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Session Overview
Measures in WDP
Wednesday, 05/Jun/2019:
11:30am - 1:00pm

Session Chair: Jan Hartvigsen
Session Chair: Femke Abma
Location: Room 99

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Social Insurance Literacy: What Is It, And Can It Be Measured?

Christian Ståhl1,2, Elin Karlsson1, Jan Sandqvist1

1Linköping University, Sweden; 2HELIX Competence Centre, Linköping, Sweden

Sickness insurance and workers’ compensation systems make decisions of peoples’ eligibility for benefits, commonly based on medical certificates which assesses the ability to work. Previous research has indicated that systems differ in the extent to which they preserve clients’ dignity, and the perceived justice in relation to the system depends on the quality of the assessment process and the communication between the client and the authority. It is further reasonable to expect that the client’s resources and ability to comprehend regulations and processes matter.

In this study, we introduce social insurance literacyas a term to capture the importance of peoples’ social position and resources, and systems’ ability to meet the varying needs of claimants, in relation to how fair a system performs and how equitable it is perceived. The concept is meant to be used as a way of describing the various factors that may influence the justice of social insurance systems, and to offer guidance in how these factors may be operationalized and measured.

The aim of the study is to define social insurance literacy through a scoping literature review of related concepts (health literacy, financial/economic literacy, legal capability/ability, social security literacy, insurance literacy), and a conceptual re-analysis of these in relation to the social insurance field. Specifically, we explore how related concepts are defined and operationalized, and how these definitions and operationalizations may be transformed into a definition and operationalization of social insurance literacy.

The literature study was followed by a workshop where a definition was settled: “Social insurance literacy is the extent to which individuals can obtain information, understand and act on the dynamics of communications, processes and decisions in a social insurance system, and the comprehensibility of the system’s communication”. The study also outlines directions for developing a measure for the concept.

Psychometric Properties of the Work Disability Diagnostic Interview (WoDDI) Used With Workers Having a Musculoskeletal or Common Mental Disorder

Marie-José Durand, Marie-France Coutu

Université de Sherbrooke, Canada

Clinicians and especially new clinicians, need to systematically assess work disability factors to better intervene. The Work Disability Diagnostic Interview (WoDDI) is one promising tool to structure the interview.

Objective To describe (1) construct validity, (2) internal consistency, and (3) interrater reliability of the WoDDI with individuals on sick leave due to musculoskeletal disorders (MSDs) and common mental disorders (CMDs).

Methods A cross-sectional design was used with a non-probability sample. The inclusion criteria for workers were: (1) MSD- or CMD-related sick leave between 3 to 24 months ; (2) enrolled in a rehabilitation program. Trained occupational therapists completed the WoDDI with participants. Self-administered questionnaires (job content questionnaire, psychological distress scale) were also administrated. For interrater reliability, six occupational therapists rated the WoDDI based on standardized case studies (MSD; CMD).

Results 290 workers (140 MSD and 150 CMD) have been evaluated. Self-administered questionnaire results for both groups suggest low decision latitude (≤ 72), high psychological demand (≥ 24) and high psychological distress (≥ 30.95). Regarding for construct validity, exploratory factor analysis (EFA) revealed similar dimensions in both versions (illness representation, clinical judgment of the severity of the medical condition, and high level of work demands). This allowed reducing the number of items by approximately 20 to 40%, depending on the version. Internal consistencies ranged for MSD version from: 0,75 to 0,80 and for CMD version: 0,40 to 0,75. Interrater reliability was satisfactory as regards the nature of the instrument (Cohen’s Kappa from 0,34 to 0,43).

Conclusion Despite the reported limitations, by reducing the number of items included, the content of the WoDDI appears to correlate well with the current scientific literature on the populations under study. It also fits in with a biopsychosocial understanding of individuals on work disability. However, the CMD version of the instrument requires revision and retesting.

