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Work Rehabilitation Questionnaire

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Purpose

The Work Rehabilitation Questionnaire (WORQ) is a patient questionnaire to assess and evaluate functioning in vocational rehabilitation settings using the ICF Core Set for Vocational Rehabilitation.

Link to Instrument

Instrument Details

Acronym WORQ

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Time to Administer

15-25 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Instrument Reviewers

Tri Pham, Medical Student from UT Southwestern

Non-Specific Patient Population

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Test/Retest Reliability

Participants at Vocational Rehab Center (Finger et al., 2014; n = 52; mean age = 36.75 (12.4))

  • Adequate test-retest reliability (ICC = 0.789)

Internal Consistency


Participants at Vocational Rehab Center (Finger et al., 2014; n = 74; mean age = 37.68 years (12.7))
  • Excellent internal consistency (Cronbach’s alpha = 0.887)

Construct Validity

Convergent Validity

Participants at Vocational Rehab Center (Finger et al., 2014; n = 74; mean age = 37.68 years (12.7))

  • Adequate convergent validity between WORQ with quality of life as measured by EuroQol-single index (r = -0.419), Short Form-36 (r = -0.353), and WHO Quality of Life-BREF (r = -0.439)
  • Adequate convergent validity between QORZ with Short Form-36 subsections ‘emotion role’ (r = -0.513) and ‘mental function’ (r = -0.358)
  • Poor convergent validity between WORQ with Short Form-36 subsections ‘general health’ (r = 0.164), ‘physical functional’ (r = -0.215), ‘physical role’ (r = -0.298), ‘social functioning’ (r = 0.115), ‘pain’ (r = 0.294), ‘vitality’ (r = 0.049), and ‘anticipated health in 1 year’ (r = 0.151)
  • Adequate convergent validity between WORQ with depression as measured by Becks Depression Inventory II (r = 0.511)

Content Validity

“Content validity for the context of VR is assumed due to the fact that the items in the questionnaire were derived from the ICF Core Set for VR. The Core Set was rigorously developed using input from patients, clinicians, experts, and the literature to assess and describe the relevant factors concerning functioning in VR independent of the health condition or VR setting.” (Finger et al., 2014)

Face Validity

“Looking at face validity, professionals rated WORQ to be comprehensive concerning functioning in VR but WORQ seemed to miss additional contextual factors such as work place descriptions or personal factors such as coping strategies. Patients in general appreciated the breadth of coverage of WORQ (face validity), as they felt that the questionnaire allowed them to reflect upon their daily problems in functioning that hinder them to successfully return to work. Through WORQ, the patients felt as it seemed that they were able to express and convey their physical problems as well as their psychosocial issues and needs.” (Finger et al., 2014)

Musculoskeletal Conditions

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Standard Error of Measurement (SEM)

Patients with MSK Conditions in Vocational Rehab (Finger, Wicki-Roten, Leger, & Escorpizo, 2019; n = 89; mean age = 44 years (2.4);  self-reported French version was used)
  • SEM for entire group: 0.323 points out of the maximal average score of 10

 

Patients with MSK Conditions Undergoing Inpatient Rehab (Finger, Escorpizo, & Tennant, 2019; n = 221; mean age = 43.47 years (SD=10.9); self-reported French version was used)

  • SEM for entire group: 1.53
  • SEM for entire group: 3.05 (using shortened version: WORQ-BRIEF)

 

Patients with MSK Conditions in Outpatient Physical Therapy (Husmann et al., 2019; n = 51; mean age = 39.96 years (12.9); self-reported German version of WORQ was used)

  • SEM for entire group: 13.53 points out of maximal sum score of 400

Minimal Detectable Change (MDC)

Patients with MSK Conditions in Vocational Rehab (Finger, Wicki-Roten, Leger, & Escorpizo, 2019; n = 89; mean age = 44 years (2.4); self-reported French version was used)

  • MDC for entire group: 0.895 on a 0-10 scale

Patients with MSK Conditions Undergoing Inpatient Rehab (Finger, Escorpizo, & Tennant, 2019; n = 221; mean age = 43.47 years (SD=10.9); self-reported French version was used)

  • MDC for entire group: 4.23% or .42 on 0-10 scale.
  • MDC for entire group: 8.47% or .85 on 0-10 scale (using shortened version: WORQ-BRIEF)

Patients with MSK Conditions in Outpatient Physical Therapy (Husmann et al., 2019; n = 51; mean age = 39.96 years (12.9); self-reported German version of WORQ was used)

  • MDC for entire group: 8.09% or 32.35 points out of 400.

