in a+ults .ith osteoarthritis/
41,42
!he "L$)16
an+ the "L$)? have +emonstrate+ acce*table construct vali+it- in such *o*ulations as arthritic
em*lo-ees o( a lar'e (inancial services (irm, em*lo-ees .ith musculos#eletal +isor+ers, em*lo-ees .ith
shoul+er or elbo. +isor+ers, an+ em*lo-ees *artici*atin' in .or#site (itness activities versus non)
*artici*atin' em*lo-ees/
46,44,45,46
/.0. RESPONSIVENESS
Aes*onsiveness re(ers to the +e'ree to .hich an instrument can +etect chan'e, or +i((erences in the
outcomes that it *ur*orts to measure, over time/
4:
Jvi+ence on .hether the "L$ e3hibits a+e8uate
res*onsiveness varies b- version, stu+- *o*ulation, an+ scale/ 2- .a- o( e3am*le, the out*ut +eman+s
an+ mental)inter*ersonal scales o( the "L$)25 +etecte+ im*rovement in em*lo-ees .ith an3iet-/ !hose
*erceivin' im*rovement in their an3iet- +urin' the 12).ee# re*ortin' *erio+ in+icate+ more im*rove+
(unctionin' at .or# than those *erceivin' no chan'e, .ith mo+erate e((ect siMes %)/?6 an+ )1/6&/
4?

One metho+ (or assessin' an instrument5s res*onsiveness is b- i+enti(-in' .hether it e3hibits
(loor or ceilin' e((ects, .hich occur .hen an instrument is unable to +etect chan'es in outcomes in
certain in+ivi+uals because their initial scores are too lo. or too hi'h to +emonstrate im*rovement
%since on the "L$ a score o( Mero in+icates limite+ none o( the time& or +ecline %a score o( 1
in+icates limite+ all o( the time&, res*ectivel-, u*on re)testin'/
49
0n a stu+- o( osteoarthritis *atients,
ho.ever, one)(ourth o( the sam*le re*orte+ the minimum scale score o( limite+ none o( the time .hile
onl- a small *ercenta'e score+ as limite+ all o( the time,
5
su''estin' that in this *o*ulation, the "L$)
25 has a sli'ht ceilin' e((ect an+ ma- be some.hat limite+ in +etectin' im*rovement in .or# (unction/
Li#e.ise, in stu+- o( a+ults .ith musculos#eletal +isor+ers, more than 15 *ercent o( *artici*ants score+
at the ceilin'9limite+ none o( the time9in three scales on the "L$)16, .hich +i+ not meet the
authors5 criteria (or acce*table +istributive *ro*erties/
51
!he "L$)16 ma- not a+e8uatel- ta* the bur+en
e3*erience+ b- those su((erin' (rom *ain(ul musculos#eletal +isor+ers an+, there(ore, ma- be limite+ in
+etectin' im*rovement in this *o*ulation/
52
0n contrast, the "L$)16 .as the onl- instrument out o( (our
that e3hibite+ no ceilin' or (loor e((ects in measurin' the .or# limitations (ace+ b- .or#ers .ith elbo.
or shoul+er +isor+ers/
56
Overall, the abilit- o( the "L$ to +etect chan'e a**ears to var- b- *o*ulation
an+ t-*e o( health con+ition/
0.0. INTERPRETABILIT,
0nter*retabilit- is +e(ine+ as =the +e'ree to .hich one can assi'n 8ualitative meanin' to an instrument5s
8uantitative scores/>
54
!he inter*retabilit- o( the "L$ ma- be assesse+ b- e3aminin' 1& the meanin' o(
the instrument5s scale scores, 2& ho. scores var- amon' +i((erent *o*ulations, 6& ho. .ell "L$ scores
in+icate .or#er ,ob *er(ormance %e/'/, *ro+uctivit-&, an+ 4& ho. chan'es in "L$ scores re(lect
in+ivi+uals5 res*onses to treatment/ Once converte+ (rom to 1, scores (or each o( the (our "L$
scales re*resent the amount o( time an in+ivi+ual .as limite+ on the ,ob +ue to health)relate+ *roblems
+urin' the 'iven re*ortin' *erio+/
55,56
2- .a- o( e3am*le, a score o( 5 on the mental)inter*ersonal
+eman+s scale in+icates an in+ivi+ual .as limite+ in *er(ormin' co'nitive an+;or social activities at
.or# +urin' 5 *ercent o( the re*ortin' *erio+/ @++itionall-, a .ei'hte+ sum o( scale scores can be
com*uter to 'enerate the "L$ Pro+uctivit- Loss 0n+e3 score, .hich is =inter*rete+ as the *ercenta'e
re+uction in health relate+ *ro+uctivit- com*are+ to a benchmar# 'rou* o( em*lo-ees .ith no .or#
limitations/>
5:
!hus, the "L$ can be use+ to assess the amount o( time in+ivi+uals are limite+ on the
,ob as .ell as to com*are +i((erent em*lo-ee *o*ulations %e/'/, +i((erent chronic con+ition 'rou*s& to a
health- *o*ulation in terms o( *ro+uctivit- loss/ Finall-, the "L$ o(ten is use+ in clinical trials to
assess the +e'ree to .hich treatments im*act *atients5 abilit- to meet ,ob +eman+s/
5?
