Translation, cross-cultural adaptation and validation of the
Translation, cross-cultural adaptation and validation of the
Work Role Functioning Questionnaire (WRFQ) to Spanish
Work Role Functioning Questionnaire (WRFQ) to Spanish
spoken in Spain
spoken in Spain
Traducción, adaptación cultural y validación del Work Role
Traducción, adaptación cultural y validación del Work Role
Functioning Questionnaire (WRFQ) al castellano hablado en España.
Functioning Questionnaire (WRFQ) al castellano hablado en España.
José María Ramada Rodilla
José María Ramada Rodilla
TESI DOCTORAL UPF / 2014
TESI DOCTORAL UPF / 2014
DIRECTORS DE LA TESI
DIRECTORS DE LA TESI
Dra. Consol Serra Pujadas
CiSAL – Centro de Investigación en Salud Laboral, Universidad Pompeu Fabra.
PRBB Building. Doctor Aiguader, 88. 08003- Barcelona, España.
Dra. Consol Serra Pujadas
CiSAL – Centro de Investigación en Salud Laboral, Universidad Pompeu Fabra.
PRBB Building. Doctor Aiguader, 88. 08003- Barcelona, España.
Dr. George L Delclós Clanchet
Southwest Center for Occupational and Environmental Health, the University of
Texas School of Public Health. 1200 Pressler Street. Houston, Texas 77030, USA.
Dr. George L Delclós Clanchet
Southwest Center for Occupational and Environmental Health, the University of
Texas School of Public Health. 1200 Pressler Street. Houston, Texas 77030, USA.
DEPARTAMENT DE CIÈNCIES EXPERIMENTALS I DE LA SALUT
DEPARTAMENT DE CIÈNCIES EXPERIMENTALS I DE LA SALUT
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A mis tres hijos, que son la pasión de mi vida,
por su capacidad para comprender, aceptar y amar.
A la memoria de mi padre a quien tanto le debo.
A mis tres hijos, que son la pasión de mi vida,
por su capacidad para comprender, aceptar y amar.
A la memoria de mi padre a quien tanto le debo.
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AKNOWLEDGEMENTS (Agradecimientos – Agraïments)
AKNOWLEDGEMENTS (Agradecimientos – Agraïments)
Esta tesis llega cuando en mis gafas ya necesito una cierta adición de dioptrías
Esta tesis llega cuando en mis gafas ya necesito una cierta adición de dioptrías
para poder leer de cerca. Así que quiero comenzar por dar las gracias a todos los
para poder leer de cerca. Así que quiero comenzar por dar las gracias a todos los
que toman decisiones sobre el futuro académico de las personas sabiendo que el
que toman decisiones sobre el futuro académico de las personas sabiendo que el
empuje de la juventud no está en la edad sino en el espíritu.
empuje de la juventud no está en la edad sino en el espíritu.
Me viene a la cabeza la leyenda de San Agustín de Hipona y el niño en la playa y
Me viene a la cabeza la leyenda de San Agustín de Hipona y el niño en la playa y
no sé cómo voy a meter, con mi capacidad limitada, todo el agua del mar en un
no sé cómo voy a meter, con mi capacidad limitada, todo el agua del mar en un
hoyo tan pequeño. También ahora, en esta parte de mi tesis, se me ha pasado
hoyo tan pequeño. También ahora, en esta parte de mi tesis, se me ha pasado
por la cabeza buscar el respaldo de mis Directores para controlar los sesgos, pero
por la cabeza buscar el respaldo de mis Directores para controlar los sesgos, pero
no he querido correr el riesgo de que me recomienden la realización de otra
no he querido correr el riesgo de que me recomienden la realización de otra
revisión sistemática. Así que con mis solas palabras asumo el reto en solitario.
revisión sistemática. Así que con mis solas palabras asumo el reto en solitario.
Moltíssimes gràcies Consol. Gràcies mestra. La llista dels motius pel quals em
Moltíssimes gràcies Consol. Gràcies mestra. La llista dels motius pel quals em
sento tan agraït amb tu podria ser interminable. Comptes amb tota la meva
sento tan agraït amb tu podria ser interminable. Comptes amb tota la meva
admiració i respecte per la teva decència professional com a metgessa del treball i
admiració i respecte per la teva decència professional com a metgessa del treball i
investigadora, per la teva particular i innovadora visió de la salut laboral,
investigadora, per la teva particular i innovadora visió de la salut laboral,
professionalitat i capacitat com a directora de tesi. Gràcies pel teu suport
professionalitat i capacitat com a directora de tesi. Gràcies pel teu suport
permanent en aquest projecte i per ser, en l’hospital on treballem, una cap i una
permanent en aquest projecte i per ser, en l’hospital on treballem, una cap i una
companya de treball infatigable, incombustible. Mil gràcies per totes les
companya de treball infatigable, incombustible. Mil gràcies per totes les
oportunitats que m'has anat oferint al llarg d’aquestos darrers anys i que he
oportunitats que m'has anat oferint al llarg d’aquestos darrers anys i que he
intentat aprofitar sempre.
intentat aprofitar sempre.
Gracias Jordi, por guiar mis primeros pasos en el mundo de la investigación en
Gracias Jordi, por guiar mis primeros pasos en el mundo de la investigación en
2010, siendo mi tutor del Máster en Salud Laboral; en ese momento empezó a
2010, siendo mi tutor del Máster en Salud Laboral; en ese momento empezó a
gestarse la posibilidad de seguir más allá, después del Máster. Gracias maestro,
gestarse la posibilidad de seguir más allá, después del Máster. Gracias maestro,
por enseñarme tanto en la Unidad de Patología Laboral, por la magnífica
por enseñarme tanto en la Unidad de Patología Laboral, por la magnífica
experiencia en la Escuela de Salud Pública de la Universidad de Texas, por poner
experiencia en la Escuela de Salud Pública de la Universidad de Texas, por poner
a mi disposición tu enorme valía como clínico y como profesor. Gracias por tu
a mi disposición tu enorme valía como clínico y como profesor. Gracias por tu
humanidad, consideración, accesibilidad, ejemplaridad como investigador y
humanidad, consideración, accesibilidad, ejemplaridad como investigador y
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paciencia como director de tesis. También, gracias a Conchita por su hospitalidad
paciencia como director de tesis. También, gracias a Conchita por su hospitalidad
y amabilidad durante mi estancia en Houston (Texas) en 2013.
y amabilidad durante mi estancia en Houston (Texas) en 2013.
Gracias Fernando, por abrirme las puertas del CiSAL, por tus constantes
Gracias Fernando, por abrirme las puertas del CiSAL, por tus constantes
propuestas para involucrarme en proyectos y por tu apoyo desde el primer minuto
propuestas para involucrarme en proyectos y por tu apoyo desde el primer minuto
para que mi estancia en la Universidad de Groningen (Holanda) en 2013 fuera
para que mi estancia en la Universidad de Groningen (Holanda) en 2013 fuera
posible.
posible.
Thank you Ute, Femke and Iris (University Medical Center Groningen, The
Thank you Ute, Femke and Iris (University Medical Center Groningen, The
Netherlands). Your warm welcome, support and help in this thesis at any time in
Netherlands). Your warm welcome, support and help in this thesis at any time in
Groningen were invaluable. Thank you, Roy, for making statistical analysis
Groningen were invaluable. Thank you, Roy, for making statistical analysis
understandable and also for your kind and disinterested help and availability at all
understandable and also for your kind and disinterested help and availability at all
times.
times.
Gràcies a la Direcció del PSMAR, on exerceixo com a metge del treball. Gràcies
Gràcies a la Direcció del PSMAR, on exerceixo com a metge del treball. Gràcies
per fer realitat que aquesta organització sigui un dels pols més dinàmics de
per fer realitat que aquesta organització sigui un dels pols més dinàmics de
coneixement assistencial, docent i de recerca de la ciutat de Barcelona. Gràcies
coneixement assistencial, docent i de recerca de la ciutat de Barcelona. Gràcies
pel suport prestat per l'obtenció de la menció europea al títol de doctorat. Gràcies
pel suport prestat per l'obtenció de la menció europea al títol de doctorat. Gràcies
als/les companys/es metges/esses i infermers/es del PSMAR, que m'han ajudat
als/les companys/es metges/esses i infermers/es del PSMAR, que m'han ajudat
amb tanta generositat en el treball de camp.
amb tanta generositat en el treball de camp.
Gràcies als companys i companyes del Servei de Salut Laboral del PSMAR, pel
Gràcies als companys i companyes del Servei de Salut Laboral del PSMAR, pel
suport donat a aquest projecte sempre que l’he necessitat: a Aida, a Carmen, a
suport donat a aquest projecte sempre que l’he necessitat: a Aida, a Carmen, a
Chelo, a Julià i a Nuria. Mil gràcies a Fina Pi-Sunyer i a Joan Mirabent, per ser tan
Chelo, a Julià i a Nuria. Mil gràcies a Fina Pi-Sunyer i a Joan Mirabent, per ser tan
excel·lents infermers del treball i per tanta generositat en vostra col·laboració
excel·lents infermers del treball i per tanta generositat en vostra col·laboració
durant el treball de camp. Moltíssimes gràcies Dra. Villar (Rocio), sense el teu
durant el treball de camp. Moltíssimes gràcies Dra. Villar (Rocio), sense el teu
suport i companyonia de veritable col·lega tal vegada la estada a Groningen no
suport i companyonia de veritable col·lega tal vegada la estada a Groningen no
hagués estat possible. De tot cor, moltes gràcies companys i companyes.
hagués estat possible. De tot cor, moltes gràcies companys i companyes.
Gracias a los amigos y amigas del CiSAL-UPF por contar siempre conmigo, a
Gracias a los amigos y amigas del CiSAL-UPF por contar siempre conmigo, a
pesar de no estar físicamente presente en el PRBB. Gracias a Montse Fernández
pesar de no estar físicamente presente en el PRBB. Gracias a Montse Fernández
y a Sandra Garrido por su ayuda siempre diligente en cualquier gestión con la
y a Sandra Garrido por su ayuda siempre diligente en cualquier gestión con la
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Universidad y con el CIBERSP. Gracias a María López por el ánimo ofrecido en
Universidad y con el CIBERSP. Gracias a María López por el ánimo ofrecido en
todo momento y a Sergio Vargas por todos los favores realizados durante estos
todo momento y a Sergio Vargas por todos los favores realizados durante estos
años.
años.
Y para terminar gracias a mis hermanas y a mi madre, siempre disponibles. Yo
Y para terminar gracias a mis hermanas y a mi madre, siempre disponibles. Yo
siento por vosotras tres verdadera devoción; a Ram Dulthummon por su apoyo y
siento por vosotras tres verdadera devoción; a Ram Dulthummon por su apoyo y
por sus palabras (always in English) para poner algún límite a mi fantasía a veces
por sus palabras (always in English) para poner algún límite a mi fantasía a veces
desbordada y ayudarme a mantener los pies sobre la tierra; a mis tres hijos José,
desbordada y ayudarme a mantener los pies sobre la tierra; a mis tres hijos José,
Borja y María Ángeles, por su generosa ayuda con la base de datos, por soportar
Borja y María Ángeles, por su generosa ayuda con la base de datos, por soportar
mil veces los ensayos de mis exposiciones y por sus muestras de aliento
mil veces los ensayos de mis exposiciones y por sus muestras de aliento
permanente.
permanente.
Y como no, gracias a la madre de mis tres hijos, Ángeles Calaforra, por su
Y como no, gracias a la madre de mis tres hijos, Ángeles Calaforra, por su
inmensa generosidad, por estar siempre ahí cuando ha sido necesario, por su
inmensa generosidad, por estar siempre ahí cuando ha sido necesario, por su
paciencia inagotable, y por sus consejos siempre sensatos cuando han aparecido
paciencia inagotable, y por sus consejos siempre sensatos cuando han aparecido
dudas sobre el sentido de este proyecto en este momento de mi vida.
dudas sobre el sentido de este proyecto en este momento de mi vida.
A todos y todas, un millón de gracias.
A todos y todas, un millón de gracias.
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SUMMARY
SUMMARY
Background
Background
Health and work mutually influence the working population. Health-related work
Health and work mutually influence the working population. Health-related work
functioning is the worker’s ability to meet work demands for a given health status.
functioning is the worker’s ability to meet work demands for a given health status.
Quality validated measurement tools are needed to assess how workers function
Quality validated measurement tools are needed to assess how workers function
at work along their professional life course and to evaluate interventions to
at work along their professional life course and to evaluate interventions to
accommodate job conditions to the worker’s skills and health status.
accommodate job conditions to the worker’s skills and health status.
The use of directly translated measurement tools may lead to unreliable or
The use of directly translated measurement tools may lead to unreliable or
misleading results in research and practice, and could limit the exchange of
misleading results in research and practice, and could limit the exchange of
information in the scientific community. Due to possible cultural differences in
information in the scientific community. Due to possible cultural differences in
perception of work, health and disease, instruments developed in other languages
perception of work, health and disease, instruments developed in other languages
or cultures should be systematically translated, adapted and validated for use in
or cultures should be systematically translated, adapted and validated for use in
different target languages or cultures.
different target languages or cultures.
The Work Role Functioning Questionnaire (WRFQ) is an instrument designed to
The Work Role Functioning Questionnaire (WRFQ) is an instrument designed to
measure self-perceived difficulties to perform work, in active workers, given a
measure self-perceived difficulties to perform work, in active workers, given a
certain health condition. Its results can be interpreted in terms of work functioning,
certain health condition. Its results can be interpreted in terms of work functioning,
work performance, work productivity, work disability and presenteeism, and they
work performance, work productivity, work disability and presenteeism, and they
can be transformed into meaningful social and economic outcomes.
can be transformed into meaningful social and economic outcomes.
Objective
Objective
The aim of this thesis was to provide a high quality validated instrument in
The aim of this thesis was to provide a high quality validated instrument in
Spanish, able to assess the impact of health on “work functioning” and describe
Spanish, able to assess the impact of health on “work functioning” and describe
the extent to which workers improve or deteriorate their ability to meet the
the extent to which workers improve or deteriorate their ability to meet the
demands of the job in Spanish-speaking populations.
demands of the job in Spanish-speaking populations.
This overall objective was carried out through three specific objectives: 1) to
This overall objective was carried out through three specific objectives: 1) to
review the literature on the methodology for cross-cultural adaptation and
review the literature on the methodology for cross-cultural adaptation and
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validation (CCAV) of health questionnaires; 2) to estimate the degree of
validation (CCAV) of health questionnaires; 2) to estimate the degree of
compliance with literature recommendations for CCAV in Spanish and Latin
compliance with literature recommendations for CCAV in Spanish and Latin
American scientific journals; and 3) to translate and cross-culturally adapt the
American scientific journals; and 3) to translate and cross-culturally adapt the
WRFQ and validate it in a sample of a general working Spanish-speaking
WRFQ and validate it in a sample of a general working Spanish-speaking
population.
population.
Methods
Methods
An evidence-based decision was taken to select a generic measurement
An evidence-based decision was taken to select a generic measurement
instrument that evaluates health-related work functioning. A comprehensive
instrument that evaluates health-related work functioning. A comprehensive
literature review was performed to identify and synthesize recommendations on
literature review was performed to identify and synthesize recommendations on
the methodology of CCAV of health questionnaires. Five high impact journals in
the methodology of CCAV of health questionnaires. Five high impact journals in
epidemiology and/or public health from Spain and Latin America were analyzed to
epidemiology and/or public health from Spain and Latin America were analyzed to
estimate the degree of compliance with the methodological recommendations.
estimate the degree of compliance with the methodological recommendations.
A systematic 5-step procedure (direct translation, synthesis, back-translation,
A systematic 5-step procedure (direct translation, synthesis, back-translation,
consolidation by an expert committee and pre-test) described in the literature was
consolidation by an expert committee and pre-test) described in the literature was
followed to translate, cross-cultural adapt and validate the WRFQ. The
followed to translate, cross-cultural adapt and validate the WRFQ. The
applicability, readability and integrity of the Spanish version of the Work Role
applicability, readability and integrity of the Spanish version of the Work Role
Functioning Questionnaire (WRFQ-SpV), together with its preliminary internal
Functioning Questionnaire (WRFQ-SpV), together with its preliminary internal
consistency, test-retest reliability and validity were assessed in a pre-test with 40
consistency, test-retest reliability and validity were assessed in a pre-test with 40
participants.
participants.
Next, a cross-sectional study was conducted among 455 active workers of a
Next, a cross-sectional study was conducted among 455 active workers of a
general working population to evaluate the reliability and validity of the WRFQ-
general working population to evaluate the reliability and validity of the WRFQ-
SpV. A longitudinal survey was carried out to examine the responsiveness in a
SpV. A longitudinal survey was carried out to examine the responsiveness in a
sample of 102 workers of this general working population. The consensus-based
sample of 102 workers of this general working population. The consensus-based
standards on measurement properties of health status measurement instruments
standards on measurement properties of health status measurement instruments
(COSMIN) guided the design of the different studies.
(COSMIN) guided the design of the different studies.
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Results
Results
To identify and synthesize the literature recommendations on the methodology of
To identify and synthesize the literature recommendations on the methodology of
CCAV of health questionnaires, 21 articles (out of 214 citations) and seven
CCAV of health questionnaires, 21 articles (out of 214 citations) and seven
relevant books were selected for full text analysis. A high degree of consensus
relevant books were selected for full text analysis. A high degree of consensus
was found on the steps to follow to guarantee conceptual, semantic, idiomatic and
was found on the steps to follow to guarantee conceptual, semantic, idiomatic and
experiential equivalence. Two steps were widely recommended to carry out the
experiential equivalence. Two steps were widely recommended to carry out the
CCAV process: first, the cross-cultural adaptation process (following a systematic
CCAV process: first, the cross-cultural adaptation process (following a systematic
and rigorous procedure); and secondly, validation in the target language
and rigorous procedure); and secondly, validation in the target language
(evaluating reliability, validity and responsiveness). Only 6% of the retrieved
(evaluating reliability, validity and responsiveness). Only 6% of the retrieved
articles followed all recommended steps.
articles followed all recommended steps.
The CCAV of the WRFQ was carried out without major difficulty. Idiomatic
The CCAV of the WRFQ was carried out without major difficulty. Idiomatic
challenges were found and an expert committee provided a solution. The
challenges were found and an expert committee provided a solution. The
questionnaire showed adequate applicability and good face and content validity.
questionnaire showed adequate applicability and good face and content validity.
Internal consistency was satisfactory (Cronbach alpha =0.98). The original five
Internal consistency was satisfactory (Cronbach alpha =0.98). The original five
factor structure of the WRFQ reflected fair dimensionality of the construct (Chi-
factor structure of the WRFQ reflected fair dimensionality of the construct (Chi-
square, 1445.8; 314 degrees of freedom; root mean square error of approximation
square, 1445.8; 314 degrees of freedom; root mean square error of approximation
[RMSEA] =0.08; comparative fit index [CFI] >0.95 and weighed root mean residual
[RMSEA] =0.08; comparative fit index [CFI] >0.95 and weighed root mean residual
[WRMR] >0.90). The test–retest reliability showed good reproducibility of the
[WRMR] >0.90). The test–retest reliability showed good reproducibility of the
questionnaire outcomes (0.77 ≤ intraclass correlation coefficient [ICC] ≤ 0.93 and
questionnaire outcomes (0.77 ≤ intraclass correlation coefficient [ICC] ≤ 0.93 and
standard error of measurement [SEM] =7.10). For construct validity assessment,
standard error of measurement [SEM] =7.10). For construct validity assessment,
all formulated hypotheses were confirmed differentiating groups with different jobs,
all formulated hypotheses were confirmed differentiating groups with different jobs,
health conditions and ages. Moreover, we verified that the WRFQ-SpV was able to
health conditions and ages. Moreover, we verified that the WRFQ-SpV was able to
detect (true) changes over time.
detect (true) changes over time.
Conclusions:
Conclusions:
The CCAV process should follow several well established steps. However, the
The CCAV process should follow several well established steps. However, the
degree of compliance of the scientific literature with the methodological
degree of compliance of the scientific literature with the methodological
recommendations for CCAV can be improved. The WRFQ-SpV is a reliable and
recommendations for CCAV can be improved. The WRFQ-SpV is a reliable and
valid instrument to measure health-related work functioning in day-to-day practice
valid instrument to measure health-related work functioning in day-to-day practice
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and research in occupational health. Suggestive evidence about the possible use
and research in occupational health. Suggestive evidence about the possible use
of the WRFQ-SpV in evaluative studies was found. More research is needed to
of the WRFQ-SpV in evaluative studies was found. More research is needed to
examine the instrument responsiveness for groups who do not experience health
examine the instrument responsiveness for groups who do not experience health
improvement or deteriorate.
improvement or deteriorate.
Key words:
Key words:
Work functioning instrument; questionnaires; scales; health survey; measurement
Work functioning instrument; questionnaires; scales; health survey; measurement
instrument; cross-cultural comparison; validation studies; psychometric properties;
instrument; cross-cultural comparison; validation studies; psychometric properties;
reliability; validity; responsiveness.
reliability; validity; responsiveness.
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RESUMEN
RESUMEN
Antecedentes
Antecedentes
Salud y trabajo constituyen un binomio con una permanente influencia mutua. El
Salud y trabajo constituyen un binomio con una permanente influencia mutua. El
desempeño del trabajo en relación con la salud se define como la capacidad de
desempeño del trabajo en relación con la salud se define como la capacidad de
un/a trabajador/a para dar respuesta a las demandas del trabajo dado un
un/a trabajador/a para dar respuesta a las demandas del trabajo dado un
determinado estado de salud. Se necesitan herramientas de medición validadas
determinado estado de salud. Se necesitan herramientas de medición validadas
de calidad para evaluar los niveles de desempeño del trabajo a lo largo de la vida
de calidad para evaluar los niveles de desempeño del trabajo a lo largo de la vida
laboral y para evaluar las intervenciones destinadas a adaptar las condiciones de
laboral y para evaluar las intervenciones destinadas a adaptar las condiciones de
trabajo a las habilidades y el estado de salud de la población trabajadora.
trabajo a las habilidades y el estado de salud de la población trabajadora.
El uso de instrumentos literalmente traducidos puede dar lugar a resultados poco
El uso de instrumentos literalmente traducidos puede dar lugar a resultados poco
fiables o engañosos en la práctica y en la investigación, pudiendo limitar el
fiables o engañosos en la práctica y en la investigación, pudiendo limitar el
intercambio de información en la comunidad científica. Debido a las posibles
intercambio de información en la comunidad científica. Debido a las posibles
diferencias culturales en la percepción del trabajo, la salud y la enfermedad, los
diferencias culturales en la percepción del trabajo, la salud y la enfermedad, los
instrumentos desarrollados en otros idiomas o culturas deberían ser traducidos de
instrumentos desarrollados en otros idiomas o culturas deberían ser traducidos de
manera sistemática, adaptados y validados para su uso en idiomas o culturas
manera sistemática, adaptados y validados para su uso en idiomas o culturas
diferentes.
diferentes.
El Cuestionario de Desempeño del Trabajo (del inglés Work Role Functioning
El Cuestionario de Desempeño del Trabajo (del inglés Work Role Functioning
Questionnaire, WRFQ) es un instrumento para medir las dificultades auto-
Questionnaire, WRFQ) es un instrumento para medir las dificultades auto-
percibidas para desempeñar el trabajo, en trabajadores en activo, dado un
percibidas para desempeñar el trabajo, en trabajadores en activo, dado un
determinado estado de salud. Sus resultados pueden ser interpretados en
determinado estado de salud. Sus resultados pueden ser interpretados en
términos de desempeño, rendimiento o productividad en el trabajo, discapacidad
términos de desempeño, rendimiento o productividad en el trabajo, discapacidad
laboral y presentismo, pudiendo ser transformados en resultados con significación
laboral y presentismo, pudiendo ser transformados en resultados con significación
social y económica.
social y económica.
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Objetivo
Objetivo
El objetivo de esta tesis fue poner a disposición un instrumento de calidad
El objetivo de esta tesis fue poner a disposición un instrumento de calidad
validado en español, capaz de evaluar el impacto de la salud en el desempeño del
validado en español, capaz de evaluar el impacto de la salud en el desempeño del
trabajo, y describir el grado en que los trabajadores mejoran o empeoran su
trabajo, y describir el grado en que los trabajadores mejoran o empeoran su
capacidad para dar respuesta a las demandas del trabajo.
capacidad para dar respuesta a las demandas del trabajo.
Este objetivo general se llevó a cabo por medio de tres objetivos específicos: 1)
Este objetivo general se llevó a cabo por medio de tres objetivos específicos: 1)
revisar la literatura sobre la metodología para la traducción, adaptación cultural y
revisar la literatura sobre la metodología para la traducción, adaptación cultural y
validación (TACV) de cuestionarios de salud; 2) estimar el grado de cumplimiento
validación (TACV) de cuestionarios de salud; 2) estimar el grado de cumplimiento
de las recomendaciones metodológicas en revistas científicas Españolas y de
de las recomendaciones metodológicas en revistas científicas Españolas y de
América Latina; 3) Traducir y adaptar el WRFQ y validarlo en una muestra de la
América Latina; 3) Traducir y adaptar el WRFQ y validarlo en una muestra de la
población general trabajadora hispano-parlante.
población general trabajadora hispano-parlante.
Métodos
Métodos
Se seleccionó un instrumento genérico para evaluar el desempeño del trabajo en
Se seleccionó un instrumento genérico para evaluar el desempeño del trabajo en
relación con la salud en base a la evidencia. Se llevó a cabo una revisión
relación con la salud en base a la evidencia. Se llevó a cabo una revisión
bibliográfica exhaustiva para identificar y sistematizar las recomendaciones de la
bibliográfica exhaustiva para identificar y sistematizar las recomendaciones de la
literatura sobre la TACV de cuestionarios de salud y adicionalmente se analizaron
literatura sobre la TACV de cuestionarios de salud y adicionalmente se analizaron
cinco revistas de epidemiología y/o salud pública de España y América Latina,
cinco revistas de epidemiología y/o salud pública de España y América Latina,
con los factores de impacto más altos, para estimar el grado de cumplimiento con
con los factores de impacto más altos, para estimar el grado de cumplimiento con
las recomendaciones metodológicas.
las recomendaciones metodológicas.
Se
siguió
un
procedimiento
en
5
pasos
(traducción
directa,
síntesis,
Se
siguió
un
procedimiento
en
5
pasos
(traducción
directa,
síntesis,
retrotraducción, consolidación por un comité de expertos y pre-test) descrito en la
retrotraducción, consolidación por un comité de expertos y pre-test) descrito en la
literatura para traducir, adaptar y validar el WRFQ. Se realizó un pre-test con 40
literatura para traducir, adaptar y validar el WRFQ. Se realizó un pre-test con 40
participantes para evaluar la aplicabilidad, legibilidad e integridad de la versión
participantes para evaluar la aplicabilidad, legibilidad e integridad de la versión
española del WRFQ (WRFQ-SpV), junto con su consistencia interna, fiabilidad
española del WRFQ (WRFQ-SpV), junto con su consistencia interna, fiabilidad
test-retest y validez.
test-retest y validez.
xiv
xiv
xiv
xiv
Posteriormente, se llevó a cabo un estudio transversal con una muestra de 455
Posteriormente, se llevó a cabo un estudio transversal con una muestra de 455
trabajadores en activo para evaluar la fiabilidad y validez del WRFQ-SpV. Se llevó
trabajadores en activo para evaluar la fiabilidad y validez del WRFQ-SpV. Se llevó
a cabo un estudio longitudinal en una muestra de 102 trabajadores en activo de
a cabo un estudio longitudinal en una muestra de 102 trabajadores en activo de
una población general para examinar su sensibilidad al cambio. Se utilizaron los
una población general para examinar su sensibilidad al cambio. Se utilizaron los
estándares de consenso para la evaluación de las propiedades de medición de
estándares de consenso para la evaluación de las propiedades de medición de
los cuestionarios de salud (COSMIN) en el diseño de los diferentes estudios.
los cuestionarios de salud (COSMIN) en el diseño de los diferentes estudios.
Resultados
Resultados
Para identificar y sistematizar las recomendaciones metodológicas existentes en
Para identificar y sistematizar las recomendaciones metodológicas existentes en
la literatura, se seleccionaron 21 artículos (de un total de 214 citas) y siete libros
la literatura, se seleccionaron 21 artículos (de un total de 214 citas) y siete libros
relevantes para su análisis. Se encontró un alto grado de consenso en la
relevantes para su análisis. Se encontró un alto grado de consenso en la
realización de dos pasos en la TACV para garantizar la equivalencia conceptual,
realización de dos pasos en la TACV para garantizar la equivalencia conceptual,
semántica, idiomática y vivencial. El primero, el proceso de adaptación cultural
semántica, idiomática y vivencial. El primero, el proceso de adaptación cultural
(siguiendo un procedimiento sistemático y riguroso), y el segundo, la validación en
(siguiendo un procedimiento sistemático y riguroso), y el segundo, la validación en
el idioma de destino (evaluando la fiabilidad, validez y sensibilidad al cambio).
el idioma de destino (evaluando la fiabilidad, validez y sensibilidad al cambio).
El grado de cumplimiento de las recomendaciones metodológicas para llevar a
El grado de cumplimiento de las recomendaciones metodológicas para llevar a
cabo la TACV puede ser mejorado. El 6% de los artículos recuperados siguieron
cabo la TACV puede ser mejorado. El 6% de los artículos recuperados siguieron
todos los pasos recomendados en la literatura que les eran aplicables.
todos los pasos recomendados en la literatura que les eran aplicables.
La TACV del WRFQ se llevó a cabo sin dificultades relevantes. Se encontraron
La TACV del WRFQ se llevó a cabo sin dificultades relevantes. Se encontraron
desafíos idiomáticos y un comité de expertos proporcionó una solución. El
desafíos idiomáticos y un comité de expertos proporcionó una solución. El
cuestionario mostró una adecuada aplicabilidad, validez aparente o lógica así
cuestionario mostró una adecuada aplicabilidad, validez aparente o lógica así
como de contenido. La consistencia interna fue satisfactoria (alfa de Cronbach
como de contenido. La consistencia interna fue satisfactoria (alfa de Cronbach
=0.98). La estructura original de cinco factores del WRFQ refleja una adecuada
=0.98). La estructura original de cinco factores del WRFQ refleja una adecuada
dimensionalidad del constructo (Chi-cuadrado, 1445,8; 314 grados de libertad;
dimensionalidad del constructo (Chi-cuadrado, 1445,8; 314 grados de libertad;
error cuadrático medio de aproximación [RMSEA] =0,08, índice de ajuste
error cuadrático medio de aproximación [RMSEA] =0,08, índice de ajuste
comparativo [CFI] >0,95 y media ponderada de la raíz residual [WRMR] >0,90). La
comparativo [CFI] >0,95 y media ponderada de la raíz residual [WRMR] >0,90). La
fiabilidad test-retest mostró una buena reproductibilidad de las puntuaciones del
fiabilidad test-retest mostró una buena reproductibilidad de las puntuaciones del
cuestionario (0.77 ≤ coeficiente de correlación intraclase [CCI] ≤ 0.93 y error
cuestionario (0.77 ≤ coeficiente de correlación intraclase [CCI] ≤ 0.93 y error
estándar de la medida [SEM] =7.10). Para la evaluación de la validez de
estándar de la medida [SEM] =7.10). Para la evaluación de la validez de
xv
xv
constructo se confirmaron todas las hipótesis formuladas, diferenciando grupos
constructo se confirmaron todas las hipótesis formuladas, diferenciando grupos
con diferentes trabajos, problemas de salud y grupos de edad. Se verificó que el
con diferentes trabajos, problemas de salud y grupos de edad. Se verificó que el
WRFQ-SpV fue capaz de detectar cambios (verdaderos) a lo largo del tiempo.
WRFQ-SpV fue capaz de detectar cambios (verdaderos) a lo largo del tiempo.
Conclusiones
Conclusiones
El proceso de TACV debería seguir varios pasos bien establecidos. Sin embargo,
El proceso de TACV debería seguir varios pasos bien establecidos. Sin embargo,
el grado de cumplimiento de las recomendaciones metodológicas propuestas en
el grado de cumplimiento de las recomendaciones metodológicas propuestas en
la literatura científica para la TACV puede ser mejorado. El WRFQ-SpV es un
la literatura científica para la TACV puede ser mejorado. El WRFQ-SpV es un
instrumento fiable y válido para medir el desempeño del trabajo en relación con la
instrumento fiable y válido para medir el desempeño del trabajo en relación con la
salud tanto para la práctica diaria como para la investigación en salud laboral. Se
salud tanto para la práctica diaria como para la investigación en salud laboral. Se
ha encontrado evidencia sugerente sobre el posible uso de la WRFQ-SpV con
ha encontrado evidencia sugerente sobre el posible uso de la WRFQ-SpV con
fines evaluativos. Se necesita investigación adicional para examinar la
fines evaluativos. Se necesita investigación adicional para examinar la
sensibilidad al cambio del instrumento en grupos que no experimentan mejoría o
sensibilidad al cambio del instrumento en grupos que no experimentan mejoría o
que sufren deterioro de su salud.
que sufren deterioro de su salud.
Palabras clave:
Palabras clave:
Desempeño en el trabajo; cuestionarios, escalas; encuesta de salud; instrumento
Desempeño en el trabajo; cuestionarios, escalas; encuesta de salud; instrumento
de
de
medición;
adaptación
cultural;
estudios
de
validación;
propiedades
psicométricas; fiabilidad; validez; sensibilidad al cambio.
xvi
medición;
adaptación
cultural;
estudios
de
validación;
propiedades
psicométricas; fiabilidad; validez; sensibilidad al cambio.
xvi
xvi
xvi
PREFACE
PREFACE
The analysis of measurement instruments for use in occupational health research
The analysis of measurement instruments for use in occupational health research
and practice is currently an area of research interest within the Center for
and practice is currently an area of research interest within the Center for
Research in Occupational Health (CiSAL), and it is in this context that this doctoral
Research in Occupational Health (CiSAL), and it is in this context that this doctoral
thesis was undertaken. Its content is part of a CiSAL research project entitled
thesis was undertaken. Its content is part of a CiSAL research project entitled
“Evaluation of health-related work functioning and identification of preventive
“Evaluation of health-related work functioning and identification of preventive
interventions
interventions
with
the
Spanish
version
of
the Work
Role
Functioning
with
the
Spanish
version
of
the Work
Role
Functioning
Questionnaire”. This project is funded by the Instituto de Salud Carlos III, ISCIII
Questionnaire”. This project is funded by the Instituto de Salud Carlos III, ISCIII
(Ministry of
(Ministry of
Economy and Competitiveness, Spanish Government), FIS:
Economy and Competitiveness, Spanish Government), FIS:
PI12/02556 (Principal Investigator, Consol Serra Pujadas; co-investigators, José
PI12/02556 (Principal Investigator, Consol Serra Pujadas; co-investigators, José
María Ramada and George Delclos).
María Ramada and George Delclos).
This project arises from the need for validated instruments to assess the impact of
This project arises from the need for validated instruments to assess the impact of
health on “work functioning” in Spanish-speaking populations. There are a number
health on “work functioning” in Spanish-speaking populations. There are a number
of instruments to evaluate “health-related work functioning” in English, but these
of instruments to evaluate “health-related work functioning” in English, but these
have not always been adapted and/or validated into the Spanish context. Thus,
have not always been adapted and/or validated into the Spanish context. Thus,
identifying and selecting an instrument to properly measure health-related work
identifying and selecting an instrument to properly measure health-related work
functioning and then translating, adapting and validating its measurement
functioning and then translating, adapting and validating its measurement
properties, for future use in research, was consistent with the goals of this project.
properties, for future use in research, was consistent with the goals of this project.
According to the policy of the Doctoral Program Committee in the Department of
According to the policy of the Doctoral Program Committee in the Department of
Experimental and Health Sciences at Pompeu Fabra University, this thesis is
Experimental and Health Sciences at Pompeu Fabra University, this thesis is
presented as a compendium of four scientific publications, derived from the
presented as a compendium of four scientific publications, derived from the
literature review and field work conducted in the Parc de Salut Mar de Barcelona
literature review and field work conducted in the Parc de Salut Mar de Barcelona
health system. The first publication was written in Spanish and the other three in
health system. The first publication was written in Spanish and the other three in
English. All have been published recently in international occupational health peer-
English. All have been published recently in international occupational health peer-
reviewed journals, indexed in PubMed, with the PhD candidate as first author.
reviewed journals, indexed in PubMed, with the PhD candidate as first author.
xvii
xvii
The results have been presented in part at several scientific meetings, specifically:
The results have been presented in part at several scientific meetings, specifically:
the First CiSAL Annual Scientific Meeting (1), the Second Scientific Conference on
the First CiSAL Annual Scientific Meeting (1), the Second Scientific Conference on
Work Disability Prevention and Integration (WDPI) ( 2 ), the XXII Diada of the
Work Disability Prevention and Integration (WDPI) ( 2 ), the XXII Diada of the
Catalan Society of Safety and Occupational Medicine (3), the Third CiSAL Annual
Catalan Society of Safety and Occupational Medicine (3), the Third CiSAL Annual
Scientific Meeting (4) and the First BiblioPRO Scientific Meeting (5).
Scientific Meeting (4) and the First BiblioPRO Scientific Meeting (5).
In addition to the funding from the Instituto de Salud Carlos III (PI12/ 02556), this
In addition to the funding from the Instituto de Salud Carlos III (PI12/ 02556), this
thesis received partial financial support from the The University of Texas School of
thesis received partial financial support from the The University of Texas School of
Public Health at Houston (USA) and from the Network of Biomedical Research
Public Health at Houston (USA) and from the Network of Biomedical Research
Centers in Epidemiology and Public Health (CIBERESP), for completion of short-
Centers in Epidemiology and Public Health (CIBERESP), for completion of short-
term stays at international universities, in order to fulfill the requirements for a
term stays at international universities, in order to fulfill the requirements for a
doctorate with European mention.
doctorate with European mention.
(1) Ramada JM, Serra C, Delclós J. Adaptación cultural y validación de cuestionarios de salud:
revisión y recomendaciones metodológicas. 1ª Jornada Científica CISAL. Barcelona, 2011.
(1) Ramada JM, Serra C, Delclós J. Adaptación cultural y validación de cuestionarios de salud:
revisión y recomendaciones metodológicas. 1ª Jornada Científica CISAL. Barcelona, 2011.
(2) Ramada JM, Serra C, Delclós GL. Cross-cultural adaptation and health questionnaires validation:
revision and methodological recommendations. Second Scientific Conference on Work Disability
Prevention and Integration ‘Healthy ageing in a working society’. WDPI; Groningen, 2012.
(2) Ramada JM, Serra C, Delclós GL. Cross-cultural adaptation and health questionnaires validation:
revision and methodological recommendations. Second Scientific Conference on Work Disability
Prevention and Integration ‘Healthy ageing in a working society’. WDPI; Groningen, 2012.
(3) Ramada JM. Qüestionaris de salut de qualitat: requisits bàsics. XXII Diada de la Societat
Catalana de Seguretat i Medicina del Treball. Barcelona, 2012.
(3) Ramada JM. Qüestionaris de salut de qualitat: requisits bàsics. XXII Diada de la Societat
Catalana de Seguretat i Medicina del Treball. Barcelona, 2012.
(4) Ramada JM, Serra C, Delclós J. Traducción, adaptación cultural y validación del “Work role
functioning questionnaire (WRFQ-27)”. 3ª Jornada Científica CISAL. Barcelona, 2013.
(4) Ramada JM, Serra C, Delclós J. Traducción, adaptación cultural y validación del “Work role
functioning questionnaire (WRFQ-27)”. 3ª Jornada Científica CISAL. Barcelona, 2013.
(5) Ramada JM, Serra C, Amick BC, Castaño JR, Delclós GL. Adaptación cultural del "Work Role
Functioning Questionnaire (WRFQ)" al castellano hablado en España. I Jonada Científica
BiblioPRO. IMIM-CIBERESP. Barcelona, 2013.
(5) Ramada JM, Serra C, Amick BC, Castaño JR, Delclós GL. Adaptación cultural del "Work Role
Functioning Questionnaire (WRFQ)" al castellano hablado en España. I Jonada Científica
BiblioPRO. IMIM-CIBERESP. Barcelona, 2013.
xviii
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xviii
PRÓLOGO
PRÓLOGO
El análisis de instrumentos de medición para su uso en la investigación y la
El análisis de instrumentos de medición para su uso en la investigación y la
práctica diaria en salud laboral es, en estos momentos, un área de interés para la
práctica diaria en salud laboral es, en estos momentos, un área de interés para la
investigación del Centro de Investigación en Salud Laboral (CiSAL), y es en este
investigación del Centro de Investigación en Salud Laboral (CiSAL), y es en este
contexto en el que se ha desarrollado la presente tesis doctoral. El contenido de
contexto en el que se ha desarrollado la presente tesis doctoral. El contenido de
esta tesis forma parte del proyecto de investigación del CiSAL, titulado
esta tesis forma parte del proyecto de investigación del CiSAL, titulado
“Evaluación de la capacidad para trabajar y posibilidades de intervención
“Evaluación de la capacidad para trabajar y posibilidades de intervención
mediante el Work Role Functioning Questionnaire adaptado al castellano”. Este
mediante el Work Role Functioning Questionnaire adaptado al castellano”. Este
proyecto ha sido financiado por el Instituto de Salud Carlos III, ISCIII (Ministerio de
proyecto ha sido financiado por el Instituto de Salud Carlos III, ISCIII (Ministerio de
Economía
Economía
y
Competitividad,
Gobierno
de
España),
FIS:
PI12/02556,
y
Competitividad,
Gobierno
de
España),
FIS:
PI12/02556,
(Investigadora principal Consol Serra Pujadas; co-investigadores José María
(Investigadora principal Consol Serra Pujadas; co-investigadores José María
Ramada y George Delclós).
