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RehabilitationMeasuresDatabase

Work Limitations Questionnaire-25

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Purpose

A 25-item questionnaire used to measure the degrees to which health conditions interfere with specific components of job performance and the productivity impact of these work limitations.

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Instrument Details

Acronym WLQ

Area of Assessment

Occupational Performance

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Cost Description

Free of charge for noncommercial applications

Key Descriptions

  • Includes four scales: Time Management scale, Physical Demands scale, Mental-Interpersonal demands scale, Output demands scale
  • Scale score range from 0 (limited none of the time) to 100 (limited all of the time)
  • Represent the reported amount of time in the prior two weeks respondents were limited on-the-job
  • WLQ scores can be converted into a potential estimate of productivity loss

Number of Items

25

Time to Administer

5-10 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Instrument Reviewers

Eliza Tilson, College of William & Mary ’21 

ICF Domain

Activity

Measurement Domain

Participation & Activities

Considerations

  • Several variations of this questionnaire exist in the literature (WLQ-25, WLQ-16, WLQ-8)
  • Time Management scale consists of five items, Physical Demands scale has six items, the Mental/Interpersonal scale has nine items, Output Demands scale has five items
  • The score describes the amount of time in the last 2 weeks respondents’ were limited on the job
  • A total WLQ index score can be calculated and converted in order to estimate productivity loss
  • Available in English and over 30 official language translations

Arthritis

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Normative Data

Rheumatoid Arthritis: (Walker et al. 2005, n = 836; mean age 53.3 years ± 10.5 years; 77% of subjects female; 39.4% of subjects college graduates; mean and median hours worked were 36.9 (± 13.9) and 40.0 respectively; 6.0% of subjects worked 10 hours or less; reported health kept patients from performing their work 3.9 days ± 7.4 in the last 30 days; number of limited days in last six months 20.7 ± 40.7)

 

  • 5.9 (SD 5.6)

Rheumatoid arthritis: (Lerner et al. 2001, n = 121; mean age 41.3 years ± 11.1; 27.3% male; 85.1% White; education mean: 15.1 (1.9))

 

Scale

Items

Mean

SD

48-Item WLQ

 

 

 

  • Time Demands

9

32.5

27.4

  • Physical Demands

11

32.4

34.5

  • Mental Demands

14

32.9

25.0

  • Interpersonal demands

7

21.4

26.2

  • Output demands

7

25.7

26.2

25-Item WLQ

 

 

 

  • Time Demands

5

36.6

35.3

  • Physical Demands

6

32.2

33.3

  • Mental /Interpersonal Demands

9

28.8

25.5

  • Output demands

5

26.0

26.0

Internal Consistency

Rheumatoid Arthritis: (Walker et al. 2005)

  • High alpha reliability for WLQ components
    • Time Management Demands (TMS) (alpha = 0.87)
    • Physical Demands (PDS) (alpha = 0.83)
    • Mental Demands (MDS) (alpha = 0.83)
    • Output Demands (ODS) (alpha = 0.84)

Rheumatoid Arthritis: (Lerner et al. 2001)

Scale

Cronbach α

48-Item WLQ

 

  • Time Demands

0.89

  • Physical Demands

0.96

  • Mental Demands

0/94

  • Interpersonal demands

0.91

  • Output demands

0.91

25-Item WLQ

 

  • Time Demands

0.89

  • Physical Demands

0.89

  • Mental /Interpersonal Demands

0.91

  • Output demands

0.88

Construct Validity

Rheumatoid Arthritis: (Walker et al. 2005)

  • Inversely associated with SF-36 Mental Component Score (r = - 0.60) and Physical Component Score (r=- 0.49)
    • Fatigue (r=0.50)
    • Pain (r=0.46)
    • Health Assessment Questionnaire (HAQ) (r=0.56)
    • HAQ-II (r=0.54)
  • Weaker associations with WLQ and SF-36:
    • Days unable to perform (r=0.29)
    • Days activities cut down (r=0.38)
    • Education level (r=- 0.13)
    • Annual earnings (r= - 0.10)

 

  • Correlations of these variables with HAQ
    • Days unable to perform (r=0.30)
    • Days activities cut down (r=0.37)
    • Education level (r=- 0.15)
    • Annual earnings (r=- 0.20)

 

  • No association found between the WLQ index and Rheumatoid Arthritis duration (coefficient = 0.02)

Floor/Ceiling Effects

Rheumatoid Arthritis: (Lerner et al. 2001)

48-Item WLQ

% Floor

% Ceiling

  • Time Demands

10.1

0

  • Physical Demands

19.3

1.8

  • Mental Demands

6.4

0

  • Interpersonal demands

27.5

0

  • Output demands

15.6

0

25-Item WLQ

 

 

  • Time Demands

13.9

0.9

  • Physical Demands

20.9

1.7

  • Mental /Interpersonal Demands

14.8

0

  • Output demands

16.5

0

Osteoarthritis

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Normative Data

Osteoarthritis: (Lerner et al. 2002, n = 230; mean age 53.7 years ± 7.1; 65.4% female; 94.7% Caucasian; highest-level education: 34.8% high school, 37.9% college, 27.3% post graduate; occupation: 56.1% non-manual, 25.2% sales and service, 17.0% manual, 1.7% missing; 10.5% self-employed)

 

Scale

No. items

Meana

SD

Physical demands

6

23.4

22.2

Time management

5

28.7

31.5

Mental-interpersonal demands

9

20.3

27.1

Output demands

6

21.8

26.7

 

 