Pilot review shows need for a Core Outcome Set for Work Participation (COS-WP)

Margarita Ravinskaya1, Cecilia A.C. Prinsen2, Carel Hulshof1, Jos H. Verbeek3, Regina Kunz4, Miranda Langendam5, Jan L. Hoving1

1Amsterdam UMC, Academic Medical Center, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam, the Netherlands.; 2Amsterdam UMC, VU University Medical Centre, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.; 3Finish Institute of Occupational Health, Cochrane Work, Kuopio, Finland.; 4Academic Unit EbIM, Evidence Based Insurance Medicine, Department of Clinical Research, University of Basel, Switzerland; 5Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health research institute, the Netherlands.

Background: Within the occupational health (OH) and insurance medicine (IM) field ‘work participation’ is an important outcome concept. Not only are there several outcomes related to the ‘work participation’ concept, but the instruments that measure these types of outcomes can vary. Lack of standardisation in outcome measurement and reporting significantly hinders the synthesis of research. We explored the need for a core outcome set (COS) in the field of OH by performing a pilot review to gain insight into reported outcomes, their terms and definitions, and the type of outcome measurement instruments reported in trials.

Methods: We used trials that were included in 7 Cochrane reviews published at Cochrane Work that described a variety of disorders, OH interventions and work participation (WP) outcomes.

Results: In total 82 trials reported on outcomes including: return to work (RTW), sick leave, absenteeism, work status, functional status, productivity, and work functioning. Outcomes were measured at different follow up times ranging from a few weeks to 4 years after baseline; definitions, cut points for RTW or sick leave varied such as time to first day of 100% RTW, cumulative days off work, sick leave rate; mean monthly sick leave days; diverse statistics were included such as rates, means, odds or hazard ratios; and different sources such as self-report data, questionnaires, or administrative databases were used.

Conclusions: The variation in outcomes and measurements highlights the need for a COS-WP which is relevant within the field of OH. The Coronel Institute of OH at the Academic Medical Center in Amsterdam has started an international collaborative project to develop a COS-WP, in collaboration with Cochrane Insurance Medicine and Cochrane Work. We call on the international community of practitioners, clients and researchers in OH and IM to help us join forces for the development of such a core outcome set.

Intensity Of Occupational Physical Activity - Do Self-Reported Rating And Technical Measures Agree?

Mette Korshøj1,2, Nidhi Gupta1, Ole Steen Mortensen2, Andreas Holtermann1,3

1National Research Centre for the Working Environment, Denmark; 2Department of occupational medicine, Holbæk Sygehus, Holbæk, Denmark; 3Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark


Occupational physical activity seems to impact health harmfully. However, the previous studies are predominantly based on self-reports of occupational physical activity which can be biased. One of the proposed harmful factors is intensity of occupational physical activity, which can be self-reported, e.g. rating of perceived exertion (RPE), or objectively measured, e.g. by heart rate reserve (HRR). Yet, knowledge of the agreement between RPE and HRR during occupational physical activity are lacking. Thus, we aimed to investigate this.


A cross-sectional analysis was performed in the DPhacto cohort, including 683 workers from cleaning, manufacturing and transport sectors. RPE was collected by questionnaire (How physically demanding do you normally consider your present work? With a response scale from 1-10, where 10 is most demanding). HRR was obtained by diurnal objective measures of heart rate (HR). HRR was calculated by subtracting the resting HR from the maximal HR. A linear regression model was applied, adjusted for age and sex.


RPE was significantly associated (B 0.06, SE 0.01, 95%CI 0.03 – 0.09) and correlated (R2 0.21, p <0.0001) to %HRR during work. Cardiorespiratory fitness, occupational lifting, BMI and sex significantly biased the difference between RPE and HRR. Mean difference between RPE converted to HR and objectively measured HR was 72 bpm, indicating that RPE may overestimate intensity of occupational physical activity.


RPE and %HRR were significantly associated and correlated; however the mean difference of HR from RPE and objective measures indicated that RPE tend to overestimate intensity of the occupational physical activity.

