Int Arch Occup Environ Health (2011) 84:705–712 The association between decreased work ability and pro- ductivity loss at work diVered for the absence or presence of poor psychosocial work factors. Especially, job control seems an important factor to remain productive when expe- riencing decreased work ability. Johansson and Lundberg (2004) have proposed in their model ‘illness Xexibility’ that employees with a high degree of control of their work tasks or adjustment latitude are more likely to go to work because they can modify their work tasks in such a way as to be able to carry on despite impaired health. A comparable mecha- nism for productivity loss at work could be envisaged in the sense of having opportunities to change tasks in such a way that they can still be performed despite health impairments. Social support was not measured in the current study, but it was shown that among workers with impaired health due to early inXammatory joint conditions, low support from col- leagues predicted a reduced productivity at work (Geuskens et al. 2008). Likewise, eVort–reward imbalance and job dis- satisfaction were not measured, but strong associations were found between both psychosocial factors with produc- tivity loss at work in a population of oYce workers report- ing work-related neck/shoulder or hand/arm symptoms during the past 3 months (van den Heuvel et al. 2007). The importance of job control in continuing work or remaining active appears also from literature on return to work and sickness absence for speciWc diagnostic groups (Duijts et al. 2007; Werner and Cote 2009). In conclusion, this study conWrmed that workers whose work ability was decreased reported more productivity loss at work. Job control buVered the loss of productivity at work among workers with decreased work ability. These results conWrm that the relation between impaired health and decreased work output depends on autonomy of the worker. Hence, levels of productivity loss within speciWc diagnostic disease groups will not be equal for all workers. Job control can be increased by giving workers the opportu- nities to decide themselves for example on their working goal, working method, or working hours, taking into account existing quality norms. ConXict of interest The authors declare that they have no conXict of interest. Open Access This article is distributed under the terms of the Cre- ative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. 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