Healthy controls: (Lerner et al. 2002, n = 37; mean age 45.0 years ± 6.91; 54.1% female; 94.6% Caucasian; highest-level education: 27.8% high school, 55.5% college, 16.7% post graduate; occupation: 37.8% non-manual, 46.0% sales and service, 16.2% manual, 0% missing; 11.1% self-employed)

 

WLQ Scale (Range: 0–100)a

Unadjusted Means (SE)

Adjusted Means (SE)b

 

Group

 

Group

P-value

 

Osteoarthritis (n = 230)

Healthy Controls (n = 37)

P-value

Osteoarthritis (n = 230)

Healthy Controls (n = 37)

 

Physical demands

23.4 (1.5)

4.5 (1.4)

<0.001

22.7 (24.7)

8.5 (21.2)

0.0001

Time management

28.7 (2.1)

7.2 (3.1)

<0.001

28.5 (32.8)

10.6 (28.7)

0.002

Mental-interpersonal demands

20.3 (1.8)

10.6 (2.7)

0.004

19.9 (28.4)

11.4 (24.6)

0.110

Output demands

21.8 (1.8)

7.2 (2.8)

<0.001

21.2 (27.6)

8.8 (23.9)

0.014

 

Internal Consistency

Osteoarthritis: (Lerner et al. 2002)

  • Cronbach’s alpha values
    • Physical demands (α=0.93)
    • Time management (α=0.95)
    • Mental-interpersonal demands (α=0.97)
  • Output demands (α=0.96)

Construct Validity

Osteoarthritis: (Lerner et al. 2002)

  • High item-to-scale correlation coefficients: Mental-Interpersonal, Time Management, and Output Demands scales (0.79-0.92)
  • Comparatively lower item-to-scale correlation in Physical Demands scale (0.72-0.82)

Floor/Ceiling Effects

Osteoarthritis: (Lerner et al. 2002

  • Percent Highest limitations for OA patients
    • Physical demands (0.9)
    • Time management (2.2)
    • Mental-interpersonal demands (1.3)
    • Output demands (1.8)

 

  • Percent Lowest limitations for OA patients
    • Physical demands (20.4)
    • Time management (24.9)
    • Mental-interpersonal demands (25.8)
    • Output demands (27.7)

Limb Deficiency

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Normative Data

Upper extremity Deficits: (Roy 2011, n=509, mean age: 45.3 (9.2), 57% female, outpatient clinic)

  • WLQ-25 index score: 10.6 (5.9)
  • WLQ-25 Summed score: 37.5 (18.1)

Construct Validity

Upper extremity Deficits: (Roy 2011)

Scale

WLQ-Index Score

WLQ-25 Summed Score

RA-WIS

QuickDASH

CPG-Total

CPG-Pain

CPG-Disability Score

SPADI-P

WLQ-Index Score

 

.93

.50

.41

.23

.27

.31

.23

WLQ-25 Summed Score

 

 

.53

.41

.22

.29

.31

.27

  • Time-management demands

.69

.73

.44

.37

.10

.14

.19

.17

  • Physical demands

.19

.35

.19

.07

.07

.10

.14

 

  • Mental-interpersonal demands

.78

.81

.44

.41

.18

.25

.21

.23

  • Output demands

.88

.74

.39

.28

.24

.26

.32

.21

RA-WIS

 

 

 

.57

.33

.37

.37

.47

 

a WLQ-25:Work Limitations Questionnaire-25, RA-WIS:Work Instability Scale for Rheumatoid Arthritis, CPG:Chronic Pain Grade Questionnaire, SPADIP:pain subscale of the Shoulder Pain and Disability Questionnaire. Correlations above .50 (moderate [.70r.50] to high [r.70] correlations) are shown in boldface type. * Significant at P.05, ** significant at P.01.

Floor/Ceiling Effects

Upper extremity Deficits: (Roy 2011)

  • 16% Ceiling effect at baseline
  • 29-23% ceiling effect at 6 month follow up

Bibliography

Fehmidah Munir, The Work Limitation Questionnaire, Occupational Medicine, Volume 58, Issue 4, June 2008, Pages 310–311, https://doi.org/10.1093/occmed/kqn039

Jean-Sébastien Roy, Joy C. MacDermid, Benjamin C. Amick, III, Harry S. Shannon, Robert McMurtry, James H. Roth, Ruby Grewal, Kenneth Tang, Dorcas Beaton, Validity and Responsiveness of Presenteeism Scales in Chronic Work-Related Upper-Extremity Disorders, Physical Therapy, Volume 91, Issue 2, 1 February 2011, Pages 254–266, https://doi.org/10.2522/ptj.20090274

Lerner, D., Amick, B. C., Rogers, W. H., Malspeis, S., Bungay, K., & Cynn, D. (2001). The Work Limitations Questionnaire. Medical Care, 39(1), 72-85. Retrieved from https://www.jstor.org/stable/3767701?seq=1#page_thumbnails_tab_contents

Lerner D, Reed JI, Massarotti E, Wester LM, Burke TA. The Work Limitations Questionnaire's validity and reliability among patients with osteoarthritis. J Clin Epidemiol. 2002 Feb;55(2):197-208. doi: 10.1016/s0895-4356(01)00424-3. PMID: 11809359.

Walker N, Michaud K, Wolfe F. Work limitations among working persons with rheumatoid arthritis: results, reliability, and validity of the work limitations questionnaire in 836 patients. J Rheumatol. 2005 Jun;32(6):1006-12. PMID: 15940759.

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