Cross-Cultural Adaptation of the Chinese version of Work Rehabilitation Questionnaire (C-WORQ)

Yanwen Xu1,2, Xunwen Lo2, Xiaomin Liu2, Ru Huang2

1Yixing Joru Rehabilitation Hospital, China, People's Republic of; 2Guangdong Provincial Work Injury Rehabilitation Hospital


The development of the Work Rehabilitation Questionnaire (WORQ) under the framework of WHO-ICF has proven to be a valid and reliable instrument to assess work functioning. However, the use of WORQ in return to work of workers with work-related injuries is not yet reported. The aims of this study were to translate the English version of WORQ to Chinese version (C-WORQ) and report the psychometric properties of C-WORQ in a group of Chinese workers with work-related injuries.


The forward translation approach was used to translate WORQ from English to Chinese. An expert panel was formed to examine content validity. Internal consistency, test-retest reliability and criterion validity and were analyzed by the intra-class correlation coefficient (ICC) and correlation analysis, respectively. The construct validity was analyzed by the exploratory factor analysis approach.


There were 42 questions related to functioning were consisted in C-WORQ. The ICC was between 0.601 to 0.915 indicating good test-retest reliability (n=29). The C-WORQ demonstrated excellent internal consistency (Cronbach’s Alpha 0.961) (n=108) and principal components analysis revealed that four components were extracted with 61.638% of the variance explained. C-WORQ showed moderate correlation with The Lam Assessment of Stages of Employment Readiness (r=0.541, p<0.001).


C-WORQ is a reliable and valid version of work rehabilitation measures for use in Chinese workers with work-related injuries.

Validation of the Work Assessment Triage Tool for Selecting Rehabilitation Interventions for Injured Workers

Douglas P. Gross1, Ivan A. Steenstra2, William S. Shaw3, Parnian Yousefi1, Colin Bellinger4, Osmar R. Zaïane1

1University of Alberta, Canada; 2Morneau Shepell, Canada; 3University of Connecticut; 4Dalhousie University, Canada

Background - Musculoskeletal disorders are leading causes of work disability. Effective interventions exist for promoting return-to-work in patients with musculoskeletal conditons (i.e., functional restoration, multidisciplinary biopsychosocial rehabilitation, workplace-based interventions, etc.), but it is difficult to select the optimal intervention for specific patients. The Work Assessment Triage Tool (WATT) is a clinical decision support tool created to help clinicians select interventions. The WATT algorithm categorizes patients based on individual, occupational, and clinical characteristics according to likelihood of successful return-to-work following rehabilitation. The WATT was developed using machine learning analyses on a dataset from workers’ compensation claimants being considered for rehabilitation between December 2009 and January 2011. Internal validation showed acceptable classification accuracy, but WATT has not been tested beyond the original development sample.

Purpose - Our purpose was to externally validate the WATT.

Methods - A population-based cohort design was used, with administrative and clinical data extracted from a Canadian provincial compensation database. Data were available on workers being considered for rehabilitation between January 2013 and December 2016. Data was obtained on patient characteristics (i.e., age, sex, education level), clinical factors (i.e., diagnosis, part of body affected, pain and disability ratings), occupational factors (ie. occupation, employment status, modified work availability), type of rehabilitation program undertaken, and return-to-work outcomes (receipt of wage replacement benefits 30 days after assessment). Analysis included classification accuracy statistics of WATT recommendations for selecting interventions that lead to successful RTW outcomes.

Results - The sample included 5296 workers of which 33% had spinal conditions. Sensitivity of the WATT was 0.16 while specificity was 0.84. Overall accuracy was 73.0%.

Conclusion - Accuracy of the WATT rules for selecting successful rehabilitation programs in the new dataset was modest. Algorithm revision and further validation is needed, although it appears rules developed using machine learning may be limited by lack of reproducibility.

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