Ramada y George Delclós).
Este proyecto surge de la necesidad de disponer de instrumentos en Español
Este proyecto surge de la necesidad de disponer de instrumentos en Español
validados para evaluar el impacto de la salud sobre el “desempeño del trabajo” en
validados para evaluar el impacto de la salud sobre el “desempeño del trabajo” en
poblaciones hispano-parlantes. Existe un número de instrumentos para evaluar el
poblaciones hispano-parlantes. Existe un número de instrumentos para evaluar el
“desempeño del trabajo” en relación con la salud en Inglés, pero no siempre han
“desempeño del trabajo” en relación con la salud en Inglés, pero no siempre han
sido adaptados y/o validados en el contexto Español. Por ello, la identificación y
sido adaptados y/o validados en el contexto Español. Por ello, la identificación y
selección de un instrumento para medir adecuadamente el “desempeño del
selección de un instrumento para medir adecuadamente el “desempeño del
trabajo” en relación con la salud y proceder a su traducción, adaptación y
trabajo” en relación con la salud y proceder a su traducción, adaptación y
validación de sus propiedades de medición, para su uso en futuras
validación de sus propiedades de medición, para su uso en futuras
investigaciones, es consistente con los objetivos de este proyecto.
investigaciones, es consistente con los objetivos de este proyecto.
Conforme a la normativa dada por la Comisión de Dirección del Programa de
Conforme a la normativa dada por la Comisión de Dirección del Programa de
Doctorado del Departamento de Ciencias Experimentales y de la Salud de la
Doctorado del Departamento de Ciencias Experimentales y de la Salud de la
Universidad Pompeu Fabra, esta tesis doctoral se presenta como un compendio
Universidad Pompeu Fabra, esta tesis doctoral se presenta como un compendio
de cuatro publicaciones científicas en las que el doctorando es el primer autor,
de cuatro publicaciones científicas en las que el doctorando es el primer autor,
fruto de la revisión de la literatura y el trabajo de campo llevado a cabo en el
fruto de la revisión de la literatura y el trabajo de campo llevado a cabo en el
sistema hospitalario del Parc de Salut Mar de Barcelona. La primera de las
sistema hospitalario del Parc de Salut Mar de Barcelona. La primera de las
publicaciones fue escrita en español y las tres restantes en inglés. Tres de ellas
publicaciones fue escrita en español y las tres restantes en inglés. Tres de ellas
xix
xix
han sido publicadas recientemente en revistas internacionales de salud laboral,
han sido publicadas recientemente en revistas internacionales de salud laboral,
indexadas en PubMed y con revisión por pares. La cuarta se encuentra en el
indexadas en PubMed y con revisión por pares. La cuarta se encuentra en el
momento de la impresión de esta tesis en proceso de revisión por pares, en una
momento de la impresión de esta tesis en proceso de revisión por pares, en una
revista internacional de salud laboral, asimismo indexada en Pubmed.
revista internacional de salud laboral, asimismo indexada en Pubmed.
Los resultados han sido presentados parcialmente en la Primera Jornada
Los resultados han sido presentados parcialmente en la Primera Jornada
Científica Anual del CiSAL (6); la Second Scientific Conference on Work Disability
Científica Anual del CiSAL (6); la Second Scientific Conference on Work Disability
Prevention and Integration (WDPI) (7); la XXII Diada de la Societat Catalana de
Prevention and Integration (WDPI) (7); la XXII Diada de la Societat Catalana de
Seguretat i Medicina del Treball (8); la Tercera Jornada Científica Anual del CiSAL
Seguretat i Medicina del Treball (8); la Tercera Jornada Científica Anual del CiSAL
(9) y en la Primera Jornada Científica BiblioPRO (10).
(9) y en la Primera Jornada Científica BiblioPRO (10).
Adicionalmente a la financiación del Instituto de Salud Carlos III (PI12/ 02556),
Adicionalmente a la financiación del Instituto de Salud Carlos III (PI12/ 02556),
esta tesis recibió apoyo económico parcial de la Escuela de Salud Pública de la
esta tesis recibió apoyo económico parcial de la Escuela de Salud Pública de la
Universidad de Texas (Estados Unidos de América) y del Centro de Investigación
Universidad de Texas (Estados Unidos de América) y del Centro de Investigación
Biomédica en Red de Epidemiología y Salud Pública (CIBERESP).
Biomédica en Red de Epidemiología y Salud Pública (CIBERESP).
(6) Ramada JM, Serra C, Delclós J. Adaptación cultural y validación de cuestionarios de salud:
revisión y recomendaciones metodológicas. 1ª Jornada Científica CISAL. Barcelona, 2011.
(6) Ramada JM, Serra C, Delclós J. Adaptación cultural y validación de cuestionarios de salud:
revisión y recomendaciones metodológicas. 1ª Jornada Científica CISAL. Barcelona, 2011.
(7) Ramada JM, Serra C, Delclós GL. Cross-cultural adaptation and health questionnaires validation:
revision and methodological recommendations. Second Scientific Conference on Work Disability
Prevention and Integration ‘Healthy ageing in a working society’. WDPI; Groningen, 2012.
(7) Ramada JM, Serra C, Delclós GL. Cross-cultural adaptation and health questionnaires validation:
revision and methodological recommendations. Second Scientific Conference on Work Disability
Prevention and Integration ‘Healthy ageing in a working society’. WDPI; Groningen, 2012.
(8) Ramada JM. Qüestionaris de salut de qualitat: requisits bàsics. XXII Diada de la Societat
Catalana de Seguretat i Medicina del Treball. Barcelona, 2012.
(8) Ramada JM. Qüestionaris de salut de qualitat: requisits bàsics. XXII Diada de la Societat
Catalana de Seguretat i Medicina del Treball. Barcelona, 2012.
(9) Ramada JM, Serra C, Delclós J. Traducción, adaptación cultural y validación del “Work role
functioning questionnaire (WRFQ-27)”. 3ª Jornada Científica CISAL. Barcelona, 2013.
(9) Ramada JM, Serra C, Delclós J. Traducción, adaptación cultural y validación del “Work role
functioning questionnaire (WRFQ-27)”. 3ª Jornada Científica CISAL. Barcelona, 2013.
(10) Ramada JM, Serra C, Amick BC, Castaño JR, Delclós GL. Adaptación cultural del "Work Role
Functioning Questionnaire (WRFQ)" al castellano hablado en España. I Jonada Científica
BiblioPRO. IMIM-CIBERESP. Barcelona, 2013.
(10) Ramada JM, Serra C, Amick BC, Castaño JR, Delclós GL. Adaptación cultural del "Work Role
Functioning Questionnaire (WRFQ)" al castellano hablado en España. I Jonada Científica
BiblioPRO. IMIM-CIBERESP. Barcelona, 2013.
xx
xx
TABLE OF CONTENTS
TABLE OF CONTENTS
Page
Page
ACKNOWLEDGEMENTS (Agradecimientos – Agraïments)
v
ACKNOWLEDGEMENTS (Agradecimientos – Agraïments)
v
SUMMARY
ix
SUMMARY
ix
RESUMEN
xiii
RESUMEN
xiii
PREFACE
xvii
PREFACE
xvii
PRÓLOGO
xix
PRÓLOGO
xix
1. INTRODUCTION
1
1. INTRODUCTION
1
1.1. Statement of the problem
1
1.1. Statement of the problem
1
1.2. From work disability to health-related work functioning
2
1.2. From work disability to health-related work functioning
2
1.3. General overview of work outcome measurement tools
7
1.3. General overview of work outcome measurement tools
7
1.4. Methodological quality in health-questionnaire validation
11
1.4. Methodological quality in health-questionnaire validation
11
2. OBJECTIVES
23
2. OBJECTIVES
23
2.1. Study I Objectives
23
2.1. Study I Objectives
23
2.2. Study II Objectives
23
2.2. Study II Objectives
23
2.3. Study III Objectives
23
2.3. Study III Objectives
23
2.4. Study IV Objectives
23
2.4. Study IV Objectives
23
xxi
xxi
Page
3. PAPER # 1
25
Page
3. PAPER # 1
Ramada JM, Serra C, Delclós GL. Adaptación cultural y validación de
Ramada JM, Serra C, Delclós GL. Adaptación cultural y validación de
cuestionarios de salud: revisión y recomendaciones metodológicas.
cuestionarios de salud: revisión y recomendaciones metodológicas.
Salud Publica Mex. 2013;55:57-66.
Salud Publica Mex. 2013;55:57-66.
4. PAPER # 2
37
4. PAPER # 2
Ramada JM, Serra C, Amick III BC, Castaño JR, Delclos GL. Cross-
Ramada JM, Serra C, Amick III BC, Castaño JR, Delclos GL. Cross-
cultural adaptation of the work role functioning questionnaire to Spanish
cultural adaptation of the work role functioning questionnaire to Spanish
spoken in Spain. J Occup Rehabil. 2013;23:566-75.
spoken in Spain. J Occup Rehabil. 2013;23:566-75.
5. PAPER # 3
49
5. PAPER # 3
Ramada JM, Serra C, Amick III BC, Abma FI, Castaño JR, Pidemunt G,
Ramada JM, Serra C, Amick III BC, Abma FI, Castaño JR, Pidemunt G,
Bültmann U, Delclos GL. Reliability and validity of the Work Role
Bültmann U, Delclos GL. Reliability and validity of the Work Role
Functioning Questionnaire (Spanish version). [Submitted for peer-
Functioning Questionnaire (Spanish version). [Submitted for peer-
review].
review].
PAPER # 4
99
PAPER # 4
Ramada JM, Delclos GL, Amick III BC, Abma FI, Castaño JR, Pidemunt
Ramada JM, Delclos GL, Amick III BC, Abma FI, Castaño JR, Pidemunt
G, Bültmann, Serra C.Responsiveness of the Work Role Functioning
G, Bültmann, Serra C.Responsiveness of the Work Role Functioning
Questionnaire (Spanish version). J Occup Environ Med. [In Press
Questionnaire (Spanish version). J Occup Environ Med. [In Press
2013].
2013].
25
37
49
99
6. GENERAL DISCUSSION
135
6. GENERAL DISCUSSION
135
6.1. The concept of health-related work functioning.
135
6.1. The concept of health-related work functioning.
135
6.2. Selection of an instrument to measure health-related work functioning.
139
6.2. Selection of an instrument to measure health-related work functioning.
139
xxii
xxii
xxii
xxii
6.3. Cross-cultural adaptation and validation process (reliability, validity and
responsiveness).
6.3. Cross-cultural adaptation and validation process (reliability, validity and
140
6.4. Standards to be used for methodological quality in health-questionnaire
validation.
responsiveness).
140
6.4. Standards to be used for methodological quality in health-questionnaire
144
validation.
144
6.5. Implications for research and practice.
146
6.5. Implications for research and practice.
146
6.6. Future research.
147
6.6. Future research.
147
7. GENERAL CONCLUSIONS
157
7. GENERAL CONCLUSIONS
157
8. APPENDICES
158
8. APPENDICES
158
Appendix I: WRFQ (English version)
158
Appendix I: WRFQ (English version)
158
Appendix II: WRFQ (Spanish version)
161
Appendix II: WRFQ (Spanish version)
161
Appendix III: Single items of the WAI
165
Appendix III: Single items of the WAI
165
Appendix IV: Global perceived effect question (GPE-Q)
167
Appendix IV: Global perceived effect question (GPE-Q)
167
Appendix V: Clinical Research Ethical Committee approval
169
Appendix V: Clinical Research Ethical Committee approval
169
Appendix VI: Informed consent
171
Appendix VI: Informed consent
171
Appendix VII: Poster Primera Jornada Científica CiSAL (2011)
173
Appendix VII: Poster Primera Jornada Científica CiSAL (2011)
173
Appendix VIII: Poster WDPI, Groningen, The Netherlands (2012)
177
Appendix VIII: Poster WDPI, Groningen, The Netherlands (2012)
177
Appendix iX: Poster Tercera Jornada Científica Cisal (2013)
181
Appendix iX: Poster Tercera Jornada Científica Cisal (2013)
181
xxiii
xxiii
184
184
1. INTRODUCTION
1. INTRODUCTION
1.1. Statement of the problem
1.1. Statement of the problem
Health and work form an indivisible duality in which mutual influence is permanent.
Health and work form an indivisible duality in which mutual influence is permanent.
The World Health Organization (WHO) defines health as "a state of complete
The World Health Organization (WHO) defines health as "a state of complete
physical, mental and social well-being" and not merely the absence of disease.
physical, mental and social well-being" and not merely the absence of disease.
This definition is part of the Declaration of Principles of the WHO since its founding
This definition is part of the Declaration of Principles of the WHO since its founding
in 1948 (1).
in 1948 (1).
Work is a health determinant and there is an increasing body of evidence showing
Work is a health determinant and there is an increasing body of evidence showing
that work has positive health effects when working conditions are reasonably
that work has positive health effects when working conditions are reasonably
acceptable (2,3). Decent work sums up the aspirations of people in their working
acceptable (2,3). Decent work sums up the aspirations of people in their working
lives. It involves opportunities for productive work, delivers a fair income, security
lives. It involves opportunities for productive work, delivers a fair income, security
in the workplace and social protection for families, opportunities for personal
in the workplace and social protection for families, opportunities for personal
development and social integration, freedom for people to express their concerns,
development and social integration, freedom for people to express their concerns,
organize and participate in the decisions that affect their lives and equality of
organize and participate in the decisions that affect their lives and equality of
opportunity and treatment for all women and men. A community or a country
opportunity and treatment for all women and men. A community or a country
improves population health status when everyone who is able to work can get a
improves population health status when everyone who is able to work can get a
decent job (4).
decent job (4).
Increased life expectancy and prolongation of retirement age are increasing the
Increased life expectancy and prolongation of retirement age are increasing the
overall age of the workforce, and might result in an increasing number of
overall age of the workforce, and might result in an increasing number of
employees working with chronic diseases (5-7). Interventions to keep these
employees working with chronic diseases (5-7). Interventions to keep these
workers in the labor market and promote work participation are being increasingly
workers in the labor market and promote work participation are being increasingly
developed to support a sustainable, active, and productive work life (7,8).
developed to support a sustainable, active, and productive work life (7,8).
Furthermore, rehabilitation programs and interventions to adapt or accommodate
Furthermore, rehabilitation programs and interventions to adapt or accommodate
working conditions to the workers' health and skills are becoming more frequent,
working conditions to the workers' health and skills are becoming more frequent,
with the goal of achieving a safe return to work after a period of sick leave.
with the goal of achieving a safe return to work after a period of sick leave.
1
1
The effectiveness of these rehabilitation programs and interventions has usually
The effectiveness of these rehabilitation programs and interventions has usually
been assessed using outcome measures such as work status (active, temporary
been assessed using outcome measures such as work status (active, temporary
or permanent disability), time to return to work, duration of functional disability and
or permanent disability), time to return to work, duration of functional disability and
costs of incapacity to work (8-11). These outcomes have been useful but are
costs of incapacity to work (8-11). These outcomes have been useful but are
limited, as they mainly assess whether workers are present or absent from their
limited, as they mainly assess whether workers are present or absent from their
jobs. They do not offer information about the worker's participation in the job or the
jobs. They do not offer information about the worker's participation in the job or the
degree to which the worker is able to respond to the job's demands (12,13).
degree to which the worker is able to respond to the job's demands (12,13).
Quality validated measurement tools are needed to assess how workers function
Quality validated measurement tools are needed to assess how workers function
at work along their professional life course, and the existing continuum between
at work along their professional life course, and the existing continuum between
working successfully at one extreme and work absence at the other (14).
working successfully at one extreme and work absence at the other (14).
Outcome measures able to describe the extent to which workers increase or
Outcome measures able to describe the extent to which workers increase or
decrease their ability to meet job demands and to fully assess rehabilitation
decrease their ability to meet job demands and to fully assess rehabilitation
programs and intervention effectiveness are needed in Spanish-speaking
programs and intervention effectiveness are needed in Spanish-speaking
occupational health settings, yet there is a lack of quality validated instruments in
occupational health settings, yet there is a lack of quality validated instruments in
Spanish for this purpose. Thus, the rationale for this thesis is to provide an
Spanish for this purpose. Thus, the rationale for this thesis is to provide an
evidence base for an instrument to evaluate health-related work functioning, and
evidence base for an instrument to evaluate health-related work functioning, and
make it available to Spanish-speaking occupational health professionals and
make it available to Spanish-speaking occupational health professionals and
researchers for use in daily practice and research.
researchers for use in daily practice and research.
1.2.
1.2.
From work disability to health-related work functioning
From work disability to health-related work functioning
Disability can be described as the environmentally determined effect of an
Disability can be described as the environmentally determined effect of an
impairment that, in interaction with other factors and within a specific social
impairment that, in interaction with other factors and within a specific social
context, is likely to cause an individual to experience an undue disadvantage in his
context, is likely to cause an individual to experience an undue disadvantage in his
or her personal, social or professional life (15). Work disability could be defined as
or her personal, social or professional life (15). Work disability could be defined as
the effect of an illness or an accident in the ability of a person to perform a
the effect of an illness or an accident in the ability of a person to perform a
particular work activity.
particular work activity.
Disability is not an absolute attribute of an individual; rather, it is a social construct.
Disability is not an absolute attribute of an individual; rather, it is a social construct.
A person who is blind, or deaf, or needs a wheelchair to move can be completely
A person who is blind, or deaf, or needs a wheelchair to move can be completely
2
2
2
2
dependent in one setting, but fully autonomous and functional in a different one.
dependent in one setting, but fully autonomous and functional in a different one.
Thus, the effect of impairment will always be referred to a given environment, and
Thus, the effect of impairment will always be referred to a given environment, and
if we restrict disability to the functional effects of this impairment, regardless of the
if we restrict disability to the functional effects of this impairment, regardless of the
environment, we put the burden of the problem and the responsibility to find a
environment, we put the burden of the problem and the responsibility to find a
solution on the individual.
solution on the individual.
From a social perspective, work disability should be understood as a manageable
From a social perspective, work disability should be understood as a manageable
situation, where different stake holders (workers, employers, human resource
situation, where different stake holders (workers, employers, human resource
managers, supervisors, unions and occupational health professionals) should be
managers, supervisors, unions and occupational health professionals) should be
involved to respond to an individual’s needs so that he/she can function
involved to respond to an individual’s needs so that he/she can function
successfully at work. Disability is, therefore, a social rather than a medical issue
successfully at work. Disability is, therefore, a social rather than a medical issue
and from this perspective it is easier to understand that positive action towards
and from this perspective it is easier to understand that positive action towards
integration and job participation is required, rather than merely passive measures
integration and job participation is required, rather than merely passive measures
to provide income support (15).
to provide income support (15).
Once tucked into this paradigm, it is possible to analyze from a broader
Once tucked into this paradigm, it is possible to analyze from a broader
perspective the economic and social impact of removing barriers for integration of
perspective the economic and social impact of removing barriers for integration of
individuals with disabilities. Imaginative and economically viable solutions
individuals with disabilities. Imaginative and economically viable solutions
addressing a wider range of interventions may arise from this, varying from
addressing a wider range of interventions may arise from this, varying from
improving the workers’ skills (through training and rehabilitation programs), to
improving the workers’ skills (through training and rehabilitation programs), to
facilitating accommodation in suitable workplaces or intervening to adapt the
facilitating accommodation in suitable workplaces or intervening to adapt the
workplace and/or working conditions to the specific needs of these individuals.
workplace and/or working conditions to the specific needs of these individuals.
A significant number of research teams and occupational health services are
A significant number of research teams and occupational health services are
increasingly designing and implementing rehabilitation and/or accommodation
increasingly designing and implementing rehabilitation and/or accommodation
programs to adapt working conditions to worker skills and health to support an
programs to adapt working conditions to worker skills and health to support an
active working life (7,8,16,17). To fully assess intervention effectiveness requires
active working life (7,8,16,17). To fully assess intervention effectiveness requires
outcome measures that describe the extent to which people increase their ability
outcome measures that describe the extent to which people increase their ability
to meet the demands of the job.
to meet the demands of the job.
3
3
Health-related work functioning is a comprehensive concept that incorporates the
Health-related work functioning is a comprehensive concept that incorporates the
previously described paradigm shift, and can be defined as the ability of a worker
previously described paradigm shift, and can be defined as the ability of a worker
to meet work demands for a given physical and emotional health status (18).
to meet work demands for a given physical and emotional health status (18).
Theoretically, working conditions and demands are modifiable and health is a
Theoretically, working conditions and demands are modifiable and health is a
dynamic concept that can change over a lifetime. Hence, health-related work
dynamic concept that can change over a lifetime. Hence, health-related work
functioning constitutes a continuum rather than a dichotomy, with “working
functioning constitutes a continuum rather than a dichotomy, with “working
successfully” at one end and “work absence” at the other. Measuring the results of
successfully” at one end and “work absence” at the other. Measuring the results of
the impact of health on work in terms of "present” versus “absent" is not enough to
the impact of health on work in terms of "present” versus “absent" is not enough to
understand what happens along this continuum (19). Based on the individual’s
understand what happens along this continuum (19). Based on the individual’s
work performance and on-the-job productivity (Figure 1), and especially in the
work performance and on-the-job productivity (Figure 1), and especially in the
current European socio-economic context, it constitutes a phenomenon of great
current European socio-economic context, it constitutes a phenomenon of great
interest in occupational health care settings and research.
interest in occupational health care settings and research.
The rationale for this thesis arises from the need for quality validated
The rationale for this thesis arises from the need for quality validated
measurement instruments to assess health-related work functioning in Spanish-
measurement instruments to assess health-related work functioning in Spanish-
speaking settings. This will serve to enhance the evaluation of rehabilitation,
speaking settings. This will serve to enhance the evaluation of rehabilitation,
accommodation or adaptation programs. The emphasis is on the ability of the
accommodation or adaptation programs. The emphasis is on the ability of the
instrument to measure the worker's participation, and not only whether workers are
instrument to measure the worker's participation, and not only whether workers are
present or absent from their jobs.
present or absent from their jobs.
4
4
4
4
5
5
Health
Status
Work
Demands
WORK FUNCTIONING
Work Absence
Exhausting Oneself
Societal Context
Labour Market Context
Organizational Context (Workplace System)
Occupational
Health
Care
WORKER
Productive & Healthy
Working Successfully
WORK FUNCTIONING
Working
Healthy
Participation
Business
Productivity
NONDISCRIMINATION
CONFIDENTIALITY
RESPECT
VOLUNTARINESS
Health
Status
Work
Demands
WORK FUNCTIONING
Work Absence
Exhausting Oneself
Productive & Healthy
Working Successfully
WORK FUNCTIONING
Societal Context
Labour Market Context
Organizational Context (Workplace System)
Occupational
Health
Care
WORKER
Human
Resources
Management
Organizational Context (Workplace System)
Labour Market Context
Societal Context
Working
Healthy
Participation
Business
Productivity
NONDISCRIMINATION
CONFIDENTIALITY
Figure 1. Conceptual frame of Health-Related Work Functioning based on Amick, Gimeno (18) and Abma (19) and
ethical use of the questionnaire.
RESPECT
VOLUNTARINESS
Human
Resources
Management
Organizational Context (Workplace System)
Labour Market Context
Societal Context
Figure 1. Conceptual frame of Health-Related Work Functioning based on Amick, Gimeno (18) and Abma (19) and
ethical use of the questionnaire.
5
5
184
184
1.3. General overview of work outcome measurement tools
1.3. General overview of work outcome measurement tools
When reviewing the literature on work outcome measures it is possible to find
When reviewing the literature on work outcome measures it is possible to find
different approaches to work outcome measurement and, in general, it is possible
different approaches to work outcome measurement and, in general, it is possible
to retrieve four groups of work outcome measures (12). Several assess the labor
to retrieve four groups of work outcome measures (12). Several assess the labor
force status (mainly time to return to work and duration of functional disability).
force status (mainly time to return to work and duration of functional disability).
Another group assesses the economic impact of work outcomes (especially lost
Another group assesses the economic impact of work outcomes (especially lost
time from work and self-reported effectiveness in performing the job). A third set of
time from work and self-reported effectiveness in performing the job). A third set of
measures assesses the impact of health on role functioning (mixing work-role with
measures assesses the impact of health on role functioning (mixing work-role with
other roles). And finally, there is a group of work-role specific functioning
other roles). And finally, there is a group of work-role specific functioning
measurement instruments that measure health-related functioning at work.
measurement instruments that measure health-related functioning at work.
Several studies and reviews have analyzed both strengths and weaknesses of
Several studies and reviews have analyzed both strengths and weaknesses of
each group of measurement tools (12,18,20-26).
each group of measurement tools (12,18,20-26).
Focusing on the instruments that measure our phenomenon of interest (health-
Focusing on the instruments that measure our phenomenon of interest (health-
related work functioning), a number of health and/or job specific work functioning
related work functioning), a number of health and/or job specific work functioning
measurement instruments together with other generic instruments have been
measurement instruments together with other generic instruments have been
developed. The most relevant are shown in Table 1.
developed. The most relevant are shown in Table 1.
When measuring health-related work functioning in research and practice,
When measuring health-related work functioning in research and practice,
evidence-based decisions should be made about which instrument to use. Evans
evidence-based decisions should be made about which instrument to use. Evans
recommends considering three areas when choosing a questionnaire: the
recommends considering three areas when choosing a questionnaire: the
psychometric properties of the instrument, administration complexity, and the
psychometric properties of the instrument, administration complexity, and the
setting of the evaluation (27). Firstly, it is essential to know the purpose for use of
setting of the evaluation (27). Firstly, it is essential to know the purpose for use of
the instrument (in medicine, for example, it could be for diagnosis, evaluation or
the instrument (in medicine, for example, it could be for diagnosis, evaluation or
prediction) (28). Then, depending on this, it is necessary to find out whether the
prediction) (28). Then, depending on this, it is necessary to find out whether the
measurement properties of the instrument have been assessed with quality
measurement properties of the instrument have been assessed with quality
methodology.
methodology.
If the instrument is going to be applied for diagnostic or prognostic purposes, such
If the instrument is going to be applied for diagnostic or prognostic purposes, such
as to estimate work functioning status or to distinguish between different courses
as to estimate work functioning status or to distinguish between different courses
7
7
(or outcomes) of work functioning, evidence of its discriminative ability should be
(or outcomes) of work functioning, evidence of its discriminative ability should be
provided; in this case, parameters of reliability are very important (including those
provided; in this case, parameters of reliability are very important (including those
of measurement error). But if the aim is to apply the instrument to evaluate
of measurement error). But if the aim is to apply the instrument to evaluate
interventions or to monitor work functioning in individuals, the instrument needs to
interventions or to monitor work functioning in individuals, the instrument needs to
provide evidence of its ability to detect (true) changes over time; in this case,
provide evidence of its ability to detect (true) changes over time; in this case,
parameters of responsiveness (on top of measurement error) are crucial (28).
parameters of responsiveness (on top of measurement error) are crucial (28).
It is also necessary to know in which language or culture the questionnaire was
It is also necessary to know in which language or culture the questionnaire was
originally developed. If the intention is to use it in a different language, then it is
originally developed. If the intention is to use it in a different language, then it is
necessary to determine whether the process of cross-cultural adaptation and
necessary to determine whether the process of cross-cultural adaptation and
validation in the target language employed quality evidence-based methods.
validation in the target language employed quality evidence-based methods.
In the 2000s a series of specific work-role functioning questionnaires were
In the 2000s a series of specific work-role functioning questionnaires were
developed; among them, the Work Limitations Questionnaire (WLQ) and the Work
developed; among them, the Work Limitations Questionnaire (WLQ) and the Work
Role Functioning Questionnaire (WRFQ) (12,29) where developed as generic
Role Functioning Questionnaire (WRFQ) (12,29) where developed as generic
instruments to measure work functioning. These instruments provide an overall
instruments to measure work functioning. These instruments provide an overall
work functioning score, but also allow an estimation of work functioning in relation
work functioning score, but also allow an estimation of work functioning in relation
to each domain of work demands (work scheduling, output, physical, mental and
to each domain of work demands (work scheduling, output, physical, mental and
social demands).
social demands).
The WRFQ measures perceived difficulties to perform the job due to health
The WRFQ measures perceived difficulties to perform the job due to health
problems. As mentioned above, it is a generic instrument conceptually developed
problems. As mentioned above, it is a generic instrument conceptually developed
to represent a wide range of health conditions and work demands and is freely
to represent a wide range of health conditions and work demands and is freely
available in the literature for professionals and researchers. The questionnaire has
available in the literature for professionals and researchers. The questionnaire has
undergone various levels of validity and reliability testing and has displayed
undergone various levels of validity and reliability testing and has displayed
relevant levels of reliability and content, construct and criterion validity. Numerous
relevant levels of reliability and content, construct and criterion validity. Numerous
studies have demonstrated the usefulness of this tool in English-speaking health
studies have demonstrated the usefulness of this tool in English-speaking health
care environments (30-32) and it has been successfully translated, adapted and
care environments (30-32) and it has been successfully translated, adapted and
validated in Canadian French (33), Brazilian Portuguese (34) and Dutch
validated in Canadian French (33), Brazilian Portuguese (34) and Dutch
(14,19,35). No such version exists in Spanish.
(14,19,35). No such version exists in Spanish.
8
8
8
8
Type
Reference
Generic WF instrument. Single global rating.
(36)
Generic WF instrument. Single global rating.
(37)
Generic WF instrument. Single global rating.
(38)
Specific WF instrument for lost productive time.
(39)
Generic WF instrument. Overall and subscales rating.
(40)
Specific WF instrument for daily follow-up.
(41)
Specific WFfor quantity and quality of work.
(42)
Specific WF for rheumatic conditions.
(43)
Specific WF for angina pectoris.
(44)
Specific WF or arthritic population.
(45)
Specific WF for clinically depressed population.
(46)
Specific WF for nurses with common mental disorders
(47)
Generic WF instrument. Overall rating.
(48)
Generic WF instrument. Overall rating.
(49)
Generic WF instrument. Overall and subscales rating.
(29)
Generic WF instrument. Overall and subscales rating.
(12)
Acronym
HPQ
WPAI
WPSI
WHI
HLQ
HRPQ-D
QQ
HAQ
−
WALS
LEAPS
NWFQ
EWPS
SPS
WLQ
WRFQ
Name of the Instrument
Health and Work Performance Questionnaire
Work Productivity and Activity Impairment Questionnaire
Work Productivity Short Inventory
Work and Health Interview
Health and Labor Questionnaire
Health Related Productivity Questionnaire Dairy
Quantity and Quality Instrument
Health Assessment Questionnaire
Angina-related Limitations at Work Questionnaire
Workplace Activity Limitations Scale
Lam Employment Absence and Productivity Scale
Nurses Work Functioning Questionnaire
Endicott Work Productivity Scale
Standford Presenteeism Scale
Work Limitations Questionnaire
Work Role Functioning Questionnaire
Type
Reference
Generic WF instrument. Single global rating.
(36)
Generic WF instrument. Single global rating.
(37)
Generic WF instrument. Single global rating.
(38)
Specific WF instrument for lost productive time.
(39)
Generic WF instrument. Overall and subscales rating.
(40)
Specific WF instrument for daily follow-up.
(41)
Specific WFfor quantity and quality of work.
(42)
Specific WF for rheumatic conditions.
(43)
Specific WF for angina pectoris.
(44)
Specific WF or arthritic population.
(45)
Specific WF for clinically depressed population.
(46)
Specific WF for nurses with common mental disorders
(47)
Generic WF instrument. Overall rating.
(48)
Generic WF instrument. Overall rating.
(49)
Generic WF instrument. Overall and subscales rating.
(29)
Generic WF instrument. Overall and subscales rating.
(12)
Table 1. Specific and generic work functioning measurement instruments.
Name of the Instrument
Health and Work Performance Questionnaire
Work Productivity and Activity Impairment Questionnaire
Work Productivity Short Inventory
Work and Health Interview
Health and Labor Questionnaire
Health Related Productivity Questionnaire Dairy
Quantity and Quality Instrument
Health Assessment Questionnaire
Angina-related Limitations at Work Questionnaire
Workplace Activity Limitations Scale
Lam Employment Absence and Productivity Scale
Nurses Work Functioning Questionnaire
Endicott Work Productivity Scale
Standford Presenteeism Scale
Work Limitations Questionnaire
Work Role Functioning Questionnaire
Table 1. Specific and generic work functioning measurement instruments.
Acronym
HPQ
WPAI
WPSI
WHI
HLQ
HRPQ-D
QQ
HAQ
−
WALS
LEAPS
NWFQ
EWPS
SPS
WLQ
WRFQ
9
9
9
9
184
184
1.4. Methodological quality in health-questionnaire validation
1.4. Methodological quality in health-questionnaire validation
Since measurement is at the core of occupational health research and practice,
Since measurement is at the core of occupational health research and practice,
access to quality measurement instruments is essential. Ensuring that it is well-
access to quality measurement instruments is essential. Ensuring that it is well-
designed and its content appropriate to measuring what it claims to measure
designed and its content appropriate to measuring what it claims to measure
should not be underestimated. In absolute terms, valid instruments do not exist.
should not be underestimated. In absolute terms, valid instruments do not exist.
Validating a measuring instrument is a process, sometimes complex, in which a
Validating a measuring instrument is a process, sometimes complex, in which a
base of evidence has to be constructed to support that the instrument meets a
base of evidence has to be constructed to support that the instrument meets a
number of measurement properties. When quality evidence is provided about the
number of measurement properties. When quality evidence is provided about the
presence or absence of these properties, it is possible to assign a degree of
presence or absence of these properties, it is possible to assign a degree of
quality to the instrument for a specific purpose. Hence, the methodology used to
quality to the instrument for a specific purpose. Hence, the methodology used to
carry out a validation process becomes the most important determinant to accept
carry out a validation process becomes the most important determinant to accept
or reject the quality of a measurement instrument.
or reject the quality of a measurement instrument.
This process becomes more challenging when using a measurement instrument
This process becomes more challenging when using a measurement instrument
developed in a particular language or culture with the aim of using it in a different
developed in a particular language or culture with the aim of using it in a different
one. In these cases, a simple (direct) translation of the questionnaire could be
one. In these cases, a simple (direct) translation of the questionnaire could be
unreliable, because misinterpretation could appear due to language and cultural
unreliable, because misinterpretation could appear due to language and cultural
differences in the perception of work, health and/or disease. In these
differences in the perception of work, health and/or disease. In these
circumstances, it is necessary to perform a cross-cultural validation, following a
circumstances, it is necessary to perform a cross-cultural validation, following a
systematic procedure. For several authors the cross-cultural validation is part of
systematic procedure. For several authors the cross-cultural validation is part of
the construct validation and should be assessed to guarantee the validity of the
the construct validation and should be assessed to guarantee the validity of the
instrument (28,50-52).
instrument (28,50-52).
There are several approaches in the literature to address the validation process of
There are several approaches in the literature to address the validation process of
a measuring instrument. Some approaches come from internationally renowned
a measuring instrument. Some approaches come from internationally renowned
experts in the design and validation methodology of questionnaires (28,53-59).
experts in the design and validation methodology of questionnaires (28,53-59).
Others come from different research groups that have achieved international
Others come from different research groups that have achieved international
standards. Among the latter, the following stand out: the consensus-based
standards. Among the latter, the following stand out: the consensus-based
standards on terminology and recommendations to assess the methodological
standards on terminology and recommendations to assess the methodological
quality of studies on measurement properties of health status measurements
quality of studies on measurement properties of health status measurements
11
11
instruments (COSMIN) (50-52);the standardized methodology for evaluating the
instruments (COSMIN) (50-52);the standardized methodology for evaluating the
measurement of patient-reported outcomes (EMPRO) to assist the choice of
measurement of patient-reported outcomes (EMPRO) to assist the choice of
instruments (60); the methodology of the Health Technology Assessment
instruments (60); the methodology of the Health Technology Assessment
Programme (HTA Programme) to evaluate patient-based outcome measures for
Programme (HTA Programme) to evaluate patient-based outcome measures for
use in clinical trials (61) and the criteria proposed by the Scientific Advisory
use in clinical trials (61) and the criteria proposed by the Scientific Advisory
Committee of the Medical Outcomes Trust (62).
Committee of the Medical Outcomes Trust (62).
To state that a questionnaire has been validated, it is necessary to provide
To state that a questionnaire has been validated, it is necessary to provide
evidence about certain features: 1) whether an instrument measures what it
evidence about certain features: 1) whether an instrument measures what it
purports to measure, 2) how it reflects the theory underlying the phenomenon
purports to measure, 2) how it reflects the theory underlying the phenomenon
being measured, 3) the degree to which the scores are an adequate reflection of
being measured, 3) the degree to which the scores are an adequate reflection of
a gold standard, 4) the extent to which the scores of the instrument are consistent
a gold standard, 4) the extent to which the scores of the instrument are consistent
with stated hypotheses,5) the degree of simplicity, feasibility and acceptability to
with stated hypotheses,5) the degree of simplicity, feasibility and acceptability to
patients, users and researchers, 4) the ability to measure free from error and,
patients, users and researchers, 4) the ability to measure free from error and,
therefore, ability to provide reproducible results when applied to individuals who
therefore, ability to provide reproducible results when applied to individuals who
have not changed over time, and 5) the sensitivity to detecting true changes over
have not changed over time, and 5) the sensitivity to detecting true changes over
time. All these features are related to three properties of the questionnaires:
time. All these features are related to three properties of the questionnaires:
validity, reliability and responsiveness.
validity, reliability and responsiveness.
However, the terminology found in the literature can be confusing for several
However, the terminology found in the literature can be confusing for several
reasons. First, there are differences in terms used as synonyms for measurement
reasons. First, there are differences in terms used as synonyms for measurement
properties (e.g. reliability, repeatability, stability, reproducibility and precision are
properties (e.g. reliability, repeatability, stability, reproducibility and precision are
used interchangeably). Second, there are different definitions given to the same
used interchangeably). Second, there are different definitions given to the same
concept (e.g. different authors give different definitions for responsiveness). Third,
concept (e.g. different authors give different definitions for responsiveness). Third,
different research groups evaluate different properties and characteristics of the
different research groups evaluate different properties and characteristics of the
instruments when assessing their quality (e.g. evaluation of appropriateness,
instruments when assessing their quality (e.g. evaluation of appropriateness,
interpretability, acceptability or feasibility are recommended in some guides but not
interpretability, acceptability or feasibility are recommended in some guides but not
others). Fourth, there is a wide variety of classifications of measurement properties
others). Fourth, there is a wide variety of classifications of measurement properties
depending on authors and research groups (e.g. some authors, but not all,
depending on authors and research groups (e.g. some authors, but not all,
consider evaluating the cross-cultural adaptation as a part of construct validity;
consider evaluating the cross-cultural adaptation as a part of construct validity;
12
12
12
12
some consider responsiveness to be an aspect of validity, and also that face
some consider responsiveness to be an aspect of validity, and also that face
validity is an aspect of content validity).
validity is an aspect of content validity).
In this thesis a comprehensive review of the literature was conducted to
In this thesis a comprehensive review of the literature was conducted to
systematize the steps involved in validating a health questionnaire, the Work Role
systematize the steps involved in validating a health questionnaire, the Work Role
Functioning
Functioning
Questionnaire
(WRFQ),
following
the
methodological
Questionnaire
(WRFQ),
following
the
methodological
recommendations which found greater consensus. Next, the requirements for
recommendations which found greater consensus. Next, the requirements for
conducting a quality cross-cultural adaptation of health questionnaires were
conducting a quality cross-cultural adaptation of health questionnaires were
defined in detail and the properties evaluated were based on those most
defined in detail and the properties evaluated were based on those most
frequently recommended by experts and consensus groups, and then applied to
frequently recommended by experts and consensus groups, and then applied to
this questionnaire.
this questionnaire.
13
13
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59. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al.
59. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al.
Quality criteria were proposed for measurement properties of health status
Quality criteria were proposed for measurement properties of health status
questionnaires. J Clin Epidemiol. 2007;60:34-42.
questionnaires. J Clin Epidemiol. 2007;60:34-42.
60. Valderas JM, Ferrer M, Mendívil J, Garin O, Rajmil L, Herdman M, et al.
60. Valderas JM, Ferrer M, Mendívil J, Garin O, Rajmil L, Herdman M, et al.
Development of EMPRO: a tool for the standardized assessment of patient-
Development of EMPRO: a tool for the standardized assessment of patient-
reported outcome measures. Value Health. 2008;11:700-8.
reported outcome measures. Value Health. 2008;11:700-8.
61. Fitzpatrick R, Davey C, Buxton MJ, Jones DR. Evaluating patient-based
61. Fitzpatrick R, Davey C, Buxton MJ, Jones DR. Evaluating patient-based
outcome measures for use in clinical trials. Health Technol Assessment.
outcome measures for use in clinical trials. Health Technol Assessment.
1998;2:1-74.
1998;2:1-74.
62. Aaronson N, Alonso J, Burnam A, Lohr KN, Patrick DL, Perrin E, et al.
62. Aaronson N, Alonso J, Burnam A, Lohr KN, Patrick DL, Perrin E, et al.
Assessing health status and quality-of-life instruments: attributes and review
Assessing health status and quality-of-life instruments: attributes and review
criteria. Qual Life Res. 2002;11:193-205.
criteria. Qual Life Res. 2002;11:193-205.
21
21
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184
2. OBJECTIVES
2. OBJECTIVES
2.1. Study I Objectives
2.1. Study I Objectives
To review the literature on the methodology for cross-cultural adaptation and
To review the literature on the methodology for cross-cultural adaptation and
validation
validation
(CCAV)
of
health
questionnaires
and
to
synthesize
(CCAV)
of
health
questionnaires
and
to
synthesize
recommendations based on the scientific literature to facilitate this process.
recommendations based on the scientific literature to facilitate this process.
