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Objective: Systemic sclerosis (SSc) can restrict employment participation. Our objectives were to comparatively evaluate health factors, work factors, and workplace accommodations between those who are employed and those who recently gave up employment., Methods: A cross-sectional study was conducted of employed and recently working, but now unemployed, individuals with SSc. Demographics, employment sectors, health factors, flare frequency, work context, and information about the need, availability, and use of workplace supports were collected., Results: Participants were 140 individuals (108 [77.1%] women, 32 [22.9%] men), of whom 110 (78.6%) were employed and 30 (21.4%) were unemployed. Participants worked in education/health/sciences/arts (n = 51, 36.4%), sales/retail (n = 23, 16.5%), banking/insurance/business/technology (n = 22, 15.7%), government (n = 15, 10.7%), construction/utilities (n = 10, 7.1%), and manufacturing/agriculture/mining/logging (n = 10, 7.1%). Employed participants had a lower mean age (48.4 vs 54.3 yrs), and higher level of education (77.3% with postsecondary education vs 22.7% without). Those who had no flares were more frequently employed (41.7%), compared to those who had 1 to 2 flares (35.2%) and ≥ 3 flares (23.1%). The availability of workplace accommodations differed significantly between the employed and unemployed: flexible hours (74.5% vs 40%, P = 0.0005), more rest periods (73.6% vs 46.7%, P = 0.0001), special equipment (82.7% vs 46.7%, P < 0.0001), and work schedule flexibility (66.4% vs 33.3%, P = 0.003)., Conclusion: Health factors alone do not differentiate those who are employed and those who gave up employment. This study lays the groundwork for where SSc-specific efforts in workplace policies and practices should be directed, especially workplace support., (Copyright © 2024 by the Journal of Rheumatology.)

Objective: The Outcome Measures in Rheumatology (OMERACT) Worker Productivity Group continues efforts to assess psychometric properties of measures of presenteeism., Methods: Psychometric properties of single-item and dual answer multiitem scales were assessed, as well as methods to evaluate thresholds of meaning., Results: Test-retest reliability and construct validity of single item global measures was moderate to good. The value of measuring both degree of difficulty and amount of time with difficulty in multiitems questionnaires was confirmed. Thresholds of meaning vary depending on methods and external anchors applied., Conclusion: We have advanced our understanding of the performance of presenteeism measures and have developed approaches to describing thresholds of meaning.

Objective: Indicators of work role functioning (being at work, and being productive while at work) are important outcomes for persons with arthritis. As the worker productivity working group at OMERACT (Outcome Measures in Rheumatology), we sought to provide an evidence base for consensus on standardized instruments to measure worker productivity [both absenteeism and at-work productivity (presenteeism) as well as critical contextual factors]., Methods: Literature reviews and primary studies were done and reported to the OMERACT 12 (2014) meeting to build the OMERACT Filter 2.0 evidence for worker productivity outcome measurement instruments. Contextual factor domains that could have an effect on scores on worker productivity instruments were identified by nominal group techniques, and strength of influence was further assessed by literature review., Results: At OMERACT 9 (2008), we identified 6 candidate measures of absenteeism, which received 94% endorsement at the plenary vote. At OMERACT 11 (2012) we received over the required minimum vote of 70% for endorsement of 2 at-work productivity loss measures. During OMERACT 12 (2014), out of 4 measures of at-work productivity loss, 3 (1 global; 2 multiitem) received support as having passed the OMERACT Filter with over 70% of the plenary vote. In addition, 3 contextual factor domains received a 95% vote to explore their validity as core contextual factors: nature of work, work accommodation, and workplace support., Conclusion: Our current recommendations for at-work productivity loss measures are: WALS (Workplace Activity Limitations Scale), WLQ PDmod (Work Limitations Questionnaire with modified physical demands scale), WAI (Work Ability Index), WPS (Arthritis-specific Work Productivity Survey), and WPAI (Work Productivity and Activity Impairment Questionnaire). Our future research focus will shift to confirming core contextual factors to consider in the measurement of worker productivity.

Objective: To examine perceived independence, overprotection, and support, and their association with the employment participation of young adults with rheumatic disease., Methods: One hundred and forty-three young adults, ages 18 to 30 years, with systemic lupus erythematosus (54.5%) and juvenile arthritis (45.5%) completed a 30-min online questionnaire of their work and education experiences. Information collected was demographic, health (e.g., pain, fatigue, disease activity), work context (e.g., career satisfaction, helpfulness of job accommodation/benefits, and workplace activity limitations), and psychosocial (e.g., independence, social support, and overprotection). Log-Poisson regression analysis examined factors associated with employment status., Results: Over half of respondents were employed (59%) and 26% were enrolled in school. Respondents reported moderate to high perceptions of independence and social support. However, 27% reported that "quite a bit" to "a great deal" of overprotection characterized their relationships with those closest to them. At the bivariate level, employed participants and those indicating greater perceived independence reported greater social support and less overprotection. Multivariable analysis revealed that being employed was associated with older age, more job accommodations/benefits perceived as being helpful, and greater perceived independence., Conclusion: This is one of the first studies examining the employment of young adults with rheumatic diseases. Findings highlight the importance of psychosocial perceptions such as independence and overprotection, in addition to support related to working. Additional research is needed to better understand the role of those close to young adults with rheumatic diseases in supporting independence and encouraging employment.