1.0. BURDEN
Eue to its brevit-, the "L$)25 *resents a lo. bur+en (or res*on+ents an+ has been re*orte+ to ta#e onl-
(ive minutes to com*lete/ !he "$L)16 an+ the "$L)? *resent an even lo.er bur+en (or res*on+ents/
Ho.ever, (rom the researcher5s *ers*ective, there is a tra+eo(( in re+ucin' res*on+ents5 bur+en b- usin'
the shorter versions an+ ensurin' the instrument retains a+e8uate reliabilit- an+ vali+it-/ Moreover, the
stan+ar+ re*ortin' *erio+ o( t.o .ee#s shoul+ not im*ose an- un+ue strain on res*on+ents5 abilit- to
recall their .or# limitations e3*eriences +urin' that time/
2.0. ALTERNATIVE FORMS
@lternative (orms o( the "L$ inclu+e those versions that are com*rise+ o( (e.er items than the ori'inal
25)item instrument9the "L$)16 an+ the "L$)?/ @++itionall-, there are online, *hone, an+ mail
versions o( the "L$/ Finall-, there are a number o( mo+ules that can be a**en+e+ to the ori'inal
instrument, inclu+in' a "or# @bsence mo+ule as .ell as mo+ules measurin' .or#, health, me+ical care,
an+ +emo'ra*hic characteristics/
59
3.0. CULTURAL - LANGUAGE ADAPTATIONS
!he "L$ ori'inall- .as +evelo*e+ (or use in the 1nite+ States an+ thus .as .ritten in Jn'lish %1/S/&/
0t is available in over 6 o((icial lan'ua'e translations, inclu+in' French, Nerman, S*anish, an+ 0talian/
6
10.0. DISCUSSION
10.1. S&'!*&4% a!" L)5)&a&)(!% (6 &4 WLQ
!he "L$ o((ers a number o( stren'ths as a 'eneric health)relate+ *ro+uctivit- outcomes measurement
instrument/ First, its conce*tual mo+el9an+ resultin' measurement mo+el9ca*ture .or# limitations
outcomes that are relevant to a variet- o( ,obs, are consi+ere+ im*ortant (rom the .or#er5s *ers*ective,
an+ o(ten are relate+ to on)the),ob *ro+uctivit-/
61
@s a result, the "L$ can be use+ to com*are .or#
limitations outcomes across a .i+e ran'e o( *h-sical an+ emotional health *roblems/ Secon+, the (our
scales com*risin' the "L$ allo. one to +iscern ho. +i((erent health *roblems im*act +i((erent as*ects
o( ,ob *er(ormance/ 2- .a- o( e3am*le, arthritis li#el- .ill limit in+ivi+uals (rom meetin' *h-sical ,ob
+eman+s .hile +e*ression .ill be more li#el- to limit .or#ers5 abilit- to meet mental)inter*ersonal
+eman+s/ !hir+, in terms o( *s-chometric *ro*erties, the "L$ +emonstrates a+e8uate reliabilit- an+
vali+it- amon' a variet- o( chronic con+ition 'rou*s %*articularl- the "L$)25&7 im*oses onl- a
minimal bur+en on res*on+ents7 an+, since it is a sel()re*ort instrument, 'enerall- shoul+ not *rove cost)
*rohibitive in most research situations/ @n a++itional stren'th o( the "L$ is that its *otential uses an+
a**lications, .hich are +iscusse+ belo., e3ten+ be-on+ sim*l- measurin' in+ivi+uals5 .or# limitations/
!he "L$ e3hibits a (e. notable .ea#nesses/ 0n *articular, the e3tent that the "L$ is
res*onsive to chan'es in outcomes in +i((erent *o*ulations remains relativel- un#no.n/ !his *artl- is
+ue to the (act that res*onsiveness, *er se, has not been e3tensivel- e3amine+ to +ate as .ell as +ue to
the ceilin' e((ects that have emer'e+ in the stu+ies +escribe+ above/ @++itionall-, the 8uestionnaire itsel(
as#s res*on+ents to thin# about three +i((erent *otential in(luences on their .or# *ro+uctivit-9*h-sical
