Validity, reliability, and responsiveness of the work productivity and activity impairment questionnaire in Crohn's disease. The relationship among multiple patient-reported outcomes measures for patients with ulcerative colitis receiving treatment with MMX® formulated delayed-release mesalamine A new validation of the Spanish Work Productivity and Activity Impairment Questionnaire-Crohn's disease version. The Validity and Reproducibility of a Work Productivity and Activity Impairment Instrument Patient‐Reported Outcomes Data From REVEAL at the Time of Enrollment (Baseline): A Prospective Observational Study of Patients With Polycythemia Vera in the United States The effects of adalimumab treatment and psoriasis severity on self-reported work productivity and activity impairment for patients with moderate to severe psoriasis. Response and remission are associated with improved quality of life, employment and disability status, hours worked, and productivity of patients with ulcerative colitis Effect of Adalimumab on Clinical Outcomes and Health-related Quality of Life Among Patients With Ulcerative Colitis in a Clinical Practice Setting: Results From InspirADA Construct Validity and Responsiveness of the Single-Item Presenteeism Question in Patients With Lower Back Pain for the Measurement of Presenteeism The effect of etanercept on work productivity in patients with early active rheumatoid arthritis: results from the COMET study. Acetyl-L-Carnitine Supplementation During HCV Therapy With Pegylated Interferon-α 2b Plus Ribavirin: Effect on Work Performance; A Randomized Clinical Trial The Short Inflammatory Bowel Disease Questionnaire: a quality of life instrument for community physicians managing inflammatory bowel disease. CCRPT Investigators. Canadian Crohn's Relapse Prevention Trial. TOTALL: high cost of allergic rhinitis—a national Swedish population-based questionnaire study Adalimumab improves patient-reported outcomes and reduces indirect costs in patients with moderate to severe Crohn's disease: results from the CARE trial. Health-related quality of life, work productivity, and health care resource utilization of subjects with irritable bowel syndrome: baseline results from LOGIC (Longitudinal Outcomes Study of Gastrointestinal Symptoms in Canada), a naturalistic study. Health-Related Quality of Life and Productivity Losses in Patients With Depression and Anxiety Disorders Assessing Health Status in Inflammatory Bowel Disease Using a Novel Single-Item Numeric Rating Scale The Impact of a Workplace-Based Weight Loss Program on Work-Related Outcomes in Overweight Male Shift Workers Does primary sclerosing cholangitis impact quality of life in patients with inflammatory bowel disease? Development and validation of a rapid, generic measure of disease control from the patient's perspective: the IBD-Control questionnaire Effects on Presenteeism and Absenteeism From a 1-Year Workplace Randomized Controlled Trial Among Health Care Workers Obesity and Presenteeism: The Impact of Body Mass Index on Workplace Productivity The Crohn's and colitis knowledge score: a test for measuring patient knowledge in inflammatory bowel disease
BACKGROUND Crohn 's disease ( CD ) is a chronic inflammatory bowel disease usually diagnosed in early adult life and characterized by unpredictable flares and debilitating symptoms such as diarrhea , abdominal pain , and fever , which can interfere with a patient 's ability to work and perform daily activities . OBJECTIVE The aim of this study was to assess the validity , reliability , and responsiveness of the Work Productivity and Activity Impairment question naire in CD ( WPAI : CD ) . METHODS The WPAI : CD was tested in CD patients enrolled in a 26-week r and omized clinical trial of cer-tolizumab pegol versus placebo . Discriminative validity of WPAI : CD absenteeism , presenteeism(reduced on-the-job effectiveness ) , overall work productivity loss ( absenteeism + presenteeism ) , and activity impairment scores was assessed relative to 5 measures of disease severity and health status : CD Activity Index ( CDAI ) , Short Form-36 physical component summary ( PCS ) and mental health component summary ( MCS ) scores , Inflammatory Bowel Disease Question naire ( IBDQ ) , and the 5-dimensional EuroQoL health-related quality -of-life visual analog scale ( EQ-VAS ) . Responsiveness was assessed by comparing changes in WPAI : CD scores from baseline to week 26 for patients in remission ( CDAI < 150 points ) versus no remission . St and ardized Response Means ( SRMs ) were calculated to evaluate the magnitude of the changes . RESULTS A total of 662 patients ( mean [ range ] age , 37.4 [ 18 - 77 ] years ; male , 288 [ 43.5 % ] ; white , 629 [ 95.0 % ] ) were enrolled in the study . Patients with CD of the worst severity ( CDAI > median ) showed significantly higher impairment in work ( + 10.5 % ) and activities ( + 10.4 % ) versus patients with " best health " ( no problems ) ( both , P < or = 0.001 ) . Patients with " worst " IBDQ , PCS , MCS , and EQ-VAS scores also showed significantly higher impairments in work ( IBDQ , VAS -24.2 % ; PCS , -24.1 % ; MCS , -15.9 % ; EQ-VAS , -16.5 % ) and activities ( IBDQ , -23.3 % ; PCS , -21.8 % ; MCS , -16.5 % ; EQ-VAS , -17.2 % ) versus " best " scores ( all , P < 0.05 ) . There were significant differences between WPAI : CD impairment scores for patients in remission versus patients failing to achieve remission ( P < 0.05 ) . SRMs were small ( ie , < 0.5 ) in the nonre-mission group , and moderate to large ( ie , > 0.5 ) for patients in remission . CONCLUSIONS The discriminative validity , reliability , and responsiveness of the WPAI : CD were demonstrated . The WPAI : CD may be useful for evaluating drug impact on CD Purpose Ulcerative colitis ( UC ) is associated with impaired