The objective of the Outcome Measures in Rheumatology (OMERACT) Worker Productivity working group is to identify worker productivity outcome measures that meet the requirements of the OMERACT filter. At the OMERACT 11 Workshop, we focused on the at-work limitations/productivity component of worker productivity (i.e., presenteeism) - an area with diverse conceptualization and instrumentation approaches. Various approaches to quantify at-work limitations/productivity (e.g., single-item global and multi-item measures) were examined, and available evidence pertaining to OMERACT truth, discrimination, and feasibility were presented to conference participants. Four candidate global measures of presenteeism were put forth for a plenary vote to determine whether current evidence meets the OMERACT filter requirements. Presenteeism globals from the Work Productivity and Activity Impairment Questionnaire (72% support) and Rheumatoid Arthritis-specific Work Productivity Survey (71% support) were endorsed by conference participants; however, neither the presenteeism global item from the Health and Work Performance Questionnaire nor the Quantity and Quality method achieved the level of support required for endorsement at the present time. The plenary was also asked whether the central item from the Work Ability Index should also be considered as a candidate measure for potential endorsement in the future. Of participants at the plenary, 70% supported this presenteeism global measure. Progress was also made in other areas through discussions at individual breakout sessions. Topics examined include the merits of various multi-item measures of at-work limitations/productivity, methodological issues related to interpretability of outcome scores, and approaches to appraise and classify contextual factors of worker productivity. Feedback gathered from conference participants will inform the future research agenda of the working group.

Objective: To estimate and compare lost work hours attributable to presenteeism, defined as reduced productivity while working, in individuals with osteoarthritis (OA) or rheumatoid arthritis (RA), according to 4 instruments., Methods: In our prospective study, 250 workers with OA (n = 130) or RA (n = 120) were recruited from community and clinical sites. Lost hours due to presenteeism at baseline were estimated using the Health and Labor Questionnaire (HLQ), the Work Limitations Questionnaire (WLQ), the World Health Organization's Health and Work Performance Questionnaire (HPQ), and the Work Productivity and Activity Impairment Questionnaire (WPAI). Only those respondents working over the past 2 weeks were included. Repeated-measures ANOVA was used to compare the lost-time estimates, according to each instrument., Results: Of the 212 respondents included in the analyses, the frequency of missing and "0" values among the instruments was different (17% and 61% for HLQ, 8% and 5% for WLQ, 1% and 16% for HPQ, 0% and 27% for WPAI, respectively). The average numbers of lost hours (SD) per 2 weeks due to presenteeism using HLQ, WLQ, HPQ, and WPAI were 1.6 (3.9), 4.0 (3.9), 13.5 (12.5), and 14.2 (16.7). The corresponding costs for the 2-week period were CAN$30.03, $83.05, $284.07, and $285.10. The differences in the lost-hour estimates according to instruments were significant (p < 0.001)., Conclusion: Among individuals with arthritis, estimates of productivity losses while working vary widely according to the instruments chosen. Further research on instrument design and implications for a standardized approach to estimate lost time due to presenteeism is needed.

Objective: To assess the importance of different social roles in the lives of people with osteoarthritis (OA), and satisfaction with time spent in roles and role performance, as well as the relationship of demographic, health, and psychological factors to role perceptions., Methods: Sixty women and 27 men (age 42-86 yrs) with hip or knee OA were recruited from rehabilitation programs and community advertising. Participants completed interview-administered questionnaires measuring demographics, OA symptoms, activity limitations, and well-being (e.g., depression). They also completed the Social Role Participation Questionnaire (SRPQ) assessing the influence of arthritis on role salience and satisfaction across diverse role domains (e.g., close relationships, employment)., Results: Participants reported many salient roles, but low to moderate satisfaction with them related to OA. SRPQ dimensions of salience and satisfaction were distinct; satisfaction with time spent in roles and with role performance was highly correlated (r = 0.83). Lower role salience was associated with being older, having less education and income, and greater illness intrusiveness. Less satisfaction with time spent in roles due to OA was associated with being younger, greater pain, and greater illness intrusiveness, whereas less satisfaction with role performance was associated with greater illness intrusiveness and depression., Conclusion: This study addresses a gap -- the influence of OA on social role participation. It underscores the importance of taking into account individual perceptions of roles, and that these perceptions are multifaceted. Understanding diverse factors related to social roles may help identify individuals at risk for role difficulties and provide targets for interventions to improve role participation.

Objective: To examine the role of demographic, illness-related, workplace support, workplace activity limitations, arthritis-related work changes, and psychosocial factors in predicting subsequent depressive symptoms among employed people with arthritis., Methods: In a prospective study, 366 employed individuals with arthritis were recruited from Toronto, Canada. Respondents completed a structured questionnaire assessing demographic, disease-related factors, workplace support, and employment-related transitions, as well as psychosocial variables at 2 timepoints 18 months apart. Depression was assessed using the Center for Epidemiologic Studies Depression Scale. Hierarchical multiple regression was used for analyses., Results: Individuals with greater education reported significantly less depression. Lower workplace support and greater workplace activity limitations were significantly associated with future depressive symptoms. No relationship was found between work transitions and later depression, but more work changes were strongly associated with concurrent depressive symptoms. An association was also found between greater pain catastrophizing and future depressive symptoms., Conclusion: Our results highlight the need to assess the influence of work-related changes, workplace support, and psychosocial variables on depressive symptoms among people with arthritis. These findings suggest that workplace interventions should address not only ways to reduce workplace activity limitations, but also ways to better manage emotional distress related to working with arthritis.