To
To
evaluate
the
degree
of
compliance
with
the
methodological
evaluate
the
degree
of
compliance
with
the
methodological
recommendations for the CCAV of health questionnaires in a selection of
recommendations for the CCAV of health questionnaires in a selection of
Spanish-language scientific journals.
Spanish-language scientific journals.
2.2. Study II Objectives
2.2. Study II Objectives
To translate and adapt the Work Role Functioning Questionnaire to Spanish
To translate and adapt the Work Role Functioning Questionnaire to Spanish
spoken in Spain.
spoken in Spain.
To perform a preliminary evaluation of the Spanish version of the Work Role
To perform a preliminary evaluation of the Spanish version of the Work Role
Functioning Questionnaire psychometric properties by means of a pre-test.
Functioning Questionnaire psychometric properties by means of a pre-test.
2.3. Study III Objective
2.3. Study III Objective
To examine the reliability and validity of the Spanish version of the Work Role
To examine the reliability and validity of the Spanish version of the Work Role
Functioning Questionnaire in a Spanish-speaking general working population.
Functioning Questionnaire in a Spanish-speaking general working population.
2.4. Study IV Objective
2.4. Study IV Objective
To examine the responsiveness of the Spanish version of the Work Role
To examine the responsiveness of the Spanish version of the Work Role
Functioning Questionnaire in a Spanish-speaking general working population.
Functioning Questionnaire in a Spanish-speaking general working population.
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23
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184
3. PAPER # 1
3. PAPER # 1
Adaptación cultural y validación de cuestionarios de
Adaptación cultural y validación de cuestionarios de
salud: revisión y recomendaciones metodológicas. Salud
salud: revisión y recomendaciones metodológicas. Salud
Pública de México. 2013; 55:57-66.
Pública de México. 2013; 55:57-66.
25
25
Ramada-Rodilla JM, Serra-Pujadas C, Delclós-Clanchet GL. Adaptación cultural y
validación de cuestionarios de salud: revisión y recomendaciones metodológicas. Salud
Publica Mex. 2013; 55(1):57-66 http://dx.doi.org/10.1590/S0036-36342013000100009
184
184
3. PAPER # 2
3. PAPER # 2
Cross-cultural adaptation of the work role functioning
Cross-cultural adaptation of the work role functioning
questionnaire to Spanish spoken in Spain. Journal of
questionnaire to Spanish spoken in Spain. Journal of
Occupational Rehabilitation. 2013;23:566-75.
Occupational Rehabilitation. 2013;23:566-75.
37
37
Ramada JM, Serra C, Amick BC 3rd, Castaño JR, Delclos GL. Cross-cultural
adaptation of the Work Role Functioning Questionnaire to Spanish spoken in
Spain. J Occup Rehabil. 2013 Dec;23(4):566-75. doi: 10.1007/s10926-013-9420-6
184
184
4. PAPER # 3
4. PAPER # 3
Reliability and validity of the Work Role Functioning
Reliability and validity of the Work Role Functioning
Questionnaire (Spanish version). [Submitted for peer-
Questionnaire (Spanish version). [Submitted for peer-
review].
review].
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49
Ramada JM, Serra C, Amick BC 3rd, Abma FI, Castaño JR, Pidemunt G, Bültmann U, Delclos
GL. Reliability and validity of the work role functioning questionnaire (Spanish version). J
Occup Rehabil. 2014 Dec;24(4):640-9. doi:10.1007/s10926-013-9495-0.
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TITLE:
TITLE:
Reliability and validity of the Work Role Functioning Questionnaire (Spanish
version).
AUTHORS:
Reliability and validity of the Work Role Functioning Questionnaire (Spanish
version).
AUTHORS:
1,2,3
1,2,3
José M Ramada Rodilla, MD, MSc
José M Ramada Rodilla, MD, MSc
1,2,3
1,2,3
Consol Serra Pujadas, MD, PhD
Benjamin C Amick, PhD4,5
Femke I Abma, PhD6
Juan R Castaño Asins, MD7
Gemma Pidemunt Moli, MD, PhD8
Ute Bültmann, PhD6
George L Delclós Clanchet, MD, MPH, PhD1,3,4
Consol Serra Pujadas, MD, PhD
Benjamin C Amick, PhD4,5
Femke I Abma, PhD6
Juan R Castaño Asins, MD7
Gemma Pidemunt Moli, MD, PhD8
Ute Bültmann, PhD6
George L Delclós Clanchet, MD, MPH, PhD1,3,4
AFFILIATIONS:
AFFILIATIONS:
1
Centro de Investigación en Salud Laboral (CiSAL), Universidad Pompeu
Fabra, Barcelona, España.
1
Centro de Investigación en Salud Laboral (CiSAL), Universidad Pompeu
Fabra, Barcelona, España.
2
Servicio de Salud Laboral, Parc de Salut MAR, Barcelona, España.
2
Servicio de Salud Laboral, Parc de Salut MAR, Barcelona, España.
3
CIBER de Epidemiología y Salud Pública (CIBERESP).
3
CIBER de Epidemiología y Salud Pública (CIBERESP).
4
Southwest Center for Occupational and Environmental Health, The University
of Texas School of Public Health. Houston, Texas, USA.
4
Southwest Center for Occupational and Environmental Health, The University
of Texas School of Public Health. Houston, Texas, USA.
5
Institute for work & Health. 80 University Avenue, Toronto, Ontario, Canada.
5
Institute for work & Health. 80 University Avenue, Toronto, Ontario, Canada.
6
Department of Health Sciences, Work & Health, University Medical Center
Groningen, University of Groningen. Groningen, The Netherlands.
6
Department of Health Sciences, Work & Health, University Medical Center
Groningen, University of Groningen. Groningen, The Netherlands.
7
Psychiatry Service. Parc de Salut MAR. Hospital del Mar. Barcelona, Spain.
7
Psychiatry Service. Parc de Salut MAR. Hospital del Mar. Barcelona, Spain.
8
Orthopedic Surgery and Traumatology Service. Parc de Salut MAR. Hospital
del Mar. Barcelona, Spain.
8
Orthopedic Surgery and Traumatology Service. Parc de Salut MAR. Hospital
del Mar. Barcelona, Spain.
CORRESPONDING AUTHOR:
CORRESPONDING AUTHOR:
José Mª Ramada Rodilla
CiSAL - Universidad Pompeu Fabra
Dr. Aiguader, 88
08003-Barcelona
Correo electrónico: [email protected]
Tel. 932483066
José Mª Ramada Rodilla
CiSAL - Universidad Pompeu Fabra
Dr. Aiguader, 88
08003-Barcelona
Correo electrónico: [email protected]
Tel. 932483066
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ABSTRACT
ABSTRACT
Purpose: Recently, the cross-cultural adaptation of the Work Role Functioning
Purpose: Recently, the cross-cultural adaptation of the Work Role Functioning
Questionnaire to Spanish was carried out, achieving satisfactory psychometric properties.
Questionnaire to Spanish was carried out, achieving satisfactory psychometric properties.
Now we examined the reliability and validity of the adapted Spanish version (WRFQ-SpV)
Now we examined the reliability and validity of the adapted Spanish version (WRFQ-SpV)
in a general working population with and without (physical and mental) health issues to
in a general working population with and without (physical and mental) health issues to
evaluate its measurement properties.
evaluate its measurement properties.
Methods: A cross-sectional study was conducted among active workers. For reliability,
Methods: A cross-sectional study was conducted among active workers. For reliability,
we calculated Cronbach alpha to assess ‘internal consistency’, and the standard error of
we calculated Cronbach alpha to assess ‘internal consistency’, and the standard error of
measurement (SEM) to evaluate ‘measurement error’. We assessed the 'structural
measurement (SEM) to evaluate ‘measurement error’. We assessed the 'structural
validity' through confirmatory factor analyses and 'construct validity' by means of
validity' through confirmatory factor analyses and 'construct validity' by means of
hypotheses testing. The consensus-based standard for the selection of health status
hypotheses testing. The consensus-based standard for the selection of health status
measurement instruments (COSMIN) taxonomy were used in the design of the study.
measurement instruments (COSMIN) taxonomy were used in the design of the study.
Results: A total of 455 workers completed the questionnaire. It showed excellent internal
Results: A total of 455 workers completed the questionnaire. It showed excellent internal
consistency (α=0.98). The SEM for the overall scale was 7.10. The original five factor
consistency (α=0.98). The SEM for the overall scale was 7.10. The original five factor
structure reflected fair dimensionality of the construct (Chi-square, 1445.8; 314 degrees of
structure reflected fair dimensionality of the construct (Chi-square, 1445.8; 314 degrees of
freedom; RMSEA=0.08; CFI > 0.95 and WRMR > 0.90). For construct validity, all
freedom; RMSEA=0.08; CFI > 0.95 and WRMR > 0.90). For construct validity, all
hypotheses were confirmed differentiating groups with different jobs, health conditions and
hypotheses were confirmed differentiating groups with different jobs, health conditions and
ages. Moderate to strong correlations were found between WRFQ-SpV and a related
ages. Moderate to strong correlations were found between WRFQ-SpV and a related
construct (work ability).
construct (work ability).
Conclusions: Our study provides evidence of the reliability and validity of the WRFQ-SpV
Conclusions: Our study provides evidence of the reliability and validity of the WRFQ-SpV
to measure health-related work functioning in day-to-day practice and research in
to measure health-related work functioning in day-to-day practice and research in
occupational health care and the rehabilitation of disabled workers. It should be useful to
occupational health care and the rehabilitation of disabled workers. It should be useful to
monitor improvements in work functioning after implementing rehabilitation and/or
monitor improvements in work functioning after implementing rehabilitation and/or
accommodation programs. Longitudinal studies are needed to assess the responsiveness
accommodation programs. Longitudinal studies are needed to assess the responsiveness
of the questionnaire.
of the questionnaire.
Key terms: validity; reliability; work-functioning instrument; measurement instrument;
Key terms: validity; reliability; work-functioning instrument; measurement instrument;
psychometric properties; self-report.
psychometric properties; self-report.
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INTRODUCTION
INTRODUCTION
Increasing life expectancy in developed countries and delayed retirement age are
Increasing life expectancy in developed countries and delayed retirement age are
increasing the overall age of the workforce. Aging workers are more likely to have
increasing the overall age of the workforce. Aging workers are more likely to have
chronic health issues and a certain degree of disability, but most are able to
chronic health issues and a certain degree of disability, but most are able to
maintain job competence with some workplace adjustments and/or rehabilitation
maintain job competence with some workplace adjustments and/or rehabilitation
programs [1-4]. Also, there is evidence showing that work has positive health
programs [1-4]. Also, there is evidence showing that work has positive health
effects when conditions are reasonably acceptable; therefore, promoting an active
effects when conditions are reasonably acceptable; therefore, promoting an active
working life is recommendable [5,6].
working life is recommendable [5,6].
Quality work functioning tools are required to obtain valid measurements to
Quality work functioning tools are required to obtain valid measurements to
evaluate the impact of health on work functioning and to monitor the extent to
evaluate the impact of health on work functioning and to monitor the extent to
which workers improve their ability to meet job demands after a rehabilitation or
which workers improve their ability to meet job demands after a rehabilitation or
accommodation program. This will enable healthcare professionals, human
accommodation program. This will enable healthcare professionals, human
resources managers, employers and other stakeholders to support an active and
resources managers, employers and other stakeholders to support an active and
healthy labor force. Moreover, valid outcome measures are needed to assess how
healthy labor force. Moreover, valid outcome measures are needed to assess how
workers function at work over the course of their job careers and the existing
workers function at work over the course of their job careers and the existing
continuum between working successfully at one extreme and disability and work-
continuum between working successfully at one extreme and disability and work-
absence at the other [7].
absence at the other [7].
There are a number of tools to measure constructs related to self-perceived work
There are a number of tools to measure constructs related to self-perceived work
functioning, including the Functional Status Index [8], the Work Productivity and
functioning, including the Functional Status Index [8], the Work Productivity and
Activity Impairment Questionnaire [9], the Health and Labor Questionnaire [10],
Activity Impairment Questionnaire [9], the Health and Labor Questionnaire [10],
the Endicott Work Productivity Scale [11], the Work Ability Index [12], the Role-
the Endicott Work Productivity Scale [11], the Work Ability Index [12], the Role-
based Performance Scale [13], the Stanford Presenteeism Scale [14], the Work
based Performance Scale [13], the Stanford Presenteeism Scale [14], the Work
Instability Scale [15], and the Work Activity Limitations Scale [16].
Instability Scale [15], and the Work Activity Limitations Scale [16].
Since 'being present at work without being able to meet job demands'
Since 'being present at work without being able to meet job demands'
(presenteeism) [17] is not the same as 'performing work demands successfully', a
(presenteeism) [17] is not the same as 'performing work demands successfully', a
series of work-role specific functioning questionnaires were developed in the
series of work-role specific functioning questionnaires were developed in the
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53
2000’s. Among those, there are different versions of the Work Limitations
2000’s. Among those, there are different versions of the Work Limitations
Questionnaire [18] and the Work Role Functioning Questionnaire (WRFQ) [19].
Questionnaire [18] and the Work Role Functioning Questionnaire (WRFQ) [19].
The WRFQ measures perceived difficulties to perform the job due to health
The WRFQ measures perceived difficulties to perform the job due to health
problems. This questionnaire is a generic instrument conceptually developed to
problems. This questionnaire is a generic instrument conceptually developed to
represent a wide range of health conditions and work demands. Furthermore, it is
represent a wide range of health conditions and work demands. Furthermore, it is
freely available in the literature for professionals and researchers. Recently, it has
freely available in the literature for professionals and researchers. Recently, it has
been successfully translated, adapted and validated to be used in different
been successfully translated, adapted and validated to be used in different
contexts (e.g. Canadian French [20], Brazilian Portuguese [21], Dutch [7,22] and
contexts (e.g. Canadian French [20], Brazilian Portuguese [21], Dutch [7,22] and
Spanish spoken in Spain [23]). These versions have shown good psychometric
Spanish spoken in Spain [23]). These versions have shown good psychometric
properties in different populations.
properties in different populations.
Before using an adapted instrument it is important to assess its measurement
Before using an adapted instrument it is important to assess its measurement
properties [24]. Recent reviews have shown that health-related work outcome
properties [24]. Recent reviews have shown that health-related work outcome
measures and health-related work functioning instruments need better validation
measures and health-related work functioning instruments need better validation
studies to make them more meaningful for researchers, practitioners and patients
studies to make them more meaningful for researchers, practitioners and patients
[25,26]. The cross-cultural adaptation of the WRFQ to Spanish was recently
[25,26]. The cross-cultural adaptation of the WRFQ to Spanish was recently
carried out, and the questionnaire showed good test-retest reliability (intraclass
carried out, and the questionnaire showed good test-retest reliability (intraclass
correlation coefficients, ICCs between 0.77 and 0.93 for all subscales) [23], but
correlation coefficients, ICCs between 0.77 and 0.93 for all subscales) [23], but
further assessment of the validity and reliability of the questionnaire in a larger
further assessment of the validity and reliability of the questionnaire in a larger
sample was recommended.
sample was recommended.
Therefore, the objective of this study was to examine the reliability and validity of
Therefore, the objective of this study was to examine the reliability and validity of
the Spanish version of the WRFQ (WRFQ-SpV) in a general working population of
the Spanish version of the WRFQ (WRFQ-SpV) in a general working population of
Barcelona (Spain), with and without (physical and mental) health issues.
Barcelona (Spain), with and without (physical and mental) health issues.
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METHODS
METHODS
Procedures and sample characteristics
Procedures and sample characteristics
After carrying out the cross-cultural adaptation of the WRFQ to Spanish spoken in
After carrying out the cross-cultural adaptation of the WRFQ to Spanish spoken in
Spain [23], it was necessary to assess its reliability and validity in a larger sample
Spain [23], it was necessary to assess its reliability and validity in a larger sample
so that it could be used in both occupational health and rehabilitation settings;
so that it could be used in both occupational health and rehabilitation settings;
hence a cross-sectional study was conducted among active workers of a general
hence a cross-sectional study was conducted among active workers of a general
working population of Barcelona (Spain). The consensus-based standard for the
working population of Barcelona (Spain). The consensus-based standard for the
selection of health status measurement instruments (COSMIN) taxonomy was
selection of health status measurement instruments (COSMIN) taxonomy was
used in the study design [27-29].
used in the study design [27-29].
Participants were recruited at a large public hospital in Barcelona, among patients,
Participants were recruited at a large public hospital in Barcelona, among patients,
persons accompanying patients, hospital workers and other workers that were
persons accompanying patients, hospital workers and other workers that were
carrying out different duties at the hospital (ambulance drivers, bar tenders,
carrying out different duties at the hospital (ambulance drivers, bar tenders,
kitchen and cleaning staff). Patients were recruited through the outpatient services
kitchen and cleaning staff). Patients were recruited through the outpatient services
of psychiatry, physical medicine and rehabilitation, orthopedic surgery and
of psychiatry, physical medicine and rehabilitation, orthopedic surgery and
traumatology. The inclusion criteria were: 1) active workers of both sexes, working
traumatology. The inclusion criteria were: 1) active workers of both sexes, working
at least 10 hours per week in the past four weeks, 2) age 18 years and older, and
at least 10 hours per week in the past four weeks, 2) age 18 years and older, and
3) able to read and understand Spanish (the language of the questionnaire).
3) able to read and understand Spanish (the language of the questionnaire).
Participants were excluded if they had plans to stop working within the following
Participants were excluded if they had plans to stop working within the following
six months.
six months.
The study protocol and the informed consent process was reviewed and approved
The study protocol and the informed consent process was reviewed and approved
by the Clinical Research Ethical Committee of the Parc de Salut Mar (Barcelona).
by the Clinical Research Ethical Committee of the Parc de Salut Mar (Barcelona).
All participants received information about the study purpose and signed the
All participants received information about the study purpose and signed the
informed consent to participate in it.
informed consent to participate in it.
Measures
Measures
The WRFQ-SpV is a self-administered questionnaire containing 27 items grouped
The WRFQ-SpV is a self-administered questionnaire containing 27 items grouped
into 5 subscales reflecting different work demands: work scheduling, output,
into 5 subscales reflecting different work demands: work scheduling, output,
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physical, mental and social demands [23]. The recall period is four weeks and
physical, mental and social demands [23]. The recall period is four weeks and
each subscale is measured by the percentage of time in a working day the
each subscale is measured by the percentage of time in a working day the
employee has difficulty performing those demands. Response options vary on a
employee has difficulty performing those demands. Response options vary on a
five-point scale: 0=all of the time (100%), 1=most of the time, 2=half of the time
five-point scale: 0=all of the time (100%), 1=most of the time, 2=half of the time
(50%), 3=some of the time, 4=none of the time (0%) and 5=does not apply to my
(50%), 3=some of the time, 4=none of the time (0%) and 5=does not apply to my
job. For each subscale and for the overall scale, item scores were summed,
job. For each subscale and for the overall scale, item scores were summed,
divided by the number of items included in the subscale (or the overall scale), and
divided by the number of items included in the subscale (or the overall scale), and
then multiplied by 25 to obtain the scores, ranging from 0% (difficulty all the time)
then multiplied by 25 to obtain the scores, ranging from 0% (difficulty all the time)
to 100% (no difficulty at any time). The scores for "does not apply to my job" were
to 100% (no difficulty at any time). The scores for "does not apply to my job" were
transformed to missing values. Scales and/or subscales containing more than 20%
transformed to missing values. Scales and/or subscales containing more than 20%
missing values were set to missing.
missing values were set to missing.
All participants were invited to complete the WRFQ-SpV on paper, providing self-
All participants were invited to complete the WRFQ-SpV on paper, providing self-
reported information on age, gender, level of education (primary, secondary,
reported information on age, gender, level of education (primary, secondary,
higher), job type (manual, non-manual, mixed), working hours and primary health
higher), job type (manual, non-manual, mixed), working hours and primary health
condition (none, musculoskeletal, mental, others).
condition (none, musculoskeletal, mental, others).
Three single items of the work ability index (WAI) [12] were included in the survey
Three single items of the work ability index (WAI) [12] were included in the survey
for a convenience subsample of participants, who voluntarily accepted to answer
for a convenience subsample of participants, who voluntarily accepted to answer
to these items. The first was the overall item 'current work ability compared with
to these items. The first was the overall item 'current work ability compared with
the life-time best', with a possible score of 0=completely unable to work to
the life-time best', with a possible score of 0=completely unable to work to
10=work ability at its best. Recent studies showed that this overall single item
10=work ability at its best. Recent studies showed that this overall single item
highly correlates with the overall WAI score [30] and also showed the convergent
highly correlates with the overall WAI score [30] and also showed the convergent
validity and the similarity in results between the overall WAI scores and the scores
validity and the similarity in results between the overall WAI scores and the scores
of the overall single item of the WAI in large samples of participants [31]. Also,
of the overall single item of the WAI in large samples of participants [31]. Also,
there is an increasing number of studies using the overall single item of the WAI to
there is an increasing number of studies using the overall single item of the WAI to
assess 'work ability' in different populations [7,30,32,33]. The other two items
assess 'work ability' in different populations [7,30,32,33]. The other two items
measure work ability in relation to physical and mental job demands, with a
measure work ability in relation to physical and mental job demands, with a
possible score of 1=very poor to 5=very good, and are questions already validated
possible score of 1=very poor to 5=very good, and are questions already validated
in the original version of the questionnaire [12].
in the original version of the questionnaire [12].
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Reliability assessment:
Reliability assessment:
Reliability is defined as the degree to which the measurement is free from
Reliability is defined as the degree to which the measurement is free from
measurement error [27], and can also be defined as the extent to which scores for
measurement error [27], and can also be defined as the extent to which scores for
participants who have not changed are the same for repeated measurement under
participants who have not changed are the same for repeated measurement under
several conditions [35]: 1) using different sets of items from the same muli-item
several conditions [35]: 1) using different sets of items from the same muli-item
measurement instrument (internal consistency); 2) over time (test-retest reliability);
measurement instrument (internal consistency); 2) over time (test-retest reliability);
3) by different raters on the same occasion (inter-rater reliability) or 4) by the same
3) by different raters on the same occasion (inter-rater reliability) or 4) by the same
raters on different occasions (intra-rater reliability). The COSMIN taxonomy [27,35]
raters on different occasions (intra-rater reliability). The COSMIN taxonomy [27,35]
also considers measurement error as an aspect of reliability.
also considers measurement error as an aspect of reliability.
Validity assessment:
Validity assessment:
Validity of a questionnaire is defined in the literature as the degree to which an
Validity of a questionnaire is defined in the literature as the degree to which an
instrument truly measures the construct it purposes to measure. In general, three
instrument truly measures the construct it purposes to measure. In general, three
different types of validity can be distinguished: content validity, criterion validity
different types of validity can be distinguished: content validity, criterion validity
and construct validity, and within these three main types of validity there are some
and construct validity, and within these three main types of validity there are some
subtypes [35].
subtypes [35].
Content validity focuses on whether the content of the instrument corresponds with
Content validity focuses on whether the content of the instrument corresponds with
the construct that the instrument measures, with regard to relevance and
the construct that the instrument measures, with regard to relevance and
comprehensiveness. This type of validity is frequently assessed by means of a
comprehensiveness. This type of validity is frequently assessed by means of a
systematic empiric procedure in which the authors of the questionnaire, a panel of
systematic empiric procedure in which the authors of the questionnaire, a panel of
experts and a sample of the target population participate. It was already assessed
experts and a sample of the target population participate. It was already assessed
in our previous manuscript about the cross-cultural adaptation of the Work Role
in our previous manuscript about the cross-cultural adaptation of the Work Role
Functioning Questionnaire (WRFQ), following rigorously the recommendations of
Functioning Questionnaire (WRFQ), following rigorously the recommendations of
the literature [23].
the literature [23].
Criterion validity can be assessed only in situations in which there is a gold
Criterion validity can be assessed only in situations in which there is a gold
standard for the construct to be measured, and refers to how well the scores of the
standard for the construct to be measured, and refers to how well the scores of the
measurement instrument agree with the scores obtained with the gold standard.
measurement instrument agree with the scores obtained with the gold standard.
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57
Since 'Work Functioning' is a construct that has not a gold standard, this type of
Since 'Work Functioning' is a construct that has not a gold standard, this type of
validity cannot be assessed for the Work Role Functioning Questionnaire (WRFQ).
validity cannot be assessed for the Work Role Functioning Questionnaire (WRFQ).
Construct validity should be evaluated in those situations in which there is no gold
Construct validity should be evaluated in those situations in which there is no gold
standard, and refers to whether the instrument provides the expected scores,
standard, and refers to whether the instrument provides the expected scores,
based on existing knowledge about the construct [35]. There is an international
based on existing knowledge about the construct [35]. There is an international
consensus of experts [27-29] recommending to assess construct validity
consensus of experts [27-29] recommending to assess construct validity
evaluating the 'cross-cultural validity', which we already did in our previous
evaluating the 'cross-cultural validity', which we already did in our previous
manuscript [23]; the 'structural validity' which we carried out by means of a
manuscript [23]; the 'structural validity' which we carried out by means of a
Confirmatory Factor Analysis (CFA) and 'hypotheses testing', which we carried
Confirmatory Factor Analysis (CFA) and 'hypotheses testing', which we carried
out testing seven hypotheses.
out testing seven hypotheses.
Statistical analysis
Statistical analysis
WRFQ-SpV mean scores, standard deviations (SD), median scores and ranges
WRFQ-SpV mean scores, standard deviations (SD), median scores and ranges
were calculated. Floor and ceiling effects were also explored. These effects occur
were calculated. Floor and ceiling effects were also explored. These effects occur
when more than 15% of the participants' responses to a certain question cluster at
when more than 15% of the participants' responses to a certain question cluster at
the top or the bottom of the scale [34]. Since the original version of the WRFQ was
the top or the bottom of the scale [34]. Since the original version of the WRFQ was
developed for a working population with health problems [19], and our population
developed for a working population with health problems [19], and our population
contains a percentage of participants declaring no health issues, we carried out a
contains a percentage of participants declaring no health issues, we carried out a
sensitivity analysis of floor and ceiling effects, restricting the sample to only those
sensitivity analysis of floor and ceiling effects, restricting the sample to only those
participants reporting health problems to explore if there were differences in the
participants reporting health problems to explore if there were differences in the
presence of these effects due to the characteristic of the sample.
presence of these effects due to the characteristic of the sample.
Participant scores were presented by job type (manual, non-manual, mixed),
Participant scores were presented by job type (manual, non-manual, mixed),
reported health issues (none, physical, mental) and groups of age (18-35 years,
reported health issues (none, physical, mental) and groups of age (18-35 years,
36-45 years, 46-55 years, 56-65 years), assessing the statistical significance of
36-45 years, 46-55 years, 56-65 years), assessing the statistical significance of
the differences by means of the Kruskall Wallis H test (to compare median scores)
the differences by means of the Kruskall Wallis H test (to compare median scores)
and analysis of variance (ANOVA) to compare mean scores. Post-hoc paired
and analysis of variance (ANOVA) to compare mean scores. Post-hoc paired
analyses (comparing median or mean scores for each of the two groups) were
analyses (comparing median or mean scores for each of the two groups) were
performed to determine which group or groups were responsible for significant
performed to determine which group or groups were responsible for significant
differences. When comparing median scores between two groups, Mann-Whitney
differences. When comparing median scores between two groups, Mann-Whitney
58
58
58
58
test for two independent samples were used, and when comparing mean scores
test for two independent samples were used, and when comparing mean scores
between two groups t-Tests were used.
between two groups t-Tests were used.
Internal consistency was assessed using Cronbach alpha coefficients considering
Internal consistency was assessed using Cronbach alpha coefficients considering
appropriate values ≥ 0.70 [34]. The standard error of measurement (SEM) was
appropriate values ≥ 0.70 [34]. The standard error of measurement (SEM) was
calculated for a stable subgroup of participants (n=40) that completed the
calculated for a stable subgroup of participants (n=40) that completed the
questionnaire twice in similar conditions, within an interval that varied from 7 to 15
questionnaire twice in similar conditions, within an interval that varied from 7 to 15
days [35]. This subgroup of participants was composed of the first 40 participants
days [35]. This subgroup of participants was composed of the first 40 participants
of the study who completed the first round and accepted to complete the
of the study who completed the first round and accepted to complete the
questionnaire a second time within this interval.
questionnaire a second time within this interval.
A CFA was conducted to analyze the structural validity of the WRFQ-SpV, testing
A CFA was conducted to analyze the structural validity of the WRFQ-SpV, testing
whether data collected in this general working population (N=455) had an
whether data collected in this general working population (N=455) had an
adequate fit in the predetermined five factor model structure defined by the
adequate fit in the predetermined five factor model structure defined by the
authors of the original questionnaire [19]. A four factor model structure was also
authors of the original questionnaire [19]. A four factor model structure was also
tested because the Work Limitations Questionnaire [18], designed to measure on-
tested because the Work Limitations Questionnaire [18], designed to measure on-
the-job impact of chronic health problems, has a structure with four factors (one of
the-job impact of chronic health problems, has a structure with four factors (one of
them named mental-interpersonal) and earlier studies [20,21,23] recommended
them named mental-interpersonal) and earlier studies [20,21,23] recommended
caution when interpreting the internal consistency of the social demands subscale.
caution when interpreting the internal consistency of the social demands subscale.
Thus, we hypothesized it might be necessary to collapse the subscales of mental
Thus, we hypothesized it might be necessary to collapse the subscales of mental
and social demands into a single factor of psychosocial demands with seven
and social demands into a single factor of psychosocial demands with seven
items.
items.
Following recommendations in the literature regarding CFA, we did not use the
Following recommendations in the literature regarding CFA, we did not use the
standard maximum likelihood theory (applicable to continuous variables). Instead,
standard maximum likelihood theory (applicable to continuous variables). Instead,
we used the robust categorical least squares (applicable to categorical variables),
we used the robust categorical least squares (applicable to categorical variables),
based on the fact that the observed variables are measured on a Likert scale and
based on the fact that the observed variables are measured on a Likert scale and
the variables are approximately symmetrical [36-38].
the variables are approximately symmetrical [36-38].
Rhemtulla [36] suggests that when there is a minimum of five categorical variables
Rhemtulla [36] suggests that when there is a minimum of five categorical variables
in the response options, which is the case of the WRFQ, the CFA could also be
in the response options, which is the case of the WRFQ, the CFA could also be
assessed applying “the method of the standard theory of maximum likelihood”
assessed applying “the method of the standard theory of maximum likelihood”
59
59
treating these variables as if they were continuous (but we would be at the limit of
treating these variables as if they were continuous (but we would be at the limit of
acceptance of this method). To verify the possible existence of differences
acceptance of this method). To verify the possible existence of differences
depending on the method, calculations were performed applying both methods.
depending on the method, calculations were performed applying both methods.
Chi-squared tests for goodness of fit, the root mean square error of approximation
Chi-squared tests for goodness of fit, the root mean square error of approximation
(RMSEA), the comparative fit index (CFI) and the weighed root mean residual
(RMSEA), the comparative fit index (CFI) and the weighed root mean residual
(WRMR) were used to evaluate the models. Reference values for RMSEA ≤ 0.05
(WRMR) were used to evaluate the models. Reference values for RMSEA ≤ 0.05
indicating close fit, between 0.06 and 0.08, fair fit and between 0.09 and 0.1,
indicating close fit, between 0.06 and 0.08, fair fit and between 0.09 and 0.1,
mediocre fit. Reference values for CFI ≥ 0.95 and WRMR > 0.90 for acceptance
mediocre fit. Reference values for CFI ≥ 0.95 and WRMR > 0.90 for acceptance
[39].
[39].
Correlations were evaluated for item-subscale, item-total, among subscales and
Correlations were evaluated for item-subscale, item-total, among subscales and
subscale-total, using Pearson’s correlation coefficient (r), considering r ≥ 0.40 as
subscale-total, using Pearson’s correlation coefficient (r), considering r ≥ 0.40 as
evidence of moderate or strong correlations [40,41].
evidence of moderate or strong correlations [40,41].
Construct validity was assessed by means of hypotheses testing. Significance of
Construct validity was assessed by means of hypotheses testing. Significance of
the differences among groups were tested using the non-parametric Kruskall
the differences among groups were tested using the non-parametric Kruskall
Wallis H test when comparing differences among median scores and analysis of
Wallis H test when comparing differences among median scores and analysis of
the variance (ANOVA) when differences among mean scores were compared.
the variance (ANOVA) when differences among mean scores were compared.
Correlations between constructs were assessed using Pearson’s correlation
Correlations between constructs were assessed using Pearson’s correlation
coefficient (r) interpreting: r < 0.4= ’weak’; 0.4 ≤ r ≤ 0.7= ’moderate; r > 0.7=
coefficient (r) interpreting: r < 0.4= ’weak’; 0.4 ≤ r ≤ 0.7= ’moderate; r > 0.7=
’strong’ [41].
’strong’ [41].
The basic principle of construct validation by means of hypotheses testing is that
The basic principle of construct validation by means of hypotheses testing is that
hypotheses are formulated about differences in the instrument scores between
hypotheses are formulated about differences in the instrument scores between
subgroups of participants or about the relationships of the scores of the instrument
subgroups of participants or about the relationships of the scores of the instrument
under study with scores on other similar or dissimilar measuring tools [35],
under study with scores on other similar or dissimilar measuring tools [35],
therefore, seven hypotheses were formulated to asses construct validity:
therefore, seven hypotheses were formulated to asses construct validity:
Hypothesis 1, addressing health issues: 1a) Participants without health issues
Hypothesis 1, addressing health issues: 1a) Participants without health issues
report higher scores on the overall scale of the WRFQ than those with health
report higher scores on the overall scale of the WRFQ than those with health
issues; 1b) Participants with physical health issues report the lowest score on the
issues; 1b) Participants with physical health issues report the lowest score on the
60
60
subscale of physical demands; 1c) Participants with mental health issues report
subscale of physical demands; 1c) Participants with mental health issues report
the lowest score on the subscale of mental demands.
the lowest score on the subscale of mental demands.
Hypothesis 2, addressing job types: Participants with physical health issues and
Hypothesis 2, addressing job types: Participants with physical health issues and
manual job report a lower score on the WRFQ subscale of physical demands than
manual job report a lower score on the WRFQ subscale of physical demands than
those with physical health issues and non-manual or mixed jobs.
those with physical health issues and non-manual or mixed jobs.
Hypothesis 3, addressing correlation between WRFQ scores and scores of a
Hypothesis 3, addressing correlation between WRFQ scores and scores of a
related construct (work ability): 3a) There are moderate to strong correlations
related construct (work ability): 3a) There are moderate to strong correlations
between the score of the overall work ability item of the WAI (that measures a
between the score of the overall work ability item of the WAI (that measures a
related construct) and the overall score of the WRFQ; 3b) There are moderate to
related construct) and the overall score of the WRFQ; 3b) There are moderate to
strong correlations between the scores of the mental and physical demands items
strong correlations between the scores of the mental and physical demands items
of the WAI and those of the subscales of physical and mental demands of the
of the WAI and those of the subscales of physical and mental demands of the
WRFQ.
WRFQ.
Hypothesis 4, addressing age: Consistently with other studies finding that both,
Hypothesis 4, addressing age: Consistently with other studies finding that both,
chronological and functional age, are associated with a decrease in work ability
chronological and functional age, are associated with a decrease in work ability
and/or work outcomes [42-46], there is a trend on the overall scores of the WRFQ
and/or work outcomes [42-46], there is a trend on the overall scores of the WRFQ
showing worse work functioning with increasing age.
showing worse work functioning with increasing age.
All analyses were performed with SPSS (Version 15.0. Chicago, IL; 2006) and
All analyses were performed with SPSS (Version 15.0. Chicago, IL; 2006) and
Mplus (Version 7. Los Angeles, CA; 2012).
Mplus (Version 7. Los Angeles, CA; 2012).
RESULTS
RESULTS
Sample characteristics. Four hundred fifty-five participants completed the WRFQ-
Sample characteristics. Four hundred fifty-five participants completed the WRFQ-
SpV and were included in the analyses. All were active employees working an
SpV and were included in the analyses. All were active employees working an
average of 39 hours per week (SD=8.5), mean age of 42 years (SD=11) and with
average of 39 hours per week (SD=8.5), mean age of 42 years (SD=11) and with
different levels of education, job types and health issues (table 1). Compared with
different levels of education, job types and health issues (table 1). Compared with
the general Spanish working population, women and participants with higher
the general Spanish working population, women and participants with higher
educational level were overrepresented [47]. A subgroup of 181 participants also
educational level were overrepresented [47]. A subgroup of 181 participants also
completed the WAI items [Supplementary materials (1)].
completed the WAI items [Supplementary materials (1)].
61
61
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184
Table 1. Participants' characteristics.
Table 1. Participants' characteristics.
Total
n=455
Age in years, mean (SD)
Participants
with health
issues (n=299)
Participants
without health
issues (n=156)
42.1
(11.1)
43.7
(10.8)
39.0
Low
73
(16.0)
61
(20.4)
Middle
157
(34.5)
121
High
225
(49.5)
117
Manual
111
(24.4)
Non-manual
125
(27.5)
Education level, n (%)
Job type, n (%)
Mixed
Total
n=455
(11.0)
Age in years, mean (SD)
12
(7.7)
Education level, n (%)
(40.5)
36
(39.1)
108
81
(27.1)
30
(19.2)
82
(27.4)
43
(27.6)
83
(53.2)
(11.1)
43.7
(10.8)
39.0
Low
73
(16.0)
61
(20.4)
12
(7.7)
(23.1)
Middle
157
(34.5)
121
(40.5)
36
(23.1)
(69.2)
High
225
(49.5)
117
(39.1)
108
(69.2)
Manual
111
(24.4)
81
(27.1)
30
(19.2)
Non-manual
125
(27.5)
82
(27.4)
43
(27.6)
83
(53.2)
Job type, n (%)
218
(47.9)
136
(45.5)
(8.5)
38.8
(7.8)
38.7
(9.7)
Working hours/week, mean (SD)
None
156
(34.3)
0
(0.0)
156
(100.0)
Health issue type, n(%)
Physical
139
(30.5)
139
(46.5)
0
Mental health
125
(27.5)
125
(41.8)
Others
35
13.0
(7.7)
(27.7)
35
19.9
(11.7)
(32.2)
Health issue type, n(%)
Disease duration in months, mean (SD)
Mixed
Extended survey with WAI
a
WAI overall-item, mean (SD)
b
WAI physical demands, mean (SD)
b
WAI mental demands, mean (SD)
7.6
3.8
3.9
(2.1)
(1.0)
(1.2)
Men
n=71 (39.2%)
7.6
3.7
3.9
(2.1)
218
(47.9)
136
(45.5)
(8.5)
38.8
(7.8)
38.7
(9.7)
None
156
(34.3)
0
(0.0)
156
(100.0)
(0.0)
Physical
139
(30.5)
139
(46.5)
0
(0.0)
0
(0.0)
Mental health
125
(27.5)
125
(41.8)
0
(0.0)
0
0
(0.0)
(0.0)
Others
35
13.0
(7.7)
(27.7)
35
19.9
(11.7)
(32.2)
0
0
(0.0)
(0.0)
Disease duration in months, mean (SD)
(1.0)
(1.2)
Supplementary materials (1). Work Ability Index (WAI) scores obtained in a convenience
subsample of participants (n=181).
Women
n=110 (60.8%)
7.7
3.8
3.8
(11.0)
38.7
Supplementary materials (1). Work Ability Index (WAI) scores obtained in a convenience
subsample of participants (n=181).
Total
n=181
Participants
without health
issues (n=156)
42.1
38.7
Working hours/week, mean (SD)
Participants
with health
issues (n=299)
Extended survey with WAI
a
WAI overall-item, mean (SD)
(2.0)
(1.0)
Women
n=110 (60.8%)
7.6
(2.1)
7.6
(2.1)
7.7
(2.0)
3.8
(1.0)
3.7
(1.0)
3.8
(1.0)
b
3.9
(1.2)
3.9
(1.2)
3.8
(1.2)
WAI mental demands, mean (SD)
(a) Single item question of the work ability index (scale 0-10)
(a) Single item question of the work ability index (scale 0-10)
(b) Single item question of the work ability index (scale 0-5).
(b) Single item question of the work ability index (scale 0-5).
63
Men
n=71 (39.2%)
b
WAI physical demands, mean (SD)
(1.2)
Total
n=181
63
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Table 2 shows the mean, SD and median scores for each WRFQ-SpV subscale
Table 2 shows the mean, SD and median scores for each WRFQ-SpV subscale
and the overall scale. Higher values indicate better work functioning (less disability
and the overall scale. Higher values indicate better work functioning (less disability
at work). Mental and social demands subscales scored the highest mean and
at work). Mental and social demands subscales scored the highest mean and
median, and the output demands subscale scored the lowest.
median, and the output demands subscale scored the lowest.
Floor effects were not found for any subscale, but ceiling effects were found for the
Floor effects were not found for any subscale, but ceiling effects were found for the
subscales of work scheduling (20%), mental (29%) and social demands (31%),
subscales of work scheduling (20%), mental (29%) and social demands (31%),
exceeding the 15% criterion [34]. A sensitivity analysis was carried out, restricting
exceeding the 15% criterion [34]. A sensitivity analysis was carried out, restricting
the sample to only those participants reporting health problems (n=299; 66% of the
the sample to only those participants reporting health problems (n=299; 66% of the
sample), and ceiling effects also appeared for the same subscales.
sample), and ceiling effects also appeared for the same subscales.