health-related quality of life ( HRQL ) and work-related outcomes ( WRO ) . This analysis examined correspondences among measures of HRQL and WRO in patients with UC , as well as the magnitude of each measure ’s responsiveness to disease activity and treatment . Methods An open-label , prospect i ve trial of delayed-release mesalamine tablets formulated with MMX ® technology included 8 weeks of treatment for patients with active mild-to-moderate UC ( n = 137 ) and 12 months of maintenance treatment for patients with quiescent UC ( n = 206 ) . Spearman correlations ( ρ ) measured inter-domain associations across measures of generic HRQL [ 12-item Short-Form Health Survey ( SF-12v2 ) ] , disease-specific HRQL [ Short Inflammatory Bowel Disease Question naire ( SIBDQ ) ] , and disease-specific WRO [ Work Productivity and Activity Impairment for Specific Health Problems ( WPAI : SHP ) ] . Responsiveness to disease activity and treatment was assessed for each instrument . Results Changes in scores from baseline to week 8 were moderately correlated across all instrument domains : 65 of 80 ( 81 % ) between-instrument inter-domain correlations were of moderate magnitude ( 0.30 < ρ < 0.70 ) , with an average magnitude of 0.42 [ 95 % confidence interval ( CI ) 0.38–0.46 ] . Associations between symptom measures were stronger for SIBDQ ( |average ρ| = 0.41 ; 95 % CI 0.34–0.48 ) and WPAI : SHP ( 0.40 ; 0.30–0.47 ) than SF-12v2 ( 0.30 ; 0.27–0.34 ) . SIBDQ was most sensitive to treatment [ effect size ( dz ) for change from baseline to week 8 = 0.62 ; 95 % CI 0.35–0.89 ] , followed by WPAI : SHP ( dz = 0.43 ; 0.32–0.54 ) and SF-12v2 ( dz = 0.33 ; 0.27–0.39 ) . Conclusion While the SIBDQ showed the greatest overall responsiveness to disease activity and treatment , all three patient-reported outcomes instruments provided complementary interpretive information regarding the impact of UC treatment OBJECTIVES The Work Productivity and Activity Impairment Question naire ( WPAI ) is an instrument that measures work impairment in the setting of different diseases . One previous study validating the WPAI in Crohn 's disease ( CD ) patients suggested that its reproducibility may be unsatisfactory . This study evaluated the validity and reproducibility of the Spain Spanish version of the WPAI question naire in CD patients . METHODS In a prospect i ve study , convergent validity was tested comparing WPAI with quality of life and CD activity indices . Known-groups validity was assessed by comparing WPAI scores in CD patients with active versus inactive disease . Reproducibility of repeated tests was evaluated by comparing two WPAI measures obtained two to four weeks apart in stable patients . RESULTS One hundred eight patients were included in the various steps of the analysis . The WPAI showed adequate known groups validity and convergent validity . The reproducibility of the test and , specifically , that of the evaluation of presenteeism ( the impairment of productivity while working ) were good . CONCLUSIONS This study confirms the validity of WPAI for measuring work impairment  in CD patients . In contrast to previous studies , the test reproducibility was adequate Summary The construct validity of a quantitative work productivity and activity impairment ( WPAI ) measure of health outcomes was tested for use in clinical trials , along with its reproducibility when administered by 2 different methods . 106 employed individuals affected by a health problem were r and omised to receive either 2 self-administered question naires ( self administration ) or one self-administered question naire followed by a telephone interview ( interviewer administration ) . Construct validity of the WPAI measures of time missed from work , impairment of work and regular activities due to overall health and symptoms , were assessed relative to measures of general health perceptions , role ( physical ) , role ( emotional ) , pain , symptom severity and global measures of work and interference with regular activity . Multivariate linear regression models were used to explain the variance in work productivity and regular activity by validation measures . Data generated by interviewer-administration of the WPAI had higher construct validity and fewer omissions than that obtained by self-administration of the instrument . All measures of work productivity and activity impairment were positively correlated with measures which had proven construct validity . These validation measures explained 54 to 64 % of variance ( p < 0.0001 ) in productivity and activity impairment variables of the WPAI . Overall work productivity ( health and symptom ) was significantly related to general health perceptions and the global measures of interference with regular activity . The self-administered question naire had adequate reproducibility but less construct validity than interviewer administration . Both administration methods of the WPAI warrant further evaluation as a measure of morbidity Micro‐ Abstract Data from REVEAL ( Prospect i ve Observational Study of Patients With Polycythemia Vera in US Clinical Practice s ; n = 2309 ) , the first study of its kind , confirm that many patients experience quality of life and work productivity impairments that might negatively affect their lives . In the future , longitudinal data from REVEAL will be important for evaluating how such burdens change over time . Background Patients with polycythemia vera ( PV ) often experience symptoms that adversely affect their quality of life ( QoL ) . The ongoing , prospect i ve , observational REVEAL ( Prospect i ve Observational Study of Patients With Polycythemia Vera in US Clinical Practice s ) study was design ed to collect contemporary data regarding burden of disease , clinical management , patient‐reported outcomes ( PROs ) , and health care re source utilization from adult patients with PV in the United States . Patients and Methods Data on PROs were collected at enrollment using the Myeloproliferative Neoplasm Symptom Assessment Form Total Symptom Score ( MPN‐SAF TSS ; range , 0‐100 ) ; the European Organization for Research and Treatment of Cancer – Core Quality of Life Question naire , version 3.0 ( EORTC QLQ‐C30 ; range , 0‐100 ) ; and the Work Productivity and Activity Impairment Question naire – Specific Health Problem ( WPAI‐SHP ; range , 0%‐100 % ) . Results Among 2309 patients , mean ( SD ) disease duration was 5.8 ( 6.1 ) years and Charlson Comorbidity Index was 3.4 ( 0.8 ) ; 54.0 % ( 1247/2309 ) were male . Mean ( SD ) MPN‐SAF TSS was 18.8 ( 15.5 ) . The most common symptoms were fatigue ( 80.1 % [ 1844/2302 ] ) , early satiety ( 60.9 % [ 1402/2302 ] ) , and inactivity ( 57.6 % [ 1324/2302 ] ) . The most common severe symptoms were fatigue ( 16.8 % [ 387/2302 ] ) , itching ( 13.4 % [ 308/2302 ] ) , and inactivity ( 11.8 % [ 271/2302 ] ) . The mean ( SD ) EORTC QLQ‐C30 global health status/QoL score was 73.1 ( 23.2 ) : mean functional subscale scores ranged from 80.5 ( 23.9 ) for cognitive functioning to 85.7 ( 24.6 ) for social functioning . The mean WPAI‐SHP activity impairment score was 19.7 % ( n = 2300 ) . Employed patients had mean WPAI‐SHP scores for absenteeism , presenteeism , and overall work impairment of 3.2 % ( n = 810 ) , 12.1 % ( n = 807 ) , and 13.4 % ( n = 802 ) , respectively . Conclusion These data confirm that many patients with PV experience symptoms , QoL impairments , and work productivity impairments that negatively affect their lives . Longitudinal data from REVEAL will be important for evaluating how PROs change over time in these patients BACKGROUND Psoriasis significantly impairs work productivity and daily activities . OBJECTIVES We sought to examine the effects of adalimumab on psoriasis-related work productivity and activity impairment and associations between the impairment and psoriasis severity in patients with moderate to severe psoriasis . METHODS Data were from the first 16 weeks of the R and omized controlled EValuation of adalimumab Every other week dosing in moderate to severe psoriasis TriAL ( REVEAL ) . Outcomes as measured by the Work Productivity and Activity Impairment Question naire for Psoriasis ( WPAI-Psoriasis ) included employment status , total work productivity impairment , and total activity impairment . Logistic regression and analyses of covariance were used to assess the effects of adalimumab and treatment response ( ≥ 75 % improvement in Psoriasis Area and Severity Index responders ) on WPAI-Psoriasis outcomes . Longitudinal generalized estimating equations and Pearson correlation coefficients were used to assess associations between WPAI outcomes and psoriasis severity . RESULTS Greater improvements in total work productivity impairment and total activity impairment were observed with adalimumab treatment versus placebo ( 15.5 and 11.1 percentage points , respectively ; P < .001 ) . Unemployment rate , total work productivity impairment , and total activity impairment were significantly associated with greater baseline psoriasis severity . Changes in WPAI outcomes were significantly correlated with greater psoriasis severity . The Dermatology Life Quality Index had stronger associations with changes in WPAI outcomes compared with clinical severity measures ( Psoriasis Area and Severity Index and Physician Global Assessment ) . LIMITATIONS REVEAL only included WPAI data for 16 weeks . Therefore , long-term impact of adalimumab treatment on productivity outcomes could not be assessed . In addition , information on occupational job title or industry was not collected and data were not adjusted for psoriatic arthritis . CONCLUSIONS Adalimumab reduced psoriasis-related  work productivity and activity impairment in patients with moderate to severe psoriasis Background : Impairment of health‐related quality of life , employment , and productivity has been documented in patients with moderate to severe ulcerative colitis . Methods : Using prospect ively collected data from the Active Ulcerative Colitis Trials 1 and 2 , we examined the impact of clinical response or remission , as defined using the Mayo score , on health‐related quality of life , employment , disability , productivity , and hours worked per week . These analyses were based on observed data and included all 728 patients , regardless of their r and omized treatment group ( i.e. ,  placebo and infliximab patients were grouped for analysis ) . Changes in Inflammatory Bowel Disease Question naire ( IBDQ ) and Medical Outcomes Study 36‐Item Short Form ( SF‐36 ) scores among nonresponders , responders , and patients in remission were compared . In addition , changes in employment , disability status , productivity , and hours worked per week of patients in clinical remission and patients not in clinical remission were compared . Results : Ulcerative colitis patients in clinical response or remission had significantly improved IBDQ and SF‐36 scores at week 30 compared with those of nonresponders ( P < 0.001 ) . Among those not employed at baseline , including those receiving disability compensation , greater percentages of patients in remission at week 30 were employed ( 20.6 % ) and not receiving disability compensation ( 58.8 % ) than were those not in remission ( 8.3 % and 20.0 % , respectively ; P < 0.05 for both comparisons ) . At week 30 , improvements from baseline in productivity and both actual and fully productive hours worked per week were greater for patients in remission compared with those not in remission ( P < 0.05 for all three comparisons ) . Conclusions : These results confirm the validity of response and remission as defined