title: Reducing work disability in Ankylosing Spondylitis: development of a work instability scale for AS.
abstract: BACKGROUND
  The Work Instability Scale for Rheumatoid Arthritis (RA-WIS) is established and is used by physicians to identify patients at risk of job loss for rapid intervention. The study objective was to explore the concept of Work Instability (a mismatch between an individual's abilities and job demands) in Ankylosing Spondylitis (AS) and develop a Work Instability Scale specific to this population.
  
  
  METHODS
  New items generated from qualitative interviews were combined with items from the RA-WIS to form a draft AS-WIS. Rasch analysis was used to examine the scaling properties of the AS-WIS using data generated through a postal survey. The scale was validated against a gold standard of expert assessment, a test-retest survey examined reliability.
  
  
  RESULTS
  Fifty-seven participants who were in work returned the postal survey. Of the original 55 items 38 were shown to fit the Rasch model (chi(2) 37.5; df 38; p 0.494) and free of bias for gender and disease duration. Following analysis for discrimination against the gold standard assessments 20 items remained with good fit to the model (chi(2) 24.8; df 20; p 0.21). Test-retest reliability was 0.94.
  
  
  CONCLUSIONS
  The AS-WIS is a self-administered scale which meets the stringent requirements of modern measurement. Used as a screening tool it can identify those experiencing a mismatch at work who are at risk of job retention problems and work disability. Work instability is emerging as an important indication for the use of biologics, thus the AS-WIS has the potential to become an important outcome measure.
authors.affiliation: Department of Rehabilitation Medicine, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK. gilworths@aol.com
authors.forename: Gill
authors.initials: G
authors.lastname: Gilworth
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
authors.forename: Nick
authors.initials: N
authors.lastname: Barkham
authors.forename: M Glyn
authors.initials: MG
authors.lastname: Smyth
authors.forename: Philip
authors.initials: P
authors.lastname: Helliwell
authors.forename: Alan
authors.initials: A
authors.lastname: Tennant
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D003625:Data Collection; D004185:Disability Evaluation; D006233:Persons with Disabilities; D004651:Employment / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D016272:Occupational Health; D009790:Occupations; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D018582:Sick Leave; D013167:Spondylitis, Ankylosing / Q000175:diagnosis* / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014938:Work Capacity Evaluation; D016526:Workload; D055815:Young Adult