Reliability assessment: The SEMs were 7.1 for the overall score, 8.5 for work
Reliability assessment: The SEMs were 7.1 for the overall score, 8.5 for work
scheduling, 8.9 for output, 8.6 for physical, 10.6 for mental and 13.3 for social
scheduling, 8.9 for output, 8.6 for physical, 10.6 for mental and 13.3 for social
demands [Supplementary materials (2)]. Cronbach alpha coefficients were 0.98 for
demands [Supplementary materials (2)]. Cronbach alpha coefficients were 0.98 for
the overall scale and above 0.81 for all subscales (table 2).
the overall scale and above 0.81 for all subscales (table 2).
Structural validity assessment: Fit was fair for the five factor model applying
Structural validity assessment: Fit was fair for the five factor model applying
method of the robust categorical least squares for categorical variables (Chi-
method of the robust categorical least squares for categorical variables (Chi-
square, 1285.8; 314 degrees of freedom, p<0.001) and mediocre for the four factor
square, 1285.8; 314 degrees of freedom, p<0.001) and mediocre for the four factor
model (Chi-square, 1353.5; 318 degrees of freedom, p<0.001). The resulting root
model (Chi-square, 1353.5; 318 degrees of freedom, p<0.001). The resulting root
mean square error of approximation (RMSEA) were 0.08 (CI90%= 0.07-0.08) and
mean square error of approximation (RMSEA) were 0.08 (CI90%= 0.07-0.08) and
0.09 (CI90%= 0.08-0.09) for the five and four factor models respectively. The
0.09 (CI90%= 0.08-0.09) for the five and four factor models respectively. The
comparative fit index (CFI) was 0.97 for both factor structures, and the weighed
comparative fit index (CFI) was 0.97 for both factor structures, and the weighed
root mean residual (WRMR) were 1.5 and 1.6 for the five and four factor models
root mean residual (WRMR) were 1.5 and 1.6 for the five and four factor models
respectively.
respectively.
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65
184
184
67
67
448
317
452
408
443
Output demands
Physical demands
Mental demands
Social demands
Total scale
12 (2.6)
47 (10.3)
138 (30.3)
3 (0.7)
7 (1.5)
10 (2.2)
n (%)
77.05 (22.35) 0-100
82.90 (22.88) 0-100
75.66 (25.62) 0-100
79.53 (26.12) 0-100
74.79 (24.25) 0-100
84.90
91.67
84.17
91.67
82.14
85.00
Median
Range scores
75.65 (26.51) 0-100
Mean
b
scores (SD)
4 (0.88)
8 (1.76)
5 (1,10)
10 (2,20)
6 (1,32)
7 (1.54)
n at floor
n (%)
18 (3.96)
142 (31.21)
63 (13.85)
130 (28.57)
53 (11.65)
90 (19.78)
n at ceiling
n (%)
0.98
0.95
0.81
0.92
Cronbach
alpha
0.91
0.92
448
317
452
408
443
Output demands
Physical demands
Mental demands
Social demands
Total scale
12 (2.6)
47 (10.3)
138 (30.3)
3 (0.7)
7 (1.5)
10 (2.2)
n (%)
77.05 (22.35) 0-100
82.90 (22.88) 0-100
75.66 (25.62) 0-100
79.53 (26.12) 0-100
74.79 (24.25) 0-100
84.90
91.67
84.17
91.67
82.14
85.00
Median
Range scores
75.65 (26.51) 0-100
Mean
b
scores (SD)
4 (0.88)
8 (1.76)
5 (1,10)
10 (2,20)
6 (1,32)
7 (1.54)
n at floor
n (%)
18 (3.96)
142 (31.21)
63 (13.85)
130 (28.57)
53 (11.65)
90 (19.78)
n at ceiling
n (%)
0.98
0.95
0.81
0.92
Cronbach
alpha
0.91
0.92
(b) Each subscale is scored from 0 - 100. Higher scores indicate better work functioning: difficulties all the time 0/100; difficulties no of the
time 100/100.
(a) Subscales with more than 20% of items scoring "does not apply to my job" or missing values were excluded.
445
Work scheduling demands
Vali
dn
Missing / Not
a
applicable
Table 2. Reliability, floor and ceiling effects of the Spanish version of the Work Role Functioning Questionnaire, (n=455).
(b) Each subscale is scored from 0 - 100. Higher scores indicate better work functioning: difficulties all the time 0/100; difficulties no of the
time 100/100.
(a) Subscales with more than 20% of items scoring "does not apply to my job" or missing values were excluded.
445
Work scheduling demands
Vali
dn
Missing / Not
a
applicable
Table 2. Reliability, floor and ceiling effects of the Spanish version of the Work Role Functioning Questionnaire, (n=455).
67
67
68
68
69
69
64.9 (25.8)
59.8 (31.2)
73.9 (26.1)
77.0 (20.8)
67.6 (22.7)
Output demands
Physical demands
Mental demands
Social demands
Overall scale
69.5 (24.2)
76.8 (25.4)
73.1 (27.8)
66.8 (29.6)
68.6 (26.3)
65.8 (29.6)
WRFQ-SpV (b)
Mean (SD)
1.9
(10.0)
0.2 (18.8)
0.9 (14.9)
6.9 (12.1)
3.7 (12.6)
0.7 (12.1)
Mean change
score (SD)
7.1
13.3
10.5
8.6
8.9
8.5
SEM (c)
64.9 (25.8)
59.8 (31.2)
73.9 (26.1)
77.0 (20.8)
67.6 (22.7)
Output demands
Physical demands
Mental demands
Social demands
Overall scale
69.5 (24.2)
76.8 (25.4)
73.1 (27.8)
66.8 (29.6)
68.6 (26.3)
65.8 (29.6)
WRFQ-SpV (b)
Mean (SD)
(d) Standard Error of Measurement = SD of change scores / √2
(a) Mean Scores and Standard Deviation at first time.
(b) Mean Scores and Standard Deviation at second time.
66.4 (28.7)
Work scheduling demands
WRFQ-SpV (a)
Mean (SD)
1.9
(10.0)
0.2 (18.8)
0.9 (14.9)
6.9 (12.1)
3.7 (12.6)
0.7 (12.1)
Mean change
score (SD)
7.1
13.3
10.5
8.6
8.9
8.5
SEM (c)
Supplementary materials (2). Calculation of SEM with scores of the first 40
participants answering the WRFQ twice under similar conditions in a period of 7-15
days (N=40).
(d) Standard Error of Measurement = SD of change scores / √2
(a) Mean Scores and Standard Deviation at first time.
(b) Mean Scores and Standard Deviation at second time.
66.4 (28.7)
Work scheduling demands
WRFQ-SpV (a)
Mean (SD)
Supplementary materials (2). Calculation of SEM with scores of the first 40
participants answering the WRFQ twice under similar conditions in a period of 7-15
days (N=40).
69
69
70
70
The results of the CFA applying the method of the standard theory of maximum
The results of the CFA applying the method of the standard theory of maximum
likelihood for continuous variables also showed fair fit for the five factor model
likelihood for continuous variables also showed fair fit for the five factor model
(Chi-square, 1445.8; 314 degrees of freedom, p<0.001) and mediocre for the four
(Chi-square, 1445.8; 314 degrees of freedom, p<0.001) and mediocre for the four
factor model (Chi-square, 1546.2; 318 degrees of freedom, p<0.001). RMSEA
factor model (Chi-square, 1546.2; 318 degrees of freedom, p<0.001). RMSEA
were 0.08 (CI90%= 0.08-0.09) and 0.09 (CI90%= 0.08-0.09) for the five and four
were 0.08 (CI90%= 0.08-0.09) and 0.09 (CI90%= 0.08-0.09) for the five and four
factor models respectively.
factor models respectively.
All Pearson’s correlations (item-subscale, item-total, among subscales and
All Pearson’s correlations (item-subscale, item-total, among subscales and
subscale-total) were ≥ 0.40 (moderate to strong) and considered appropriate [41]
subscale-total) were ≥ 0.40 (moderate to strong) and considered appropriate [41]
(table 3).
(table 3).
Construct validity assessment by hypotheses testing: Participant median scores by
Construct validity assessment by hypotheses testing: Participant median scores by
job type (manual, non-manual, mixed) and existing health condition (none,
job type (manual, non-manual, mixed) and existing health condition (none,
physical, mental) are shown in table 4.
physical, mental) are shown in table 4.
Table 4 and the post-hoc paired analyses, presented in Supplementary materials
Table 4 and the post-hoc paired analyses, presented in Supplementary materials
(3), showed that participants without health issues had statistically significant
(3), showed that participants without health issues had statistically significant
higher overall scores than those with mental health issues and those with physical
higher overall scores than those with mental health issues and those with physical
health issues, confirming hypothesis 1a.
health issues, confirming hypothesis 1a.
Participants with physical health issues showed the lowest score on the subscale
Participants with physical health issues showed the lowest score on the subscale
of physical demands (median score=64), confirming hypothesis 1b (table 4).
of physical demands (median score=64), confirming hypothesis 1b (table 4).
Respondents with mental health issues obtained the lowest score on the subscale
Respondents with mental health issues obtained the lowest score on the subscale
of mental demands (median score=63), confirming hypothesis 1c (table 4).
of mental demands (median score=63), confirming hypothesis 1c (table 4).
Confirming hypotheses 1a, 1b, 1c and 2 showed that the instrument has ability to
Confirming hypotheses 1a, 1b, 1c and 2 showed that the instrument has ability to
differentiate between workers with and without physical or mental health problems.
differentiate between workers with and without physical or mental health problems.
71
71
184
184
Table 3. Pearson’s correlations of the WRFQa and the three single item question of the
WAIb.
Table 3. Pearson’s correlations of the WRFQa and the three single item question of the
WAIb.
Work
demands
Work scheduling
Output
Physical
Work
Scheduling Output Physical Mental
0.849
0.747
0.724
0.849
0.730
0.752
0.747
0.730
0.494
Social
Total
scale
Work
demands
0.701
0,918
Work scheduling
0.731
0,935
Output
0.576
0,821
Physical
Mental
0.724
0.752
0.494
-
Social
0.701
0.731
0.576
0.766
0.766
-
Overall scale
WAI overall-item
0.918
0.935
0.821
0.861
0.825
0.707
0.661
0.649
0.517
0.531
0.713
WAI physical demands
0.586
0.586
0.615c
0.406
0.419
0.594
WAI mental demands
0.659
0.629
0.448
0.665c
(a) Work Role Functioning Questionnaire; (b) Work Ability Index;
(c) Hypothesis 3a and 3b confirmed.
0.627
0.682
Work
Scheduling Output Physical Mental
0.849
0.747
0.724
0.849
0.730
0.752
0.747
0.730
0.494
Social
Total
scale
0.701
0,918
0.731
0,935
0.576
0,821
0,861
0,861
Mental
0.724
0.752
0.494
-
0,825
-
Social
0.701
0.731
0.576
0.766
0.766
-
Overall scale
WAI overall-item
0.918
0.935
0.821
0.861
0.825
0,825
-
0.707
0.661
0.649
0.517
0.531
0.713c
WAI physical demands
0.586
0.586
0.615c
0.406
WAI mental demands
0.659
0.629
0.448
0.665c
(a) Work Role Functioning Questionnaire; (b) Work Ability Index;
(c) Hypothesis 3a and 3b confirmed.
0.419
0.594
0.627
0.682
c
73
73
184
184
75
75
89.29
95.83
95.83
91.67
Output
Physical
Mental
Social
75.00
62.50
83.33
67.86
70.00
Mental
(N= 125)
91.67
91.67
63.75
78.57
82.00
Physical
(N= 139)
80.00
78.57
66.67
89.59
91.67
0.000
0.000
0.000
0.000
Manual
(N= 109 )
p
value
0.000
(b)
a
83.33
83.33
91.67
82.14
90.00
Non-manual
(N= 123)
91.67
91.67
85.00
83.33
85.00
Mixed
(N= 212)
Job type (median scores )
0.208
0.406
0.000
0.137
0.011
(b)
p
value
89.29
95.83
95.83
91.67
Output
Physical
Mental
Social
75.00
62.50
83.33
67.86
70.00
Mental
(N= 125)
91.67
91.67
63.75
78.57
82.00
Physical
(N= 139)
80.00
78.57
66.67
89.59
91.67
0.000
0.000
0.000
0.000
Manual
(N= 109 )
p
value
0.000
(b)
a
83.33
83.33
91.67
82.14
90.00
Non-manual
(N= 123)
91.67
91.67
85.00
83.33
85.00
Mixed
(N= 212)
Job type (median scores )
0.208
0.406
0.000
0.137
0.011
(b)
p
value
0.000
Overall scale
92.05
68.52
81.73
77.78
83.33
87.04
0.027
(a) Subscales with more than 20% of items scoring "does not apply to my job" or missing values were excluded.
Hypotheses 1a, 1b and 1c confirmed. (b) Kruskal Wallis H test.
95.00
None
(N= 156)
Work scheduling
Work
demands
Health issue (median scores )
a
Table 4. Scores obtained by health condition and job type on the WRFQ-SpV.
0.000
Overall scale
92.05
68.52
81.73
77.78
83.33
87.04
0.027
(a) Subscales with more than 20% of items scoring "does not apply to my job" or missing values were excluded.
Hypotheses 1a, 1b and 1c confirmed. (b) Kruskal Wallis H test.
95.00
None
(N= 156)
Work scheduling
Work
demands
Health issue (median scores )
a
Table 4. Scores obtained by health condition and job type on the WRFQ-SpV.
75
75
76
76
Participants with physical health issues and manual job reported a statistically
Participants with physical health issues and manual job reported a statistically
significant lower score on the WRFQ subscale of physical demands (median
significant lower score on the WRFQ subscale of physical demands (median
score=54; p=0.021) compared to those with physical health issues and non-
score=54; p=0.021) compared to those with physical health issues and non-
manual (median score=67; p=0.021) or mixed jobs (median score=71; p=0.021),
manual (median score=67; p=0.021) or mixed jobs (median score=71; p=0.021),
confirming hypothesis 2 [Supplementary material (4)].
confirming hypothesis 2 [Supplementary material (4)].
A strong correlation was found between the overall WAI item score and the overall
A strong correlation was found between the overall WAI item score and the overall
score of the WRFQ (0.71), and moderate correlations were found between the
score of the WRFQ (0.71), and moderate correlations were found between the
physical and mental demands items of the WAI and the WRFQ subscales of
physical and mental demands items of the WAI and the WRFQ subscales of
physical and mental demands (0.62 and 0.67 respectively). These correlations
physical and mental demands (0.62 and 0.67 respectively). These correlations
confirm hypothesis 3a and 3b (table 3).
confirm hypothesis 3a and 3b (table 3).
Table 5 shows the mean scores and SD of the WRFQ-SpV by age groups for each
Table 5 shows the mean scores and SD of the WRFQ-SpV by age groups for each
subscale and the overall scale, revealing a trend of worse work functioning with
subscale and the overall scale, revealing a trend of worse work functioning with
increasing age in the overall scores. The group of oldest participants (56-65 years)
increasing age in the overall scores. The group of oldest participants (56-65 years)
showed higher mean scores on work scheduling and mental demands than
showed higher mean scores on work scheduling and mental demands than
workers aged 46-55 years, and the main decrease in the mean scores for the
workers aged 46-55 years, and the main decrease in the mean scores for the
oldest workers (56-65 years) appeared to be on physical demands, although these
oldest workers (56-65 years) appeared to be on physical demands, although these
differences were not significant.
differences were not significant.
Post-hoc paired analyses, exposed in Supplementary material (5), showed that the
Post-hoc paired analyses, exposed in Supplementary material (5), showed that the
differences in the median scores for the overall scale between the group of 18-35
differences in the median scores for the overall scale between the group of 18-35
years and the group of 36-45 were not significant (p=0.267). They appeared to be
years and the group of 36-45 were not significant (p=0.267). They appeared to be
significant for the youngest group (18-35 years) compared with the group of 46-55
significant for the youngest group (18-35 years) compared with the group of 46-55
years (p=0.032) and the group of 56-65 years (p=0.005). Decreases in physical
years (p=0.032) and the group of 56-65 years (p=0.005). Decreases in physical
and social demands appeared to be significant in these paired analyses, except
and social demands appeared to be significant in these paired analyses, except
for the comparison of physical demands between the groups of 18-35 years and
for the comparison of physical demands between the groups of 18-35 years and
36-45 years. Other post-hoc paired analyses evaluating differences in the median
36-45 years. Other post-hoc paired analyses evaluating differences in the median
scores between groups of 36-45 years, 46-55 years and 56-65 years did not show
scores between groups of 36-45 years, 46-55 years and 56-65 years did not show
statistically significant differences, except for the decrease in physical demands,
statistically significant differences, except for the decrease in physical demands,
concluding that hypothesis 4 was (partially) confirmed.
concluding that hypothesis 4 was (partially) confirmed.
77
77
184
184
Supplementary materials (3). Post-hoc paired analyses comparing median scores between
Supplementary materials (3). Post-hoc paired analyses comparing median scores between
participants with none health issues and participants with mental and physical health issues.
participants with none health issues and participants with mental and physical health issues.
None
health issues
(n=109)
Mental
health issues
(n=125)
p
value
None
health issues
(n=109)
Physical
health issues
(n=139)
p
value
Work
demands
Work scheduling
95.00
70.00
<0.001
95.00
82.00
<0.001
Output
89.29
67.86
<0.001
89.29
78.57
<0.001
Physical
95.83
83.33
<0.001
95.83
63.75
Mental
95.83
62.50
<0.001
95.83
Social
91.67
75.00
<0.001
Overall score
92.05
68.52
<0.001
Work
demands
(a)
None
health issues
(n=109)
Mental
health issues
(n=125)
p
value
None
health issues
(n=109)
Physical
health issues
(n=139)
p
value
Work scheduling
95.00
70.00
<0.001
95.00
82.00
<0.001
Output
89.29
67.86
<0.001
89.29
78.57
<0.001
<0.001
Physical
95.83
83.33
<0.001
95.83
63.75
<0.001
91.67
0.050
Mental
95.83
62.50
<0.001
95.83
91.67
0.050
91.67
91.67
0.004
Social
91.67
75.00
<0.001
91.67
91.67
0.004
92.05
81.73
<0.001
Overall score
92.05
68.52
<0.001
92.05
81.73
<0.001
(a)
(a) Mann-Whitney test for two independent samples
(a)
(a)
(a) Mann-Whitney test for two independent samples
79
79
184
184
81
81
95.00
96.13
93.33
100.00
91.67
Work scheduling
Output
Physical
Mental
Social
100.00
95.83
95.83
89.29
95.00
Mixed
(N= 83)
0.306
0.031
0.006
0.496
0.030
91.67
93.75
54.17*
67.86
72.50
P
Manual
b
values (N= 52)
100.00
93.75
66.67
83.93
90.00
Nonmanual
(N=26)
91.67
91.67
70.83
82.14
85.00
Mixed
(N=61)
Physical health issues (N= 139)
0.020
0.939
0.021
0.131
0.015
83.33
60.42
72.92
71.43
72.50
P
Manual
b
values (N=20)
75.00
68.75
87.50
71.43
75.00
Nonmanual
(N=46)
75.00
58.33
80.00
59.52
60.00
Mixed
(N=59)
Mental health issues (N= 125)
0.943
0.145
0.016
0.247
0.053
P
b
values
95.00
96.13
93.33
100.00
91.67
Work scheduling
Output
Physical
Mental
Social
100.00
95.83
95.83
89.29
95.00
Mixed
(N= 83)
0.306
0.031
0.006
0.496
0.030
91.67
93.75
54.17*
67.86
72.50
P
Manual
b
values (N= 52)
100.00
93.75
66.67
83.93
90.00
Nonmanual
(N=26)
91.67
91.67
70.83
82.14
85.00
Mixed
(N=61)
Physical health issues (N= 139)
0.020
0.939
0.021
0.131
0.015
83.33
60.42
72.92
71.43
72.50
P
Manual
b
values (N=20)
75.00
68.75
87.50
71.43
75.00
Nonmanual
(N=46)
75.00
58.33
80.00
59.52
60.00
Mixed
(N=59)
Mental health issues (N= 125)
0.943
0.145
0.016
0.247
0.053
P
b
values
Overall scale
93.75
91.00
92.59
0.791
72.17
87.58
83.65
0.007
68.99
78.64
60.65
0.083
(a) Subscales with more than 20% of items scoring "does not apply to my job" or missing values were excluded. Hypothesis 2 confirmed.
(b) Kruskal Wallis H tests.
91.67
91.67
100.00
85.71
100.00
NonManual manual
(N= 30) (N=43)
Work
demands
No health issues (N= 156)
Median scores
a
Supplementary materials (4). Scores of the Spanish version of the Work Role Functioning Questionnaire, distributed by existing
health condition and job type.
Overall scale
93.75
91.00
92.59
0.791
72.17
87.58
83.65
0.007
68.99
78.64
60.65
0.083
(a) Subscales with more than 20% of items scoring "does not apply to my job" or missing values were excluded. Hypothesis 2 confirmed.
(b) Kruskal Wallis H tests.
91.67
91.67
100.00
85.71
100.00
NonManual manual
(N= 30) (N=43)
Work
demands
No health issues (N= 156)
Median scores
a
Supplementary materials (4). Scores of the Spanish version of the Work Role Functioning Questionnaire, distributed by existing
health condition and job type.
82
82
Table 5. Differences between mean scores of known age groups in WRFQa (ANOVA).
Age (Years)
18-35 (N=148) 36-45 (N=121)
46-55 (N=123)
56-65 (N=57)
Table 5. Differences between mean scores of known age groups in WRFQa (ANOVA).
Age (Years)
18-35 (N=148) 36-45 (N=121)
Work demands
Mean (SD)
46-55 (N=123)
56-65 (N=57)
Mean (SD)
Mean (SD)
Mean (SD)
p
value
Work demands
Mean (SD)
Mean (SD)
Mean (SD)
Mean (SD)
p
value
Work scheduling
78.86 (22.45)
77.84 (25.92)
75.19 (25.63)
76.90 (25.95)
0.120
Work scheduling
78.86 (22.45)
77.84 (25.92)
75.19 (25.63)
76.90 (25.95)
0.120
Output
77.84 (20.50)
76.00 (24.33)
72.53 (24.78)
70.34 (28.83)
0.130
Output
77.84 (20.50)
76.00 (24.33)
72.53 (24.78)
70.34 (28.83)
0.130
Physical
81.07 (20.19)
77.36 (23.16)
71.33 (26.41)
61.36 (33.99)
0.000
Physical
81.07 (20.19)
77.36 (23.16)
71.33 (26.41)
61.36 (33.99)
0.000
Mental
81.17 (21.73)
78.55 (26.47)
77.82 (26.68)
79.61 (28.50)
0.719
Mental
81.17 (21.73)
78.55 (26.47)
77.82 (26.68)
79.61 (28.50)
0.719
Social
88.22 (16.48)
83.10 (23.05)
81.96 (21.99)
79.79 (27.73)
0.043
Social
88.22 (16.48)
83.10 (23.05)
81.96 (21.99)
79.79 (27.73)
0.043
Overall scale
81.11 (17.40)
78.41 (21.23)
74.96 (22.70)
72.34 (27.13)
0.026
Overall scale
81.11 (17.40)
78.41 (21.23)
74.96 (22.70)
72.34 (27.13)
0.026
(a) WRFQ, Work Role Functioning Questionnaire. Hypothesis 4 (partially) confirmed.
(a) WRFQ, Work Role Functioning Questionnaire. Hypothesis 4 (partially) confirmed.
83
83
184
184
76.00
77.36
78.55
83.10
81.07
81.17
88.22
81.11
Social
Overall score
(a) t-Test.
Mental
Physical
0.267
0.051
0.529
0.213
0.474
0.444
81.11
88.22
81.17
81.07
77.84
78.86
74.96
81.96
77.82
71.33
72.53
75.19
0.032
0.027
0.277
0.017
0.097
0.206
81.11
88.22
81.17
81.07
77.84
78.86
72.34
79.79
79.61
61.36
70.34
76.90
0.005
0.008
0.721
0.001
0.027
0.025
78.41
83.10
78.55
77.36
76.00
77.84
74.96
81.96
77.82
71.33
72.53
75.19
0.377
0.960
0.695
0.307
0.424
0.687
78.41
83.10
78.55
77.36
76.00
77.84
72.34
79.79
79.61
61.36
70.34
76.90
76.00
77.36
78.55
83.10
77.84
81.07
81.17
88.22
81.11
Social
Overall score
(a) t-Test.
Mental
Physical
78.41
77.84
Output
0.097
0.380
0.888
0.002
0.154
0.151
74.96
81.96
77.82
71.33
72.53
75.19
72.34
79.79
79.61
61.36
70.34
76.90
85
0.324
0.355
0.646
0.015
0.402
0.232
0.267
0.051
0.529
0.213
0.474
0.444
81.11
88.22
81.17
81.07
77.84
78.86
74.96
81.96
77.82
71.33
72.53
75.19
0.032
0.027
0.277
0.017
0.097
0.206
81.11
88.22
81.17
81.07
77.84
78.86
72.34
79.79
79.61
61.36
70.34
76.90
0.005
0.008
0.721
0.001
0.027
0.025
78.41
83.10
78.55
77.36
76.00
77.84
74.96
81.96
77.82
71.33
72.53
75.19
0.377
0.960
0.695
0.307
0.424
0.687
78.41
83.10
78.55
77.36
76.00
77.84
72.34
79.79
79.61
61.36
70.34
76.90
0.097
0.380
0.888
0.002
0.154
0.151
74.96
81.96
77.82
71.33
72.53
75.19
72.34
79.79
79.61
61.36
70.34
76.90
85
0.324
0.355
0.646
0.015
0.402
0.232
18-35
36-45
18-35
46-55
18-35
56-65
36-45
46-55
36-45
56-65
46-55
56-65
(n=148) (n=121) p (a) (n=148) (N=123) p (a) (n=148) (N=57) p (a) (n=121) (N=123) p (a) (n=121) (N=57) p (a) (N=123) (N=57) p (a)
Mean
Mean value Mean
Mean value Mean Mean value Mean
Mean value Mean Mean value Mean Mean value
78.86
Work scheduling
Work demands
Age (Years)
Supplementary materials (5). Post-hoc paired analyses comparing differences in Mean Scores between different groups of age.
78.41
77.84
77.84
18-35
36-45
18-35
46-55
18-35
56-65
36-45
46-55
36-45
56-65
46-55
56-65
(n=148) (n=121) p (a) (n=148) (N=123) p (a) (n=148) (N=57) p (a) (n=121) (N=123) p (a) (n=121) (N=57) p (a) (N=123) (N=57) p (a)
Mean
Mean value Mean
Mean value Mean Mean value Mean
Mean value Mean Mean value Mean Mean value
78.86
Output
Work scheduling
Work demands
Age (Years)
Supplementary materials (5). Post-hoc paired analyses comparing differences in Mean Scores between different groups of age.
85
85
86
DISCUSSION
DISCUSSION
The WRFQ-SpV is a brief and easily interpretable questionnaire to measure
The WRFQ-SpV is a brief and easily interpretable questionnaire to measure
health-related work functioning, that is freely available in different languages
health-related work functioning, that is freely available in different languages
[7,20,21,23]. Results indicate it has excellent internal consistency for the overall
[7,20,21,23]. Results indicate it has excellent internal consistency for the overall
scale (Cronbach alpha = 0.98) and for all subscales (Cronbach alpha > 0.81) and
scale (Cronbach alpha = 0.98) and for all subscales (Cronbach alpha > 0.81) and
also showed adequate structural and construct validity in the study population,
also showed adequate structural and construct validity in the study population,
where healthy workers and also workers with different health issues, job types,
where healthy workers and also workers with different health issues, job types,
working hours, levels of education, sexes and ages have participated.
working hours, levels of education, sexes and ages have participated.
In a recent study conducted by our group [23], the Spanish version of the
In a recent study conducted by our group [23], the Spanish version of the
questionnaire showed adequate cross-cultural validity and test-retest reliability.
questionnaire showed adequate cross-cultural validity and test-retest reliability.
Those results, together with our current results, support that the WRFQ-SpV is a
Those results, together with our current results, support that the WRFQ-SpV is a
reliable and valid instrument to measure work functioning.
reliable and valid instrument to measure work functioning.
Percentages of missing items in the responses for the overall scale did not exceed
Percentages of missing items in the responses for the overall scale did not exceed
3%, but for the subscale of physical demands we reported 30% missing items.
3%, but for the subscale of physical demands we reported 30% missing items.
This can be explained by the frequent use in this subscale of the response option
This can be explained by the frequent use in this subscale of the response option
'does not apply to my job' that, according to the questionnaire use instructions, had
'does not apply to my job' that, according to the questionnaire use instructions, had
to be transformed to missing values. The subscale of physical demands contained
to be transformed to missing values. The subscale of physical demands contained
3,5% (n=16) real missing items.
3,5% (n=16) real missing items.
The observed ceiling effects for the subscales work scheduling, mental and social
The observed ceiling effects for the subscales work scheduling, mental and social
demands indicate a lack of discriminative ability of certain items when
demands indicate a lack of discriminative ability of certain items when
differentiating workers with good health and working. These results are consistent
differentiating workers with good health and working. These results are consistent
with other studies that also found ceiling effects for the subscales of mental and
with other studies that also found ceiling effects for the subscales of mental and
social demands [7,20,23]. According to de Vet et al. [35] one explanation could be
social demands [7,20,23]. According to de Vet et al. [35] one explanation could be
that, differently from the original version, that was developed for a working
that, differently from the original version, that was developed for a working
population with health problems [19], we included a percentage of participants
population with health problems [19], we included a percentage of participants
(34%) who reported not having any health problem. To explore this possibility, we
(34%) who reported not having any health problem. To explore this possibility, we
carried out a sensitivity analysis, restricting the sample to only those reporting
carried out a sensitivity analysis, restricting the sample to only those reporting
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87
health problems (n=299; 66% of the sample), and ceiling effects also appeared for
health problems (n=299; 66% of the sample), and ceiling effects also appeared for
the same subscales.
the same subscales.
Our results on reliability were consistent with other studies. We found similar SEM
Our results on reliability were consistent with other studies. We found similar SEM
and Cronbach alpha for the overall scale and for all subscales when compared to
and Cronbach alpha for the overall scale and for all subscales when compared to
the validated Dutch version [7].
the validated Dutch version [7].
The CFA showed a better fit for the original 5 factors structure compared with the
The CFA showed a better fit for the original 5 factors structure compared with the
4 factors structure, applying the method of "the robust categorical least squares",
4 factors structure, applying the method of "the robust categorical least squares",
but Rhemtulla [36] suggests that the CFA could also be assessed applying "the
but Rhemtulla [36] suggests that the CFA could also be assessed applying "the
method of the standard theory of maximum likelihood" treating these variables as if
method of the standard theory of maximum likelihood" treating these variables as if
they were continuous. To verify the possible existence of differences depending on
they were continuous. To verify the possible existence of differences depending on
the method, calculations were performed applying both methods, obtaining similar
the method, calculations were performed applying both methods, obtaining similar
results.
results.
Based on participant suggestions and the literature, the Dutch version added a
Based on participant suggestions and the literature, the Dutch version added a
new subscale (flexibility demands) not present in the original version, modifying
new subscale (flexibility demands) not present in the original version, modifying
five items after an exploratory factor analysis [7]. This feature did not arise during
five items after an exploratory factor analysis [7]. This feature did not arise during
the interviews conducted in the translation process and cross-cultural adaptation
the interviews conducted in the translation process and cross-cultural adaptation
to Spanish spoken in Spain [23]. However, we do not know whether this could
to Spanish spoken in Spain [23]. However, we do not know whether this could
hinder comparisons between different countries or cultures.
hinder comparisons between different countries or cultures.
Six hypotheses were confirmed, verifying that both workers reporting physical and
Six hypotheses were confirmed, verifying that both workers reporting physical and
mental health problems showed lower scores than those who reported no health
mental health problems showed lower scores than those who reported no health
problems; workers with physical and mental health problems showed the lowest
problems; workers with physical and mental health problems showed the lowest
scores for physical and mental demands respectively and moderate to strong
scores for physical and mental demands respectively and moderate to strong
correlations were found with the three single WAI items, providing evidence of
correlations were found with the three single WAI items, providing evidence of
adequate construct validity. Again, these results are consistent with the validation
adequate construct validity. Again, these results are consistent with the validation
study of the Dutch version [7], comparing the correlations between the WRFQ and
study of the Dutch version [7], comparing the correlations between the WRFQ and
other related constructs ('work ability', 'work productivity', 'work engagement' and
other related constructs ('work ability', 'work productivity', 'work engagement' and
'work involvement').
'work involvement').
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88
88
88
This study shows that the WRFQ-SpV is able to distinguish among different
This study shows that the WRFQ-SpV is able to distinguish among different
groups of job types, health conditions and ages. For the overall scores, a
groups of job types, health conditions and ages. For the overall scores, a
significant trend for worse work functioning scores with increasing age (p=0.026)
significant trend for worse work functioning scores with increasing age (p=0.026)
was found (hypothesis 4), consistent with other studies finding that both,
was found (hypothesis 4), consistent with other studies finding that both,
chronological and functional age, are associated with a decrease in work ability
chronological and functional age, are associated with a decrease in work ability
and/or work outcomes [42-46]. This trend was clear for physical functioning, output
and/or work outcomes [42-46]. This trend was clear for physical functioning, output
and social demands, but was not so clearly present for work scheduling and
and social demands, but was not so clearly present for work scheduling and
mental demands, indicating the construct 'work functioning' is not entirely
mental demands, indicating the construct 'work functioning' is not entirely
explained by chronological age [7,45].
explained by chronological age [7,45].
This could mean that there are other
This could mean that there are other
qualities that older workers might bring into the workplace (e.g. efficiency,
qualities that older workers might bring into the workplace (e.g. efficiency,
management and scheduling, expertise and experience and other more qualitative
management and scheduling, expertise and experience and other more qualitative
aspects) and other age concepts (e.g. functional age, personal perceived age or
aspects) and other age concepts (e.g. functional age, personal perceived age or
biological age) should be analyzed. The “healthy worker effect” could also be
biological age) should be analyzed. The “healthy worker effect” could also be
playing a role explaining why this trend of worse work functioning does not appear
playing a role explaining why this trend of worse work functioning does not appear
for certain subscales. Chronically ill and disabled workers are usually excluded
for certain subscales. Chronically ill and disabled workers are usually excluded
from employment [48], and therefore the older workers who remain in their jobs
from employment [48], and therefore the older workers who remain in their jobs
are likely those with better health and therefore better work functioning.
are likely those with better health and therefore better work functioning.
Consistent with prior WRFQ analyses, correlations for item-subscale, item-total,
Consistent with prior WRFQ analyses, correlations for item-subscale, item-total,
among subscales and subscale-total were evaluated and found to be appropriate
among subscales and subscale-total were evaluated and found to be appropriate
[7,20,21,23].
[7,20,21,23].
Our measurement property results are consistent with the Canadian French and
Our measurement property results are consistent with the Canadian French and
Brazilian Portuguese WRFQ cross-cultural adaptation [20,21]. In both studies, the
Brazilian Portuguese WRFQ cross-cultural adaptation [20,21]. In both studies, the
validation study was carried out in populations with musculoskeletal disorders,
validation study was carried out in populations with musculoskeletal disorders,
concluding that the adapted WRFQ versions were reliable. Only one study was
concluding that the adapted WRFQ versions were reliable. Only one study was
found that assessed the responsiveness of the WRFQ, conducted in a relatively
found that assessed the responsiveness of the WRFQ, conducted in a relatively
small, stable and healthy population, without any intervention between the first and
small, stable and healthy population, without any intervention between the first and
the second test, to that the number of workers reporting change was very small
the second test, to that the number of workers reporting change was very small
[7]. Other longitudinal studies with larger samples, designed to expect changes in
[7]. Other longitudinal studies with larger samples, designed to expect changes in
participants, should be carried out to assess WRFQ responsiveness.
participants, should be carried out to assess WRFQ responsiveness.
89
89
In conclusion, our study provides evidence of the reliability and validity of the
In conclusion, our study provides evidence of the reliability and validity of the
WRFQ-SpV to measure health-related work functioning in day-to-day practice and
WRFQ-SpV to measure health-related work functioning in day-to-day practice and
research in occupational health care and the rehabilitation of disabled workers. It
research in occupational health care and the rehabilitation of disabled workers. It
should be useful to monitor improvements in work functioning after implementing
should be useful to monitor improvements in work functioning after implementing
rehabilitation and/or accommodation programs. Longitudinal studies are needed to
rehabilitation and/or accommodation programs. Longitudinal studies are needed to
assess the responsiveness of the questionnaire.
assess the responsiveness of the questionnaire.
90
90
90
90
Acknowledgements
Acknowledgements
We want to thank the nurses of the PSMAR Josefina Pi-Sunyer, Joan Mirabent,
We want to thank the nurses of the PSMAR Josefina Pi-Sunyer, Joan Mirabent,
Victoria Abad, Silvia Rosado and Antonia Ruiz for their contribution engaging
Victoria Abad, Silvia Rosado and Antonia Ruiz for their contribution engaging
participants for the study. A word of gratitude to Roy Stewart from the University
participants for the study. A word of gratitude to Roy Stewart from the University
of Groningen for his kind helps with the statistical analysis. And gratefully
of Groningen for his kind helps with the statistical analysis. And gratefully
acknowledge the help of David Domenech, Ángeles Calaforra, Ram Dulthummon,
acknowledge the help of David Domenech, Ángeles Calaforra, Ram Dulthummon,
José, Borja and Ángeles Ramada for their gentle collaboration in all the logistics of
José, Borja and Ángeles Ramada for their gentle collaboration in all the logistics of
the questionnaires and design of the database. This project has been supported
the questionnaires and design of the database. This project has been supported
by a grant from "Fondo de Investigaciones Sanitarias (FIS: PI12/02556), Instituto
by a grant from "Fondo de Investigaciones Sanitarias (FIS: PI12/02556), Instituto
de Salud Carlos III, Subdirección General de Evaluación y Fomento de la
de Salud Carlos III, Subdirección General de Evaluación y Fomento de la
Investigación, Ministerio de Ciencia e Innovación, Gobierno de España". None of
Investigación, Ministerio de Ciencia e Innovación, Gobierno de España". None of
the study authors have competing interests.
the study authors have competing interests.
Conflict of interest
Conflict of interest
Author Jose M Ramada declares that he has no conflict of interest; author Consol
Author Jose M Ramada declares that he has no conflict of interest; author Consol
Serra declares that he has no conflict of interest; author Benjamin C Amick III
Serra declares that he has no conflict of interest; author Benjamin C Amick III
declares that he has no conflict of interest; author Femke I Abma declares that he
declares that he has no conflict of interest; author Femke I Abma declares that he
has no conflict of interest; author Juan R Castaño declares that he has no conflict
has no conflict of interest; author Juan R Castaño declares that he has no conflict
of interest; author Gemma Pidemunt declares that he has no conflict of interest;
of interest; author Gemma Pidemunt declares that he has no conflict of interest;
author Ute Bültmann declares that he has no conflict of interest and author George
author Ute Bültmann declares that he has no conflict of interest and author George
L Delclos declares that he has no conflict of interest.
L Delclos declares that he has no conflict of interest.
This project has been supported by a grant from "Fondo de Investigaciones
This project has been supported by a grant from "Fondo de Investigaciones
Sanitarias (FIS: PI12/02556), Instituto de Salud Carlos III, Subdirección General
Sanitarias (FIS: PI12/02556), Instituto de Salud Carlos III, Subdirección General
de Evaluación y Fomento de la Investigación, Ministerio de Ciencia e Innovación,
de Evaluación y Fomento de la Investigación, Ministerio de Ciencia e Innovación,
Gobierno de España".
Gobierno de España".
91
91
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5. PAPER # 4
Responsiveness
5. PAPER # 4
of
the
Work
Role
Functioning
Responsiveness
of
the
Work
Role
Functioning
Questionnaire (Spanish version). Journal of Occupational
Questionnaire (Spanish version). Journal of Occupational
and Environmental Medicine. [In Press 2013].
and Environmental Medicine. [In Press 2013].
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Ramada JM, Delclos GL, Amick BC 3rd, Abma FI, Pidemunt G, Castaño JR, Bültmann U, Serra C.
Responsiveness of the Work Role Functioning Questionnaire (Spanish version) in a general working
population. J Occup Environ Med. 2014 Feb;56(2):189-94. doi: 10.1097/JOM.0000000000000074
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TITLE:
TITLE:
Responsiveness of the Work Role Functioning Questionnaire (Spanish
Responsiveness of the Work Role Functioning Questionnaire (Spanish
version) in a general working population.
version) in a general working population.
Running title: Work Role Functioning Questionnaire Responsiveness
Running title: Work Role Functioning Questionnaire Responsiveness
AUTHORS:
AUTHORS:
1,2,3
1,2,3
José M Ramada Rodilla, MD, MSc
José M Ramada Rodilla, MD, MSc
George L Delclós Clanchet, MD, MPH, PhD1,3,4
George L Delclós Clanchet, MD, MPH, PhD1,3,4
Benjamin C Amick, PhD4,5
Benjamin C Amick, PhD4,5
Femke I Abma, PhD6
Femke I Abma, PhD6
Juan R Castaño Asins, MD7
Juan R Castaño Asins, MD7
Gemma Pidemunt Moli, MD, PhD8
Gemma Pidemunt Moli, MD, PhD8
Ute Bültmann, PhD6
Ute Bültmann, PhD6
1,2,3
1,2,3
Consol Serra Pujadas, MD, PhD
Consol Serra Pujadas, MD, PhD
AFFILIATIONS:
1
AFFILIATIONS:
1
Centro de Investigación en Salud Laboral (CiSAL), Universidad Pompeu
Fabra, Barcelona, España.
Centro de Investigación en Salud Laboral (CiSAL), Universidad Pompeu
Fabra, Barcelona, España.