using the Mayo score Abstract Background and Aims R and omised trials have described the benefits of adalimumab [ ADA ] for ulcerative colitis [ UC ] ; however , few data are available on health-related quality of life [ HRQL ] and health care costs in clinical practice . Methods InspirADA , a multicentre , prospect i ve study , evaluated the effect of ADA in patients with moderate to severe UC treated according to usual clinical practice . Outcomes assessed were : Simple Clinical Colitis Activity Index [ SCCAI ] response/remission rates ; changes in HRQL ; all-cause direct costs ; and UC-related direct and indirect costs from baseline to Week 26 . Results Data from 463 patients were analysed . At Week 26 , 67 % ( 95 % confidence interval [ CI ] : 62 % , 71 % ) of patients achieved response ; 48 % [ 95 % CI : 44 % , 53 % ] were in remission . For the overall population , significant [ all p < 0.001 ] improvements from baseline to Week 26 were observed for the Short Inflammatory Bowel Disease Question naire [ SIBDQ ] ( mean change ± st and ard deviation [ SD ] : 17.4 ± 14.5 ) and the European Quality of Life—5 Dimensions—5 Level [ EQ-5D-5L ] ( index : 0.1 ± 0.2 ; visual analogue scale [ VAS ] : 19.5 ± 25.8 ) . Parallel improvements were seen in work productivity [ 11 % absolute decrease in absenteeism ; 25 % absolute decrease in impairment while working ; and 27 % absolute decrease in impairment of ability to perform daily activities , all p < 0.001 ] . Among study completers , cumulative all-cause medical costs and UC-related medical costs were significantly [ both p < 0.001 ] reduced by 59 % and 77 % , respectively , 6 months after initiation of therapy compared with the preceding 6 months . The safety profile  of ADA was consistent with that observed in previous clinical trials . Conclusions ADA therapy in usual clinical practice is effective at improving and maintaining symptomatic control , improving HRQL , and decreasing costs of medical care among patients with UC Study Design . Validity and responsiveness study using a r and omized clinical trial and prospect i ve cohort study of patients with low back pain ( LBP ) . Objective . To provide evidence for construct validity and responsiveness to change of a single-item presenteeism question ( SIPQ ) in patients with LBP . Summary of Background Data . The SIPQ is a simple , easy to administer tool that has been used to measure the impact of back pain on reduced productivity at work ( presenteeism ) as a st and alone measure . Evidence supporting the validity and responsiveness of the SIPQ among patients with back pain is however lacking . Methods . The  SIPQ was administered to patients consulting for back pain in a r and omized controlled trial ( N = 851 ) and a cohort intervention study ( N = 922 ) . Construct validity was assessed using convergent , divergent , and known-group validity . The validity investigation included assessing associations between the SIPQ and pain , disability , psychological , health status , and quality of life measures . Responsiveness was assessed using external indicators of change as comparators , evaluating correlation of clinical change scores and effect size statistics . Results . Moderate to strong correlations were found between presenteeism and pain ( r : 0.44–0.77 ) , disability ( r : 0.53–0.70 ) , and 12-Item Short Form Health Survey physical dimensions ( r : −0.66 to −0.55 ) . Presenteeism was strongly associated with disease-specific pain and disability scales . The SIPQ was responsive to changes in productivity — presenteeism change scores indicated strong correlation with change scores , and high responsiveness in distribution- and anchor-based testing . Conclusion . The SIPQ is a potentially valid and responsive tool for assessing the impact of back pain on presenteeism . This SIPQ could , with relative ease , facilitate further research on the estimation of presenteeism within economic evaluation studies of musculoskeletal conditions , thus providing policymakers with estimates of economic impact of musculoskeletal disease . Further evidence is , however , merited to assess its relationship with st and ardized presenteeism question naires . Level of Evidence : OBJECTIVES To compare the impact of the combination of etanercept ( ETN ) and MTX with MTX alone on work productivity among  MTX-naïve patients with active early RA over a 12-month period . METHODS The COMET ( COmbination of Methotrexate and ETanercept ) trial was a 2-year double-blind r and omized clinical trial . Absenteeism during the first year was measured and it included : ( i ) number of missed workdays ; ( ii ) reduced working time ; and ( iii ) number of stopped workdays . Each absenteeism measure was estimated using a mixed model , and their variations were estimated by bootstrapping . As a sensitivity analysis , the lost workdays due to presenteeism ( reduced performance at work ) was also estimated . RESULTS Two hundred and five patients [ MTX ( n = 100 ) vs ETN + MTX ( n = 105 ) ] , who were working full time or part time at baseline and had at least one follow-up observation , were included in the analysis . Compared with the MTX group , the ETN + MTX group had a maximum of 37 fewer missed workdays or at minimum 22 fewer missed workdays . The associated productivity gain equalled 2586 pounds and 1555 pounds , respectively . When additionally accounting for presenteeism , the total improvement could be as high as 42 ( 95 % CI 16 , 69 ) fewer lost workdays representing a productivity gain of 2968 pounds . CONCLUSIONS Our results demonstrated that early treatment with ETN + MTX led to a significant attenuation of absenteeism among patients with early active RA . These productivity gains represent benefit beyond the traditional measures of clinical and radiographic improvements . Further research to simultaneously measure both absenteeism and presenteeism is warranted Background : The health status of employees with chronic hepatitis C has major implication s for organizations and labour market . Objectives : To assess the effects of Acetyl-L-Carnitine administration on work productivity , daily activity , and fatigue in subjects with chronic hepatitis C treated with Pegylated-Interferon-α2b and Ribavirin .  