A review of health-related work outcome measures and their uses, and recommended measures

Despite the growing recognition that work can contribute to the development of musculoskeletal disorders,(1,8) there are almost no data on whether and how physicians investigate the contribution of work to patients' health status or the influence of health status on work performance. This is particularly true of primary care, where much of the medical care for patients with work-related low back pain is provided.(51) As more patients with musculoskeletal injuries show up in primary care settings, it will become important to document health-related work outcomes and incorporate into practice outcome tools that enable the physician to obtain a quick and accurate accounting of needed information about patients' work. Health-related work outcomes relate to a person's labor market status: Is a person working or not working? How well is he or she working? Did the person return to a job of pay and skill comparable to the preinjury job? Outcomes can incorporate time: How long has a person been out of work? How many hours, days, or weeks has a person been reported absent? Is the person working full- or part-time? How many hours does the person perform at full effectiveness? Finally, health-related work outcomes can capture the interplay between a person's health status and work role performance: How difficult is it for a person with a given health status to perform work activities? Typically, health-related work outcomes have not specifically referred to unpaid work activities, such as volunteer work or household labor. The authors support the importance of capturing both paid and unpaid work outcomes, but in this article, paid work is the focus. Multiple publications in the literature contribute conceptually and methodologically to the health-related work outcomes field. These range from industrial psychology and labor economics to health services research, epidemiology, and pharmacoeconomics. In this paper, a window into health-related work outcomes research is created by considering the reasons for measuring these outcomes and briefly reviewing and illustrating several classes of measures. The advantages and limitations of each measure will be discussed, as the authors draw examples from own work. Although prior work has focused on upper extremity musculoskeletal disorders, the general principles for using health-related work outcomes are similar for researchers studying back injuries and disorders. In addition, a new work-related health outcome tool for measuring successful return to work (RTW) is discussed to illustrate a new class of measures, Hereafter, health-related work outcomes as are referred to as work outcomes.