2
Servicio de Salud Laboral, Parc de Salut MAR, Barcelona, España.
2
Servicio de Salud Laboral, Parc de Salut MAR, Barcelona, España.
3
CIBER de Epidemiología y Salud Pública (CIBERESP).
3
CIBER de Epidemiología y Salud Pública (CIBERESP).
4
Southwest Center for Occupational and Environmental Health, The University
4
Southwest Center for Occupational and Environmental Health, The University
of Texas School of Public Health. Houston, Texas, USA.
5
6
of Texas School of Public Health. Houston, Texas, USA.
Institute for work & Health. 80 University Avenue, Toronto, Ontario, Canada.
5
Institute for work & Health. 80 University Avenue, Toronto, Ontario, Canada.
Department of Health Sciences, Work & Health, University Medical Center
6
Department of Health Sciences, Work & Health, University Medical Center
Groningen, University of Groningen. Groningen, The Netherlands.
Groningen, University of Groningen. Groningen, The Netherlands.
7
Psychiatry Service. Parc de Salut MAR. Hospital del Mar. Barcelona, Spain.
7
Psychiatry Service. Parc de Salut MAR. Hospital del Mar. Barcelona, Spain.
8
Orthopedic Surgery and Traumatology Service. Parc de Salut MAR. Hospital
8
Orthopedic Surgery and Traumatology Service. Parc de Salut MAR. Hospital
del Mar. Barcelona, Spain.
del Mar. Barcelona, Spain.
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CORRESPONDING AUTHOR:
CORRESPONDING AUTHOR:
José Mª Ramada Rodilla
José Mª Ramada Rodilla
Occupational Health Service. Parc de Salut Mar.
Occupational Health Service. Parc de Salut Mar.
Passeig Marítim, 25-29. 08003-Barcelona. Spain
Passeig Marítim, 25-29. 08003-Barcelona. Spain
Email address: [email protected]
Email address: [email protected]
Telephone number: +34 932483066;
Telephone number: +34 932483066;
Fax number: +34 933160410
Fax number: +34 933160410
CONFLICTS OF INTEREST AND SOURCE OF FUNDING:
CONFLICTS OF INTEREST AND SOURCE OF FUNDING:
This project was supported by a grant from the "Fondo de Investigaciones
This project was supported by a grant from the "Fondo de Investigaciones
Sanitarias (FIS: PI12/02556), Instituto de Salud Carlos III, Subdirección
Sanitarias (FIS: PI12/02556), Instituto de Salud Carlos III, Subdirección
General de Evaluación y Fomento de la Investigación, Ministerio de Ciencia
General de Evaluación y Fomento de la Investigación, Ministerio de Ciencia
e Innovación, Spanish Government".
e Innovación, Spanish Government".
Conflicts of interest: none declared.
Conflicts of interest: none declared.
CLINICAL SIGNIFICANCE
CLINICAL SIGNIFICANCE
The study provides evidence that the WRFQ-SpV is an appropriate
The study provides evidence that the WRFQ-SpV is an appropriate
instrument to measure (true) changes in health-related work functioning over
instrument to measure (true) changes in health-related work functioning over
time. However, more research is needed to assess the ability of the
time. However, more research is needed to assess the ability of the
instrument detecting (true) changes in groups whose health is stable or
instrument detecting (true) changes in groups whose health is stable or
deteriorates in individualized health-related work functioning surveillance.
deteriorates in individualized health-related work functioning surveillance.
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ABSTRACT
ABSTRACT
Objective: To examine the responsiveness of the Work Role Functioning
Objective: To examine the responsiveness of the Work Role Functioning
Questionnaire Spanish-Version (WRFQ-SpV) so that it could be used in evaluative
Questionnaire Spanish-Version (WRFQ-SpV) so that it could be used in evaluative
studies.
studies.
Methods: A longitudinal survey was performed. Combinations of distribution and
Methods: A longitudinal survey was performed. Combinations of distribution and
anchor-based approaches were used. Five hypotheses were tested examining
anchor-based approaches were used. Five hypotheses were tested examining
validity of change-scores. The consensus-based standards for the selection of
validity of change-scores. The consensus-based standards for the selection of
health status measurement instruments (COSMIN) guided the study design.
health status measurement instruments (COSMIN) guided the study design.
Results: One hundred and two participants (mean age=47.3; SD=10.3) completed
Results: One hundred and two participants (mean age=47.3; SD=10.3) completed
the WRFQ-SpV twice, within a mean interval of 3.7 months (SD=1.8). Four
the WRFQ-SpV twice, within a mean interval of 3.7 months (SD=1.8). Four
hypotheses were confirmed and one was rejected. It was verified that the WRFQ-
hypotheses were confirmed and one was rejected. It was verified that the WRFQ-
SpV was able to detect (true) changes over time.
SpV was able to detect (true) changes over time.
Conclusion: Suggestive evidence about the possible use of the WRFQ-SpV with
Conclusion: Suggestive evidence about the possible use of the WRFQ-SpV with
evaluative purposes was provided. More research is needed to examine the
evaluative purposes was provided. More research is needed to examine the
instrument responsiveness for groups whose health is stable or deteriorates.
instrument responsiveness for groups whose health is stable or deteriorates.
Key
Key
terms:
responsiveness;
measurement
instrument;
work-functioning
instrument.
terms:
responsiveness;
measurement
instrument;
work-functioning
instrument.
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INTRODUCTION
INTRODUCTION
Increasing life expectancy and delayed retirement age are creating an older active
Increasing life expectancy and delayed retirement age are creating an older active
workforce. Many of the older workers likely have health issues due to chronic
workforce. Many of the older workers likely have health issues due to chronic
diseases that require some form of adaptation while working [1,2]. A paradigm
diseases that require some form of adaptation while working [1,2]. A paradigm
shift is needed in occupational health care settings to sustain a productive labour
shift is needed in occupational health care settings to sustain a productive labour
force throughout a workers career. Helping workers to remain healthy at work
force throughout a workers career. Helping workers to remain healthy at work
should be an important target for occupational health research and practice [3].
should be an important target for occupational health research and practice [3].
Work functioning (WF) is determined by the joint influence of work and health and
Work functioning (WF) is determined by the joint influence of work and health and
should be viewed as a continuum rather than a dichotomy [4]. Health is a dynamic
should be viewed as a continuum rather than a dichotomy [4]. Health is a dynamic
concept that changes over time. Regarding sickness absence, effective workplace
concept that changes over time. Regarding sickness absence, effective workplace
and/or individual interventions could contribute to an early and sustainable return
and/or individual interventions could contribute to an early and sustainable return
to work.
to work.
Both, the interventions and the persons should be evaluated and monitored in this
Both, the interventions and the persons should be evaluated and monitored in this
process. Traditional work outcome measures, such as “present versus absent” are
process. Traditional work outcome measures, such as “present versus absent” are
no longer sufficient [5]. Validated instruments are required to evaluate the impact
no longer sufficient [5]. Validated instruments are required to evaluate the impact
of health on WF and quality instruments are needed to examine “functioning at
of health on WF and quality instruments are needed to examine “functioning at
work” and to perform health-related WF surveillance.
work” and to perform health-related WF surveillance.
A number of self-reported workplace productivity measurement instruments and
A number of self-reported workplace productivity measurement instruments and
work-role specific functioning questionnaires have been developed and compared
work-role specific functioning questionnaires have been developed and compared
[6,7,8,9]. Recently, the Work Role Functioning Questionnaire (WRFQ) [4],
[6,7,8,9]. Recently, the Work Role Functioning Questionnaire (WRFQ) [4],
designed to measure health-related WF and freely available in the literature for
designed to measure health-related WF and freely available in the literature for
professionals and researchers, has been successfully translated, adapted and
professionals and researchers, has been successfully translated, adapted and
validated to be used in different languages [10-14].
validated to be used in different languages [10-14].
Recent reviews have found that health-related work outcome measures and
Recent reviews have found that health-related work outcome measures and
health-related WF instruments need better validation to make them more
health-related WF instruments need better validation to make them more
meaningful for researchers, practitioners and patients [15,16]. If an instrument is
meaningful for researchers, practitioners and patients [15,16]. If an instrument is
only used to discriminate between patients at one point in time, responsiveness of
only used to discriminate between patients at one point in time, responsiveness of
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the tool is not usually an issue. But for evaluative purposes, when it is intended to
the tool is not usually an issue. But for evaluative purposes, when it is intended to
measure change in longitudinal studies, this property is very relevant [17].
measure change in longitudinal studies, this property is very relevant [17].
Responsiveness is the ability of an instrument to detect true change over time in
Responsiveness is the ability of an instrument to detect true change over time in
the construct measured. It refers to the validity of a change score, which is the
the construct measured. It refers to the validity of a change score, which is the
difference between two scores estimated on the basis of at least two
difference between two scores estimated on the basis of at least two
measurements [17,18]. Responsiveness of the WRFQ has only been examined in
measurements [17,18]. Responsiveness of the WRFQ has only been examined in
the Dutch version. The Dutch researchers recommended further responsiveness
the Dutch version. The Dutch researchers recommended further responsiveness
assessments in samples expected to experience changes over time in either work
assessments in samples expected to experience changes over time in either work
conditions or health status [14].
conditions or health status [14].
The ultimate goal of many interventions in occupational health practice and
The ultimate goal of many interventions in occupational health practice and
research is to improve WF, and assessing whether a worker’s WF status has
research is to improve WF, and assessing whether a worker’s WF status has
changed over time is often one of the most important measurement purposes.
changed over time is often one of the most important measurement purposes.
Therefore, the objective of this study was to examine the responsiveness of the
Therefore, the objective of this study was to examine the responsiveness of the
Spanish version of the WRFQ (WRFQ-SpV) so that it could be used in evaluative
Spanish version of the WRFQ (WRFQ-SpV) so that it could be used in evaluative
studies and/or as a monitoring or surveillance instrument.
studies and/or as a monitoring or surveillance instrument.
METHODS
METHODS
Procedures and sample characteristics
Procedures and sample characteristics
A longitudinal survey was conducted to examine the responsiveness of the
A longitudinal survey was conducted to examine the responsiveness of the
WRFQ-SpV.
WRFQ-SpV.
The
recommendations
consensus-based
to
assess
the
standards
methodological
on
terminology
quality
of
studies
and
on
The
recommendations
consensus-based
to
assess
the
standards
methodological
on
terminology
quality
of
studies
and
on
measurement properties of health status measurements instruments (COSMIN)
measurement properties of health status measurements instruments (COSMIN)
guided the design of the study [18-20].
guided the design of the study [18-20].
All participants were recruited, before starting medical treatment, through the
All participants were recruited, before starting medical treatment, through the
outpatient services of psychiatry, physical medicine and rehabilitation, orthopedic
outpatient services of psychiatry, physical medicine and rehabilitation, orthopedic
surgery and traumatology at a large public hospital system in Barcelona (Spain).
surgery and traumatology at a large public hospital system in Barcelona (Spain).
Inclusion criteria were: 1) active workers of both sexes, age 18 years and over, 2)
Inclusion criteria were: 1) active workers of both sexes, age 18 years and over, 2)
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attending his/her first hospital specialist visit, 3) working at least 10 hours per week
attending his/her first hospital specialist visit, 3) working at least 10 hours per week
in the past four weeks, and 4) able to read and understand Spanish. Participants
in the past four weeks, and 4) able to read and understand Spanish. Participants
were excluded if they had plans to stop working in the next six months.
were excluded if they had plans to stop working in the next six months.
Participants were invited to complete the WRFQ-SpV twice on paper (before and
Participants were invited to complete the WRFQ-SpV twice on paper (before and
after the treatment). At the time of first completion, they provided information on
after the treatment). At the time of first completion, they provided information on
age, gender, level of education (primary, secondary, higher), job type (manual,
age, gender, level of education (primary, secondary, higher), job type (manual,
non-manual, mixed), working hours and health condition (none, musculoskeletal,
non-manual, mixed), working hours and health condition (none, musculoskeletal,
mental health, others).
mental health, others).
One to six months after finalizing treatment at the hospital all participants were
One to six months after finalizing treatment at the hospital all participants were
invited to answer the WRFQ-SpV again. At that time, a single global perceived
invited to answer the WRFQ-SpV again. At that time, a single global perceived
effect question (GPE-Q) was added asking respondents to rate their change in WF
effect question (GPE-Q) was added asking respondents to rate their change in WF
compared to their pre-treatment baseline, with response options for deterioration
compared to their pre-treatment baseline, with response options for deterioration
from -6 (much worse) to -1 (slightly worse), 0 for no change, and rating
from -6 (much worse) to -1 (slightly worse), 0 for no change, and rating
improvement from +1 (slightly better) to +6 (much better).
improvement from +1 (slightly better) to +6 (much better).
Measure
Measure
The WRFQ is a self-administered questionnaire that measures perceived
The WRFQ is a self-administered questionnaire that measures perceived
difficulties to perform the job due to health problems [4]. Instructions to use the
difficulties to perform the job due to health problems [4]. Instructions to use the
instrument have been described elsewhere [12]. The WRFQ-SpV consists of 27
instrument have been described elsewhere [12]. The WRFQ-SpV consists of 27
items, grouped into 5 subscales reflecting different work demands (work
items, grouped into 5 subscales reflecting different work demands (work
scheduling, output, physical, mental and social). Each item is scored on a Likert
scheduling, output, physical, mental and social). Each item is scored on a Likert
five-point scale, anchored to percentages of working time with difficulty handling
five-point scale, anchored to percentages of working time with difficulty handling
certain parts of the job. Response options 0, 2 and 4 are anchored to 0%, 50%
certain parts of the job. Response options 0, 2 and 4 are anchored to 0%, 50%
and 100% respectively. Response option ’does not apply to my job’ is transformed
and 100% respectively. Response option ’does not apply to my job’ is transformed
into a missing value. Total scales and/or subscales containing more than 20%
into a missing value. Total scales and/or subscales containing more than 20%
missing values are considered missing.
missing values are considered missing.
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Statistical analysis
Statistical analysis
The WRFQ-SpV median scores, ranges, mean change scores and standard
The WRFQ-SpV median scores, ranges, mean change scores and standard
deviations of change (SD change) were determined. The standard error of
deviations of change (SD change) were determined. The standard error of
measurement (SEM) and Cronbach alpha for the overall scale and each subscale
measurement (SEM) and Cronbach alpha for the overall scale and each subscale
were calculated to evaluate the reliability of the questionnaire. Floor and ceiling
were calculated to evaluate the reliability of the questionnaire. Floor and ceiling
effects were explored. These effects occur when more than 15% of responses to a
effects were explored. These effects occur when more than 15% of responses to a
certain item cluster at the top or the bottom of the scale [21].
certain item cluster at the top or the bottom of the scale [21].
According to de Vet et al. [17] and the COSMIN panel [18-20] responsiveness is
According to de Vet et al. [17] and the COSMIN panel [18-20] responsiveness is
an aspect of validity, and its assessment should emphasize evaluating the validity
an aspect of validity, and its assessment should emphasize evaluating the validity
of change scores. Therefore, analogous to validity, testing hypotheses formulated
of change scores. Therefore, analogous to validity, testing hypotheses formulated
a priori (before data collection and analysis), concerning the expected correlations
a priori (before data collection and analysis), concerning the expected correlations
and/or expected relationships in different groups measured with the instrument
and/or expected relationships in different groups measured with the instrument
and the GPE-Q, is considered an appropriate method.
and the GPE-Q, is considered an appropriate method.
A distribution approach was used to estimate the Minimal Important Change (MIC)
A distribution approach was used to estimate the Minimal Important Change (MIC)
and to evaluate the hypotheses based on SEM and Effect Size (ES). For those
and to evaluate the hypotheses based on SEM and Effect Size (ES). For those
hypotheses addressing correlations and expected change scores in different
hypotheses addressing correlations and expected change scores in different
subgroups of participants an anchor-based approach with the GPE-Q was used.
subgroups of participants an anchor-based approach with the GPE-Q was used.
The following five hypotheses were formulated:
The following five hypotheses were formulated:
Hypothesis 1: Changes in WF were expected in participants as a result of the
Hypothesis 1: Changes in WF were expected in participants as a result of the
treatment, so it was hypothesized that changes in WF over the period of treatment,
treatment, so it was hypothesized that changes in WF over the period of treatment,
assessed by the GPE-Q correlate moderate to strongly with the change scores
assessed by the GPE-Q correlate moderate to strongly with the change scores
assessed by the WRFQ-SpV. Correlations were assessed using Pearson's
assessed by the WRFQ-SpV. Correlations were assessed using Pearson's
correlation coefficient (r), interpreting r ≤ 0.4 =’weak’; 0.4 ≤ r ≤ 0.7 =’moderate’
correlation coefficient (r), interpreting r ≤ 0.4 =’weak’; 0.4 ≤ r ≤ 0.7 =’moderate’
and r > 0.7= ’strong’ [22].
and r > 0.7= ’strong’ [22].
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Hypothesis 2: Treatment was expected to result in improvement, not deterioration,
Hypothesis 2: Treatment was expected to result in improvement, not deterioration,
although both were possible. Hence, it was hypothesized a substantially greater
although both were possible. Hence, it was hypothesized a substantially greater
effect size (ES) for improvement of WF than for deterioration.
effect size (ES) for improvement of WF than for deterioration.
To examine this hypothesis, Cohen's d effect size (ES = difference of means
To examine this hypothesis, Cohen's d effect size (ES = difference of means
divided by the pooled SD) and the standardized response mean (SRM = mean
divided by the pooled SD) and the standardized response mean (SRM = mean
change divided by SD of change) were calculated as an estimate of magnitude of
change divided by SD of change) were calculated as an estimate of magnitude of
change over time. Cohen's d ES thresholds were used for interpretation of
change over time. Cohen's d ES thresholds were used for interpretation of
Cohen’s d effect size. Respondents were categorized as deteriorating group (-6 to
Cohen’s d effect size. Respondents were categorized as deteriorating group (-6 to
-1) or improving group (+1 to +6), because statistical methods underlying the SRM
-1) or improving group (+1 to +6), because statistical methods underlying the SRM
assume that all participants change in the same direction [23].
assume that all participants change in the same direction [23].
Small ES values (0.20 ≤ ES ≤ 0.50) were hypothesized for participants reporting
Small ES values (0.20 ≤ ES ≤ 0.50) were hypothesized for participants reporting
deterioration in WF, and large ES values (ES ≥ 0.80) for those reporting
deterioration in WF, and large ES values (ES ≥ 0.80) for those reporting
improvement.
improvement.
Hypothesis 3: Positive changes in WF reported on the GPE-Q, predict positive
Hypothesis 3: Positive changes in WF reported on the GPE-Q, predict positive
changes in the scores of the WRFQ-SpV. Therefore, it is expected that
changes in the scores of the WRFQ-SpV. Therefore, it is expected that
participants reporting improvement in WF on the GPE-Q, show an "important
participants reporting improvement in WF on the GPE-Q, show an "important
change" for the overall scale and each subscale of the WRFQ-SpV.
change" for the overall scale and each subscale of the WRFQ-SpV.
“Important change” was defined as a mean change score larger than both the MIC
“Important change” was defined as a mean change score larger than both the MIC
and the SEM, because responsiveness was being examined for evaluative
and the SEM, because responsiveness was being examined for evaluative
purposes [21]. Statistical significance of the differences between the WRFQ-SpV
purposes [21]. Statistical significance of the differences between the WRFQ-SpV
scores found at baseline and at follow-up was assessed by means of paired t
scores found at baseline and at follow-up was assessed by means of paired t
tests.
tests.
Since the WRFQ is a Patient Reported Outcome (PRO), the MIC was considered
Since the WRFQ is a Patient Reported Outcome (PRO), the MIC was considered
from the perspective of the patient, and was therefore defined using the GPE-Q as
from the perspective of the patient, and was therefore defined using the GPE-Q as
an anchor, as the smallest change of the WRFQ-SpV score which participants
an anchor, as the smallest change of the WRFQ-SpV score which participants
perceive as minimally important [17]. The MIC value for improvement was set at
perceive as minimally important [17]. The MIC value for improvement was set at
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the mean change score of participants reporting an improvement from +1 (slight
the mean change score of participants reporting an improvement from +1 (slight
improvement) to +2 (some improvement).
improvement) to +2 (some improvement).
Hypothesis 4: Participants, who received treatment for physical issues, reporting
Hypothesis 4: Participants, who received treatment for physical issues, reporting
improvement on the GPE-Q, show an "important change" for the WRFQ-SpV
improvement on the GPE-Q, show an "important change" for the WRFQ-SpV
subscale of physical demands (defining "important change" as a change score
subscale of physical demands (defining "important change" as a change score
larger than both, the MIC and the SEM). Statistical significance of change was
larger than both, the MIC and the SEM). Statistical significance of change was
assessed by means of paired t tests.
assessed by means of paired t tests.
Hypothesis 5: Participants, who received treatment for mental health issues,
Hypothesis 5: Participants, who received treatment for mental health issues,
reporting improvement on the GPE-Q, show an "important change" for the WRFQ-
reporting improvement on the GPE-Q, show an "important change" for the WRFQ-
SpV subscale of mental demands ("important change" defined like in previous
SpV subscale of mental demands ("important change" defined like in previous
hypothesis). Statistical significance of change was assessed by means of paired t
hypothesis). Statistical significance of change was assessed by means of paired t
tests.
tests.
The contents of the study and the informed consent form were reviewed and
The contents of the study and the informed consent form were reviewed and
approved by the Clinical Research Ethical Committee of the Parc de Salut Mar
approved by the Clinical Research Ethical Committee of the Parc de Salut Mar
(Barcelona, Spain) and respect all the principles of the Declaration of Helsinki and
(Barcelona, Spain) and respect all the principles of the Declaration of Helsinki and
Spanish legal regulations on protection of personal data. All analyses were
Spanish legal regulations on protection of personal data. All analyses were
performed with SPSS (Version 15.0. Chicago, IL; 2006).
performed with SPSS (Version 15.0. Chicago, IL; 2006).
RESULTS
RESULTS
Sample characteristics:
Sample characteristics:
Table 1 shows the study sample characteristics. A total of 102 participants with a
Table 1 shows the study sample characteristics. A total of 102 participants with a
mean age of 47.3 years (SD=10.3) completed the WRFQ-SpV and were included
mean age of 47.3 years (SD=10.3) completed the WRFQ-SpV and were included
in the analyses. All participants answered the questionnaire twice within a mean
in the analyses. All participants answered the questionnaire twice within a mean
interval of 3.7 months (SD=1.8). All were active employees working an average of
interval of 3.7 months (SD=1.8). All were active employees working an average of
39.6 hours per week (SD=7.2), with various levels of education, job types and
39.6 hours per week (SD=7.2), with various levels of education, job types and
health problems. Women and participants with high educational level were over
health problems. Women and participants with high educational level were over
110
110
110
110
represented in this sample, compared to the general working Spanish population
represented in this sample, compared to the general working Spanish population
[24].
[24].
Median scores, ranges, mean change scores, SD change, SEM and Cronbach
Median scores, ranges, mean change scores, SD change, SEM and Cronbach
alpha for the overall scale and each subscale are presented in table 2.
alpha for the overall scale and each subscale are presented in table 2.
Floor and ceiling effects:
Floor and ceiling effects:
The overall scale did not show floor or ceiling effects. Subscales did not show floor
The overall scale did not show floor or ceiling effects. Subscales did not show floor
effects, but ceiling effects were found for the subscales of work scheduling (15%),
effects, but ceiling effects were found for the subscales of work scheduling (15%),
mental (27%) and social demands (24%) [21] (table 2).
mental (27%) and social demands (24%) [21] (table 2).
Responsiveness by means of hypothesis testing:
Responsiveness by means of hypothesis testing:
Hypothesis 1: Correlations between the GPE-Q scores and the overall change
Hypothesis 1: Correlations between the GPE-Q scores and the overall change
scores on the WRFQ-SpV for subgroups of participants reporting improvement or
scores on the WRFQ-SpV for subgroups of participants reporting improvement or
deterioration were r=0.5 (p=0.001) and r=0.6 (p=0.002), respectively. Correlations
deterioration were r=0.5 (p=0.001) and r=0.6 (p=0.002), respectively. Correlations
for all subscales and the overall scale in each subgroup were also above 0.4,
for all subscales and the overall scale in each subgroup were also above 0.4,
except for the subscale of social demands in the subgroup of participants
except for the subscale of social demands in the subgroup of participants
improving (table 3).
improving (table 3).
Hypothesis 2: ES values and SRM are presented in table 4. For the evaluation of
Hypothesis 2: ES values and SRM are presented in table 4. For the evaluation of
change in WF, 34 participants reported deterioration by means of the GPE-Q
change in WF, 34 participants reported deterioration by means of the GPE-Q
(Mean= -3.53; SD=1.64), obtaining a mean change score in the WRFQ-SpV of -
(Mean= -3.53; SD=1.64), obtaining a mean change score in the WRFQ-SpV of -
8.45 (SD=12.67). For those reporting deterioration, Cohen's d ES and SEM were -
8.45 (SD=12.67). For those reporting deterioration, Cohen's d ES and SEM were -
0.34 and -0.67, respectively. A total of 49 participants reported improvement
0.34 and -0.67, respectively. A total of 49 participants reported improvement
(GPE-Q Mean=+3.73; SD=1.54) and an average increase in WRFQ-SpV of
(GPE-Q Mean=+3.73; SD=1.54) and an average increase in WRFQ-SpV of
+22.35 (SD=20.83). For those reporting improvement, Cohen's d ES and SRM
+22.35 (SD=20.83). For those reporting improvement, Cohen's d ES and SRM
were 1.09 and 1.07 respectively, confirming hypothesis 2.
were 1.09 and 1.07 respectively, confirming hypothesis 2.
111
111
184
184
Table 1. Sample characteristics (n=102).
Age in years, mean (SD)
a
Total
Men
Women
n=102
n=45 (44%)
n=57 (56%)
47.3 (10.3)
Education level, N (%)
Working hours/week, mean (SD)
48.5 (10.8)
28 (27.5)
12 (26.7)
16 (28.1)
Middle
38 (37.3)
20 (44.4)
High
36 (35.2)
13 (28.9)
39.6 (7.2)
Reported health issue type, N (%)
45.9 (9.4)
Low
a
Job type, N (%)
Disease duration in months:
Table 1. Sample characteristics (n=102).
41.9 (7.4)
Age in years, mean (SD)
a
Total
Men
Women
n=102
n=45 (44%)
n=57 (56%)
47.3 (10.3)
48.5 (10.8)
Low
28 (27.5)
12 (26.7)
16 (28.1)
18 (31.6)
Middle
38 (37.3)
20 (44.4)
18 (31.6)
23 (40.3)
High
36 (35.2)
13 (28.9)
23 (40.3)
37.7 (6.4)
Manual
36 (35.3)
14 (31.1)
22 (38.6)
Non-manual
27 (26.5)
10 (22.2)
Mixed
39 (38.2)
21 (46.7)
Education level, N (%)
45.9 (9.4)
Working hours/week, mean (SD)
a
39.6 (7.2)
37.7 (6.4)
Manual
36 (35.3)
14 (31.1)
22 (38.6)
17 (29.8)
Non-manual
27 (26.5)
10 (22.2)
17 (29.8)
18 (31.6)
Mixed
39 (38.2)
21 (46.7)
18 (31.6)
Physical
49 (48.0)
15 (33.3)
34 (59.7)
Mental health
Others
33 (32.4)
20 (19.6)
20 (44.4)
10 (22.3)
13 (22.8)
10 (17.5)
Mean, (SD)
22.4 (36.1)
15.2 (16.8)
28.0 (45.3)
Median, Range
12.0 1-300
12.0 1-60
Job type, N (%)
41.9 (7.4)
Reported health issue type, N (%)
Disease duration in months:
12.00 1-300
(a): Standard deviation
Physical
49 (48.0)
15 (33.3)
34 (59.7)
Mental health
Others
33 (32.4)
20 (19.6)
20 (44.4)
10 (22.3)
13 (22.8)
10 (17.5)
Mean, (SD)
22.4 (36.1)
15.2 (16.8)
28.0 (45.3)
Median, Range
12.0 1-300
12.0 1-60
12.00 1-300
(a): Standard deviation
113
113
184
184
98 (4)
Mental demands
Social demands
Total scale
77.9
83.3
83.3
70.0
80.6
75.0
Baseline
median
scores
b
6.48-100
0.00-100
0.00-100
4.17-100
0.00-100
0.00-100
Baseline
scores
range
0 (0.0)
3 (3.0)
2 (2.7)
0 (0.0)
1 (1.0)
1 (1.0)
Baseline
n at floor
(0%)
3 (3.1)
27 (26.7)
21 (23.9)
10 (13.5)
15 (15.3)
9 (9.2)
Baseline
n at ceiling
(100%)
8.6 (21.7)
10.2 (24.3)
10.0 (22.9)
7.9 (26.3)
5.8 (28.0)
9.5 (24.8)
Mean change
scores /
c
(SD change)
15.0
17.2
11.5
18.6
19.8
17.6
Standard error
measurement
(SEM)
(c) SD change: standard deviation of change.
74 (28)
101 (1)
88 (14)
98 (4)
Physical demands
Mental demands
Social demands
Total scale
77.9
83.3
83.3
70.0
80.6
75.0
Baseline
median
scores
b
6.48-100
0.00-100
0.00-100
4.17-100
0.00-100
0.00-100
Baseline
scores
range
0 (0.0)
3 (3.0)
2 (2.7)
0 (0.0)
1 (1.0)
1 (1.0)
Baseline
n at floor
(0%)
3 (3.1)
27 (26.7)
21 (23.9)
10 (13.5)
15 (15.3)
9 (9.2)
Baseline
n at ceiling
(100%)
8.6 (21.7)
10.2 (24.3)
10.0 (22.9)
7.9 (26.3)
5.8 (28.0)
9.5 (24.8)
Mean change
scores /
c
(SD change)
15.0
17.2
11.5
18.6
19.8
17.6
Standard error
measurement
(SEM)
(c) SD change: standard deviation of change.
115
0.94
0.94
0.93
0.95
0.93
0.92
Cronbach
alpha at
baseline
(a) Subscales with more than 20% of items scoring "does not apply to my job" or missing values were excluded.
(b) Each subscale is scored from 0-100. Higher scores mean better work functioning: difficulties all the time 0/100; difficulties no of the time 100/100.
98 (4)
98 (4)
Work scheduling demands
Output demands
Valid n
(missing/not
applicable)
a
Table 2. Spanish version of the Work Role Functioning Questionnaire: scores, floor and ceiling effects and Cronbach alpha at baseline.
Standard error of measurement, (n=102).
115
0.94
0.94
0.93
0.95
0.93
0.92
Cronbach
alpha at
baseline
(a) Subscales with more than 20% of items scoring "does not apply to my job" or missing values were excluded.
(b) Each subscale is scored from 0-100. Higher scores mean better work functioning: difficulties all the time 0/100; difficulties no of the time 100/100.
74 (28)
101 (1)
88 (14)
Physical demands
98 (4)
98 (4)
Work scheduling demands
Output demands
Valid n
(missing/not
applicable)
a
Table 2. Spanish version of the Work Role Functioning Questionnaire: scores, floor and ceiling effects and Cronbach alpha at baseline.
Standard error of measurement, (n=102).
115
115
116
116
Table 3. Bilateral correlations between the scores of the Global Perceived
a
Effect Question scores and the WRFQ-SpV change scores.
Mean Change score
a
WRFQ-SpV (SD)
Pearson's
b
(r)
Bilateral
significance
Work Scheduling Demands
22.9 (25.6)
0.6
Output Demands
25.6 (23.4)
0.4
< 0.001
0.001
Physical Demands
23.3 (27.0)
0.4
0.165
Mental Demands
23.1 (26.6)
0.4
Participants declaring
Improvement (n=49)
Table 3. Bilateral correlations between the scores of the Global Perceived
a
Effect Question scores and the WRFQ-SpV change scores.
Mean Change score
a
WRFQ-SpV (SD)
Pearson's
b
(r)
Bilateral
significance
Work Scheduling Demands
22.9 (25.6)
0.6
Output Demands
25.6 (23.4)
0.4
< 0.001
0.001
Physical Demands
23.3 (27.0)
0.4
0.165
0.017
Mental Demands
23.1 (26.6)
0.4
0.017
0.132
Social Demands
20.9 (27.3)
0.132
0.001
Overall Scale
22.3 (20.8)
0.3
0.5
Mean Change score
a
WRFQ-SpV
Pearson's
b
(r)
Bilateral
significance
Participants declaring
Improvement (n=49)
Social Demands
20.9 (27.3)
Overall Scale
22.3 (20.8)
0.3
0.5
Mean Change score
a
WRFQ-SpV
Pearson's
b
(r)
Bilateral
significance
Work Scheduling Demands
-24.0 (17.7)
0.6
0.006
Work Scheduling Demands
-24.0 (17.7)
0.6
0.006
Output Demands
-14.3 (10.5)
0.4
0.028
Output Demands
-14.3 (10.5)
0.4
0.028
Physical Demands
-17.7 (19.4)
0.5
0.028
Physical Demands
-17.7 (19.4)
0.5
0.028
Mental Demands
-12.1 (10.6)
0.6
0.047
Mental Demands
-12.1 (10.6)
0.6
0.047
Social Demands
-16.7 (12.3)
0.4
0.484
Social Demands
-16.7 (12.3)
0.4
0.484
Overall Scale
-10.5 (10.8)
0.6
0.002
Overall Scale
-10.5 (10.8)
0.6
0.002
Participants declaring
Deterioration (n=31)
Participants declaring
Deterioration (n=31)
(a) WRFQ-SpV: Work Role Functioning Questionnaire (Spanish version).
(a) WRFQ-SpV: Work Role Functioning Questionnaire (Spanish version).
(b) Pearson's correlation coefficient.
(b) Pearson's correlation coefficient.
117
0.001
117
184
184
119
119
b
1.07
1.12
22.35 (20.83); p<0.001
-8.45 (12.60); p=0.001
-0.67
-0.34
66.09 (25.83)
88.44 (11.43)
3.73 (1.54)
Participants reporting
a
improvement in WF
(N=49)
71.08 (24.32)
62.63 (25.54)
-3.53 (1.64)
(a) WF: Work functioning (by means of the GPE-Q);
(b) GPE-Q: Global Perceived Effect Question.
(c) Spanish version of the Work Role Functioning Questionnaire.
(d) Paired t test.
Standardized response mean (SRM)
Cohen's d effect size (with pooled SD change)
WRFQ-SpVmean score at follow-up(SD)
d
Mean change (SD); p value
WRFQ-SpV mean score at baseline (SD)
c
Mean score of the GPE-Q (SD)
Participants reporting
a
deterioration in WF
(N=34)
Table 4. Assessment of responsiveness by means of the Standardized Response Mean, using
Cohen’s d Effect Size thresholds for interpretation, (n=102).
(a) WF: Work functioning (by means of the GPE-Q);
(b) GPE-Q: Global Perceived Effect Question.
(c) Spanish version of the Work Role Functioning Questionnaire.
(d) Paired t test.
1.07
1.12
22.35 (20.83); p<0.001
Standardized response mean (SRM)
Cohen's d effect size (with pooled SD change)
WRFQ-SpVmean score at follow-up(SD)
d
Mean change (SD); p value
-0.67
-0.34
-8.45 (12.60); p=0.001
3.73 (1.54)
66.09 (25.83)
88.44 (11.43)
-3.53 (1.64)
71.08 (24.32)
62.63 (25.54)
c
WRFQ-SpV mean score at baseline (SD)
b
Participants reporting
a
improvement in WF
(N=49)
Mean score of the GPE-Q (SD)
Participants reporting
a
deterioration in WF
(N=34)
Table 4. Assessment of responsiveness by means of the Standardized Response Mean, using
Cohen’s d Effect Size thresholds for interpretation, (n=102).
119
119
120
120
Hypothesis 3: Participants reporting improvement in WF on the GPE-Q (n=49),
Hypothesis 3: Participants reporting improvement in WF on the GPE-Q (n=49),
showed mean change scores in all subscales and the overall scale above the MIC
showed mean change scores in all subscales and the overall scale above the MIC
values for improvement and the SEM. All change scores in this group were
values for improvement and the SEM. All change scores in this group were
statistically significant (p <0.001) (table 5).
statistically significant (p <0.001) (table 5).
Hypothesis 4: Participants who received treatment for physical issues, reporting
Hypothesis 4: Participants who received treatment for physical issues, reporting
improvement on the GPE-Q (n=18), showed a significant change score in the
improvement on the GPE-Q (n=18), showed a significant change score in the
subscale of physical demands (mean change score=19.2; SD=17.0; p<0.001), that
subscale of physical demands (mean change score=19.2; SD=17.0; p<0.001), that
was above the MIC value for improvement (11.3) and the SEM (12.0), confirming
was above the MIC value for improvement (11.3) and the SEM (12.0), confirming
hypothesis 4 (table 5).
hypothesis 4 (table 5).
Hypothesis 5: Participants who received treatment for mental health issues,
Hypothesis 5: Participants who received treatment for mental health issues,
reporting improvement in the GPE-Q (n=24), showed a significant change score
reporting improvement in the GPE-Q (n=24), showed a significant change score
(mean change score=18.1; SD=28.9; p=0.006) that was above the MIC value for
(mean change score=18.1; SD=28.9; p=0.006) that was above the MIC value for
improvement (7.4) but below the SEM (20.5), rejecting hypothesis 5 (table 5).
improvement (7.4) but below the SEM (20.5), rejecting hypothesis 5 (table 5).
121
121
184
184
Table 5. Scores on the Spanish version of the Work ole Functioning Questionnaire of participants
under treatment, declaring improvement in the GPE-Q, by type of health issue (mental or physical).
All participants, improvement (N=49)
WRFQ-SpV(a) WRFQ-SpV(b)
Mean (SD)
Mean (SD)
Mean change
score (SD)
p
value
MIC(c)
improvement
SEM(d)
Table 5. Scores on the Spanish version of the Work ole Functioning Questionnaire of participants
under treatment, declaring improvement in the GPE-Q, by type of health issue (mental or physical).
All participants, improvement (N=49)
WRFQ-SpV(a) WRFQ-SpV(b)
Mean (SD)
Mean (SD)
Mean change
score (SD)
p
value
MIC(c)
improvement
SEM(d)
Work scheduling demands
63.4 (30.2) 85.6 (17.3)
24.8 (27.0)* <0.001
7.3
19.1
Work scheduling demands
63.4 (30.2) 85.6 (17.3)
24.8 (27.0)* <0.001
7.3
19.1
Output demands
61.9 (30.8) 86.8 (14.2)
23.9 (31.0)* <0.001
11.1
21.9
Output demands
61.9 (30.8) 86.8 (14.2)
23.9 (31.0)* <0.001
11.1
21.9
Physical demands
70.1 (27.8) 87.7 (12.4)
68.7 (30.9) 91.8 (10.4)
20.4 (26.7)* <0.001
23.1 (26.6)* <0.001
11.3
7.4
18.9
18.8
Physical demands
70.1 (27.8) 87.7 (12.4)
68.7 (30.9) 91.8 (10.4)
20.4 (26.7)* <0.001
23.1 (26.6)* <0.001
11.3
7.4
18.9
18.8
Social demands
74.6 (26.7) 92.2 (10.8)
20.4 (28.8)* <0.001
11.1
20.4
Social demands
74.6 (26.7) 92.2 (10.8)
20.4 (28.8)* <0.001
11.1
20.4
Total score
66.1 (25.8) 88.4 (11.4) 22.4 (20.8)* <0.001
Physical health issues, improvement (N=18)
9.0
14.7
Total score
66.1 (25.8) 88.4 (11.4) 22.4 (20.8)* <0.001
Physical health issues, improvement (N=18)
9.0
14.7
MIC(c)
improvement
SEM(d)
Mental demands
WRFQ-SpV(a) WRFQ-SpV(b)
Mean (SD)
Mean (SD)
Mean change
score (SD)
p
value
MIC(c)
improvement
SEM(d)
Work scheduling demands
67.6 (28.3) 84.0 (20.6)
16.5 (19.0)
0.003
7.3
13.4
Output demands
64.1 (32.5) 85.0 (18.0)
20.9 (19.3) <0.001
11.1
Physical demands
Mental demands
64.6 (26.8) 83.8 (13.7)
74.3 (35.4) 92.6 (12.6)
19.2 (17.0)* <0.001
18.3 (25.3) 0.007
Mental demands
WRFQ-SpV(a) WRFQ-SpV(b)
Mean (SD)
Mean (SD)
Mean change
score (SD)
p
value
Work scheduling demands
67.6 (28.3) 84.0 (20.6)
16.5 (19.0)
0.003
7.3
13.4
13.6
Output demands
64.1 (32.5) 85.0 (18.0)
20.9 (19.3) <0.001
11.1
13.6
11.3
7.4
12.0
17.9
Physical demands
Mental demands
64.6 (26.8) 83.8 (13.7)
74.3 (35.4) 92.6 (12.6)
19.2 (17.0)* <0.001
18.3 (25.3) 0.007
11.3
7.4
12.0
17.9
Social demands
82.1 (26.3) 89.9 (14.3)
0.150
11.1
13.4
Social demands
82.1 (26.3) 89.9 (14.3)
0.150
11.1
13.4
Total score
68.5 (25.6) 86.7 (13.9)
18.3 (16.0) <0.001
Mental health issues, improvement (N=24)
9.0
11.3
Total score
68.5 (25.6) 86.7 (13.9)
18.3 (16.0) <0.001
Mental health issues, improvement (N=24)
9.0
11.3
MIC(c)
improvement
SEM(d)
MIC(c)
improvement
SEM(d)
WRFQ-SpV(a) WRFQ-SpV(b)
Mean (SD)
Mean (SD)
7.7 (18.9)
Mean change
score (SD)
p
value
WRFQ-SpV(a) WRFQ-SpV(b)
Mean (SD)
Mean (SD)
7.7 (18.9)
Mean change
score (SD)
p
value
59.6 (30.3) 88.0 (13.6)
62.2 (25.9) 81.0 (18.4)
28.3 (30.0) <0.001
18.8 (28.8) 0.006
7.3
11.1
21.2
20.4
Work scheduling demands
Output demands
Output demands
59.6 (30.3) 88.0 (13.6)
62.2 (25.9) 81.0 (18.4)
28.3 (30.0) <0.001
18.8 (28.8) 0.006
7.3
11.1
21.2
20.4
Physical demands
74.1 (28.1) 85.9 (22.3)
11.8 (17.7)
0.014
11.3
12.5
Physical demands
74.1 (28.1) 85.9 (22.3)
11.8 (17.7)
0.014
11.3
12.5
Mental demands
61.8 (29.3) 79.9 (25.4)
70.3 (25.5) 80.4 (20.7)
18.1 (28.9)*
10.1 (27.6)
0.006
0.092
7.4
11.1
20.5
19.5
Mental demands
Social demands
Social demands
61.8 (29.3) 79.9 (25.4)
70.3 (25.5) 80.4 (20.7)
18.1 (28.9)*
10.1 (27.6)
0.006
0.092
7.4
11.1
20.5
19.5
Total score
61.7 (26.1) 89.0 (9.6)
27.3 (24.2) <0.001
9.0
17.1
Total score
61.7 (26.1) 89.0 (9.6)
27.3 (24.2) <0.001
9.0
17.1
Work scheduling demands
(a) Mean scores at baseline; (b) Mean scores at follow-up (after treatment);
(a) Mean scores at baseline; (b) Mean scores at follow-up (after treatment);
(c) Minimal Important Change (MIC); (d) Standard error of measurement
(c) Minimal Important Change (MIC); (d) Standard error of measurement
(*) Hypotheses 3 and 4 confirmed; hypothesis 5 rejected.
