title: Content validity of global measures for at-work productivity in patients with rheumatic diseases: an international qualitative study.
abstract: To identify from a patient's perspective, difficulties and differences in the comprehension of five global presenteeism measures in patients with inflammatory arthritis and OA across seven countries.
  
  
  
  Seventy patients with a diagnosis of inflammatory arthritis or OA in paid employment were recruited from seven countries across Europe and Canada. Patients were randomly allocated to be cognitively debriefed on 3/5 global measures [Work Productivity Scale - Rheumatoid Arthritis, Work Productivity and Activity Impairment Questionnaire (WPAI), Work Ability Index, Quality and Quantity questionnaire, and WHO Health and Work Performance Questionnaire (HPQ)], with the WPAI debriefed in all patients as a standard measure of comparison between countries and patients. NVivo was used to code the data into four themes: construct and anchor, time recall, reference frame, and attribution.
  
  
  
  Discrepancies were found in the interpretation of the word performance (HPQ) between countries, with Romania and Sweden relating performance to sports rather than work. Seventy percent of patients considered that a 7-day recall (WPAI) can accurately represent how their disease affects work productivity. The compared to normal reference (Quality and Quantity questionnaire) was reportedly too ambiguous, and the comparison with colleagues (HPQ), made many feel uncomfortable. Overall, 29% of patients said the WPAI was the most relevant to them, making it the most favoured measure.
  
  
  
  Overall, patients across countries agree that the construct of work productivity in the last 7 days can accurately reflect the impact of disease while at work. Some current constructs to assess at-work productivity are not interchangeable between languages.
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, suzanne.verstappen@manchester.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Leggett
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University, Maastricht, the Netherlands.
authors.forename: Antje
authors.initials: A
authors.lastname: van der Zee-Neuen
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University, Maastricht, the Netherlands.
authors.forename: Annelies
authors.initials: A
authors.lastname: Boonen
authors.affiliation: Mobility Program Clinical Research Unit, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Dorcas
authors.initials: D
authors.lastname: Beaton
authors.affiliation: Internal Medicine and Rheumatology Clinic, Dr. Ion Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Mihai
authors.initials: M
authors.lastname: Bojinca
authors.affiliation: National Rheumatoid Arthritis Society, Maidenhead, UK.
authors.forename: Ailsa
authors.initials: A
authors.lastname: Bosworth
authors.affiliation: Department of Rheumatology, Université Pierre et Marie Curie, Paris, France.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Dadoun
authors.affiliation: Department of Rheumatology, Université Pierre et Marie Curie, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
authors.affiliation: Department of Clinical Sciences Lund, Section of Rheumatology, Lund University and Skane University Hospital, Lund, Sweden.
authors.forename: Sofia
authors.initials: S
authors.lastname: Hagel
authors.affiliation: Canadian Arthritis Patient Alliance, Toronto, ON.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hofstetter
authors.affiliation: Arthritis Research Centre of Canada, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Lacaille
authors.affiliation: Mobility Program Clinical Research Unit, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Denise
authors.initials: D
authors.lastname: Linton
authors.affiliation: Internal Medicine and Rheumatology Clinic, Dr. Ion Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Carina
authors.initials: C
authors.lastname: Mihai
authors.affiliation: Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
authors.forename: Ingemar F
authors.initials: IF
authors.lastname: Petersson
authors.affiliation: Arthritis Research Centre of Canada, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Pam
authors.initials: P
authors.lastname: Rogers
authors.affiliation: Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy and.
authors.forename: Carlo
authors.initials: C
authors.lastname: Sciré
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, Arthritis Research UK/MRC Centre for Work and Health, University of Southampton, Southampton, UK.
authors.forename: Suzanne M M
authors.initials: SM
authors.lastname: Verstappen
mesh_terms: D000203:Activities of Daily Living; D001172:Arthritis, Rheumatoid / Q000503:physiopathology*; D002170:Canada; D003071:Cognition; D004185:Disability Evaluation; D004526:Efficiency / Q000502:physiology*; D004651:Employment / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007600:Judgment; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D009784:Occupational Diseases / Q000503:physiopathology*; D010003:Osteoarthritis / Q000503:physiopathology*; D057240:Patient Preference; D000071066:Patient Reported Outcome Measures; D000069597:Presenteeism / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: cognitive debriefing interview; content validity; global measures; patient-reported outcomes; presenteeism; work productivity