health *roblems, emotional health *roblems, an+ the e((ects o( an- relate+ treatments/ !hus, re'ar+less
o( the *o*ulation in .hich the 8uestionnaire is a+ministere+, it cannot be ascertaine+ .ith certaint-
.hich o( these three (actors is lea+in' to an- 'iven res*on+ent5s +i((icult- meetin' a *articular ,ob
+eman+/ Finall-, 'iven the nature o( .or# in these technolo'icall-)oriente+ times, the *h-sical +eman+s
scale ma- measure a construct that has become obsolete (or a lar'e number o( ,obs an+ there(ore ma-
not be ta**in' an area o( .or# on .hich health *roblems im*ose a measurable bur+en (or .or#ers/
10.2. U%% a!" A77l)ca&)(!% (6 &4 WLQ
!he Scienti(ic @+visor- 4ommittee o( the Me+ical Outcomes !rust +escribes three *otential uses (or
health outcomes instruments, inclu+in' +istin'uishin' bet.een t.o or more 'rou*s, assessin' chan'e
over time, an+ *re+ictin' (uture status/
62
!he "L$ can be use+ (or all three *ur*oses in such research
conte3ts as clinical trials, observational research, an+ health *ro'ram evaluations/
66
@s +iscusse+ above,
the "L$ is an e((ective tool (or assessin' the +i((erence in .or# limitations (ace+ b- .or#ers .ith
+i((erent *h-sical an+ emotional health *roblems as .ell as (or assessin' the +i((erence bet.een ill
.or#ers com*are+ to health- controls or bet.een +i((erent severit- levels o( the same +isease/ @lon' the
same lines, the "L$ can be use+ to +etermine a 8uantitative mar#er o( on)the),ob *ro+uctivit- loss9
resultin' (rom .or# limitations9an+ ho. such loss ma- +i((er amon' +i((erent 'rou*s o( .or#ers/ !o
that en+, the "L$ Pro+uctivit- Loss 0n+e3 can be com*ute+ as the *ercenta'e +i((erence in out*ut
*ro+uce+ b- an ill em*lo-ee *o*ulation com*are+ to a health- benchmar# *o*ulation/
64
@lthou'h "L$
scale scores cannot be +irectl- converte+ into +ollar units, the "$L Pro+uctivit- Loss 0n+e3 can be use+
to calculate an em*lo-er5s *er .or#er *er -ear *ro+uctivit- losses in +ollar terms/ 2- .a- o( e3am*le,
one stu+- (oun+ that, base+ on the "$L Pro+uctivit- Loss 0n+e3, the losses attributable to em*lo-ee
*resenteeism at a lar'e telecommunications (irm ran'e+ (rom (ive to seven *ercent, translatin' to an
annual *er)em*lo-ee loss o( O2 to O2? .hen base+ on the avera'e annual salar-/
65
@lthou'h evi+ence on the "L$5s abilit- to +etect chan'e over time in various *o*ulations is
mi3e+, the instrument has +emonstrate+ a+e8uate res*onsiveness to chan'es in .or# limitations
outcomes in a select number o( stu+ies/ 2- .a- o( e3am*le, the "$L has been use+ to assess chan'es
in .or#ers5 ,ob *er(ormance in res*onse to treatment (or insomnia/
66
Future research shoul+ (ocus on
i+enti(-in' ho. an+ in .hat research conte3ts the "$L can be use+ e((ectivel- to measure chan'e/
Finall-, not onl- can the "$L Pro+uctivit- Loss 0n+e3 score be use+ to estimate *ro+uctivit-
losses, but the in+ivi+ual "$L scale scores also can be use+ to *re+ict actual *ro+uctivit- losses .hen
controllin' (or such (actors as ,ob characteristics an+ em*lo-ee characteristics/ 0n a stu+- o( em*lo-ees
servin' in customer service roles at a lar'e (irm, the time mana'ement, *h-sical +eman+s, an+ out*ut