Patients and Methods : In this prospect i ve , r and omized , placebo controlled , double blind clinical trial , 30 subjects ( Group A ) with chronic hepatitis , received Pegylated-Interferon-α2b ( 1.5 mg/kg per week ) plus Ribavirin and placebo , while 32 subjects ( Group B ) received the same dosage of Pegylated-Interferon-α2b plus Ribavirin plus 2 g Acetyl-L-Carnitine twice per day , for 12 months . Work productivity loss , impairment in daily activities , presenteeism , absenteeism , have been assessed using the Work Productivity and Activity Impairment question naire . We also evaluated severity of fatigue , mental fatigue and physical fatigue . Results : Significant difference were observed in physical fatigue , mental fatigue and severity of fatigue , aspartate aminotransferase , alanine aminotransferase , and viremia after 12 months treatment . In Group B we observed a significant decrease of presenteeism and daily activity impairment after 6 months , 12 months and at follow up . A significant increase of work productivity was observed after 12 months and at follow up . Conclusions : Office workers with chronic hepatitis C , treated with Pegylated-Interferon-α2b plus Ribavirin , had work performance loss . In subjects treated with Acetyl-L-Carnitine supplementation we observed increased daily activity and reduced presenteeism and fatigue . Acetyl-L-Carnitinegroup had a smaller reduction of productivity comparing to placebo group OBJECTIVE Health-related quality of life ( HRQOL ) affects outcome in chronic diseases such as inflammatory bowel disease ( IBD ) . The inflammatory bowel disease question naire ( IBDQ ) , a disease-specific HRQOL question naire , can define changes in health status in IBD , but simple instruments are needed for daily application . The present study proposed to develop a short version of the IBDQ , the SIBDQ , for community physicians . METHODS Using data from a clinical trial in 149 patients with Crohn 's disease , 10 items were selected ( by forward stepwise regression ) that best explained the variance of the IBDQ or dimensional scores ( bowel , systemic , social , emotional ) . The validity , reliability , and responsiveness of the SIBDQ were then assessed in 150 different patients with Crohn 's disease and 45 with ulcerative colitis . All scores were reported with a 7-point scale ( 1 = poor HRQOL , 7 = optimum HRQOL ) . RESULTS Mean SIBDQ scores were similar ( p = 0.22 ) in Crohn 's patients among 14 participating centers at study entry . Mean scores were lower in active Crohn 's disease ( range 4.00 - 4.92 ) than inactive disease ( range 4.67 - 5.83 ; p = 0.0015 ) . In active ulcerative colitis , the mean SIBDQ was 4.79 + /- 1.17 compared to 5.90 + /- 0.80 ( p = 0.0006 ) in inactive disease . The SIBDQ explained 92 % and 90 % of the IBDQ variance in Crohn 's disease and ulcerative colitis , respectively . In patients with stable Crohn 's disease , the test-retest reliability coefficient was 0.65 and Crohnbach 's alpha was 0.78 , indicating good reliability . In patients with Crohn 's disease who relapsed during follow-up , the mean SIBDQ decreased by -0.93 + 0.55 ( p = 0.001 ) . CONCLUSION The SIBDQ is valid , reliable , and able to detect meaningful clinical changes in HRQOL that might occur in the office setting Allergic rhinitis is a global illness with a well-recognised impact on quality of life and work performance . Comparatively little is known about the extent of its economic impact on society . The TOTALL study estimates the total cost of allergic rhinitis using a sample representing the entire Swedish population of working age . A question naire focused on allergic rhinitis was mailed out to a r and om population of Swedish residents , aged 18–65 years .  Health-care contacts , medications , absenteeism ( absence from work ) and presenteeism ( reduced working capacity at work ) were assessed , and the direct and indirect costs of allergic rhinitis were calculated . Medication use was evaluated in relation to the ARIA guidelines . In all , 3,501 of 8,001 ( 44 % ) answered the question naire , and 855 ( 24 % ) of these reported allergic rhinitis . The mean annual direct and indirect costs because of allergic rhinitis were € 210.3 and € 750.8 , respectively , result ing in a total cost of € 961.1 per individual/year . Presenteeism represented 70 % of the total cost .  Antihistamines  appear to be used in excess in relation to topical steroids , and the use of nasal decongestants was alarmingly high . The total cost of allergic rhinitis  in Sweden , with a population of 9.5 million , was estimated at € 1.3 billion annually . These unexpectedly high costs could be related to the high prevalence of disease , in combination with the previously often underestimated indirect costs . Improved adherence to guidelines might ease the economic burden on society BACKGROUND AND AIMS Crohn 's disease negatively affects patients '  quality of life and ability to work . We investigated the impact of adalimumab on work productivity , daily activities , and quality of life in an open-label trial ( N=945 ) . The population comprised both infliximab-naïve and -exposed patients , including infliximab primary non-responders . METHODS Patients received adalimumab induction therapy ( 160 mg/80 mg at Weeks 0/2 ) , followed by adalimumab 40 mg every other week for up to 20 weeks ( patients with