Test/Retest Reliability

Patients with MSK Conditions in Vocational Rehab (Finger, Wicki-Roten, Leger, & Escorpizo, 2019; n = 89; mean age = 44 years (2.4); self-reported French version was used)

  • Excellent test-retest reliability (ICC = 0.935)
  • Excellent test-retest reliability (ICC = 0.913), using shortened version: WORQ-BRIEF

Patients with MSK Conditions in Outpatient Physical Therapy (Husmann et al., 2019; n = 51; mean age = 39.96 years (12.9); self-reported German version of WORQ was used)

  • Adequate test-retest reliability (ICC = 0.79)

Mixed MSK Patient Population (Vermeulen et al., 2019; n = 20; self-reported Dutch version was used)

  • Adequate test-retest reliability (ICC = 0.85)

Internal Consistency

Patients with MSK Conditions Undergoing Inpatient Rehab (Finger, Escorpizo, & Tennant, 2019; n = 221; mean age = 43.47 years (SD=10.9); self-reported French version was used)

  • Excellent person separation index (ICC = 0.969)
  • Excellent person separation index (ICC = 0.918), using shortened version: WORQ-BRIEF

 

Patients with MSK Conditions in Vocational Rehab (Finger, Wicki-Roten, Leger, & Escorpizo, 2019; n = 89; mean age = 44 years (2.4; self-reported French version was used)

  • Excellent internal consistency (Cronbach’s alpha = 0.968)
  • Excellent internal consistency (Cronbach’s alpha = 0.955), using shortened version: WORQ-BRIEF

 

Mixed MSK Patient Population (Vermeulen et al., 2019; n = 114; mean age = 43.4 year (11.5); 21 patients had hand/wrist injuries and 93 had fibromyalgia; self-reported Dutch version was used)

  • Excellent internal consistency (Cronbach’s alpha = 0.95)

 

Patients with MSK Conditions in Outpatient Physical Therapy (Husmann et al., 2019; n = 51; mean age = 39.96 years (12.9); self-reported German version of WORQ was used)

  • Excellent internal consistency (Cronbach’s alpha = 0.94)

 

Reliability results – internal consistency of the WORQ

Questionnaire (n=number of items)

Cronbach’s alpha

WORK Scale (n=40)

0.94

WORQ Subscale: emotion (n=6)

0.91

WORQ Subscale: cognition (n=10)

0.90

WORQ Subscale: dexterity (n=10)

0.90

WORQ Subscale: mobility (n=4)

0.84

Construct Validity

Convergent Validity

Patients with MSK Conditions in Vocational Rehab (Finger, Wicki-Roten, Leger, & Escorpizo, 2019; n = 89; mean age = 44 years (2.4); self-reported French version was used)

  • Excellent convergent validity between WORQ and general functioning (r = 0.662)
  • Adequate convergent validity between WORQ and Hospital Anxiety and Depression Scales (HADS) ‘anxiety score’ (r = 0.564) and ‘depression score’ (r = 0.57)
  • Adequate convergent validity between WORQ and current state of health (r = 0.552)

 

Patients with MSK Conditions in Outpatient Physical Therapy (Husmann et al., 2019; n = 51; mean age = 39.96 years (12.9); self-reported German version of WORQ was used)

  • Excellent convergent validity between WORQ with WHO Disability Assessment Schedule 2.0 version (r = 0.81) and general rating of functioning with NRS 0-10 (r = 0.62)
  • Excellent convergent validity between WORQ and EuroQoL Instrument: “Today’s Health” (r = -0.49)
  • Excellent convergent validity between WORQ subscale ‘emotion’ with Hospital Anxiety and Depression Scales (r = 0.71)
  • Adequate convergent validity between WORQ with Hospital Anxiety and Depression Scales (r = 0.55)
  • Adequate convergent validity between WORQ with quality of life as measured by WHO Quality of Life Questionnaire (r = -0.47)
  • Poor convergent validity between WORQ and number of comorbidities (r = 0.10)

 Examining Work-Related Functioning in a Physical Therapy Outpatient Clinic: Validity and Reliability of the Work Rehabilitation Questionnaire (WORQ)