(*) Hypotheses 3 and 4 confirmed; hypothesis 5 rejected.
123
123
184
184
DISCUSSION
DISCUSSION
Four out of five hypotheses were confirmed to examine whether the WRFQ-SpV
Four out of five hypotheses were confirmed to examine whether the WRFQ-SpV
can be used for evaluative purposes. All hypotheses tested in this study were
can be used for evaluative purposes. All hypotheses tested in this study were
concerned with the expected changes in participants over time, based on the
concerned with the expected changes in participants over time, based on the
knowledge
knowledge
of
the
questionnaire
structure
and
conceptual
framework.
of
the
questionnaire
structure
and
conceptual
framework.
Consequently, confirming such hypotheses supports the validity of the change
Consequently, confirming such hypotheses supports the validity of the change
scores and hence, the responsiveness of the instrument [17,18,20,21].
scores and hence, the responsiveness of the instrument [17,18,20,21].
All correlations between the WRFQ-SpV and the GPE-Q were confirmed as
All correlations between the WRFQ-SpV and the GPE-Q were confirmed as
expected in hypothesis 1, with the exception of the social demands subscale in
expected in hypothesis 1, with the exception of the social demands subscale in
participants reporting improvement, supporting the validity of the change scores
participants reporting improvement, supporting the validity of the change scores
and therefore providing insight about the WRFQ-SpV responsiveness.
and therefore providing insight about the WRFQ-SpV responsiveness.
Assessing responsiveness by means of ES values and SRM, as it has been
Assessing responsiveness by means of ES values and SRM, as it has been
carried out in this study to test the second hypothesis, has created some
carried out in this study to test the second hypothesis, has created some
controversy in the literature [17,25]. While many authors have used ES as a
controversy in the literature [17,25]. While many authors have used ES as a
measure of responsiveness [26-29] and SRM as one of the more valid measures
measure of responsiveness [26-29] and SRM as one of the more valid measures
for its estimation [30], others disagree as they consider ES values as a measure of
for its estimation [30], others disagree as they consider ES values as a measure of
the magnitude of the change scores, rather than its validity [17,20,25]. In this
the magnitude of the change scores, rather than its validity [17,20,25]. In this
study, ES values and SRM were used to test a predetermined hypothesis
study, ES values and SRM were used to test a predetermined hypothesis
(grounded in the construct of the questionnaire) about the expected magnitude of
(grounded in the construct of the questionnaire) about the expected magnitude of
the ES for different groups of participants, providing additional understanding on
the ES for different groups of participants, providing additional understanding on
the validity of the change scores, and hence, suggesting that the WRFQ-SpV is a
the validity of the change scores, and hence, suggesting that the WRFQ-SpV is a
responsive questionnaire.
responsive questionnaire.
Hypotheses 3 and 4 were confirmed, but hypothesis 5 was rejected because the
Hypotheses 3 and 4 were confirmed, but hypothesis 5 was rejected because the
mean change score of the WRFQ-SpV for the subscale of mental demands was
mean change score of the WRFQ-SpV for the subscale of mental demands was
above the MIC but below the SEM. Considering responsiveness as ‘the ability to
above the MIC but below the SEM. Considering responsiveness as ‘the ability to
detect change in general’ would have lead us to confirm hypothesis 5, but
detect change in general’ would have lead us to confirm hypothesis 5, but
detecting ‘any’ change should not be considered responsiveness because ‘any’
detecting ‘any’ change should not be considered responsiveness because ‘any’
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change could refer to true change but also to measurement error or other bias
change could refer to true change but also to measurement error or other bias
[17,31], and the interest in the study was seeking true changes.
[17,31], and the interest in the study was seeking true changes.
It could be debated what is the best approach to estimate the MIC because it
It could be debated what is the best approach to estimate the MIC because it
depends on the baseline values of the instrument [32],the type of anchor from the
depends on the baseline values of the instrument [32],the type of anchor from the
patient or the clinician's perspective [33], the definition of ‘minimal important
patient or the clinician's perspective [33], the definition of ‘minimal important
change’ and the direction of change [17,32]. According to de Vet et al. [17], it is
change’ and the direction of change [17,32]. According to de Vet et al. [17], it is
reasonable to consider MIC values from the patient’s perspective for self-reported
reasonable to consider MIC values from the patient’s perspective for self-reported
instruments. Consequently, it was considered appropriate to calculate MIC values
instruments. Consequently, it was considered appropriate to calculate MIC values
from this perspective.
from this perspective.
Using receiver operating characteristic (ROC) curves and area under ROC curve
Using receiver operating characteristic (ROC) curves and area under ROC curve
(AUC) values to evaluate responsiveness would have provided additional strength
(AUC) values to evaluate responsiveness would have provided additional strength
to the results. AUC values are interpreted as the probability that a measure
to the results. AUC values are interpreted as the probability that a measure
correctly discriminates between participants who have improved and those who
correctly discriminates between participants who have improved and those who
have not. However this method could not be used because no gold standard is
have not. However this method could not be used because no gold standard is
available for WF. Many studies have used the GPE-Q as a gold standard, but it is
available for WF. Many studies have used the GPE-Q as a gold standard, but it is
doubtful the reliability and validity of such retrospective measures of change when
doubtful the reliability and validity of such retrospective measures of change when
used as a gold standard [17,31,34].
used as a gold standard [17,31,34].
It could be argued whether confirming four hypotheses is enough to conclude that
It could be argued whether confirming four hypotheses is enough to conclude that
the WRFQ-SpV is a responsive instrument or not, or that other hypotheses could
the WRFQ-SpV is a responsive instrument or not, or that other hypotheses could
had been formulated regarding the expected scores of participants reporting
had been formulated regarding the expected scores of participants reporting
deterioration. This study design was not appropriate to examine such hypotheses.
deterioration. This study design was not appropriate to examine such hypotheses.
As expected, the number of participants who deteriorated following treatment was
As expected, the number of participants who deteriorated following treatment was
small for analysis. Several authors agree that it is not possible to formulate
small for analysis. Several authors agree that it is not possible to formulate
standards on the number of hypothesis that need to be tested because testing
standards on the number of hypothesis that need to be tested because testing
responsiveness is a continuous process of accumulating evidence [17,21,31] and
responsiveness is a continuous process of accumulating evidence [17,21,31] and
this study does provide evidence about the responsiveness of the questionnaire,
this study does provide evidence about the responsiveness of the questionnaire,
mainly in participants reporting improvement.
mainly in participants reporting improvement.
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126
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126
The results of this study on responsiveness are consistent with those obtained for
The results of this study on responsiveness are consistent with those obtained for
the Dutch WRFQ version, which showed moderate responsiveness. The
the Dutch WRFQ version, which showed moderate responsiveness. The
difference between both studies is that in this study, responsiveness was
difference between both studies is that in this study, responsiveness was
assessed in a larger group of participants for whom a change was expected due to
assessed in a larger group of participants for whom a change was expected due to
the treatment. For the Dutch version responsiveness was assessed in a relatively
the treatment. For the Dutch version responsiveness was assessed in a relatively
stable and healthy population, with no intervention between the first and the
stable and healthy population, with no intervention between the first and the
second test, and the number of those reporting change was very small [14].
second test, and the number of those reporting change was very small [14].
Ceiling effects were identified for the subscales of work scheduling, mental and
Ceiling effects were identified for the subscales of work scheduling, mental and
social demands. These results are consistent with other studies concerning the
social demands. These results are consistent with other studies concerning the
WRFQ subscales of mental and social demands [10,12-14]. It seems that certain
WRFQ subscales of mental and social demands [10,12-14]. It seems that certain
items of the WRFQ have a lack of discriminative ability to differentiate workers at
items of the WRFQ have a lack of discriminative ability to differentiate workers at
the higher range of WRFQ scores. It could be argued whether these ceiling effects
the higher range of WRFQ scores. It could be argued whether these ceiling effects
could affect responsiveness, because participants scoring at the upper part of the
could affect responsiveness, because participants scoring at the upper part of the
scale at baseline cannot show further improvement.
scale at baseline cannot show further improvement.
To the authors’ knowledge, this is the first study to evaluate responsiveness in a
To the authors’ knowledge, this is the first study to evaluate responsiveness in a
population of workers expected to show changes in WF over time.
population of workers expected to show changes in WF over time.
A significant strength of this longitudinal study is that responsiveness was
A significant strength of this longitudinal study is that responsiveness was
examined by focusing more on validity than on the magnitude of the change
examined by focusing more on validity than on the magnitude of the change
scores. Consistent with the literature [17,18,25,31], a valid instrument for
scores. Consistent with the literature [17,18,25,31], a valid instrument for
evaluative purposes or to be used as surveillance instrument should provide
evaluative purposes or to be used as surveillance instrument should provide
evidence of its capacity to measure true changes.
evidence of its capacity to measure true changes.
Experts do not agree on a single preferred approach for responsiveness
Experts do not agree on a single preferred approach for responsiveness
evaluation, and instead recommend combining several approaches, including both
evaluation, and instead recommend combining several approaches, including both
anchor and distribution based methods [23,35-38]. Hence, both approaches were
anchor and distribution based methods [23,35-38]. Hence, both approaches were
combined to make the evaluation consistent with these recommendations.
combined to make the evaluation consistent with these recommendations.
This study also has limitations. It was carried out with a sample size that was
This study also has limitations. It was carried out with a sample size that was
initially considered adequate (n=102) [39]. However, stratification was necessary
initially considered adequate (n=102) [39]. However, stratification was necessary
127
127
and some subgroups were of smaller sample sizes. Further longitudinal studies
and some subgroups were of smaller sample sizes. Further longitudinal studies
with a larger number of participants and different health issues are needed,
with a larger number of participants and different health issues are needed,
especially to examine responsiveness of the instrument in groups who do not
especially to examine responsiveness of the instrument in groups who do not
experience improvement, or deteriorate.
experience improvement, or deteriorate.
The intervention was not uniform for all participants, with a wide range of
The intervention was not uniform for all participants, with a wide range of
treatments, from non-invasive (e.g., drug treatment, psychological support,
treatments, from non-invasive (e.g., drug treatment, psychological support,
occupational therapy or physical rehabilitation) to invasive (e.g., tendon or joint
occupational therapy or physical rehabilitation) to invasive (e.g., tendon or joint
infiltration, minor outpatient or major surgery), which could cause different degrees
infiltration, minor outpatient or major surgery), which could cause different degrees
of change in participants. As other authors have noted [17,31,40], the challenge in
of change in participants. As other authors have noted [17,31,40], the challenge in
the study design was to find a population with expected changes over time.
the study design was to find a population with expected changes over time.
Therefore, for this study purpose, the main point was to secure a sample of
Therefore, for this study purpose, the main point was to secure a sample of
participants in such a way that it would be expected for a proportion of participants
participants in such a way that it would be expected for a proportion of participants
to either improve or deteriorate, and then explore whether the questionnaire was
to either improve or deteriorate, and then explore whether the questionnaire was
able to detect the validity of the changes.
able to detect the validity of the changes.
Quality validated instruments are needed for occupational health research and
Quality validated instruments are needed for occupational health research and
practice. Additionally, evidence on WRFQ responsiveness is needed if it is going
practice. Additionally, evidence on WRFQ responsiveness is needed if it is going
to be used for evaluative purposes. This study provides suggestive evidence that
to be used for evaluative purposes. This study provides suggestive evidence that
the WRFQ is an adequate instrument to measure changes in health-related WF
the WRFQ is an adequate instrument to measure changes in health-related WF
over time. However, more evidence is needed on the ability of the instrument to
over time. However, more evidence is needed on the ability of the instrument to
detect changes in groups who do not experience improvement, or deteriorate
detect changes in groups who do not experience improvement, or deteriorate
during individualized health-related WF surveillance.
during individualized health-related WF surveillance.
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128
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6. GENERAL DISCUSSION
6. GENERAL DISCUSSION
In this general discussion a short summary of the main findings will be presented,
In this general discussion a short summary of the main findings will be presented,
strengths and limitations will be discussed, together with implications for research
strengths and limitations will be discussed, together with implications for research
and practice, and recommendations for future research.
and practice, and recommendations for future research.
The overall objective of this thesis was to provide an instrument to measure
The overall objective of this thesis was to provide an instrument to measure
health-related work functioning, validated through a quality process, for use in
health-related work functioning, validated through a quality process, for use in
Spanish-speaking populations. This objective arose from the need for instruments
Spanish-speaking populations. This objective arose from the need for instruments
able to describe the extent to which workers improve or deteriorate in their ability
able to describe the extent to which workers improve or deteriorate in their ability
to meet job demands, and to assess the impact of health on work functioning. This
to meet job demands, and to assess the impact of health on work functioning. This
overall objective was structured into three main themes:
overall objective was structured into three main themes:
A. Definition and description of the concept of health-related work functioning, and
A. Definition and description of the concept of health-related work functioning, and
selection of an instrument to measure this construct.
selection of an instrument to measure this construct.
B. A literature review on the methodology for cross-cultural adaptation and
validation (CCAV) of health questionnaires.
B. A literature review on the methodology for cross-cultural adaptation and
validation (CCAV) of health questionnaires.
C. The translation, cross-cultural adaptation and validation of the Work Role
Functioning Questionnaire.
C. The translation, cross-cultural adaptation and validation of the Work Role
Functioning Questionnaire.
6.1. The concept of health-related work functioning
6.1. The concept of health-related work functioning
Work functioning is a broad concept defined in the literature as the ability of a
Work functioning is a broad concept defined in the literature as the ability of a
worker to meet job demands for a given health status. It can be viewed as a
worker to meet job demands for a given health status. It can be viewed as a
continuum of situations, varying from working successfully (with full participation or
continuum of situations, varying from working successfully (with full participation or
being able to respond to all the demands of the job) to sickness absence
being able to respond to all the demands of the job) to sickness absence
(absenteeism).
(absenteeism).
In the literature, it is possible to find different perspectives to define and describe
In the literature, it is possible to find different perspectives to define and describe
this concept.
this concept.
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Amick and Gimeno (1) describe two dimensions of work functioning in relation to
Amick and Gimeno (1) describe two dimensions of work functioning in relation to
the impact of a health condition. The first dimension refers to the impact of this
the impact of a health condition. The first dimension refers to the impact of this
condition on the output of the worker in terms of economic consequences. The
condition on the output of the worker in terms of economic consequences. The
instruments to measure this dimension are mainly related to job performance and
instruments to measure this dimension are mainly related to job performance and
productivity loss, often measured by the costs associated with absenteeism and
productivity loss, often measured by the costs associated with absenteeism and
presenteeism, which are concepts also related to our phenomenon of interest.
presenteeism, which are concepts also related to our phenomenon of interest.
Work (health-related) absenteeism can be defined as an employee’s non
Work (health-related) absenteeism can be defined as an employee’s non
attendance at work due to illness, causing absences, short and long-term
attendance at work due to illness, causing absences, short and long-term
disability. Absenteeism would represent one of the extremes of work functioning,
disability. Absenteeism would represent one of the extremes of work functioning,
where work performance is absolutely impossible. Work presenteeism has
where work performance is absolutely impossible. Work presenteeism has
different meanings depending on the context where it is applied. In several
different meanings depending on the context where it is applied. In several
European countries the term (sickness) presenteeism is used in relation to those
European countries the term (sickness) presenteeism is used in relation to those
situations where the worker goes to work despite judging that one should have
situations where the worker goes to work despite judging that one should have
reported in sick (2-4). In the USA, presenteeism refers to the decreased on-the-job
reported in sick (2-4). In the USA, presenteeism refers to the decreased on-the-job
performance due to the presence of health problems that have not necessarily led
performance due to the presence of health problems that have not necessarily led
to absenteeism (5,6).
to absenteeism (5,6).
This first dimension of work functioning is often measured as the costs associated
This first dimension of work functioning is often measured as the costs associated
with reduced work outputs, errors on the job, and failure to meet job demands or
with reduced work outputs, errors on the job, and failure to meet job demands or
company production standards (6), and is frequently measured with instruments
company production standards (6), and is frequently measured with instruments
related to work functioning such as the Health and Work Performance
related to work functioning such as the Health and Work Performance
Questionnaire (7), the Work Productivity and Activity Impairment Questionnaire
Questionnaire (7), the Work Productivity and Activity Impairment Questionnaire
(8), Work Productivity Short Inventory (9), the Work and Health Interview (10), the
(8), Work Productivity Short Inventory (9), the Work and Health Interview (10), the
Health Related Productivity Questionnaire Dairy (11), the Lam Employment
Health Related Productivity Questionnaire Dairy (11), the Lam Employment
Absence and Productivity Scale (12), the Endicott Work Productivity Scale (13)
Absence and Productivity Scale (12), the Endicott Work Productivity Scale (13)
and the Standford Presenteeism Scale (14). It is not clear whether this dimension
and the Standford Presenteeism Scale (14). It is not clear whether this dimension
should be understood as "work functioning" since it centers mainly on the
should be understood as "work functioning" since it centers mainly on the
economical meaning of work outcome, rather than on an individual's operational
economical meaning of work outcome, rather than on an individual's operational
difficulties or limitations while working given certain work conditions (work
difficulties or limitations while working given certain work conditions (work
demands) or due to the existence of a health issue.
demands) or due to the existence of a health issue.
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The second dimension of work functioning by Amick and Gimeno (1) refers to the
The second dimension of work functioning by Amick and Gimeno (1) refers to the
impact of the health condition on the process of work functioning, referring to
impact of the health condition on the process of work functioning, referring to
different types of work demands. The instruments to measure this dimension are
different types of work demands. The instruments to measure this dimension are
mainly related to self-reported work limitations or work difficulties to meet job
mainly related to self-reported work limitations or work difficulties to meet job
demands, and include the Work Limitations Questionnaire (15) and the Work Role
demands, and include the Work Limitations Questionnaire (15) and the Work Role
Functioning Questionnaire (16). These instruments are able to address the costs
Functioning Questionnaire (16). These instruments are able to address the costs
associated with reduced work outputs (and hence include the first dimension
associated with reduced work outputs (and hence include the first dimension
referred by Amick and Gimeno), but mainly address the worker's limitations or
referred by Amick and Gimeno), but mainly address the worker's limitations or
difficulties in relation to different work demands. Therefore, they point towards the
difficulties in relation to different work demands. Therefore, they point towards the
possible need for interventions to modify, adapt o accommodate the process (work
possible need for interventions to modify, adapt o accommodate the process (work
demands) of the work.
demands) of the work.
Other studies put the focus on a different dimension, the quality of work output (not
Other studies put the focus on a different dimension, the quality of work output (not
defined in economic terms). In these studies, instruments like the Quantity and
defined in economic terms). In these studies, instruments like the Quantity and
Quality Instrument (17) are used. These studies most frequently use more job-
Quality Instrument (17) are used. These studies most frequently use more job-
specific outcome tools to measure increased errors in the output or increased
specific outcome tools to measure increased errors in the output or increased
labor risks due to the health condition (18,19). It can be argued whether these
labor risks due to the health condition (18,19). It can be argued whether these
measures of output quality should use the expression “work functioning” or a
measures of output quality should use the expression “work functioning” or a
different one to describe what they are measuring, since their focus is not the
different one to describe what they are measuring, since their focus is not the
individual’s performance, operational difficulties or limitations while working.
individual’s performance, operational difficulties or limitations while working.
Instead, they are measuring either the output (in terms of its quality) or the
Instead, they are measuring either the output (in terms of its quality) or the
consequences of the work due to impaired work functioning, but not work
consequences of the work due to impaired work functioning, but not work
functioning itself.
functioning itself.
Dewa and Lin (20) explored what could be an additional dimension of work
Dewa and Lin (20) explored what could be an additional dimension of work
functioning, the “extra-effort required by the worker to remain productive”. This
functioning, the “extra-effort required by the worker to remain productive”. This
dimension could also relate to the notion of presenteeism because work
dimension could also relate to the notion of presenteeism because work
functioning can be viewed as a continuum of situations varying from working
functioning can be viewed as a continuum of situations varying from working
successfully to sickness work absence. We may assume that there will be
successfully to sickness work absence. We may assume that there will be
numerous intermediate situations where health issues and/or working conditions
numerous intermediate situations where health issues and/or working conditions
can reduce the worker’s abilities to meet job demands requiring an extra-effort to
can reduce the worker’s abilities to meet job demands requiring an extra-effort to
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the worker to avoid (sickness) absenteeism. In a recent study, Leineweber (2)
the worker to avoid (sickness) absenteeism. In a recent study, Leineweber (2)
supported this argument, concluding that (sickness) presenteeism is not just an
supported this argument, concluding that (sickness) presenteeism is not just an
alternative to sickness absence, reflecting only a part of the continuum from
alternative to sickness absence, reflecting only a part of the continuum from
working successfully to work absence.
working successfully to work absence.
According to Nieuwenhuijsen (21), the concepts of “extra-effort to remain
According to Nieuwenhuijsen (21), the concepts of “extra-effort to remain
productive” and “quality of work output” have received almost no attention, and
productive” and “quality of work output” have received almost no attention, and
incorporation of both concepts in a more expanded view of work functioning would
incorporation of both concepts in a more expanded view of work functioning would
be valuable. It can be discussed whether needing more effort to be productive is
be valuable. It can be discussed whether needing more effort to be productive is
sufficiently captured by the concept of generic work role limitations. Measuring the
sufficiently captured by the concept of generic work role limitations. Measuring the
extra-effort to be productive separately enables study of its potential negative
extra-effort to be productive separately enables study of its potential negative
consequences over time, such as the impact on the worker's health, well-being
consequences over time, such as the impact on the worker's health, well-being
and family life. Incorporating quality of work output into our measures of work
and family life. Incorporating quality of work output into our measures of work
functioning would allow employers to integrate information about economic
functioning would allow employers to integrate information about economic
consequences and others, such as safety risks, errors, and client satisfaction.
consequences and others, such as safety risks, errors, and client satisfaction.
Other related (but different) concepts like work ability, work capacity, work
Other related (but different) concepts like work ability, work capacity, work
impairment, work participation and work performance can be found in the
impairment, work participation and work performance can be found in the
literature. In our opinion these concepts need clarification and a more accurate
literature. In our opinion these concepts need clarification and a more accurate
definition to capture all the different angles of the concept work functioning.
definition to capture all the different angles of the concept work functioning.
In conclusion, work functioning in this thesis relates to the second dimension
In conclusion, work functioning in this thesis relates to the second dimension
defined by Amick and Gimeno (1), referring to the "impact of health on the process
defined by Amick and Gimeno (1), referring to the "impact of health on the process
of work functioning" and is defined as work difficulties to meet job demands given
of work functioning" and is defined as work difficulties to meet job demands given
a health status. Understanding this was our phenomenon of interest, we decided
a health status. Understanding this was our phenomenon of interest, we decided
to make an evidence-based decision for selection of an instrument able to capture
to make an evidence-based decision for selection of an instrument able to capture
this construct; the Work Role Functioning Questionnaire was identified as the most
this construct; the Work Role Functioning Questionnaire was identified as the most
appropriate.
appropriate.
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6.2.
Selection of an instrument to measure health-related work functioning
6.2.
Selection of an instrument to measure health-related work functioning
Health-related work functioning questionnaires are frequently used in research and
Health-related work functioning questionnaires are frequently used in research and
practice without clear evidence of the quality of their measurement properties (22).
practice without clear evidence of the quality of their measurement properties (22).
One could argue, therefore, which tool is the best possible to assess this concept.
One could argue, therefore, which tool is the best possible to assess this concept.
Nieuwenhuijsen (21) recently conducted a systematic review of the literature to
Nieuwenhuijsen (21) recently conducted a systematic review of the literature to
identify work functioning measurement tools for occupational mental health
identify work functioning measurement tools for occupational mental health
research, suggesting that there is a lack of studies testing these tools in common
research, suggesting that there is a lack of studies testing these tools in common
mental disorders, and that new work functioning instruments are needed to
mental disorders, and that new work functioning instruments are needed to
integrate work output and the effort required to remain productive. Other recent
integrate work output and the effort required to remain productive. Other recent
systematic reviews that evaluated the methodological quality of the studies on
systematic reviews that evaluated the methodological quality of the studies on
measurement properties using work functioning instruments in patients with
measurement properties using work functioning instruments in patients with
musculoskeletal (23) and common mental disorders (24) concluded that the quality
musculoskeletal (23) and common mental disorders (24) concluded that the quality
of these studies appeared to be limited.
of these studies appeared to be limited.
Consequently, because of the low methodological quality of the validation studies
Consequently, because of the low methodological quality of the validation studies
on measurement properties using work functioning instruments, it could be
on measurement properties using work functioning instruments, it could be
concluded that we do not know enough about the measurement properties of the
concluded that we do not know enough about the measurement properties of the
existing health-related work functioning tools. Therefore it is not possible to make
existing health-related work functioning tools. Therefore it is not possible to make
evidence-based recommendations about which instrument should be used.
evidence-based recommendations about which instrument should be used.
Recently, Abma et al (25,26) performed a quality assessment of the measurement
Recently, Abma et al (25,26) performed a quality assessment of the measurement
properties of the Dutch version of the WRFQ. This research was conducted using
properties of the Dutch version of the WRFQ. This research was conducted using
rigorous
rigorous
consensus-based
standards
for
the
selection of
health
status
consensus-based
standards
for
the
selection of
health
status
measurement instruments (COSMIN) (27-29), and the authors concluded that the
measurement instruments (COSMIN) (27-29), and the authors concluded that the
WRFQ is a reliable and valid instrument to measure health-related work
WRFQ is a reliable and valid instrument to measure health-related work
functioning in the working population.
functioning in the working population.
The Work Limitations Questionnaire (WLQ) (30) is a very closely related work
The Work Limitations Questionnaire (WLQ) (30) is a very closely related work
functioning measurement tool, developed from the same item pool, and was also
functioning measurement tool, developed from the same item pool, and was also
considered in our study. In fact, both questionnaires have the same introduction
considered in our study. In fact, both questionnaires have the same introduction
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(with minimal differences); the same response options (with differences in the
(with minimal differences); the same response options (with differences in the
wording for the middle category response option), the same scoring system and
wording for the middle category response option), the same scoring system and
several items are common or have a very similar corresponding item. The main
several items are common or have a very similar corresponding item. The main
differences are the recall period (4 weeks for the WRFQ and 2-weeks for the
differences are the recall period (4 weeks for the WRFQ and 2-weeks for the
WLQ) and the number of items (27 items for the WRFQ and 25 items for the
WLQ) and the number of items (27 items for the WRFQ and 25 items for the
WLQ). Although the WLQ has shown its usefulness in several studies in English-
WLQ). Although the WLQ has shown its usefulness in several studies in English-
speaking health care environments (31-33), it was not freely available in the
speaking health care environments (31-33), it was not freely available in the
literature, and when applied to populations with common mental disorders, Abma
literature, and when applied to populations with common mental disorders, Abma
(24) found limited evidence in relation to the internal consistency, hypotheses
(24) found limited evidence in relation to the internal consistency, hypotheses
testing and no evidence regarding its responsiveness.
testing and no evidence regarding its responsiveness.
In conclusion, to our knowledge, the WRFQ is the only instrument measuring
In conclusion, to our knowledge, the WRFQ is the only instrument measuring
health-related work functioning that has been rigorously evaluated (using expert
health-related work functioning that has been rigorously evaluated (using expert
consensus-based standards), performing appropriately in terms of its reliability and
consensus-based standards), performing appropriately in terms of its reliability and
validity in a general working population. Additionally, is freely available for
validity in a general working population. Additionally, is freely available for
practitioners and researchers. Hence, we decided to translate, cross-cultural adapt
practitioners and researchers. Hence, we decided to translate, cross-cultural adapt
to Spanish and validate this instrument. However, it is not known for sure whether
to Spanish and validate this instrument. However, it is not known for sure whether
the WRFQ is the best instrument to measure our phenomenon of interest since the
the WRFQ is the best instrument to measure our phenomenon of interest since the
available evidence on the quality of the measurement properties of the other
available evidence on the quality of the measurement properties of the other
existing tools is limited.
existing tools is limited.
6.3. Cross-cultural adaptation and validation process (reliability, validity and
6.3. Cross-cultural adaptation and validation process (reliability, validity and
responsiveness)
responsiveness)
Cross-culturally adapted and validated instruments are needed to measure health-
Cross-culturally adapted and validated instruments are needed to measure health-
related work functioning in Spanish-speaking populations. A rigorous, stepwise
related work functioning in Spanish-speaking populations. A rigorous, stepwise
procedure for translation and cross-cultural adaptation of the WRFQ led to the
procedure for translation and cross-cultural adaptation of the WRFQ led to the
development of a Spanish spoken in Spain version equivalent to the original
development of a Spanish spoken in Spain version equivalent to the original
English version. A cross-sectional study was performed to evaluate the reliability
English version. A cross-sectional study was performed to evaluate the reliability
and validity of the WRFQ-SpV, and a longitudinal survey was carried out to assess
and validity of the WRFQ-SpV, and a longitudinal survey was carried out to assess
the responsiveness of the instrument. Internal consistency was good or excellent
the responsiveness of the instrument. Internal consistency was good or excellent
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for the overall scale and all subscales. Test-retest reliability showed good or very
for the overall scale and all subscales. Test-retest reliability showed good or very
good repeatability for the overall scores and all subscales. The original five factor
good repeatability for the overall scores and all subscales. The original five factor
structure reflected adequately the different dimensions of the questionnaire. The
structure reflected adequately the different dimensions of the questionnaire. The
questionnaire showed adequate construct validity confirming all tested hypothesis,
questionnaire showed adequate construct validity confirming all tested hypothesis,
and suggestive evidence was provided about the possible use of the WRFQ for
and suggestive evidence was provided about the possible use of the WRFQ for
evaluative purposes.
evaluative purposes.
In relation to the cross-cultural adaptation, minor changes were made to maximize
In relation to the cross-cultural adaptation, minor changes were made to maximize
questionnaire understandability and it was necessary to adjust the wording of
questionnaire understandability and it was necessary to adjust the wording of
certain parts of the instrument as had happened when the questionnaire was
certain parts of the instrument as had happened when the questionnaire was
adapted into Canadian French (34), Brazilian Portuguese (35) and Dutch (26).
adapted into Canadian French (34), Brazilian Portuguese (35) and Dutch (26).
The results of the test–retest reliability were very similar to those obtained by
The results of the test–retest reliability were very similar to those obtained by
Gallasch (35), but partially different from those obtained by Abma (25), who found
Gallasch (35), but partially different from those obtained by Abma (25), who found
moderate test-retest reliability for three subscales and low test-retest reliability for
moderate test-retest reliability for three subscales and low test-retest reliability for
the subscale of flexibility demands. It is relevant to notice that neither our
the subscale of flexibility demands. It is relevant to notice that neither our
validation study nor the study performed by Gallasch found it necessary to modify
validation study nor the study performed by Gallasch found it necessary to modify
the subscales. The Dutch version (25) added a new subscale (flexibility demands),
the subscales. The Dutch version (25) added a new subscale (flexibility demands),
based on participant suggestions and the literature and therefore, the test-retest
based on participant suggestions and the literature and therefore, the test-retest
reliability assessed in this study was performed using a slightly different version of
reliability assessed in this study was performed using a slightly different version of
the WRFQ. This subscale was not present in the original version, and required the
the WRFQ. This subscale was not present in the original version, and required the
modification of five items after an exploratory factor analysis, resulting in a four
modification of five items after an exploratory factor analysis, resulting in a four
factor structure (work scheduling & output, physical, mental & social, and flexibility
factor structure (work scheduling & output, physical, mental & social, and flexibility
demands).
demands).
In our study, we found fair dimensionality of the WRFQ-SpV when maintaining the
In our study, we found fair dimensionality of the WRFQ-SpV when maintaining the
original five factor structure (work scheduling, output, physical, mental and social
original five factor structure (work scheduling, output, physical, mental and social
demands). It could be argued whether the subscales of the WRFQ, developed
demands). It could be argued whether the subscales of the WRFQ, developed
more than 20 years ago, should be updated. Labor flexibility demands commonly
more than 20 years ago, should be updated. Labor flexibility demands commonly
refer to flexible work (in relation to skills, workplace or working hours) or flexible
refer to flexible work (in relation to skills, workplace or working hours) or flexible
employment (in relation to the nature of the employment contract) (36). Also, labor
employment (in relation to the nature of the employment contract) (36). Also, labor
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flexibility could be understood as possible variation in the number of employees
flexibility could be understood as possible variation in the number of employees
needed to perform a specific duty or the need for the same worker to provide
needed to perform a specific duty or the need for the same worker to provide
different tasks or services. Essentially, it is related to the capacity to adapt, or the
different tasks or services. Essentially, it is related to the capacity to adapt, or the
personal disposition to change (37). Although it seems feasible that, after these
personal disposition to change (37). Although it seems feasible that, after these
years, certain demands of the jobs could have changed or new ones could have
years, certain demands of the jobs could have changed or new ones could have
appeared, this was not apparent in the interviews conducted during the pre-test for
appeared, this was not apparent in the interviews conducted during the pre-test for
the adaptation of the questionnaire into Spanish. There may be several reasons
the adaptation of the questionnaire into Spanish. There may be several reasons
for this. First, participants were asked (in a general way) whether the questionnaire
for this. First, participants were asked (in a general way) whether the questionnaire
adequately reflected their work demands and flexibility demands did not appear as
adequately reflected their work demands and flexibility demands did not appear as
a spontaneous reply. Second, the Dutch and the Spanish samples differed
a spontaneous reply. Second, the Dutch and the Spanish samples differed
significantly in the number of participants with non-manual jobs (70% and 28% for
significantly in the number of participants with non-manual jobs (70% and 28% for
the Dutch and the Spanish samples respectively), and it is possible that non-
the Dutch and the Spanish samples respectively), and it is possible that non-
manual workers had a higher perception of the demands of flexibility than manual
manual workers had a higher perception of the demands of flexibility than manual
workers. Third, it is reasonable to think that, conceptually, work scheduling
workers. Third, it is reasonable to think that, conceptually, work scheduling
demands are part of the flexibility demands since the latter include (not
demands are part of the flexibility demands since the latter include (not
exclusively) time flexibility that is reflected in the worker’s work schedule. And
exclusively) time flexibility that is reflected in the worker’s work schedule. And
fourth, it is possible to think that there are country-specific differences on work
fourth, it is possible to think that there are country-specific differences on work
demands.
demands.
It can be argued whether the modification of the original WRFQ subscales could
It can be argued whether the modification of the original WRFQ subscales could
hinder comparisons between different countries or cultures. Adapting the
hinder comparisons between different countries or cultures. Adapting the
questionnaire, including a modification of the questionnaire subscales, will
questionnaire, including a modification of the questionnaire subscales, will
probably provide an equivalent overall measure of the construct but may not allow
probably provide an equivalent overall measure of the construct but may not allow
comparisons among different countries or cultures at the subscale level.
comparisons among different countries or cultures at the subscale level.
Consistent with prior WRFQ analyses, our measurement property results and
Consistent with prior WRFQ analyses, our measurement property results and
correlations for item-subscale, item-total, among subscales and subscale-total
correlations for item-subscale, item-total, among subscales and subscale-total
were found to be appropriate. The validation for the Canadian French (34) and
were found to be appropriate. The validation for the Canadian French (34) and
Brazilian Portuguese (35) versions were performed in populations with
Brazilian Portuguese (35) versions were performed in populations with
musculoskeletal disorders, and in the Dutch version (25) in a general working
musculoskeletal disorders, and in the Dutch version (25) in a general working
population, concluding that the adapted WRFQ versions were reliable.
population, concluding that the adapted WRFQ versions were reliable.
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The WRFQ-SpV construct validity was assessed by means of hypotheses testing,
The WRFQ-SpV construct validity was assessed by means of hypotheses testing,
confirming all seven formulated hypotheses, showing that the instrument was able
confirming all seven formulated hypotheses, showing that the instrument was able
to distinguish among different groups of job types, health conditions and ages. For
to distinguish among different groups of job types, health conditions and ages. For
the overall scores, a significant trend for worse work functioning scores with
the overall scores, a significant trend for worse work functioning scores with
increasing age was found, consistent with other findings that both, chronological
increasing age was found, consistent with other findings that both, chronological
and functional age, are associated with a decrease in work functioning (38-42).
and functional age, are associated with a decrease in work functioning (38-42).
Hypotheses about correlations with another related construct (WAI) were
Hypotheses about correlations with another related construct (WAI) were
confirmed. Again, these results were consistent with the validation study of the
confirmed. Again, these results were consistent with the validation study of the
Dutch version (25), comparing the correlations between the WRFQ and other
Dutch version (25), comparing the correlations between the WRFQ and other
related constructs ('work ability', 'work productivity', 'work engagement' and 'work
related constructs ('work ability', 'work productivity', 'work engagement' and 'work
involvement').
involvement').
To assess the WRFQ-SpV responsiveness, four out of five hypotheses were
To assess the WRFQ-SpV responsiveness, four out of five hypotheses were
confirmed, examining whether the instrument can be used in evaluative studies.
confirmed, examining whether the instrument can be used in evaluative studies.
All hypotheses tested in this study were related to expected changes in
All hypotheses tested in this study were related to expected changes in
participants over time, based on the knowledge of the questionnaire structure and
participants over time, based on the knowledge of the questionnaire structure and
its conceptual framework. Consequently, confirming these hypotheses supports
its conceptual framework. Consequently, confirming these hypotheses supports
the validity of the change scores and the responsiveness of the instrument
the validity of the change scores and the responsiveness of the instrument
(27,29,43,47).
(27,29,43,47).
The results on responsiveness are consistent with those obtained for the Dutch
The results on responsiveness are consistent with those obtained for the Dutch
WRFQ version, which showed moderate responsiveness. The difference is that in
WRFQ version, which showed moderate responsiveness. The difference is that in
this thesis, responsiveness was assessed in a larger group of participants for
this thesis, responsiveness was assessed in a larger group of participants for
whom a change was expected due to the treatment applied to the participants in
whom a change was expected due to the treatment applied to the participants in
the study. For the Dutch version, responsiveness was assessed in a relatively
the study. For the Dutch version, responsiveness was assessed in a relatively
stable and healthy population, with no intervention between the first and the
stable and healthy population, with no intervention between the first and the
second test, and the number of those reporting change was relatively small (25).
second test, and the number of those reporting change was relatively small (25).
However, since stratification was necessary during the analyses in our study,
However, since stratification was necessary during the analyses in our study,
some subgroups had small sample sizes and therefore, further longitudinal studies
some subgroups had small sample sizes and therefore, further longitudinal studies
with a larger number of participants and different health issues are needed,
with a larger number of participants and different health issues are needed,
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especially to examine the instrument responsiveness in workers whose health
especially to examine the instrument responsiveness in workers whose health
remain stable or deteriorate.
remain stable or deteriorate.
In conclusion, this thesis provides evidence of the reliability and validity of the
In conclusion, this thesis provides evidence of the reliability and validity of the
WRFQ-SpV to measure health-related work functioning in day-to-day practice and
WRFQ-SpV to measure health-related work functioning in day-to-day practice and
research in occupational health, and the first results on its responsiveness point
research in occupational health, and the first results on its responsiveness point
suggest the WRFQ is adequate for measuring changes in health-related work
suggest the WRFQ is adequate for measuring changes in health-related work
functioning over time.
functioning over time.
6.4. Standards to be used for methodological quality in health-questionnaire
6.4. Standards to be used for methodological quality in health-questionnaire
validation
validation
The "consensus-based standards for the selection of health status measurement
The "consensus-based standards for the selection of health status measurement
instruments" (COSMIN) guided the design of the different studies in this thesis.
instruments" (COSMIN) guided the design of the different studies in this thesis.
The COSMIN checklist is a useful instrument when designing a study on
The COSMIN checklist is a useful instrument when designing a study on
measurement properties. It includes explicit criteria for satisfying these standards,
measurement properties. It includes explicit criteria for satisfying these standards,
to assess the quality of the validation studies of health measurement instruments.
to assess the quality of the validation studies of health measurement instruments.