flares/non-response could receive 40 mg weekly at/after Week 12 ) . The Work Productivity and Activity Impairment Question naire and Short Inflammatory Bowel Disease Question naire were assessed . Indirect cost savings were estimated based on the average work productivity improvements at Week 20 . RESULTS Mean baseline scores indicated severe productivity impairment and poor quality of life . At Week 20 , 60 % of infliximab-naïve and 47 % of infliximab primary non-responders achieved clinical ly important improvements ( ≥9 points ) on the Short Inflammatory Bowel Disease Question naire , and 51 % and 43 % , respectively , achieved the minimum clinical ly important difference ( improvement ≥7 percentage points ) for total work productivity impairment ( non-responder imputation ) . At Week 20 , 64 % of infliximab-naïve and 55 % of infliximab primary non-responders achieved clinical ly important improvements in total activity impairment . Estimated 20-week total indirect productivity-related cost savings were € 3070 per infliximab-naïve patient and € 2059 per infliximab-exposed patient . CONCLUSIONS Adalimumab therapy significantly improved work productivity and disease-specific quality of life for patients with moderate to severe Crohn 's disease . Patients who failed prior infliximab therapy and patients naïve to infliximab benefited from adalimumab , with potentially greater benefits for  infliximab-naïve patients ( NCT00409617 ) BACKGROUND Abdominal pain/discomfort , bloating , and constipation are gastrointestinal dysmotility and sensory symptoms associated with irritable bowel syndrome ( IBS ) . No studies have followed patients with IBS symptoms for 1 year under conditions of routine clinical practice to assess prospect ively the impact of treatments on health outcomes . OBJECTIVE The objective of this ongoing , naturalistic study is to assess the long-term impact of IBS treatments on quality of life ( QOL ) , work productivity , and re source utilization . This report describes the baseline characteristics and patterns of care of the patients enrolled in this study . METHODS Patients with physician-diagnosed IBS symptoms were enrolled from 147 physician sites across Canada between May 4 , 2004 , and March 31 , 2005 . Clinical data were collected at baseline and at the end of the 12-month follow-up ( patients were followed for 1 year between May 4 , 2005 , and March 31 , 2006 ) . Patient-reported outcomes were collected at baseline and at months 1 , 2 , 6 , 9 , and 12 . Health-related QOL , health status , and work productivity were assessed with the IBS-QOL , a 5-item EuroQol descriptive system , and Work Productivity and Activity Impairment question naires , respectively . A re source utilization question naire elicited information on physician ; visits , treatments , and procedures . Baseline data are reported here . RESULTS Data were obtained from 1555 patients ; 85.1 % ( 1320/1552 ) were women . Patients had a mean ( SD ) age of 45.8 ( 15.0 ) years and mean ( SD ) duration of IBS symptoms of 11.4 ( 11.5 ) years . Self-reported bowel patterns were predominantly constipation ( 41.0 % , 587/1433 ) and constipation alternating with diarrhea ( 39.4 % , 564/1433 ) ; 60.3 % ( 938/1555 ) of subjects used > or =3 IBS treatments in the previous 4 weeks . Approximately 50 % of all patients reported distress " quite a bit or " extremely " for abdominal pain , gas , bloating , and constipation . The mean overall IBS-QOL score ( 0 - 100 scale , with 0 indicating poor QOL ) was 66.3 ; food avoidance ( 51.8 ) and health worry ( 59.3 ) were the most serious concerns . Patients reported 5.6 % work absenteeism , 31.4 % presenteeism , and 34.6 % overall work productivity loss , equivalent to 13.8 hours lost productivity per 40-hour workweek . CONCLUSIONS The baseline data from this ongoing , prospect i ve , naturalistic study are consistent with previous findings that suggested significant use of health care re sources with concomitant low QOL and decreased work productivity in patients with IBS symptoms Objectives : To assess the explanatory power of disease severity and health-related quality of life ( HRQOL ) on absenteeism and presenteeism in a working population suffering from depression and /or anxiety disorders . Methods : We used data of a large , multicenter , r and omized trial ( n = 644 ) .  Pearson chi-squared tests , analysis of variance , and multinomial logistic regression analyses were performed to explore associations of the type of the disorder and HRQOL with different types of productivity losses .  Multivariate regression analyses were performed to assess associations with the duration of absenteeism . Results : The type of the disorder , disease severity , and HRQOL were associated with different types of productivity losses . Health-related quality of life and age were significantly associated with the duration of absenteeism . Conclusions : Our findings indicate that HRQOL may significantly explain the type of productivity loss as well as the duration of absenteeism Background Current instruments used to measure disease activity and health-related quality of life in patients with Crohn ’s disease ( CD ) and ulcerative colitis ( UC ) are often cumbersome , time-consuming , and expensive ; although used in clinical trials , they are not convenient for clinical practice . A  numeric rating scale ( NRS ) is a quick , inexpensive , and convenient patient-reported outcome that can capture the patient ’s overall perception of health . Aims The aim of this study was to assess the validity , reliability , and responsiveness of an NRS and evaluate its use in clinical practice in patients with CD and UC . Methods We prospect ively evaluated  patient-reported NRS scores  and measured correlations between NRS and a range of severity measures , including  physician-reported NRS , Crohn ’s disease activity index ( CDAI ) , Harvey-Bradshaw index ( HBI ) , inflammatory bowel disease question naire ( IBDQ ) , and C-reactive protein ( CRP ) in patients with CD . Subsequently , we evaluated the correlation between the NRS and st and ard measures of health status ( HBI or simple colitis clinical activity index [ SCCAI ] ) and laboratory tests ( sedimentation rate [ ESR ] , CRP , and fecal calprotectin ) in patients with CD and UC . Results The patient-reported NRS showed excellent correlation with CDAI ( R2 = 0.59 , p < 0.0001 ) , IBDQ ( R2 = 0.66 , p < 0.0001 ) , and HBI ( R2 = 0.32 , p < 0.0001 ) in patients with CD . The NRS showed poor , but statistically significant correlation with SCCAI ( R2 = 0.25 , p < 0.0001 ) in patients with UC . The NRS did not correlate with CRP , ESR , or calprotectin . The NRS was reliable and responsive to change . Conclusions The NRS is a valid , reliable , and responsive measure that may be useful to evaluate patients with CD and possibly UC Objective : The aim of this study was to evaluate the impact of a workplace-based weight loss program ( Workplace POWER [ Preventing Obesity Without Eating like a Rabbit ] ) for male shift workers on a number of work-related outcomes . Methods : A total of 110 overweight/obese ( body mass index = 25–40 ) ( mean [ SD ] age = 44.3 [ 8.6 ] years ; body mass index = 30.5 [ 3.6 ] ) male employees at Tomago Aluminium ( New South Wales , Australia ) were r and omized to either ( i ) Workplace POWER program ( n = 65 ) or ( ii ) a 14-week wait-list control group ( n = 45 ) . Men were assessed at baseline and 14-week follow-up for weight , quality of life , sleepiness , productivity at work ( presenteeism ) , absenteeism , and workplace injuries . Results : Retention was 81 % . Intention-to-treat analysis using linear mixed models revealed a significant intervention effect for weight , quality of life ( mental ) , presenteeism , absenteeism , and injuries . Conclusions : The Workplace POWER weight loss program improved a number of important work-related outcomes in male shift workers Background : Impairment of health‐related quality of life ( HRQoL ) is an important concern in inflammatory bowel disease ( IBD ; ulcerative colitis [ UC ] , Crohn 's disease [ CD ] ) . Between 2%–10 % of patients with IBD have primary sclerosing cholangitis ( PSC ) . There has been limited examination of the disease‐specific HRQoL in this population compared to non‐PSC IBD controls . Methods : This was a retrospective , case – control study performed at a tertiary referral center . Cases comprised 26 patients with a known diagnosis of PSC and IBD ( 17 UC , 9 CD ) . Three r and om controls were selected for each case after matching for IBD type , gender , age , and duration of disease . Disease‐specific HRQoL was measured using the Short Inflammatory Bowel Disease Question naire ( SIBDQ ) . Disease activity for CD was measured using the Harvey – Bradshaw index ( HB ) and using the UC activity index for UC . Independent predictors of HRQoL were identified . Results : There was no significant difference in the age , gender distribution , or disease duration between PSC‐IBD and controls . There was no difference in use of immunomodulators or biologics between the 2 groups . Mean SIBDQ score was comparable between PSC‐IBD patients ( 54.5 ) and controls ( 54.1 ) , both for UC and CD . Likewise , the disease activity scores were also similar ( 2.8 versus 3.1 , P = 0.35 ) . On multivariate analysis , higher disease activity score ( −1.33 , 95 % confidence interval [ CI ] 95 % CI −1.85 to −0.82 ) and shorter disease duration were predictive of lower HRQoL. Coexisting PSC did not influence IBD‐related HRQoL. There was a higher proportion of permanent work disability in PSC‐IBD ( 7.7 % ) compared to controls ( 0 % ) . Conclusions : PSC does not seem to influence disease‐specific HRQoL in our patients with IBD but is associated with a higher rate of work disability . ( Inflamm Bowel Dis 2010 Introduction The use of patient reported outcome measures to support routine inflammatory bowel disease ( IBD ) care is not widespread and suggests that existing question naires lack relevance to day-to-day decisions or are too cumbersome to administer . We developed a simple , generic tool for capturing disease control from the patient 's perspective to address these barriers . Methods Development based on literature review , patient focus groups/interviews and a steering group , defining a limited set of generic questions . The ‘ IBD-Control ’ question naire comprises 13 items plus a visual analogue scale ( VAS ) ( 0–100 ) . Prospect i ve validation involved baseline completion of  IBD-Control , quality of life ( QoL ) question naire ( UK-IBD-Q )  ,  EuroQol ( EQ-5D ) , Hospital Anxiety and Depression Score ;  and  clinician assessment  ( blinded to question naire ; recording Harvey-Bradshaw Index or Simple Clinical Colitis Activity Index ; Global Clinician Rating ; treatment outcome ) . Results 299 patients returned baseline surveys ( Crohn 's disease , n=160 ; ulcerative colitis , n=139 ) and 138 attended for repeat visits .  