Questionnaires WORQ
Average Sum score
WORQ
Emotion Score
WORQ
Cognition Score
WORQ
Dexterity Score
WORQ
Mobility Score
EQ-5D scale: “Today’s health” − 0.49** − 0.28* − 0.26 − 0.38** − -0.46**
HADS          
 HADS Overall score 0.55** 0.71** 0.53** 0.38** 0.13
 HADS Anxiety score 0.55** 0.66** 0.43** 0.42** 0.20
 HADS Depression score 0.49** 0.62** 0.54** 0.31* 0.09
WHODAS 2.0 – 12-item version 0.81** 0.53** 0.52** 0.65** 0.67**
General rating of functioning (NRS 0–10) 0.62** 0.36* 0.34* 0.32* 0.29*
WHOQoL − 0.47** − 0.35* − 0.34* − 0.33* − 0.38**
Number of comorbidities, median/range 0.10 0.10 0.04 0.11 0.08
Time off work (month) 0.22 0.22 0.30* 0.06 − 0.06
  1. EQ-5D EuroQol Instrument, HADS Hospital Anxiety and Depression Scales, WHODAS 2.0 WHO Disability Assessment Schedule 2.0 version, NRS numeric rating scale, WHOQoL World Health Organization Quality of Life Questionnaire
  2. *Correlation is significant at the 0.05 level
  3. **Correlation is significant at the 0.01 level

Mixed MSK Patient Population (Vermeulen et al., 2019; n = 21; patients had either hand/wrist injuries or fibromyalgia; self-reported Dutch version was used)

  • Excellent convergent validity between WORQ with Short Form-36 subsections ‘physical functioning’ (r = -0.71), ‘role limitations-physical’ (r = -0.64), and ‘vitality’ (r = -0.65)
  • Poor convergent validity between WORQ with Michigan Hand Outcomes Questionnaire subsection ‘work’ (r = 0.25)
  • Poor convergent validity between WORQ with Disabilities of the Arm, Shoulder, and Hand subsection ‘optional: work’ (r = 0.28)
  • Adequate convergent validity between WORQ with Disabilities of the Arm, Shoulder, and Hand subsection ‘disability/symptom’ (r = 0.56)
  • Excellent convergent validity between WORQ ‘social’ factor with Short Form-36 subsection ‘general health’ (r = -0.73)
  • Adequate convergent validity between WORQ with Short Form-36 subsections ‘mental health’ (r = -0.43), ‘social functioning’ (r = -0.43), ‘bodily pain’ (r = -0.50), and ‘general health’ (r = -0.39)
  • Excellent convergent validity between WORQ ‘Physical’ factor with Short Form-36 subsections ‘physical functioning’ (r = -0.84) and ‘bodily pain’ (r = -0.61)
  • Adequate convergent validity between WORQ ‘Cognition’ factor with Short Form-36 subsections ‘vitality’ (r = -0.52), ‘mental health’ (r = -0.57), and ‘social functioning’ (r = -0.58)
  • Adequate convergent validity between WORQ ‘Physical’ factor with Short Form-36 subsections ‘role limitations-physical’ (r = -0.59) and ‘vitality’ (r = -0.49)
  • Adequate convergent validity between WORQ ‘Mood’ factor with Short Form-36 subsections ‘mental health’ (r = -0.58), physical functioning (r = -0.51), vitality (r = -0.51), and ‘bodily pain’ (r = -0.42)
  • Adequate convergent validity between WORQ ‘Emotions’ factor with Short Form-36 subsection ‘role limitations-emotional’ (-0.39) and ‘mental health’ (r = -0.58)
  • Poor convergent validity between WORQ ‘Social’ factor with Short Form-36 subsection ‘social functioning’ (r = -0.26)
  • Adequate convergent validity between WORQ ‘ADL’ factor with Michigan Hand Outcomes Questionnaire subsection ‘Overall ADL’ (r = -0.49)

 

Discriminant Validity

Mixed MSK Patient Population (Vermeulen et al., 2019; n = 21; patients had either hand/wrist injuries or fibromyalgia; self-reported Dutch version was used)

