title: Work Ability Index predicts application for disability pension after work-related medical rehabilitation for chronic back pain.
abstract: OBJECTIVE
  To determine whether the Work Ability Index (WAI), a short 7-item self-report questionnaire addressing issues of perceived disability, impairment, and expectations for resuming work, predicts application for disability pension, recommendations for further treatment, and other adverse work-related criteria in patients with chronic back pain after rehabilitation.
  
  
  METHODS
  Cohort study with 3-month follow-up.
  
  
  METHODS
  Seven inpatient rehabilitation centers.
  
  
  METHODS
  Patients (N=294; 168 women; mean age, 49.9y) with chronic back pain.
  
  
  METHODS
  The WAI was completed at the beginning of rehabilitation. All patients were treated according to the German rehabilitation guidelines for chronic back pain and work-related medical rehabilitation.
  
  
  METHODS
  Application for disability pension, as assessed by a postal questionnaire 3 months after discharge.
  
  
  RESULTS
  Receiver operating characteristic curve analysis of the association between the WAI at baseline and subsequent application for disability pension revealed an area under the curve of .80 (95% confidence interval [CI], .62-.97). Youden index was highest when the WAI cutoff value was ≤20 points (sensitivity, 72.7%; specificity, 82.2%; total correct classification, 81.7%). After adjusting for age and sex, persons with a baseline WAI score of ≤20 points had 15.6 times (95% CI, 3.6-68.2) higher odds of subsequent application for disability pension, 4.9 times (95% CI, 1.5-16.8) higher odds of unemployment, and 6 times (95% CI, 2.4-15.2) higher odds of long-term sick leave at follow-up.
  
  
  CONCLUSIONS
  The WAI could help rehabilitation professionals identify patients with back pain with a high risk of a subsequent application for disability pension.
authors.affiliation: Department for Rehabilitation Medicine, Coordination Centre for Applied Rehabilitation Research, Hannover Medical School, Hannover. Electronic address: bethge.matthias@mh-hannover.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Bethge
authors.forename: Christoph
authors.initials: C
authors.lastname: Gutenbrunner
authors.forename: Silke
authors.initials: S
authors.lastname: Neuderth
mesh_terms: D000328:Adult; D001416:Back Pain / Q000534:rehabilitation*; D002908:Chronic Disease; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010415:Pensions / Q000706:statistics & numerical data*; D012372:ROC Curve; D057566:Self Report; D014938:Work Capacity Evaluation
keywords: AUC; Back pain; HRQOL; ICD-10; International Classification of Diseases–10th Revision; Medical Outcomes Study 36-Item Short-Form Health Survey; Needs assessment; Pensions; Questionnaires; ROC; Rehabilitation; SES; SF-36; WAI; WMR; Work Ability Index; area under the curve; health-related quality of life; receiver operating characteristic; standardized effect size; work-related medical rehabilitation