Completion time ( mean ; SD ) : 1 min 15 s ; 25 s ; Internal consistency : Cronbach 's α for all 13 items ( 0.85 ) ; for subgroup of eight questions ( ‘ IBD-Control-8 ’ ; 0.86 ) . Strong correlation between IBD-Control-8 and IBD-Control-VAS ( r=0.81 ) . Test-retest reliability ( 2 week repeat ) : intra-class correlation=0.97 for IBD-Control-8 and 0.96 for IBD-Control-VAS . Construct validity : Moderate-to-strong correlations between IBD-Control-8 and IBD-Control-VAS versus activity indices , UK-IBD-Q and EQ-5D ( utility ) with r values 0.52–0.86 . Discriminant validity ( mean instrument scores for remission , mild , moderate or severe ) : p<0.001 ( analysis of variance ( ANOVA ) ) . Sensitivity to change : Effect sizes : 0.76–1.44 . Conclusions The IBD-Control is a rapid , reliable , valid and sensitive instrument for measuring overall disease control from the patient 's perspective . Unlike existing patient reported outcome measures , its simplicity , ease-of-use and generic applicability make it a c and i date for supporting routine care Objectives : It is unknown whether workplace interventions successfully improving health outcomes can also provide concurrent improvements in presenteeism and absenteeism . Methods : A 1-year cluster r and omized controlled trial was conducted on 144 employees at a care unit in Denmark . The intervention consisted of calorie-limited diet , physical exercise , and cognitive behavioral training during working hours 1 hour per week . The reference group was offered presentations about healthy lifestyle .  Absenteeism and presenteeism ( productivity , workability , and sickness absence ) were recorded at baseline and after 3 and 12 months of intervention . Results : In intention-to-treat analysis , a significant effect of the intervention was found for productivity after 3 months . Nevertheless , after 12 months no significant effects on absenteeism or presenteeism were found . Conclusions : This study suggests that a worksite intervention , despite successfully reducing overweight , does not induce lasting improvements on absenteeism or presenteeism Objective : To examine whether obesity is associated with increased presenteeism ( health-related limitations at work ) . Methods : R and omly selected manufacturing employees ( n = 341 ) were assessed via height and weight measures , demographic survey , wage data , and the Work Limitations Question naire . The Work Limitations Question naire measures productivity on four dimensions . Analyses of variance and analyses of covariance were computed to identify productivity differences based on body mass index ( BMI ) . Results : Moderately or extremely obese workers ( BMI ≥35 ) experienced the greatest health-related work limitations , specifically regarding time needed to complete tasks and ability to perform physical job dem and s. These workers experienced a 4.2 % health-related loss in productivity , 1.18 % more than all other employees , which equates to an additional $ 506 annually in lost productivity per worker . Conclusions : The relationship between BMI and presenteeism is characterized by a threshold effect , where extremely or moderately obese workers are significantly less productive than mildly obese workers OBJECTIVE : The aim of this study was to develop a valid and reliable question naire assessing patient knowledge of inflammatory bowel disease ( IBD ) and its treatment — the Crohn 's and Colitis Knowledge ( CCKNOW ) Score . METHODS : A total of 30 multiple choice questions were constructed into a draft question naire . This was piloted on a r and om selection of participants with differing IBD knowledge levels ; junior doctors , nurses , and ward clerks . Factor analysis eliminated questions with poor discriminant ability . The result ing 24-item question naire ( CCKNOW score )  was retested on the three groups , and a Kruskal-Wallis test determined the question naire 's ability to discriminate between the groups . Reliability and readability were tested using Cronbach 's α and the Flesch Kincaid reading score . The vali date d CCKNOW was then tested on patients from the Leicestershire IBD data base . RESULTS : CCKNOW scores differed significantly across the groups of doctors , nurses , and ward clerks ( median 22 , 16 , and five , respectively ) T = 40.35 , p < 0.0001 . The reliability was very good with a Cronbach 's α of 0.95 and the readability was also high . The median score on the CCKNOW  for IBD patients was 10 , with no significant difference between ulcerative colitis and Crohn 's disease . Patients who are members of NACC ( National Association of Crohn 's and Colitis ) achieve statistically significantly higher scores than do nonmembers ( difference in medians 4 , 95 % confidence interval 4–6 , p < 0.0001 ) . CONCLUSIONS : The CCKNOW score provides a valuable index of overall knowledge . It is self-administered and psychometric tests show it to be valid , reliable , and readable . It may be used in the future as a tool to evaluate patient education programs
The evidence supports the WPAI as having test-retest reliability ( reproducibility ) over time ; convergent validity , as indicated by moderate correlations with measures of quality of life and moderate-to-strong correlations with measures of disease activity ; known-groups validity , as indicated by differences in WPAI scores between patients with active and inactive disease ; ability ( sensitivity ) to detect change , as indicated by substantial improvement in scores for patients who achieve remission , accompanied by substantial worsening of scores for patients who relapse ; and , responsiveness to treatment , with improvements in scores following treatments that reduce disease activity .
Patients with ulcerative colitis , a type of inflammatory bowel disease , report negative impacts of disease symptoms on work-related outcomes , including absenteeism and presenteeism .
As a way to better underst and the impact of this disease and its treatment on work-related outcomes , the current review examines the use of the Work Productivity and Activity Impairment Question naire ( WPAI ) , a patient-reported outcomes measure of absenteeism , presenteeism , and impairment in other activities , in studies of patients with ulcerative colitis .
This review assesses the measurement properties of the WPAI in this patient population : its reliability , construct validity , ability to detect change , and responsiveness to effective treatments .