Since there are other approaches available in the literature to evaluate the
Since there are other approaches available in the literature to evaluate the
methodological quality of studies on measurement properties, whether any other
methodological quality of studies on measurement properties, whether any other
approach would have been a better method can be discussed.
approach would have been a better method can be discussed.
In
the
literature
review
we
identified
two
sources
of
methodological
In
the
literature
review
we
identified
two
sources
of
methodological
recommendations: one from internationally recognized experts in the design and
recommendations: one from internationally recognized experts in the design and
validation of questionnaires (43-50) and the other from different research groups
validation of questionnaires (43-50) and the other from different research groups
that achieved different standards (51,52), sometimes by expert consensus (27-
that achieved different standards (51,52), sometimes by expert consensus (27-
29,53).
29,53).
The main advantage of using research group standards is that they are not based
The main advantage of using research group standards is that they are not based
on the criterion of a single specialist but the judgment of a group of experts. This
on the criterion of a single specialist but the judgment of a group of experts. This
should
should
make
research
group
standards
more
reliable
when
assessing
methodological quality of studies or evaluating quality of instruments. In our
144
144
make
research
group
standards
more
reliable
when
assessing
methodological quality of studies or evaluating quality of instruments. In our
144
144
opinion, consistent with Terwee (54), some (e.g. the criteria proposed by the
opinion, consistent with Terwee (54), some (e.g. the criteria proposed by the
Scientific Advisory Committee of the Medical Outcomes Trust or the method
Scientific Advisory Committee of the Medical Outcomes Trust or the method
proposed by the Health Technology Assessment Programme) (51,52) have some
proposed by the Health Technology Assessment Programme) (51,52) have some
relevant disadvantages because they do not have user-friendly checklists and/or
relevant disadvantages because they do not have user-friendly checklists and/or
were not developed as methodological quality assessment tools for systematic
were not developed as methodological quality assessment tools for systematic
reviews.
reviews.
Other checklists were developed for similar, but different objectives. One relevant
Other checklists were developed for similar, but different objectives. One relevant
instrument is the "evaluating the measurement of patient-reported outcomes"
instrument is the "evaluating the measurement of patient-reported outcomes"
(EMPRO) checklist (53), developed for the standardized assessment of patient-
(EMPRO) checklist (53), developed for the standardized assessment of patient-
reported outcomes (PROs) to assist the choice of instruments. This tool allows
reported outcomes (PROs) to assist the choice of instruments. This tool allows
rating the quality of an instrument rather than the methodological quality of a
rating the quality of an instrument rather than the methodological quality of a
validation study. Although in this checklist several methodological quality aspects
validation study. Although in this checklist several methodological quality aspects
of the study are taken into account, the “evaluation of the methodological quality of
of the study are taken into account, the “evaluation of the methodological quality of
a validation study” and the “evaluation of the quality of an instrument” are
a validation study” and the “evaluation of the quality of an instrument” are
conceptually different issues.
conceptually different issues.
Thus, different methodologies are available in the literature for different evaluation
Thus, different methodologies are available in the literature for different evaluation
purposes. The most appropriate choice will depend on the objective of the study,
purposes. The most appropriate choice will depend on the objective of the study,
the motivation to use consensus-based standards instead of the criterion of a
the motivation to use consensus-based standards instead of the criterion of a
single expert, and the degree of user-friendliness that is needed.
single expert, and the degree of user-friendliness that is needed.
Since the studies of this thesis were carried out to validate the WRFQ-SpV, it was
Since the studies of this thesis were carried out to validate the WRFQ-SpV, it was
ensuring the quality of the validation studies according to international consensus-
ensuring the quality of the validation studies according to international consensus-
based standards was crucial. In this sense, both the COSMIN and the EMPRO
based standards was crucial. In this sense, both the COSMIN and the EMPRO
checklists could have been used. The final decision on the COSMIN standards
checklists could have been used. The final decision on the COSMIN standards
was taken on the basis that the main use of this checklist is to assess the quality
was taken on the basis that the main use of this checklist is to assess the quality
of the validation studies rather than the quality of the instrument (which is the main
of the validation studies rather than the quality of the instrument (which is the main
purpose of the EMPRO checklist).
purpose of the EMPRO checklist).
145
145
6.5. Implications for research and practice
6.5. Implications for research and practice
The WRFQ-SpV is a brief and user-friendly instrument to measure health-related
The WRFQ-SpV is a brief and user-friendly instrument to measure health-related
work functioning, consisting of 27 items grouped in five subscales related to
work functioning, consisting of 27 items grouped in five subscales related to
different work demands. It offers scores as percentages from 0 to 100 for the
different work demands. It offers scores as percentages from 0 to 100 for the
overall scale and each subscale, and is easily interpretable and linkable to
overall scale and each subscale, and is easily interpretable and linkable to
meaningful social and economic outcomes.
meaningful social and economic outcomes.
The age of workers is increasing, and an early, safe and productive
The age of workers is increasing, and an early, safe and productive
reincorporation to work after a sick leave absence is necessary in the current
reincorporation to work after a sick leave absence is necessary in the current
social context. Individualized monitoring of health-related work functioning is
social context. Individualized monitoring of health-related work functioning is
becoming a necessity in occupational health services and the WRFQ-SpV might
becoming a necessity in occupational health services and the WRFQ-SpV might
be a helpful instrument for Spanish-speaking occupational health professionals in
be a helpful instrument for Spanish-speaking occupational health professionals in
day-to-day practice and research. Also, several interventions to accommodate
day-to-day practice and research. Also, several interventions to accommodate
work conditions to workers' skills and health status are being implemented to
work conditions to workers' skills and health status are being implemented to
facilitate an active working life and achieve better work functioning. The
facilitate an active working life and achieve better work functioning. The
effectiveness of these interventions needs to be evaluated using quality validated
effectiveness of these interventions needs to be evaluated using quality validated
instruments, and the WRFQ-SpV could be a useful instrument for these purposes.
instruments, and the WRFQ-SpV could be a useful instrument for these purposes.
The WRFQ-SpV might also be helpful for human resource managers directly
The WRFQ-SpV might also be helpful for human resource managers directly
involved in those processes. Since the instrument provides information on job
involved in those processes. Since the instrument provides information on job
demands difficult to meet for the worker, it could be used as a starting point to: 1)
demands difficult to meet for the worker, it could be used as a starting point to: 1)
diagnose current functioning of workers without over-medicalizing the situation; 2)
diagnose current functioning of workers without over-medicalizing the situation; 2)
monitor work functioning to provide guidance on work accommodations or
monitor work functioning to provide guidance on work accommodations or
preventive actions; and 3) to evaluate (with caution) the results of an intervention.
preventive actions; and 3) to evaluate (with caution) the results of an intervention.
This study provides suggestive evidence that the WRFQ-SpV is an adequate
This study provides suggestive evidence that the WRFQ-SpV is an adequate
instrument to measure changes in health-related work functioning over time.
instrument to measure changes in health-related work functioning over time.
However, more evidence is needed on the ability of the instrument to detect
However, more evidence is needed on the ability of the instrument to detect
changes in individualized health-related work functioning surveillance in groups
changes in individualized health-related work functioning surveillance in groups
whose
whose
146
health
remains
stable
or
deteriorates,
and
more
evidence
on
146
146
health
remains
stable
or
deteriorates,
and
more
evidence
on
146
responsiveness is needed if it is to be used for individual surveillance or in
responsiveness is needed if it is to be used for individual surveillance or in
evaluative studies.
evaluative studies.
De Vet (43) describes three important uses of instruments: diagnosis (the
De Vet (43) describes three important uses of instruments: diagnosis (the
discriminative
discriminative
ability
of
the
instrument
is
very
important),
evaluation
ability
of
the
instrument
is
very
important),
evaluation
(responsiveness of the instrument is crucial) and prediction of future course. The
(responsiveness of the instrument is crucial) and prediction of future course. The
studies included in this thesis showed that the WRFQ is able to differentiate
studies included in this thesis showed that the WRFQ is able to differentiate
between several subgroups (mental and physical health issues, type of job and
between several subgroups (mental and physical health issues, type of job and
groups of age). Abma (25) showed that the instrument could also differentiate
groups of age). Abma (25) showed that the instrument could also differentiate
groups with different need for recovery and fatigue, indicating that the instrument
groups with different need for recovery and fatigue, indicating that the instrument
has discriminative ability. Although one of the studies in this thesis provides
has discriminative ability. Although one of the studies in this thesis provides
suggestive
suggestive
evidence
of
the
responsiveness
of
the
questionnaire,
this
evidence
of
the
responsiveness
of
the
questionnaire,
this
measurement property has yet not been sufficiently examined for individual
measurement property has yet not been sufficiently examined for individual
surveillance and intervention assessment. Therefore, the WRFQ-SpV is not yet
surveillance and intervention assessment. Therefore, the WRFQ-SpV is not yet
recommended for these purposes (individual surveillance and intervention
recommended for these purposes (individual surveillance and intervention
assessment) and additional research is needed to further examine this
assessment) and additional research is needed to further examine this
measurement property.
measurement property.
Finally, it is important to ensure that the questionnaire is used in a manner that
Finally, it is important to ensure that the questionnaire is used in a manner that
respects the conceptual framework to prevent unethical use. For this purpose,
respects the conceptual framework to prevent unethical use. For this purpose,
occupational health professionals and company managers should provide public
occupational health professionals and company managers should provide public
and clear commitment to the basic principles of voluntariness, respect,
and clear commitment to the basic principles of voluntariness, respect,
confidentiality and non-discrimination.
confidentiality and non-discrimination.
6.6. Future research
6.6. Future research
Validation of a measuring instrument is an ongoing process through which a body
Validation of a measuring instrument is an ongoing process through which a body
of evidence is created about the different features of the tool. There is no
of evidence is created about the different features of the tool. There is no
agreement in the literature regarding standards on the number and/or the degree
agreement in the literature regarding standards on the number and/or the degree
of quality of validation processes that an instrument should follow to confirm that is
of quality of validation processes that an instrument should follow to confirm that is
a feasible (understandable, practical, easily interpretable) and validated instrument
a feasible (understandable, practical, easily interpretable) and validated instrument
(reliable, valid and responsive).
(reliable, valid and responsive).
147
147
The WRFQ has been adapted and validated in different cultural contexts and
The WRFQ has been adapted and validated in different cultural contexts and
populations (22,34,35,55-57). Additional validation processes in other languages
populations (22,34,35,55-57). Additional validation processes in other languages
and cultures, as well as in other occupational settings, work conditions and
and cultures, as well as in other occupational settings, work conditions and
populations with different health issues would be desirable. It is particularly
populations with different health issues would be desirable. It is particularly
necessary to assess the responsiveness of the questionnaire in groups whose
necessary to assess the responsiveness of the questionnaire in groups whose
health remain stable or deteriorate and also to examine the responsiveness of the
health remain stable or deteriorate and also to examine the responsiveness of the
instrument
instrument
assessing
individual
surveillance
and
evaluating
workplace
assessing
individual
surveillance
and
evaluating
workplace
interventions.
interventions.
Various perspectives of work functioning are being used in the literature and in
Various perspectives of work functioning are being used in the literature and in
occupational health settings, and other concepts referring to “optimal” or
occupational health settings, and other concepts referring to “optimal” or
“satisfactory” work functioning are arising in the recent literature (25,58-63). A
“satisfactory” work functioning are arising in the recent literature (25,58-63). A
comprehensive analysis of these concepts for a deeper insight on the meaning of
comprehensive analysis of these concepts for a deeper insight on the meaning of
the managed terms is lacking, and an international consensus-based agreement
the managed terms is lacking, and an international consensus-based agreement
of experts to unify cut-offs and definitions is needed.
of experts to unify cut-offs and definitions is needed.
National and international comparisons on work functioning trajectories over time,
National and international comparisons on work functioning trajectories over time,
effectiveness of interventions to enable sustainable work participation and
effectiveness of interventions to enable sustainable work participation and
analyses on barriers and facilitators for productive work functioning over the
analyses on barriers and facilitators for productive work functioning over the
working life are not available. However, they are necessary to enhance the
working life are not available. However, they are necessary to enhance the
Spanish policies pursuing the European Commission’s 2020 strategy and targets
Spanish policies pursuing the European Commission’s 2020 strategy and targets
for employment (for Spain, 74% of 20-64 year-olds to be employed) (63) by means
for employment (for Spain, 74% of 20-64 year-olds to be employed) (63) by means
of improving worker health and participation.
of improving worker health and participation.
148
148
148
148
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[updated
2013
Jan
21;
cited
2013
Nov
23].
Available
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156
156
64. European Commission (EU). Europe 2020: Targets [Internet]. Brussels; 2010
[updated
2013
Jan
21;
cited
2013
Nov
23].
Available
from:
http://ec.europa.eu/europe2020/europe-2020-in-a-nutshell/targets/index_en.htm
156
156
7. GENERAL CONCLUSION
7. GENERAL CONCLUSION
As a result of the need for a tool to assess health-related work functioning in daily
As a result of the need for a tool to assess health-related work functioning in daily
practice and research in occupational health, the WRFQ was selected based on
practice and research in occupational health, the WRFQ was selected based on
the best available evidence in the literature. A comprehensive literature review on
the best available evidence in the literature. A comprehensive literature review on
the methodology for translation, cultural adaptation and validation of health
the methodology for translation, cultural adaptation and validation of health
questionnaires was performed to facilitate a proposal to carry out this process.
questionnaires was performed to facilitate a proposal to carry out this process.
This proposal was applied rigorously to the WRFQ, obtaining a version adapted to
This proposal was applied rigorously to the WRFQ, obtaining a version adapted to
Spanish (spoken in Spain), equivalent to the original English version.
Spanish (spoken in Spain), equivalent to the original English version.
The WRFQ-SpV was validated in different studies and appears to be a reliable
The WRFQ-SpV was validated in different studies and appears to be a reliable
and valid instrument to measure health-related work functioning in Spanish-
and valid instrument to measure health-related work functioning in Spanish-
speaking populations. Also, the results provide evidence of the responsiveness of
speaking populations. Also, the results provide evidence of the responsiveness of
the instrument, suggesting the possibility of its use in evaluative studies since it
the instrument, suggesting the possibility of its use in evaluative studies since it
was able to detect (true) changes over time.
was able to detect (true) changes over time.
However, more research is needed to confirm the responsiveness of the
However, more research is needed to confirm the responsiveness of the
instrument for use in individual surveillance and to assess the effectiveness of
instrument for use in individual surveillance and to assess the effectiveness of
work interventions to improve work functioning.
work interventions to improve work functioning.
157
157
8. APPENDICES
8. APPENDICES
Appendix I: WRFQ (English version)
Appendix I: WRFQ (English version)
158
158
158
158
WL-27
WL-27
YOUR WORK AND HEALTH
YOUR WORK AND HEALTH
These questions ask you to rate the amount of time during the past four weeks
that you had difficulty handling certain parts of your job.
These questions ask you to rate the amount of time during the past four weeks
that you had difficulty handling certain parts of your job.
Mark the “Does Not Apply to My Job” box only if the question describes
something that is not part of your job.
Mark the “Does Not Apply to My Job” box only if the question describes
something that is not part of your job.
In the past 4 weeks, how much of the time did your physical health or emotional
problems make it difficult for you to do the following?
In the past 4 weeks, how much of the time did your physical health or emotional
problems make it difficult for you to do the following?
DIFFICULT
1. Work the required number
of hours
2. Get going easily at the
beginning of the workday
3. Start on your job as soon as
you arrive at work
4. Do your work without
stopping to take extra
breaks or rests
5. Stick to a routine or
schedule
6. Handle the workload
7. Work fast enough
8. Finish work on time
9. Do your work without
making mistakes
10.Satisfy the people who
judge your work
11.Feel a sense of
accomplishment in your
work
12.Feel you have done what
you are capable of doing
13.Walk or move around
different work locations (for
example, going to meetings)
14.Lift, carry, or move objects
at work weighing more than
10 pounds
All
of the
Time
(100%)
Most
of the
Time
Half of
the
Time
(50%)
Some
of the
Time
None
of the
Time
(0%)
Does Not
Apply to
My Job
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
159
DIFFICULT
1. Work the required number
of hours
2. Get going easily at the
beginning of the workday
3. Start on your job as soon as
you arrive at work
4. Do your work without
stopping to take extra
breaks or rests
5. Stick to a routine or
schedule
6. Handle the workload
7. Work fast enough
8. Finish work on time
9. Do your work without
making mistakes
10.Satisfy the people who
judge your work
11.Feel a sense of
accomplishment in your
work
12.Feel you have done what
you are capable of doing
13.Walk or move around
different work locations (for
example, going to meetings)
14.Lift, carry, or move objects
at work weighing more than
10 pounds
All
of the
Time
(100%)
Most
of the
Time
Half of
the
Time
(50%)
Some
of the
Time
None
of the
Time
(0%)
Does Not
Apply to
My Job
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
159
DIFFICULT
15.Sit, stand, or stay in one
position for longer than 15
minutes while working
16.Repeat the same motions
over and over again while
working
17.Bend, twist, or reach while
working
18.Use hand-held tools or
equipment (for example, a
phone, pen, keyboard,
computer mouse, drill,
hairdryer or sander)
19.Keep your mind on your
work
20.Think clearly when working
All
of the
Time
(100%)
Most
of the
Time
Half of
the
Time
(50%)
Some
of the
Time
None
of the
Time
(0%)
Does Not
Apply to
My Job
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
26.Control your temper around
people when working
1
2
3
4
5
0
27.Help other people to get
work done
1
2
3
4
5
0
21.Do work carefully
22.Concentrate on your work
23.Work without losing your
train of thought
24.Easily read or use your
eyes when working
25.Speak with people in
person, in meetings or on
the phone
160
DIFFICULT
15.Sit, stand, or stay in one
position for longer than 15
minutes while working
16.Repeat the same motions
over and over again while
working
17.Bend, twist, or reach while
working
18.Use hand-held tools or
equipment (for example, a
phone, pen, keyboard,
computer mouse, drill,
hairdryer or sander)
19.Keep your mind on your
work
20.Think clearly when working
All
of the
Time
(100%)
Most
of the
Time
Half of
the
Time
(50%)
Some
of the
Time
None
of the
Time
(0%)
Does Not
Apply to
My Job
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
26.Control your temper around
people when working
1
2
3
4
5
0
27.Help other people to get
work done
1
2
3
4
5
0
21.Do work carefully
22.Concentrate on your work
23.Work without losing your
train of thought
24.Easily read or use your
eyes when working
25.Speak with people in
person, in meetings or on
the phone
160
8. APPENDICES
8. APPENDICES
Appendix II: WRFQ (Spanish version)
Appendix II: WRFQ (Spanish version)
161
161
WRFQ-27
WRFQ-27
SU TRABAJO Y SU SALUD
SU TRABAJO Y SU SALUD
En las siguientes preguntas le pedimos que nos indique, para las últimas cuatro
semanas, la cantidad de tiempo en que tuvo dificultad para realizar ciertos aspectos de
su trabajo.
En las siguientes preguntas le pedimos que nos indique, para las últimas cuatro
semanas, la cantidad de tiempo en que tuvo dificultad para realizar ciertos aspectos de
su trabajo.
Marque la casilla “No Aplicable a Mi Trabajo” sólo en caso de que la pregunta se refiera
a algo que no es parte de su trabajo.
Marque la casilla “No Aplicable a Mi Trabajo” sólo en caso de que la pregunta se refiera
a algo que no es parte de su trabajo.
En las últimas 4 semanas, ¿durante cuánto tiempo de su trabajo le fue difícil realizar las
siguientes actividades por motivos de su salud física o problemas emocionales?
En las últimas 4 semanas, ¿durante cuánto tiempo de su trabajo le fue difícil realizar las
siguientes actividades por motivos de su salud física o problemas emocionales?
Fue
difícil
todo el
tiempo
(100%)
1. Trabajar el número
de horas requeridas
2. Empezar la jornada
de trabajo con
facilidad
3. Ponerse a trabajar
nada más llegar al
trabajo
4. Hacer su trabajo sin
parar a hacer
descansos
adicionales
5. Ajustarse a una
rutina u horario
6. Manejar su carga
de trabajo
7. Trabajar lo
suficientemente
rápido.
8. Acabar el trabajo a
tiempo
9. Hacer su trabajo
sin cometer errores
10. Satisfacer a las
personas que
evalúan su trabajo
11. Tener sensación de
trabajo bien hecho
162
Fue
difícil la
mayor
parte del
tiempo
Fue
difícil la
mitad del
tiempo
(50%)
Fue
difícil
una parte
del
tiempo
Nunca
fue
difícil
(0%)
No
aplicable
a mi
Trabajo
Fue
difícil
todo el
tiempo
(100%)
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
1. Trabajar el número
de horas requeridas
2. Empezar la jornada
de trabajo con
facilidad
3. Ponerse a trabajar
nada más llegar al
trabajo
4. Hacer su trabajo sin
parar a hacer
descansos
adicionales
5. Ajustarse a una
rutina u horario
6. Manejar su carga
de trabajo
7. Trabajar lo
suficientemente
rápido.
8. Acabar el trabajo a
tiempo
9. Hacer su trabajo
sin cometer errores
10. Satisfacer a las
personas que
evalúan su trabajo
11. Tener sensación de
trabajo bien hecho
162
Fue
difícil la
mayor
parte del
tiempo
Fue
difícil la
mitad del
tiempo
(50%)
Fue
difícil
una parte
del
tiempo
Nunca
fue
difícil
(0%)
No
aplicable
a mi
Trabajo
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
Fue
difícil
todo el
tiempo
(100%)
12. Sentir que ha
hecho lo que es
capaz de hacer
13. Caminar o
desplazarse a
distintos lugares de
trabajo
14. Levantar, cargar o
mover objetos de
más de 5 kg de
peso, en el trabajo.
15. Permanecer
sentado, de pie o
en una misma
posición durante
más de 15 minutos,
mientras trabaja
16. Repetir los mismos
movimientos una y
otra vez mientras
trabaja
17. Doblarse, girarse o
alcanzar un objeto
mientras trabaja
18. Usar equipos o
herramientas de
mano
19. Mantener la mente
en su trabajo
20. Pensar con claridad
mientras trabaja
21. Hacer el trabajo
con cuidado
22. Concentrarse en su
trabajo
23. Trabajar sin perder
el hilo (de las
ideas).
Fue
difícil la
mayor
parte del
tiempo
Fue
difícil la
mitad del
tiempo
(50%)
Fue
difícil
una parte
del
tiempo
Nunca
fue
difícil
(0%)
No
aplicable
a mi
Trabajo
Fue
difícil
todo el
tiempo
(100%)
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
163
12. Sentir que ha
hecho lo que es
capaz de hacer
13. Caminar o
desplazarse a
distintos lugares de
trabajo
14. Levantar, cargar o
mover objetos de
más de 5 kg de
peso, en el trabajo.
15. Permanecer
sentado, de pie o
en una misma
posición durante
más de 15 minutos,
mientras trabaja
16. Repetir los mismos
movimientos una y
otra vez mientras
trabaja
17. Doblarse, girarse o
alcanzar un objeto
mientras trabaja
18. Usar equipos o
herramientas de
mano
19. Mantener la mente
en su trabajo
20. Pensar con claridad
mientras trabaja
21. Hacer el trabajo
con cuidado
22. Concentrarse en su
trabajo
23. Trabajar sin perder
el hilo (de las
ideas).
Fue
difícil la
mayor
parte del
tiempo
Fue
difícil la
mitad del
tiempo
(50%)
Fue
difícil
una parte
del
tiempo
Nunca
fue
difícil
(0%)
No
aplicable
a mi
Trabajo
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
163
Fue
difícil
todo el
tiempo
(100%)
24. Leer o usar los ojos
con facilidad
mientras trabaja
25. Hablar con la gente
cara a cara, en
reuniones o por
teléfono
26. Controlar su genio
delante de otras
personas mientras
trabaja
27. Ayudar a otras
personas a acabar
el trabajo
164
Fue
difícil la
mayor
parte del
tiempo
Fue
difícil la
mitad del
tiempo
(50%)
Fue
difícil
una parte
del
tiempo
Nunca
fue
difícil
(0%)
No
aplicable
a mi
Trabajo
Fue
difícil
todo el
tiempo
(100%)
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
24. Leer o usar los ojos
con facilidad
mientras trabaja
25. Hablar con la gente
cara a cara, en
reuniones o por
teléfono
26. Controlar su genio
delante de otras
personas mientras
trabaja
27. Ayudar a otras
personas a acabar
el trabajo
164
Fue
difícil la
mayor
parte del
tiempo
Fue
difícil la
mitad del
tiempo
(50%)
Fue
difícil
una parte
del
tiempo
Nunca
fue
difícil
(0%)
No
aplicable
a mi
Trabajo
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
8. APPENDICES
8. APPENDICES
Appendix III: Single items of the work ability index (WAI)
Appendix III: Single items of the work ability index (WAI)
Por favor, responda a las siguientes preguntas:
Por favor, responda a las siguientes preguntas:
1. Suponga que su capacidad para el trabajo en el mejor momento de su vida
tiene un valor de 10 puntos. ¿Cuántos puntos le daría a su capacidad para el
trabajo actualmente? (Un 0 significa que actualmente es totalmente incapaz de
trabajar).
1. Suponga que su capacidad para el trabajo en el mejor momento de su vida
tiene un valor de 10 puntos. ¿Cuántos puntos le daría a su capacidad para el
trabajo actualmente? (Un 0 significa que actualmente es totalmente incapaz de
trabajar).
0
1
2
3
4
Totalmente
Incapaz
de trabajar
5
6
7
8
9
10
Capacidad de
trabajar en su
mejor momento
2. ¿Cómo calificaría su capacidad para el trabajo actual con respecto a las
exigencias físicas de su trabajo?
0
1
2
3
4
Buena
Bastante buena
Moderada
Bastante pobre
Muy pobre
1
2
Buena
Bastante buena
Moderada
Bastante pobre
Muy pobre
4
5
6
7
8
9
10
Capacidad de
trabajar en su
mejor momento
2. ¿Cómo calificaría su capacidad para el trabajo actual con respecto a las
exigencias físicas de su trabajo?
Buena
Bastante buena
Moderada
Bastante pobre
Muy pobre
3. ¿Cómo calificaría su capacidad para el trabajo actual con respecto a las
exigencias mentales de su trabajo?
0
1
2
3
4
165
3
Totalmente
Incapaz
de trabajar
0
1
2
3
4
3. ¿Cómo calificaría su capacidad para el trabajo actual con respecto a las
exigencias mentales de su trabajo?
0
1
2
3
4
0
Buena
Bastante buena
Moderada
Bastante pobre
Muy pobre
165
184
184
8. APPENDICES
8. APPENDICES
Appendix IV: Global perceived effect question (GPE-Q)
Appendix IV: Global perceived effect question (GPE-Q)
Comparado con hace 6 meses, ¿cómo diría que está hoy su
capacidad para trabajar?
Ha mejorado
(Indique cuánto)
Ha mejorado muchísimo
Ha mejorado mucho
Ha mejorado bastante
Ha mejorado moderadamente
Prácticamente igual
(Indique cuánto)
Casi no ha mejorado
Sin cambios
Casi no ha empeorado
Comparado con hace 6 meses, ¿cómo diría que está hoy su
capacidad para trabajar?
Ha empeorado
Ha mejorado
(Indique cuánto)
(Indique cuánto)
Ha empeorado muchísimo
Ha mejorado muchísimo
Ha empeorado mucho
Ha mejorado mucho
Ha empeorado bastante
Ha mejorado bastante
Prácticamente igual
(Indique cuánto)
Casi no ha mejorado
Sin cambios
Casi no ha empeorado
Ha empeorado
(Indique cuánto)
Ha empeorado muchísimo
Ha empeorado mucho
Ha empeorado bastante
Ha empeorado moderadamente
Ha mejorado moderadamente
Ha mejorado algo
Ha empeorado algo
Ha mejorado algo
Ha empeorado algo
Ha mejorado un poco
Ha empeorado un poco
Ha mejorado un poco
Ha empeorado un poco
167
Ha empeorado moderadamente
167
184
184
8. APPENDICES
8. APPENDICES
Appendix V: Clinical Research Ethical Committee approval
Appendix V: Clinical Research Ethical Committee approval
169
169
Informe del Comité Ético de Investigación Clínica
Informe del Comité Ético de Investigación Clínica
Doña Mª Teresa Navarra Alcrudo Secretaria del Comité Ético de Investigación Clínica Parc
de Salut MAR
Doña Mª Teresa Navarra Alcrudo Secretaria del Comité Ético de Investigación Clínica Parc
de Salut MAR
CERTIFICA
CERTIFICA
Que éste Comité ha evaluado el proyecto de investigación clínica nº 2011/4168/I titulado
“Traducción, adaptación cultural y validación del "Work role functioning questionnaire"
(WRFQ) castellano hablado en España” propuesto por el Dr. José María Ramada Rodilla del
Servicio de Salud Laboral del Hospital del Mar.
Que éste Comité ha evaluado el proyecto de investigación clínica nº 2011/4168/I titulado
“Traducción, adaptación cultural y validación del "Work role functioning questionnaire"
(WRFQ) castellano hablado en España” propuesto por el Dr. José María Ramada Rodilla del
Servicio de Salud Laboral del Hospital del Mar.
Que adjunta documento de consentimiento informado.
Que adjunta documento de consentimiento informado.
Y que considera que:
Y que considera que:
Se cumplen los requisitos necesarios de idoneidad del protocolo en relación con los objetivos
del estudio y están justificados los riesgos y molestias previsibles para el sujeto.
Se cumplen los requisitos necesarios de idoneidad del protocolo en relación con los objetivos
del estudio y están justificados los riesgos y molestias previsibles para el sujeto.
La capacidad del investigador y los medios disponibles son apropiados para llevar a cabo el
estudio.
La capacidad del investigador y los medios disponibles son apropiados para llevar a cabo el
estudio.
El alcance de las compensaciones económicas que se solicitan está plenamente justificado.
El alcance de las compensaciones económicas que se solicitan está plenamente justificado.
Y que éste Comité acepta que dicho proyecto de investigación sea realizado en el Hospital
del Mar por el Dr. José María Ramada Rodilla como investigador principal tal como recoge el
ACTA de la reunión del día 8 de Marzo de 2011.
Y que éste Comité acepta que dicho proyecto de investigación sea realizado en el Hospital
del Mar por el Dr. José María Ramada Rodilla como investigador principal tal como recoge el
ACTA de la reunión del día 8 de Marzo de 2011.
Lo que firmo en Barcelona, a 1 de Abril de 2011
Lo que firmo en Barcelona, a 1 de Abril de 2011
Firmado: ....................................
Doña Mª Teresa Navarra Alcrudo
Firmado: ....................................
Doña Mª Teresa Navarra Alcrudo
CEIC – Parc de Salut MAR
Dr. Aiguader, 88 I 08003 Barcelona I Telèfon 93 316 06 77 I Fax 93 316 06 36
[email protected] | www.parcdesalutmar.cat
170
CEIC – Parc de Salut MAR
Dr. Aiguader, 88 I 08003 Barcelona I Telèfon 93 316 06 77 I Fax 93 316 06 36
[email protected] | www.parcdesalutmar.cat
170
8. APPENDICES
8. APPENDICES
Appendix VI: Informed consent
Appendix VI: Informed consent
CONSENTIMIENTO INFORMADO PARA LA PARTICIPACIÓN VOLUNTARIA EN LA
INVESTIGACIÓN QUE LLEVA POR TÍTULO:
CONSENTIMIENTO INFORMADO PARA LA PARTICIPACIÓN VOLUNTARIA EN LA
INVESTIGACIÓN QUE LLEVA POR TÍTULO:
Traducción, adaptación cultural y validación del "Work Role Functioning
Questionnaire (WRFQ)"
Traducción, adaptación cultural y validación del "Work Role Functioning
Questionnaire (WRFQ)"
Yo _____________________________________, con DNI/Pasaporte _______________
Yo _____________________________________, con DNI/Pasaporte _______________
He sido informado sobre el principal objetivo y alcance del estudio que para la traducción,
adaptación cultural y validación del cuestionario "Work Role Functioning Questionnaire" (WRFQ).
He tenido oportunidad de efectuar preguntas sobre el estudio, he recibido respuestas satisfactorias
y he recibido suficiente información sobre el mismo.
He sido informado sobre el principal objetivo y alcance del estudio que para la traducción,
adaptación cultural y validación del cuestionario "Work Role Functioning Questionnaire" (WRFQ).
He tenido oportunidad de efectuar preguntas sobre el estudio, he recibido respuestas satisfactorias
y he recibido suficiente información sobre el mismo.
Entiendo que la participación es voluntaria. Entiendo que puedo abandonar el estudio cuando lo
desee, sin que tenga que dar explicaciones y sin que ello afecte a MIS cuidados médicos.
Entiendo que la participación es voluntaria. Entiendo que puedo abandonar el estudio cuando lo
desee, sin que tenga que dar explicaciones y sin que ello afecte a MIS cuidados médicos.
También he sido informado de forma clara, precisa y suficiente de que los datos serán tratados y
custodiados con respeto a mi intimidad y a la vigente normativa de protección de datos. Sobre
estos datos me asisten los derechos de acceso, rectificación, cancelación y oposición que podré
ejercitar mediante solicitud ante el investigador responsable en la dirección de contacto que figura
en este documento. Estos datos no podrán ser cedidos sin mi consentimiento expreso y no lo
otorgo en este acto.
También he sido informado de forma clara, precisa y suficiente de que los datos serán tratados y
custodiados con respeto a mi intimidad y a la vigente normativa de protección de datos. Sobre
estos datos me asisten los derechos de acceso, rectificación, cancelación y oposición que podré
ejercitar mediante solicitud ante el investigador responsable en la dirección de contacto que figura
en este documento. Estos datos no podrán ser cedidos sin mi consentimiento expreso y no lo
otorgo en este acto.
Declaro que he leído y conozco el contenido del presente documento. Y, por ello, firmo este
consentimiento informado de forma voluntaria para manifestar mi deseo de participar en este
estudio de INVESTIGACIÓN hasta que decida lo contrario.
Declaro que he leído y conozco el contenido del presente documento. Y, por ello, firmo este
consentimiento informado de forma voluntaria para manifestar mi deseo de participar en este
estudio de INVESTIGACIÓN hasta que decida lo contrario.
Al firmar este consentimiento no renuncio a ninguno de mis derechos. Recibiré una copia de este
consentimiento para guardarlo y poder consultarlo en el futuro.
Al firmar este consentimiento no renuncio a ninguno de mis derechos. Recibiré una copia de este
consentimiento para guardarlo y poder consultarlo en el futuro.
Barcelona, ______ de _______________ de _______
Barcelona, ______ de _______________ de _______
Dr. José Mª Ramada Rodilla
DNI 22.675.983
Dirección de contacto:
Parc de Salut Mar. Servicio de Salud Laboral.
Passeig Marítim, 25-29
Firma de la persona que consiente
en colaborar en el estudio.
Dr. José Mª Ramada Rodilla
DNI 22.675.983
Dirección de contacto:
Parc de Salut Mar. Servicio de Salud Laboral.
08003-Barcelona
Passeig Marítim, 25-29
171
Firma de la persona que consiente
en colaborar en el estudio.
08003-Barcelona
171
184
184
8. APPENDICES
8. APPENDICES
Appendix VII: Poster
Appendix VII: Poster
Ramada JM, Serra C, Delclós J. Adaptación cultural y validación de
Ramada JM, Serra C, Delclós J. Adaptación cultural y validación de
cuestionarios de salud: revisión y recomendaciones metodológicas. Primera
cuestionarios de salud: revisión y recomendaciones metodológicas. Primera
Jornada Científica CISAL. Barcelona, 2011.
Jornada Científica CISAL. Barcelona, 2011.
173
173
184
184
Traducción, adaptación cultural y validación del
“Work Role Functioning Questionaire, (WRFQ)”
al castellano hablado en España
José M. Ramada
a,b;
Jordi Delclós
a,c,d;
Consol Serra
Traducción, adaptación cultural y validación del
“Work Role Functioning Questionaire, (WRFQ)”
al castellano hablado en España
José M. Ramada
a,b,d
(a)Centro de Investigación en Salud Laboral (CISAL), Universidad Pompeu Fabra. Barcelona; (b)Servicio de Salud Laboral, Parc de Salut MAR. Barcelona; (c) Epidemiology, Human Genetics and Environmental Sciences Division The University of Texas School of Public Health Houston Texas EE UU; (d) CIBER de Epidemiología y Salud Pública (CIBERESP)
Environmental Sciences Division, The University of Texas School of Public Health, Houston, Texas, EE.UU; (d) CIBER de Epidemiología y Salud Pública (CIBERESP).
Marco conceptual del WRF
ANTECEDENTES
Mercado laboral
Exigencias del trabajo
Contexto O
Organizacional
i i
l
Productividad en el negocio
Funcionar /
Funcionar / Trabajar bien Salud:
DOLOR Cuidado de la salud
Modificado por Amick & Gimeno, 2009
Work
Productivity
Work
Demands
Health-Related
HealthWork Role
Functioning
Este tipo de adaptaciones culturales exige la
utilización de un método estandarizado que garantice
la equivalencia entre la herramienta original y la
versión adaptada, así como la máxima preservación
de las propiedades psicométricas del mismo3-5.
Individual
Performance
Cuidado de la salud
Modificado por Amick & Gimeno, 2009
¿Qué estamos midiendo?
 Cuestionario autoadministrado que contiene 27 Items.
 Estructurado en 5 subescalas relacionadas con las exigencias del trabajo.
 Subescalas:
S b
l
exigencias
i
i d
de gestión
tió d
dell titiempo; fí
físicas;
i
psicológicas;
i ló i
sociales
i l y de
d producción.
d
ió
 Las respuestas se vinculan con el % de tiempo de la jornada de trabajo en que se es capaz de desempeñar productivamente
las exigencias del trabajo.
 Las respuestas se refieren siempre a las 4 últimas semanas.
 Es aplicable a diferentes sectores de la actividad económica, utilizando la categoría de respuesta ‘Does Not Apply to My Job’ .
 Se puede aplicar a trabajdores con diferentes tipos de enfermedad y estados de salud.
FASES DE LA ADAPTACIÓN CULTURAL AL CASTELLANO DEL WRFQ‐27
FASE 5:
Consolidación por
comité de expertos
Traducción
directa
Pre-test
Fiabilidad y
homogeneidad
Test-retest de fiablidad
EVALUACIÓN 2:
Validez de
contenido
EVALUACIÓN 3:
Comité de
expertos
2.
3.
4.
5.
FASE 3:
FASE 4:
FASE 5:
Traducción inversa
(retro-traducción)
Consolidación por
comité de expertos
Pre-test
Validez de
constructo
EVALUACIÓN DE LA FIABILIDAD Y LA VALIDEZ DE LAS PROPIEDADES PSICOMÉTRICAS
EVALUACIÓN 1:
Técnicas de
validación para
grupos conocidos
Fiabilidad y
homogeneidad
BIBLIOGRAFÍA:
1.
FASE 2:
2
Síntesis de las
traducciones
--- Obtención del cuestionario final adaptado ---
EVALUACIÓN DE LA FIABILIDAD Y LA VALIDEZ DE LAS PROPIEDADES PSICOMÉTRICAS
Coef. α de Cronbach
El objetivo del presente estudio es la traducción y
adaptación
adaptac
ó
del
de
“Work
o
Role
oe
Functioning
u ct o g
Questionnaire, WRFQ” al castellano hablado en
España así como la evaluación de la validez y
fiabilidad de las propiedades psicométricas de la
versión adaptada.
Benjamin C. Amick III
--- Obtención del cuestionario final adaptado ---
EVALUACIÓN 1:
OBJETIVO
CARACTERÍSTICAS DEL WRFQ‐27
FASE 4:
Traducción inversa
(retro-traducción)
Este tipo de adaptaciones culturales exige la
utilización de un método estandarizado que garantice
la equivalencia entre la herramienta original y la
versión adaptada, así como la máxima preservación
de las propiedades psicométricas del mismo3-5.
Individual
Performance
Health
Status
FASE 1:
FASE 3:
Work
Productivity
Work
Demands
FASES DE LA ADAPTACIÓN CULTURAL AL CASTELLANO DEL WRFQ‐27
FASE 2:
2
Síntesis de las
traducciones
Los investigadores que aborden un proceso de
traducción, adaptación y validación de una
herramienta ya existente en la literatura científica
internacional deben tener en cuenta las diferencias
en la percepción de la salud y la enfermedad de
2.
q
poblaciones en las cuales se desea aplicar
p
p
aquellas
Contexto
Social  Cuestionario autoadministrado que contiene 27 Items.
 Estructurado en 5 subescalas relacionadas con las exigencias del trabajo.
 Subescalas:
S b
l
exigencias
i
i d
de gestión
tió d
dell titiempo; fí
físicas;
i
psicológicas;
i ló i
sociales
i l y de
d producción.
d
ió
 Las respuestas se vinculan con el % de tiempo de la jornada de trabajo en que se es capaz de desempeñar productivamente
las exigencias del trabajo.
 Las respuestas se refieren siempre a las 4 últimas semanas.
 Es aplicable a diferentes sectores de la actividad económica, utilizando la categoría de respuesta ‘Does Not Apply to My Job’ .
 Se puede aplicar a trabajdores con diferentes tipos de enfermedad y estados de salud.
FASE 1:
a,b,d
La comunidad científica internacional viene
realizando grandes esfuerzos para evaluar las
condiciones de trabajo y salud de las poblaciones
usando parámetros comunes a nivel internacional.