  • Excellent discriminant validity between WORQ with Michigan Hand Outcomes Questionnaire subsection ‘aesthetics’ (r = -0.08), the Tampa Scale for Kinesiophobia (r = -0.03), and the E-Link Dynamometer (r = 0.17)
  • Adequate to excellent discriminant validity between all WORQ factors with Michigan Hand Outcomes Questionnaire subsection ‘satisfaction’ (r = -0.11 to -0.37)
  • Excellent discriminant validity between all WORQ factors with Michigan Hand Outcomes Questionnaire subsection ‘aesthetics’ (r = -0.20 to 0.21)
  • Adequate to excellent discriminant validity between all WORQ factors with Tampa Scale for Kinesiophobia (r = -0.31 to 0.26)
  • Adequate to excellent discriminant validity between all WORQ factors with E-Link Dynamometer (r = -0.02 to 0.34)

 

Construct validity (n = 21) using Spearman’s rank correlation coefficient

From: Cross-Cultural Adaptation and Psychometric Evaluation of the Dutch Version of the Work Rehabilitation Questionnaire (WORQ-VL)

  Factor 1 Factor 2 Factor 3 Factor 4 Factor 5 Factor 6 Factor 7 WORQ-VL (sum score)
Cognition Physical Mood ADL Sensory Emotions Social
SFa-36
 Physical functioning − 0.40 − 0.84** − 0.51* − 0.60** − 0.22 − 0.17 − 0.38 − 0.71**
 Role limitations—physical − 0.45* − 0.59** − 0.37 − 0.44* − 0.23 − 0.39 − 0.40 − 0.64**
 Role limitations—emotional − 0.30 0.25 0.05 0.22 − 0.32 − 0.39 − 0.35 − 0.01
 Vitality (energy‎/fatigue) − 0.52* − 0.49* − 0.51* − 0.33 − 0.41 − 0.53* − 0.41 − 0.65**
 Mental health − 0.57** − 0.15 − 0.58** − 0.18 − 0.28 − 0.58** − 0.15 − 0.43*
 Social functioning − 0.58** − 0.35 − 0.34 − 0.11 − 0.41 − 0.31 − 0.26 − 0.43*
 Bodily pain − 0.31 − 0.61** − 0.50* − 0.42 0.02 − 0.23 − 0.15 − 0.50*
 General health − 0.41 − 0.31 − 0.10 0.09 − 0.57 − 0.16 − 0.73** − 0.39
MHQ-DLVb
 Overall hand function − 0.10 − 0.23 − 0.21 − 0.33 − 0.11 − 0.19 − 0.05 − 0.28
 Overall ADL − 0.02 − 0.42 − 0.21 − 0.49* 0.09 − 0.07 0.05 − 0.31
 Work − 0.12 0.36 0.27 0.26 0.18 − 0.15 − 0.03 0.25
 Pain − 0.27 − 0.18 − 0.03 0.09 0.04 − 0.27 − 0.36 − 0.14
 Aesthetics − 0.04 − 0.07 0.21 − 0.20 − 0.10 0.00 0.05 − 0.08
 Satisfaction − 0.18 − 0.37 − 0.34 − 0.29 − 0.11 − 0.29 − 0.22 − 0.38
 MHQ total score − 0.05 − 0.02 0.05 − 0.15 0.05 − 0.10 − 0.02 − 0.05
DASHc
 Disability/symptom 0.18 0.57* 0.62** 0.65** − 0.05 0.20 0.17 0.56*
 Optional: sports/music − 0.08 0.44 0.31 0.56* − 0.47 0.13 − 0.14 0.31
 Optional: work 0.03 0.28 0.45 0.50* − 0.20 0.05 − 0.14 0.28
TSKd 0.19 − 0.08 − 0.31 − 0.15 0.18 0.26 0.20 − 0.03
E-link dynamometer (injury side) 0.00 0.26 0.31 0.04 0.29 − 0.02 0.34 0.17
  1. Correlations in bold correspond to an expected high correlation (11 hypotheses convergent validity)
  2. Correlations in italic correspond to an expected non or weak correlation (4 hypotheses discrimant validity)
  3. *Correlation is significant at the 0.05 level (2-tailed)
  4. **Correlation is significant at the 0.01 level (2-tailed)
  5. aShort-Form Health survey 36 Dutch Language Version
  6. bMichigan Hand Outcomes Questionnaire, Dutch Language Version
  7. cDisabilities of the Arm, Shoulder, and Hand
  8. dTampa Scale for Kinesiophobia

(Vermeulen et al., 2019; n = 21; patients had either hand/wrist injuries or fibromyalgia; self-reported Dutch version was used)