+eman+s scales .ere statisticall- si'ni(icantl- associate+ .ith .or#er *ro+uctivit-9(or ever- 1)*oint
increase in scale score %i/e/, 1C increase in .or# limitations&, total em*lo-ee *ro+uctivit- +ecrease+ b-
as much as (ive *ercent/
6:
Niven the variet- o( a**lications o( the "L$, this instrument is use(ul to a
ran'e o( sta#ehol+ers, inclu+in' em*lo-ers an+ their health *lan a+ministrators, the *harmaceutical
in+ustr-, +isease mana'ement *ro'rams, an+ other health *ro'ram an+ *olic- +evelo*ers an+ anal-sts/
1
Patient)Ae*orte+ Outcome an+ $ualit- o( Li(e 0nstruments Eatabase %Pro$OL0E&/ !he .or# limitations 8uestionnaire/
Bul- 29/ Phtt*:;;.../*ro8oli+/or';instruments;.or#QlimitationsQ8uestionnaireQ.l8R @ccesse+ 61 October 29/
2
Lerner E, @mic# 24, Ao'ers "H, Mals*eis S, 2un'a- S, 4-nn, E/ !he "or# Limitations $uestionnaire/ Me+ical 4are/
21 Ban769%1&::2)?5/
6
21 Ban769%1&::2)?5/
4
!u(ts Me+ical 4enter/ 0nstitute (or 4linical Aesearch an+ Health Polic- Stu+ies/ !he "or# Limitations $uestionnaire/
26/ Phtt*:;;16/19/11/162;icrh*s;res*ro';thi;.l8/as*R @ccesse+ 61 October 29/
5
Lerner E, 4han' H, Ao'ers "H, 2enson 4, Schein B, @llaire S/ @ metho+ (or im*utin' the im*act o( health *roblems on
at).or# *er(ormance an+ *ro+uctivit- (rom available health +ata/ Bournal o( Occu*ational an+ Jnvironmental Me+icine/
29 Ma-751%5&:515)24/
6
:
!u(ts .ebsite, OMmin#o.s#i
?
Me+ical Outcomes !rust Scienti(ic @+visor- 4ommittee/ 0nstrument Aevie. 4riteria/ Medical Outcomes Trust Bulletin.
1995/
9
1995/
1
21 Ban769%1&::2)?5/
11
21 Ban769%1&::2)?5/
12
21 Ban769%1&::2)?5/
16
21 Ban769%1&::2)?5/
14
21 Ban769%1&::2)?5/
15
21 Ban769%1&::2)?5/
16
21 Ban769%1&::2)?5/
1:
Sane, Aobert L/ 26/ 1n+erstan+in' Health 4are Outcomes/ Bones an+ 2arlett Publishers, 0nc/ 2oston, Massachusetts/
1?
1995/
19
2
21 Ban769%1&::2)?5/
21
Prasa+ M, "ahl8vist P, Shi#iar A, Shih T4/ @ revie. o( sel()re*ort instruments measurin' health)relate+ .or#
*ro+uctivit-: a *atient)re*orte+ outcomes *ers*ective/ Pharmacoeconomics/ 24722%4&:225)44/
22
Lo(lan+ BH, PiMMi L, Fric# SE/ @ revie. o( health)relate+ .or#*lace *ro+uctivit- loss instruments/ Pharmacoeconomics/
24722%6&:165)?4/
26
Jric#son SA, Nuthrie S, Lanetten)Lee M, Himle B, Ho((man B, Santos SF, Banec# @S, Uivin S, @belson BL/ Severit- o(
an3iet- an+ .or#)relate+ outcomes o( *atients .ith an3iet- +isor+ers/ Depression and Anxiety/ 29 Oct 19:1):/
24
Lerner E, @mic# 24 6r+, Lee B4, Aoone- !, Ao'ers "H, 4han' H, 2ern+t JA/ Aelationshi* o( em*lo-ee)re*orte+ .or#
limitations to .or# *ro+uctivit-/ Me+ical 4are/ 26 Ma-741%5&:649)59/
25
Lerner E, Aee+ B0, Massarotti J, "ester LM, 2ur#e !@/ !he "or# Limitations $uestionnaireVs vali+it- an+ reliabilit-
amon' *atients .ith osteoarthritis/ Bournal o( 4linical J*i+emiolo'-/ 22 Feb755%2&:19:)2?/
26
2eaton EJ, Senne+- 4@/ 2e-on+ return to .or#: testin' a measure o( at).or# +isabilit- in .or#ers .ith musculos#eletal
*ain/ Quality of Life Research/ 25 Oct714%?&:1?69):9/
2:
!an' S, Pitts S, Sol.a- S, 2eaton E/ 4om*arison o( the *s-chometric *ro*erties o( (our at).or# +isabilit- measures in
.or#ers .ith shoul+er or elbo. +isor+ers/ Journal of Occupational Rehailitation/ 29 Bun719%2&:142)54/
2?