Estar ausente
CARACTERÍSTICAS DEL WRFQ‐27
Traducción
directa
Productividad en el negocio
Funcionar /
Funcionar / Trabajar bien Health-Related
HealthWork Role
Functioning
El objetivo del presente estudio es la traducción y
adaptación
adaptac
ó
del
de
“Work
o
Role
oe
Functioning
u ct o g
Questionnaire, WRFQ” al castellano hablado en
España así como la evaluación de la validez y
fiabilidad de las propiedades psicométricas de la
versión adaptada.
Benjamin C. Amick III
Consol Serra
El “Work Role Functioning Questionnaire” (WRFQ) es
una herramienta que permite medir el grado de
discapacidad laboral y evaluar el impacto percibido
de un problema de salud sobre la capacidad del
trabajador para realizar su trabajo1.
Work role functioning
Salud:
DOLOR OBJETIVO
Health
Status
a,c,d;
ANTECEDENTES
Contexto O
Organizacional
i i
l
Los investigadores que aborden un proceso de
traducción, adaptación y validación de una
herramienta ya existente en la literatura científica
internacional deben tener en cuenta las diferencias
en la percepción de la salud y la enfermedad de
2.
q
poblaciones en las cuales se desea aplicar
p
p
aquellas
Contexto
Social Jordi Delclós
Mercado laboral
Exigencias del trabajo
La comunidad científica internacional viene
realizando grandes esfuerzos para evaluar las
condiciones de trabajo y salud de las poblaciones
usando parámetros comunes a nivel internacional.
Estar ausente
¿Qué estamos midiendo?
Marco conceptual del WRF
El “Work Role Functioning Questionnaire” (WRFQ) es
una herramienta que permite medir el grado de
discapacidad laboral y evaluar el impacto percibido
de un problema de salud sobre la capacidad del
trabajador para realizar su trabajo1.
Work role functioning
a,b;
(a)Centro de Investigación en Salud Laboral (CISAL), Universidad Pompeu Fabra. Barcelona; (b)Servicio de Salud Laboral, Parc de Salut MAR. Barcelona; (c) Epidemiology, Human Genetics and Environmental Sciences Division The University of Texas School of Public Health Houston Texas EE UU; (d) CIBER de Epidemiología y Salud Pública (CIBERESP)
Environmental Sciences Division, The University of Texas School of Public Health, Houston, Texas, EE.UU; (d) CIBER de Epidemiología y Salud Pública (CIBERESP).
Coef. α de Cronbach
Test-retest de fiablidad
EVALUACIÓN 2:
Validez de
contenido
EVALUACIÓN 3:
Comité de
expertos
Validez de
constructo
Técnicas de
validación para
grupos conocidos
BIBLIOGRAFÍA:
Amick BC III, Lerner D, Rogers WH, Rooney T, Katz JN. A review of health‐related work outcome measures and their uses, and recommended measures. Spine. 2000 Dec; 25(24) 3152 60
25(24):3152‐60.
Beaton DE, Bombardier C, Guillemin F, Bosi Ferraz M. Guidelines for the process of cross‐ cultural adaptation of self‐reports measures. Spine. 2000;25(24):3186–91.
Hutchinson A, Bentzen N, Konig‐Zanhn C. Cross cultural health outcome assessment: a user’s guide. The Netherlands: ERGHO; 1996.
Guillemin F. Cross‐cultural adaptation and validation of health status measures. Scand J Rheumatol 1995;24(2):61–3.
Alexandre NMC, Guirardello EB. Adaptación cultural de instrumentos utilizados en salud ocupacional. Rev Panam Salud Pública. 2002;11(2):109–11.
1.
2.
3.
4.
5.
Amick BC III, Lerner D, Rogers WH, Rooney T, Katz JN. A review of health‐related work outcome measures and their uses, and recommended measures. Spine. 2000 Dec; 25(24) 3152 60
25(24):3152‐60.
Beaton DE, Bombardier C, Guillemin F, Bosi Ferraz M. Guidelines for the process of cross‐ cultural adaptation of self‐reports measures. Spine. 2000;25(24):3186–91.
Hutchinson A, Bentzen N, Konig‐Zanhn C. Cross cultural health outcome assessment: a user’s guide. The Netherlands: ERGHO; 1996.
Guillemin F. Cross‐cultural adaptation and validation of health status measures. Scand J Rheumatol 1995;24(2):61–3.
Alexandre NMC, Guirardello EB. Adaptación cultural de instrumentos utilizados en salud ocupacional. Rev Panam Salud Pública. 2002;11(2):109–11.
175
175
184
184
8. APPENDICES
8. APPENDICES
Appendix VIII: Poster
Appendix VIII: Poster
Ramada JM, Serra C, Delclós GL. Cross-cultural adaptation and health
Ramada JM, Serra C, Delclós GL. Cross-cultural adaptation and health
questionnaires validation: revision and methodological recommendations.
questionnaires validation: revision and methodological recommendations.
Second Scientific Conference on Work Disability Prevention and Integration
Second Scientific Conference on Work Disability Prevention and Integration
‘Healthy ageing in a working society’. WDPI; Groningen, 2012.
‘Healthy ageing in a working society’. WDPI; Groningen, 2012.
177
177
184
184
Cross‐cultural adaptation and validation of the Work Role Functioning Questionnaire to Spanish spoken in Spain.
Cross‐cultural adaptation and validation of the Work Role Functioning Questionnaire to Spanish spoken in Spain.
Jose Maria Ramada1,2,3, Consol Serra 1,2,3, George L Delclos2,3,4
Jose Maria Ramada1,2,3, Consol Serra 1,2,3, George L Delclos2,3,4
(1) Occupational Health Service. Parc de Salut MAR. Barcelona, Spain. (2) Center for Research in Occupational Health (CiSAL), University Pompeu Fabra. Barcelona, Spain. (3) CIBER of Epidemiology and Public Health (CIBERESP). (4) Epidemiology, Human U
e s ty o peu ab a a ce o a, Spa (3) C
o p de o ogy a d ub c ea t (C
S ) ( ) p de o ogy, u a
Genetics and Environmental Sciences Division, The University of Texas School of Public Health, Houston, Texas, USA.
Introduction Introduction Results
• Translation, cultural adaptation and validation (TCAV) of existing questionnaires to other
languages and cultures facilitates international and multicultural research projects
promoting information exchange and reducing time and costs to develop similar
instruments1.
• The simple
p translation of a q
questionnaire mayy lead to misinterpretation
p
due to language
g g
and cultural differences. When using questionnaires developed in other countries and
languages in scientific studies it is necessary, besides the translation, to carry out a cross‐
cultural adaptation and validation2.
• The Work Role Functioning Questionnaire (WRFQ) is a self‐completed work disability
tool used to measure the perceived impact of a health problem on the worker’s ability
to perform his job3.
1. García de Yébenes MJ, Rodriguez‐Salvanés F, Carmona‐Ortells L. Validación de cuestionarios. Reumatol Clin.
2009;5:171‐177.
2. Beaton DE, Bombardier C, Guillemin F, Bosi Ferraz M. Guidelines for the process of cross‐cultural adaptation of
self‐reports measures. Spine. 2000;25:3186‐3191.
3. Amick BC III, Lerner D, Rogers WH, Rooney T, Katz JN. A review of health‐related work outcome measures and
their uses, and recommended measures. Spine. 2000; 25:3152‐60.
Table 1. Participants' socio-demographic characteristics. Pre-test with the adapted version of the WRFQ* to Spanish
spoken in Spain (n=40). April-May, 2012.
Total
Age in years, mean (SD)
Education level, n (%)
Job type, n (%)
• Panel of experts to assess content validity.
• Techniques for analysis of known groups to assess construct validity assessed.
• Internal consistency (Item‐to‐subscale and item‐to‐total correlations), and checking of
floor and ceiling effects were examined.
Low
13 (32,5)
7 (46,7)
6 (24,0)
15 (37,5)
6 (40,0)
9 (36,0)
High
12 (30,0)
2 (13,3)
10 (40,0)
Manual
17 (42,5)
6 (40,0)
11 (44,0)
11 (27,5)
5 (33,3)
6 (24,0)
Mixed
12 (30,0)
4 (26,7)
8 (32,0)
40,23 (10,7)
P
H
A
S
E
Step 3:
Step 4
Synthesis of
translations
Back
translation
Consolidation
by expert
committee
C
U
L
T
U
R
A
L
A
D
A
P
T
A
T
I
O
N
P
H
A
S
E
V
A
L
I
D
A
T
I
O
N
Validity
2. Content validity
Validated
Version
7 (46,7)
6 (24,0)
6 (40,0)
9 (36,0)
High
12 (30,0)
2 (13,3)
10 (40,0)
Manual
17 (42,5)
6 (40,0)
11 (44,0)
Non-manual
11 (27,5)
5 (33,3)
6 (24,0)
Mixed
12 (30,0)
4 (26,7)
8 (32,0)
Working hours/week, mean (SD)
40,23 (10,7)
36,7 (9,8)
6 (40,0)
(40 0)
11 (44,0)
(44 0)
8 (53,3)
9 (36,0)
Both
6 (15,0)
1 (6,7)
5 (20,0)
Both
6 (15,0)
1 (6,7)
5 (20,0)
23,1 (22,4)
Median
n at floor
n at ceiling Cronbach's
(0%) n (%) (100%) n (%)
alpha
Objective
41,6 (61,8)
Disease duration in months, mean (SD)
The aim of this study is to translate and adapt the WRFQ to Spanish spoken in Spain and
evaluate its validity and reliability.
Subscaletotal
correlations
67,7
6
,
0,88
(27,8)
5-100
75,0
0 (0,0)
3 (7,5)
0,95
64,4
0,90
Output demands
39 (1)
(25,8)
14,3-100
67,9
0 (0,0)
1 (2,5)
0,94
59,0
0,95
Physical demands
36 (4)
(32,3)
4,17-100
62,5
0 (0,0)
5 (12,5)
0,88
73,9
0,96
Mental demands
40 (0)
0-100
79,2
1 (2,5)
9 (22,5)
0,81
(26,1)
76,9
0,56
Social demands
35 (5)
(21,1)
25-100
83,3
0 (0,0)
5 (12,5)
0,83
67,6
0,97
-Total score
40 (0)
(22,7)
21,3-98,1 74,5
0 (0,0)
0 (0,0)
(*) Subscales with more than 20% of items scoring "does not apply to my job" or missing values were excluded.
(§) Each subscale is scored from 0 - 100. Higher scores indicate better work functioning: difficulties all the time
0/100; difficulties no of the time 100/100.
• Structured interviews (n=40) with workers with musculoskeletal and prevalent mental
health disorders were performed to evaluate the comprehensibility, usability,
applicability and completeness of the adapted questionnaire.
• Panel of experts to assess content validity.
• Techniques for analysis of known groups to assess construct validity assessed.
• Internal consistency (Item‐to‐subscale and item‐to‐total correlations), and checking of
floor and ceiling effects were examined.
Work scheduling demands
0,92
(0,85-0,96)
Output demands
0,89
(0,78-0,94)
Physical demands
0,93
(0,84-0,97)
Mental demands
0,85
(0,72-0,92)
Social demands
0,77
(0,58-0,88)
Total score
0,94
(0,83-0,98)
F
I
R
S
T
P
H
A
S
E
C
R
O
S
S
85 0
85,0
65 0
65,0
0 478
0,478
Output demands
78,6
82,1
0,850
Physical demands
85,0
55,0
0,007
Mental demands
75,0
95,8
0,018
Social demands
83,3
87,5
0,917
3. Criterion validity
(*) Work Role Functioning Questionnaire.
4. Construct validity
(**) Each subscale is scored from 0 - 100. Higher scores indicate better work functioning: difficulties all the time 0/100;
difficulties no of the time 100/100.
P
H
A
S
E
n at floor
n at ceiling Cronbach's
(0%) n (%) (100%) n (%)
alpha
Step 3:
Step 4
Direct
translation
Synthesis of
translations
Back
translation
Consolidation
by expert
committee
(§) Each subscale is scored from 0 - 100. Higher scores indicate better work functioning: difficulties all the time
0/100; difficulties no of the time 100/100.
IC 95%**
CCI
Step 5
Work scheduling demands
0,92
(0,85-0,96)
Output demands
0,89
(0,78-0,94)
Pre-test
Physical demands
0,93
(0,84-0,97)
Mental demands
0,85
(0,72-0,92)
Social demands
0,77
(0,58-0,88)
Total score
0,94
(0,83-0,98)
* WRFQ: Work Role Functioning Questionnaire
** IC 95%: Interval of confidence to 95%
Process report
Table 4. Subscale description by type of health problem (mental or physical). Pre-test with the adapted version of the
WRFQ* to Spanish spoken in Spain (n=40). April-May, 2012.
Translated and Cross-cultural Adapted Version
Median**
Reliability
Mental health
problem
Test U of Mann Whitney
Physical health
problem
Asymptotic significance (bilateral)
2. Test-retest reliability
3. Inter-rater reliability
4. Intra-rater reliability
1. Face validity
Validity
Responsiveness
Subscaletotal
correlations
67,7
6
,
0,88
(27,8)
5-100
75,0
0 (0,0)
3 (7,5)
0,95
64,4
0,90
Output demands
39 (1)
(25,8)
14,3-100
67,9
0 (0,0)
1 (2,5)
0,94
59,0
0,95
Physical demands
36 (4)
(32,3)
4,17-100
62,5
0 (0,0)
5 (12,5)
0,88
73,9
0,96
Mental demands
40 (0)
0-100
79,2
1 (2,5)
9 (22,5)
0,81
(26,1)
76,9
0,56
Social demands
35 (5)
(21,1)
25-100
83,3
0 (0,0)
5 (12,5)
0,83
67,6
0,97
-Total score
40 (0)
(22,7)
21,3-98,1 74,5
0 (0,0)
0 (0,0)
(*) Subscales with more than 20% of items scoring "does not apply to my job" or missing values were excluded.
1. Internal consistency
W k scheduling
Work
h d li d
demands
d
Median
Test-retest
Step 2:
C
U
L
T
U
R
A
L
V
A
L
I
D
A
T
I
O
N
Range
39 (1)
Asymptotic significance (bilateral)
S
E
C
O
N
D
Mean§
(SD)
Subscales
Step 1:
A
D
A
P
T
A
T
I
O
N
41,6 (61,8)
Table 3. Test-retest reliability. Intraclass Correlation Coefficients (ICC).
Pre-test of the Spanish version of the WRFQ*, April-May 2012.
Barcelona, November 2011.
Test U of Mann Whitney
Physical health
problem
Work scheduling
g
demands
• Test‐retest
Test retest reliability at 15 days was assessed by calculating the Intraclass Correlation
Coefficient (ICC) after administering the WRFQ twice to the same sample of 40 workers.
CCI
23,1 (22,4)
Table 2. Pre-test results with the Spanish version of the Work Role Functioning Questionnaire, (n=40). April-May, 2012.
Valid n
(missing/not
applicable)*
• SSystematic
i 5‐step
5
procedure:
d
di
direct
translation,
l i
synthesis,
h i back‐translation,
b k
l i
expert
committee and pre‐test.
34,68 (51,1)
*WRFQ: Work Role Functioning Questionnaire.
Methods
Figure 1. Translation, cultural adaptation and validation (Adapted from Beaton et al. 2000).
IC 95%**
Disease type
type, n(%)
46,1 (9,6)
17 (42,5)
(42 5)
2. Test-retest reliability
1. Face validity
13 (32,5)
15 (37,5)
17 (42,5)
Table 4. Subscale description by type of health problem (mental or physical). Pre-test with the adapted version of the
WRFQ* to Spanish spoken in Spain (n=40). April-May, 2012.
4. Intra-rater reliability
Low
Middle
Mental
* WRFQ: Work Role Functioning Questionnaire
** IC 95%: Interval of confidence to 95%
3. Inter-rater reliability
Job type, n (%)
49,8 (10,7)
Physical
Median**
Reliability
Education level, n (%)
47,9 (8,9)
9 (36,0)
Range
Mental health
problem
49,1 (10,0)
11 (44,0)
(44 0)
Pre-test
Translated and Cross-cultural Adapted Version
Age in years, mean (SD)
Women
n=15 (37,5%) n=25 (62,5%)
6 (40,0)
(40 0)
39 (1)
1. Internal consistency
S
E
C
O
N
D
1. García de Yébenes MJ, Rodriguez‐Salvanés F, Carmona‐Ortells L. Validación de cuestionarios. Reumatol Clin.
2009;5:171‐177.
2. Beaton DE, Bombardier C, Guillemin F, Bosi Ferraz M. Guidelines for the process of cross‐cultural adaptation of
self‐reports measures. Spine. 2000;25:3186‐3191.
3. Amick BC III, Lerner D, Rogers WH, Rooney T, Katz JN. A review of health‐related work outcome measures and
their uses, and recommended measures. Spine. 2000; 25:3152‐60.
Men
n=40
8 (53,3)
Step 5
Process report
• The Work Role Functioning Questionnaire (WRFQ) is a self‐completed work disability
tool used to measure the perceived impact of a health problem on the worker’s ability
to perform his job3.
Total
17 (42,5)
(42 5)
Subscales
Step 2:
• The simple
p translation of a q
questionnaire mayy lead to misinterpretation
p
due to language
g g
and cultural differences. When using questionnaires developed in other countries and
languages in scientific studies it is necessary, besides the translation, to carry out a cross‐
cultural adaptation and validation2.
Table 1. Participants' socio-demographic characteristics. Pre-test with the adapted version of the WRFQ* to Spanish
spoken in Spain (n=40). April-May, 2012.
17 (42,5)
Table 2. Pre-test results with the Spanish version of the Work Role Functioning Questionnaire, (n=40). April-May, 2012.
Work scheduling
g
demands
• Translation, cultural adaptation and validation (TCAV) of existing questionnaires to other
languages and cultures facilitates international and multicultural research projects
promoting information exchange and reducing time and costs to develop similar
instruments1.
Mental
34,68 (51,1)
Mean§
(SD)
Results
Physical
Test-retest
Barcelona, November 2011.
Direct
translation
36,7 (9,8)
Table 3. Test-retest reliability. Intraclass Correlation Coefficients (ICC).
Pre-test of the Spanish version of the WRFQ*, April-May 2012.
Figure 1. Translation, cultural adaptation and validation (Adapted from Beaton et al. 2000).
C
R
O
S
S
46,1 (9,6)
*WRFQ: Work Role Functioning Questionnaire.
• Test‐retest
Test retest reliability at 15 days was assessed by calculating the Intraclass Correlation
Coefficient (ICC) after administering the WRFQ twice to the same sample of 40 workers.
F
I
R
S
T
49,8 (10,7)
Non-manual
Disease type
type, n(%)
Methods
• Structured interviews (n=40) with workers with musculoskeletal and prevalent mental
health disorders were performed to evaluate the comprehensibility, usability,
applicability and completeness of the adapted questionnaire.
47,9 (8,9)
Middle
Working hours/week, mean (SD)
Valid n
(missing/not
applicable)*
• SSystematic
i 5‐step
5
procedure:
d
di
direct
translation,
l i
synthesis,
h i back‐translation,
b k
l i
expert
committee and pre‐test.
Women
n=15 (37,5%) n=25 (62,5%)
49,1 (10,0)
Disease duration in months, mean (SD)
The aim of this study is to translate and adapt the WRFQ to Spanish spoken in Spain and
evaluate its validity and reliability.
Men
n=40
Objective
Step 1:
(1) Occupational Health Service. Parc de Salut MAR. Barcelona, Spain. (2) Center for Research in Occupational Health (CiSAL), University Pompeu Fabra. Barcelona, Spain. (3) CIBER of Epidemiology and Public Health (CIBERESP). (4) Epidemiology, Human U
e s ty o peu ab a a ce o a, Spa (3) C
o p de o ogy a d ub c ea t (C
S ) ( ) p de o ogy, u a
Genetics and Environmental Sciences Division, The University of Texas School of Public Health, Houston, Texas, USA.
2. Content validity
Validated
Version
W k scheduling
Work
h d li d
demands
d
85 0
85,0
65 0
65,0
0 478
0,478
Output demands
78,6
82,1
0,850
Physical demands
85,0
55,0
0,007
Mental demands
75,0
95,8
0,018
Social demands
83,3
87,5
0,917
3. Criterion validity
(*) Work Role Functioning Questionnaire.
4. Construct validity
(**) Each subscale is scored from 0 - 100. Higher scores indicate better work functioning: difficulties all the time 0/100;
difficulties no of the time 100/100.
Responsiveness
Conclusions
Our results confirm that the process used for translation and cross‐cultural adaptation of the WRFQ was carried out successfully and indicate the existence of a good preservation of its psychometric properties1,2.
Conclusions
Our results confirm that the process used for translation and cross‐cultural adaptation of the WRFQ was carried out successfully and indicate the existence of a good preservation of its psychometric properties1,2.
BIBLIOGRAFIA:
BIBLIOGRAFIA:
1. Ramada JM, Serra C, Delclós GL. Adaptación cultural y validación de cuestionarios de salud: revisión y recomendaciones metodológicas. Salud Publica Mex. 2013;55:57‐66.
2. Ramada JM, Serra C, Amick III BC, Castaño J, Delclos GL. Cross‐Cultural Adaptation of the Work Role Functioning Questionnaire to Spanish Spoken in Spain. J Occup Rehabil. 2013; [Epub ahead of print]. 179
1. Ramada JM, Serra C, Delclós GL. Adaptación cultural y validación de cuestionarios de salud: revisión y recomendaciones metodológicas. Salud Publica Mex. 2013;55:57‐66.
2. Ramada JM, Serra C, Amick III BC, Castaño J, Delclos GL. Cross‐Cultural Adaptation of the Work Role Functioning Questionnaire to Spanish Spoken in Spain. J Occup Rehabil. 2013; [Epub ahead of print]. 179
184
184
8. APPENDICES
8. APPENDICES
Appendix VIII: Poster
Appendix VIII: Poster
Ramada JM, Serra C, Delclós J. Traducción, adaptación cultural y validación
Ramada JM, Serra C, Delclós J. Traducción, adaptación cultural y validación
del “Work role functioning questionnaire (WRFQ-27)”. 3ª Jornada Científica
del “Work role functioning questionnaire (WRFQ-27)”. 3ª Jornada Científica
CISAL. Barcelona, 2013.
CISAL. Barcelona, 2013.
181
181
184
184
Cross‐cultural adaptation and validation of the Work Role Functioning Questionnaire to Spanish spoken in Spain.
Cross‐cultural adaptation and validation of the Work Role Functioning Questionnaire to Spanish spoken in Spain.
José M Ramada1,2,3, Consol Serra 1,2,3, Benjamin Amik III4, Juan R Castaño5,6, George L Delclos2,3,4
José M Ramada1,2,3, Consol Serra 1,2,3, Benjamin Amik III4, Juan R Castaño5,6, George L Delclos2,3,4
(1) Occupational Health Service. Parc de Salut MAR. Barcelona, Spain. (2) Center for Research in Occupational Health (CiSAL), University Pompeu Fabra. Barcelona, Spain. (3) CIBER of Epidemiology and Public Health (CIBERESP). (4) Epidemiology, Human Genetics and Environmental Sciences Di i i
Division, The University of Texas School of Public Health, Houston, Texas, USA. (5) Psychiatry Service. Parc de Salut MAR, Barcelona. (6) Th U i
it f T
S h l f P bli H lth H t
T
USA (5) P hi t S i P d S l t MAR B
l
(6)
Neuropsychiatry and Addictions Institute (INAD), Parc de Salut MAR, Barcelona. Introduction (1) Occupational Health Service. Parc de Salut MAR. Barcelona, Spain. (2) Center for Research in Occupational Health (CiSAL), University Pompeu Fabra. Barcelona, Spain. (3) CIBER of Epidemiology and Public Health (CIBERESP). (4) Epidemiology, Human Genetics and Environmental Sciences Di i i
Division, The University of Texas School of Public Health, Houston, Texas, USA. (5) Psychiatry Service. Parc de Salut MAR, Barcelona. (6) Th U i
it f T
S h l f P bli H lth H t
T
USA (5) P hi t S i P d S l t MAR B
l
(6)
Neuropsychiatry and Addictions Institute (INAD), Parc de Salut MAR, Barcelona. Introduction Results
Results
Table 1. Participants' characteristics. • Translation, cultural adaptation and validation (TCAV) of existing questionnaires to other
languages and cultures facilitates international and multicultural research projects
promoting information exchange and reducing time and costs to develop similar
instruments1.
• The simple translation of a questionnaire
q estionnaire may
ma lead to misinterpretation due
d e to language
lang age
and cultural differences. When using questionnaires developed in other countries and
languages in scientific studies it is necessary, besides the translation, to carry out a cross‐
cultural adaptation and validation2.
Job type, n (%) 1.
2.
3.
Participants Total with health n=455 issues (n=299) Age in years, mean (SD) Education level, n (%) (11.1) (16.0) (34 5)
(34.5) (49.5) (24.4) (27.5) 43.7 61 121
117 81 82 (10.8) (20.4) (40 5)
(40.5)
(39.1) (27.1) (27.4) 39.0 12 36
108 30 43 (11.0) (7.7) (23 1)
(23.1)
(69.2) (19.2) (27.6) 218 38.7 None 156 Physical 139 (47.9) (8.5) (34.3) (30.5) 136 38.8 0 139 (45.5) (7.8) (0.0) (46.5) 83 38.7 156 0 (53.2) (9.7) (100.0) (0.0) Mixed Mental health 125 (27.5) Others 35 (7.7) Disease duration in months, mean (SD) 13.0 (27.7) García de Yébenes MJ, Rodriguez‐Salvanés F, Carmona‐Ortells L. Validación de cuestionarios. Reumatol Clin. 2009;5:171‐177.
Beaton DE, Bombardier C, Guillemin F, Bosi Ferraz M. Guidelines for the process of cross‐cultural adaptation of self‐reports
measures. Spine. 2000;25:3186‐3191.
Amick BC III, Lerner D, Rogers WH, Rooney T, Katz JN. A review of health‐related work outcome measures and their uses, and
recommended measures. Spine. 2000; 25:3152
25:3152‐60.
60.
• Translation, cultural adaptation and validation (TCAV) of existing questionnaires to other
languages and cultures facilitates international and multicultural research projects
promoting information exchange and reducing time and costs to develop similar
instruments1.
• The simple translation of a questionnaire
q estionnaire may
ma lead to misinterpretation due
d e to language
lang age
and cultural differences. When using questionnaires developed in other countries and
languages in scientific studies it is necessary, besides the translation, to carry out a cross‐
cultural adaptation and validation2.
Job type, n (%) 0 (0.0) 0 (0.0) 0 (0.0) 1.
2.
3.
Work demands The aim of this study is to translate and adapt the WRFQ to Spanish spoken in Spain and
evaluate its validity and reliability.
Methods
Valid n Work scheduling Output Physical Mental Social 445 448 317 452 408 Overall scale 443 Missing / Not a
applicable n (%) 10 7 138 3 47 Mean b
scores (SD) (2.2) (1.5) (30.3) (0.7) (10.3) 12 (2.6) Range Median scores (26.51) (24.25) (25.62) (26.12) (22.88) 0‐100 0‐100 0‐100 0‐100 0‐100 85.00 82.14 84.17 91.67 91.67 n at floor n at ceiling Cronbach n (%) n (%) alpha 0.91 7 (1.54) 90 (19.78) 0.92 6 (1,32) 53 (11.65) 0.92 5 (1,10) 63 (13.85) 0.95 10 (2,20) 130 (28.57) 0.81 8 (1.76) 142 (31.21) 77.05 (22.35) 0‐100 84.90 4 (0.88) 75.65 74.79 75.66 79.53 82.90 18 (3.96) • Structured interviews (n=40) with workers with musculoskeletal and prevalent mental
health disorders were performed to evaluate the comprehensibility, usability,
applicability and completeness of the adapted questionnaire.
Table 3. Pearson’s correlations of the WRFQa and the three single item question of the WAIb. • Panel of experts to assess content validity.
Work scheduling Output Work Scheduling Output ‐ 0.849 ‐ 0.849 Physical Mental Social Overall scale 0.747 0.724 0.701 0.918 0.730 0.752 0.731 0.935 WAI overall item
WAI overall‐item
0 0
0.707
0 66
0.661 06 9
0.649 WAI physical demands 0.586 0.586 0.615 Work demands • Techniques for analysis of known groups to assess construct validity assessed.
• Internal consistency (Item‐to‐subscale and item‐to‐total correlations), and checking of
floor and ceiling effects were examined.
• Test‐retest
Test retest reliability at 15 days was assessed by calculating the Intraclass Correlation
Coefficient (ICC) after administering the WRFQ twice to the same sample of 40 workers.
Physical Mental Social Total scale 0.747 0.730 ‐ 0.724 0.752 0.701 0.731 0,918 0,935 0.494 ‐ 0.576 0.766 ‐ 0.494 0.576 0.821 c
0.825 0,821 0,861 0,825 ‐ 0
0.517
0 3
0.531
0
0.713
3
0.406 0.419 0.594 c
0.627 0.682 0.766 0.861 WAI mental demands 0.659 0.629 0.448 0.665 (a) Work Role Functioning Questionnaire; (b) Work Ability Index; (c) Hypothesis 3a and 3b confirmed. (10.8) (20.4) (40 5)
(40.5)
(39.1) (27.1) (27.4) 39.0 12 36
108 30 43 (11.0) (7.7) (23 1)
(23.1)
(69.2) (19.2) (27.6) 218 38.7 None 156 Physical 139 (47.9) (8.5) (34.3) (30.5) 136 38.8 0 139 (45.5) (7.8) (0.0) (46.5) 83 38.7 156 0 (53.2) (9.7) (100.0) (0.0) Mixed 125 (41.8) 35 (11.7) 19.9 (32.2) 0 (0.0) 0 (0.0) 0 (0.0) Table 2. Reliability, floor and ceiling effects of the Spanish version of the Work Role Functioning Questionnaire, (n=455). Work demands The aim of this study is to translate and adapt the WRFQ to Spanish spoken in Spain and
evaluate its validity and reliability.
Methods
Valid n Work scheduling Output Physical Mental Social 445 448 317 452 408 Overall scale 443 Missing / Not a
applicable n (%) 10 7 138 3 47 Mean b
scores (SD) (2.2) (1.5) (30.3) (0.7) (10.3) 12 (2.6) Range Median scores (26.51) (24.25) (25.62) (26.12) (22.88) 0‐100 0‐100 0‐100 0‐100 0‐100 85.00 82.14 84.17 91.67 91.67 n at floor n at ceiling Cronbach n (%) n (%) alpha 0.91 7 (1.54) 90 (19.78) 0.92 6 (1,32) 53 (11.65) 0.92 5 (1,10) 63 (13.85) 0.95 10 (2,20) 130 (28.57) 0.81 8 (1.76) 142 (31.21) 77.05 (22.35) 0‐100 84.90 4 (0.88) 75.65 74.79 75.66 79.53 82.90 18 (3.96) 0.98 ( )
(a) Subscales with more than 20% of items scoring "does not apply to my job" or missing values were excluded.
g
pp y
yj
g
(b) Each subscale is scored from 0 ‐ 100. Higher scores indicate better work functioning: difficulties all the time 0/100; difficulties no of the time 100/100. • SSystematic
i 5‐step
5
procedure:
d
di
direct
translation,
l i
synthesis,
h i back‐translation,
b k
l i
expert
committee and pre‐test.
• Structured interviews (n=40) with workers with musculoskeletal and prevalent mental
health disorders were performed to evaluate the comprehensibility, usability,
applicability and completeness of the adapted questionnaire.
Table 3. Pearson’s correlations of the WRFQa and the three single item question of the WAIb. • Panel of experts to assess content validity.
Work scheduling Output Work Scheduling Output ‐ 0.849 ‐ 0.849 Physical Mental Social Overall scale 0.747 0.724 0.701 0.918 0.730 0.752 0.731 0.935 WAI overall item
WAI overall‐item
0 0
0.707
0 66
0.661 06 9
0.649 WAI physical demands 0.586 0.586 0.615 Work demands • Techniques for analysis of known groups to assess construct validity assessed.
• Internal consistency (Item‐to‐subscale and item‐to‐total correlations), and checking of
floor and ceiling effects were examined.
• Test‐retest
Test retest reliability at 15 days was assessed by calculating the Intraclass Correlation
Coefficient (ICC) after administering the WRFQ twice to the same sample of 40 workers.
c
43.7 61 121
117 81 82 0.98 ( )
(a) Subscales with more than 20% of items scoring "does not apply to my job" or missing values were excluded.
g
pp y
yj
g
(b) Each subscale is scored from 0 ‐ 100. Higher scores indicate better work functioning: difficulties all the time 0/100; difficulties no of the time 100/100. • SSystematic
i 5‐step
5
procedure:
d
di
direct
translation,
l i
synthesis,
h i back‐translation,
b k
l i
expert
committee and pre‐test.
(11.1) (16.0) (34 5)
(34.5) (49.5) (24.4) (27.5) Mental health 125 (27.5) Others 35 (7.7) Disease duration in months, mean (SD) 13.0 (27.7) Objective
Participants without health issues (n=156) 42.1 73 157
157 225 111 125 Low Middl
Middle High Manual Non‐manual Working hours/week, mean (SD) Health issue type, n(%) García de Yébenes MJ, Rodriguez‐Salvanés F, Carmona‐Ortells L. Validación de cuestionarios. Reumatol Clin. 2009;5:171‐177.
Beaton DE, Bombardier C, Guillemin F, Bosi Ferraz M. Guidelines for the process of cross‐cultural adaptation of self‐reports
measures. Spine. 2000;25:3186‐3191.
Amick BC III, Lerner D, Rogers WH, Rooney T, Katz JN. A review of health‐related work outcome measures and their uses, and
recommended measures. Spine. 2000; 25:3152
25:3152‐60.
60.
Table 2. Reliability, floor and ceiling effects of the Spanish version of the Work Role Functioning Questionnaire, (n=455). Objective
Participants Total with health n=455 issues (n=299) Age in years, mean (SD) Education level, n (%) • The Work Role Functioning Questionnaire (WRFQ) is a self‐completed work disability
tool used to measure the perceived impact of a health problem on the worker’s ability
to perform his job3.
125 (41.8) 35 (11.7) 19.9 (32.2) Participants without health issues (n=156) 42.1 73 157
157 225 111 125 Low Middl
Middle High Manual Non‐manual Working hours/week, mean (SD) Health issue type, n(%) • The Work Role Functioning Questionnaire (WRFQ) is a self‐completed work disability
tool used to measure the perceived impact of a health problem on the worker’s ability
to perform his job3.
Table 1. Participants' characteristics. Physical Mental Social Total scale 0.747 0.730 ‐ 0.724 0.752 0.701 0.731 0,918 0,935 0.494 ‐ 0.576 0.766 ‐ 0.494 0.576 0.821 c
0.825 0,821 0,861 0,825 ‐ 0
0.517
0 3
0.531
0
0.713
3
0.406 0.419 0.594 c
0.627 0.682 0.766 0.861 WAI mental demands 0.659 0.629 0.448 0.665 (a) Work Role Functioning Questionnaire; (b) Work Ability Index; (c) Hypothesis 3a and 3b confirmed. c
Table 4. Scores obtained by health condition and job type on the WRFQ‐SpV. Work demands
Work scheduling Output Physical y
Mental Social a
Health issue (median scores ) None (N= 156)
95.00 89.29 95.83
95.83 91.67 (b)
78.57 63.75 91.67 91.67 Job type (median scores ) Mental Physical p (N= 125)
(N= 139) value 0.000 70.00 82.00 67.86 83.33
62.50 75.00 Table 4. Scores obtained by health condition and job type on the WRFQ‐SpV. a
0.000 0.000 0.000 0.000 (b)
Manual Non‐manual Mixed p (N= 109 )
(N= 123)
(N= 212) value
80.00 78.57 66.67 89.59 91.67 90.00 82.14 91.67
83.33 83.33 85.00 83.33 85.00
91.67 91.67 Work demands
0.011 0.137 0.000
0.406 0.208 Work scheduling Output Physical y
Mental Social 0.000 Overall scale 92.05 68.52 81.73 77.78 83.33 87.04 0.027 (a) Subscales with more than 20% of items scoring "does not apply to my job" or missing values were excluded. Hypotheses 1a, 1b and 1c confirmed. (b) Kruskal Wallis H test. a
a
Health issue (median scores ) None (N= 156)
95.00 89.29 95.83
95.83 91.67 Job type (median scores ) (b)
Mental Physical p (N= 125)
(N= 139) value 0.000 70.00 82.00 67.86 83.33
62.50 75.00 78.57 63.75 91.67 91.67 0.000 0.000 0.000 0.000 (b)
Manual Non‐manual Mixed p (N= 109 )
(N= 123)
(N= 212) value
80.00 78.57 66.67 89.59 91.67 90.00 82.14 91.67
83.33 83.33 85.00 83.33 85.00
91.67 91.67 0.011 0.137 0.000
0.406 0.208 0.000 Overall scale 92.05 68.52 81.73 77.78 83.33 87.04 0.027 (a) Subscales with more than 20% of items scoring "does not apply to my job" or missing values were excluded. Hypotheses 1a, 1b and 1c confirmed. (b) Kruskal Wallis H test. Table 5. Differences between mean scores of known age groups in WRFQa (ANOVA). Age (Years) 18‐35 (N=148) 36‐45 (N=121) 46‐55 (N=123) 56‐65 (N=57) Table 5. Differences between mean scores of known age groups in WRFQa (ANOVA). Mean (SD) Mean (SD) Mean (SD) Mean (SD) p value Age (Years) Work demands Work demands Mean (SD) Mean (SD) Mean (SD) Mean (SD) p value Work scheduling
Output Physical
Mental Social 78.86 (22.45)
77.84 (20.50) 81.07 (20.19)
81.17 (21.73) 88.22 (16.48)
77.84 (25.92) 76.00 (24.33) 77.36 (23.16) 78.55 (26.47) 83.10 (23.05) 75.19 (25.63)
72.53 (24.78) 71.33 (26.41)
77.82 (26.68) 81.96 (21.99)
76.90 (25.95)
70.34 (28.83) 61.36 (33.99)
79.61 (28.50) 79.79 (27.73)
0.120
0.130 0.000
0.719 0.043
Work scheduling
Output Physical
Mental Social 78.86 (22.45)
77.84 (20.50) 81.07 (20.19)
81.17 (21.73) 88.22 (16.48)
77.84 (25.92) 76.00 (24.33) 77.36 (23.16) 78.55 (26.47) 83.10 (23.05) 75.19 (25.63)
72.53 (24.78) 71.33 (26.41)
77.82 (26.68) 81.96 (21.99)
76.90 (25.95)
70.34 (28.83) 61.36 (33.99)
79.61 (28.50) 79.79 (27.73)
0.120
0.130 0.000
0.719 0.043
Overall scale 81.11 (17.40) 78.41 (21.23) 74.96 (22.70) 72.34 (27.13) 0.026 Overall scale 81.11 (17.40) 78.41 (21.23) 74.96 (22.70) 72.34 (27.13) 0.026 (a) WRFQ, Work Role Functioning Questionnaire. Hypothesis 4 (partially) confirmed. 56‐65 (N=57) (a) WRFQ, Work Role Functioning Questionnaire. Hypothesis 4 (partially) confirmed. Conclusions
Conclusions
1. The WRFQ‐SpV was validated in different studies and appears to be a reliable and valid instrument to measure health‐related work functioning in Spanish‐speaking populations.
2. The results provide evidence of the responsiveness of the instrument, suggesting the possibility of its use in evaluative studies since it was able to detect (true) changes over time.
1. The WRFQ‐SpV was validated in different studies and appears to be a reliable and valid instrument to measure health‐related work functioning in Spanish‐speaking populations.
2. The results provide evidence of the responsiveness of the instrument, suggesting the possibility of its use in evaluative studies since it was able to detect (true) changes over time.
BIBLIOGRAFIA:
BIBLIOGRAFIA:
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Ramada JM, Serra C, Delclós GL. Adaptación cultural y validación de cuestionarios de salud: revisión y recomendaciones metodológicas. Salud Publica Mex. 2013;55:57‐66.
Ramada JM, Serra C, Amick III BC, Castaño J, Delclos GL. Cross‐Cultural Adaptation of the Work Role Functioning Questionnaire to Spanish Spoken in Spain. J Occup Rehabil. 2013; [Epub ahead of print]. Ramada JM, Serra C, Amick III BC, Abma FI, Castaño JR, Pidemunt G, Bültmann U, Delclos GL. Reliability and validity of the Work Role Functioning Questionnaire (Spanish version). [Submitted for peer‐review].
Ramada JM, Delclos GL, Amick III BC, Abma FI, Castaño JR, Pidemunt G, Bültmann, Serra C.Responsiveness of the Work Role Functioning Questionnaire (Spanish version). J Occup Environ Med. [In Press 2013].
18‐35 (N=148) 36‐45 (N=121) 46‐55 (N=123) 183
Ramada JM, Serra C, Delclós GL. Adaptación cultural y validación de cuestionarios de salud: revisión y recomendaciones metodológicas. Salud Publica Mex. 2013;55:57‐66.
Ramada JM, Serra C, Amick III BC, Castaño J, Delclos GL. Cross‐Cultural Adaptation of the Work Role Functioning Questionnaire to Spanish Spoken in Spain. J Occup Rehabil. 2013; [Epub ahead of print]. Ramada JM, Serra C, Amick III BC, Abma FI, Castaño JR, Pidemunt G, Bültmann U, Delclos GL. Reliability and validity of the Work Role Functioning Questionnaire (Spanish version). [Submitted for peer‐review].
Ramada JM, Delclos GL, Amick III BC, Abma FI, Castaño JR, Pidemunt G, Bültmann, Serra C.Responsiveness of the Work Role Functioning Questionnaire (Spanish version). J Occup Environ Med. [In Press 2013].
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