Content Validity

“In the context of the content evaluation, all patients found that WORQ covered all relevant aspects of work-related functioning.” (Finger et al., 2019; n = 89; self-reported French version was used) 94% of patients reported that WORQ covered all relevant topics and 83% found the answer options to be meaningful. They felt that WORQ facilitated a patient-centric approach to their care, because of its comprehensive set of questions allowed them to report their experience as patients. In particular, the work-related issues asked from part one of WORQ were considered valuable, although some participants found it difficult to rate the current support of their employer, given their current sick leave. (Husmann et al., 2019)

Floor/Ceiling Effects

Patients with MSK Conditions in Vocational Rehab (Finger, Wicki-Roten, Leger, & Escorpizo, 2019; n = 89; mean age = 44 years (2.4); self-reported French version was used)

  • Excellent: No ceiling or bottom effect was detected. The WORQ sumscores ranged from 6 to 346/400 points

Patients with MSK Conditions Undergoing Inpatient Rehab (Finger, Escorpizo, & Tennant, 2019; n = 221; mean age = 43.47 years (SD=10.9), self-reported French version was used )

  • Adequate ceiling effect of 0.45% found for WORQ sumscore
  • Adequate floor effect of 9.5% found for WORQ sumscore

Mixed MSK Patient Population (Vermeulen et al., 2019; n = 114; mean age = 43.4 year (11.5); 21 patients had hand/wrist injuries and 93 had fibromyalgia; self-reported Dutch version was used)

  • Excellent: No floor of ceiling effects detected in total score
  • Adequate floor effect of 15.8% for question item 39 and 40.
  • Poor ceiling effect of >30% on question items 13, 28, and 31.

Patients with MSK Conditions in Outpatient Physical Therapy (Husmann et al., 2019; n = 51; mean age = 39.96 years (12.9); self-reported German version of WORQ was used)

  • Excellent: No ceiling or floor effect was detected.

Spinal Injuries

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Content Validity

The content of the WORQ was compared to individual patient interviews, the Comprehensive ICF Core Set for SCI, and assessment instrument used in VR and SCI. 80% of ICF categories in the WORQ were indicated in at least one of the nine patient interviews; 54% were confirmed by the Comprehensive ICF Core Set for SCI; and 30% were confirmed by four questionnaires (SF36, McGill Pain Questionnaire, Hospital Anxiety and Depression Scale, and Beck Depression inventory). The WORQ proved to have content validity for utility in patients with SCI within the context of VR. WORQ-SELF can be used to assess the functioning and disability of patients in the return to work process. (Bergamaschi et al., 2014)

Bibliography

Finger, M. E., Escorpizo, R., Bostan, C., & De Bie, R. (2014). Work Rehabilitation Questionnaire (WORQ): development and preliminary psychometric evidence of an ICF-based questionnaire for vocational rehabilitation. Journal of occupational rehabilitation, 24(3), 498-510.

Bergamaschi, R. P., Escorpizo, R., Staubli, S., & Finger, M. E. (2014). Content validity of the work rehabilitation questionnaire-self-report version WORQ-SELF in a subgroup of spinal cord injury patients. Spinal cord, 52(3), 225-230.

Finger, M. E., Wicki-Roten, V., Leger, B., & Escorpizo, R. (2019). Cross-cultural adaptation of the Work Rehabilitation Questionnaire (WORQ) to French: A valid and reliable instrument to assess work functioning. Journal of occupational rehabilitation, 29(2), 350-360.

Finger, M. E., Escorpizo, R., & Tennant, A. (2019). Measuring Work-Related Functioning Using the Work Rehabilitation Questionnaire (WORQ). International Journal of Environmental Research and Public Health, 16(15), 2795.

Vermeulen, K., Woestyn, M., Oostra, K., Geers, S., Ryngaert, K., Van de Velde, K., ... & Van de Velde, D. (2019). Cross-Cultural Adaptation and Psychometric Evaluation of the Dutch Version of the Work Rehabilitation Questionnaire (WORQ-VL). Journal of occupational rehabilitation, 29(3), 514-525.

Husmann, A., Escorpizo, R., & Finger, M. E. (2019). Examining work-related functioning in a physical therapy outpatient clinic: Validity and reliability of the Work Rehabilitation Questionnaire (WORQ). Journal of Occupational Rehabilitation, 1-11.

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