1995/
29
6
21 Ban769%1&::2)?5/
61
Lerner E, @mic# 24, Ao'ers "H, Mals*eis S, 2un'a- S, 4-nn, E/ !he "or# Limitations $uestionnaire/ Medical !are/
21 Ban769%1&::2)?5/
62
66
Lavi'ne BJ, Nri''s BB, !u WM, Lerner EB/ Hot (lashes, (ati'ue, treatment e3*osures an+ .or# *ro+uctivit- in breast
cancer survivors/ Bournal o( 4ancer Survivorshi*/ 2? Eec72%4&:296)62/
64
Lerner E, @+ler E@, 4han' H, 2ern+t JA, 0rish B!, La*its#- L, Hoo+ MT, Aee+ B, Ao'ers "H/ !he clinical an+
occu*ational correlates o( .or# *ro+uctivit- loss amon' em*lo-e+ *atients .ith +e*ression/ Bournal o( Occu*ational an+
Jnvironmental Me+icine/ 24 Bun746%6 Su**l&:S46)55/
65
Lerner 22
66
Lavi'ne BJ, Nri''s BB, !u WM, Lerner EB/ Hot (lashes, (ati'ue, treatment e3*osures an+ .or# *ro+uctivit- in breast cancer
survivors/ Bournal o( 4ancer Survivorshi*/ 2? Eec72%4&:296)62/
6:
6?
69
amon' *atients .ith osteoarthritis/ Journal of !linical "pidemiolo#y/ 22 Feb755%2&:19:)2?/
4
1995/
41
42
46
2urton "N, Mc4alister S!, 4hen 4T, J+in'ton E"/ !he association o( health status, .or#site (itness center
*artici*ation, an+ t.o measures o( *ro+uctivit-/ Journal of Occupational and "n$ironmental Medicine/ 25
@*r74:%4&:646)51/
44
45
46
2urton 25
4:
1995/
4?
49
5
51
52
56
54
1995/
55
Lo(lan+ BH, PiMMi L, Fric# SE/ @ revie. o( health)relate+ .or#*lace *ro+uctivit- loss instruments/ Pharmacoeconomics/
24722%6&:165)?4/
56
5:
5?
Jrman M, Nuirau+ @, Boish LN, Lerner E/ Uol*i+em e3ten+e+)release 12/5 m' associate+ .ith im*rovements in .or#
*er(ormance in a 6)month ran+omiMe+, *lacebo)controlle+ trial/ Slee*/ 2? Oct 1761%1&:16:1)?/
59
6
61
62
1995/
66
Lerner E, 4han' H, Ao'ers "H, 2enson 4, Schein B, @llaire S/ @ metho+ (or im*utin' the im*act o( health *roblems on
at).or# *er(ormance an+ *ro+uctivit- (rom available health +ata/ Bournal o( Occu*ational an+ Jnvironmental Me+icine/
29 Ma-751%5&:515)24/
64
65
OMmin#o.s#i AB, NoetMel AU, 4han' S, Lon' S/ !he a**lication o( t.o health an+ *ro+uctivit- instruments at a lar'e
em*lo-er/ Journal of Occupational and "n$ironmental Medicine/ 24 Bul746%:&:665)4?/
66
Jrman M, Nuirau+ @, Boish LN, Lerner E/ Uol*i+em e3ten+e+)release 12/5 m' associate+ .ith im*rovements in .or#
*er(ormance in a 6)month ran+omiMe+, *lacebo)controlle+ trial/ Slee*/ 2? Oct 1761%1&:16:1)?/
6:
Lerner E, @mic# 24 6r+, Lee B4, Aoone- !, Ao'ers "H, 4han' H, 2ern+t JA/ Aelationshi* o( em*lo-ee)re*orte+ .or#
limitations to .or# *ro+uctivit-/ Medical !are/ 26 Ma-741%5&:649)59/

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