Using “IBD disability index” can help predict reduced work productivity associated with working while sick

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January 18, 2019
Posted by: Nataly Shtraizent, PhD

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Using “IBD disability index” can help predict reduced work productivity associated with working while sick

Acknowledgement: This article is a summary of “Association Between IBD Disability and Reduced Work Productivity (Presenteeism): A Population-Based Study in Manitoba, Canada” recently published in Inflammatory Bowel Diseases by Leigh Ann Shafer, PhD;  John R Walker, PhD;  Gayle Restall, PhD;  Tarun Chhibba, MD;  Meloney Ivekovic Harminder Singh, MD, MPH;  Laura E Targownik, MD, MSHS;  Charles N Bernstein, MD. The article was written by Nataly Shtraizent, PhD, Research Manager at the Crohn’s & Colitis Foundation.


Scientists from the University of Manitoba have evaluated the relationship between IBD-related impairment in quality of life and decreased work productivity. People who live with a chronic disease, like IBD, feel that they have to come to work even while feeling sick, because they feel a combination of the fear of falling behind, the feeling of being irreplaceable and the desire to overperform to compensate for disease related impairments. This type of behavior, known as presenteeism, can be characteristic to people working while living with a chronic disease, like IBD. 


Researchers at the University of Manitoba used the IBD Disability Index (IBDDI), a survey, designed to define the level of functional activity in IBD patients. The IBDDI survey includes questions about sleep, energy, body image, pain, and other symptoms. It also includes questions related to the environment of the patient. Assessing IBD-related disability in relation to presenteeism addresses the question of compatibility and flexibility of the work environment and the professional community in relationship to the functionality of a person with IBD, who lives in a negative feedback loop between the anxiety around inability to be productive and the desire to be more productive. The goal of surveying is to promote a more flexible, supportive environment, that may reduce the anxiety associated with the disease and prevent presenteeism. 


Principal Investigator of the research study Leigh Ann Shafer, PhD and colleagues evaluated IBD patients who work at least half-time and hypothesized that the IBDDI can be used to establish the likelihood of presenteeism. They started by collecting the self-reported information from 744 patients about whether they think that they underperformed at work, followed by assessment of work productivity, using the Stanford Presenteeism Scale (SPS). The SPS score is based on a questionnaire focused on two general dimensions of presenteeism in the context of any health problem: work focus (process outcome of work) and psychological focus (emotion, cognition, and behavior).  Shafer and team wanted to direct the study participants attention specifically to their IBD and thus they created a modified SPS questionnaire, which included the following questions:   


(a) Because of my inflammatory bowel disease, the stresses of my job were harder to handle.

(b) Despite my inflammatory bowel disease, I was able to finish hard tasks.

(c) Inflammatory bowel disease distracted me from taking pleasure in work.

(d) I felt hopeless about finishing certain work tasks due to my inflammatory bowel disease.

(e) At work, I was able to focus on achieving my goals despite my inflammatory bowel disease.

(f) Despite having inflammatory bowel disease, I felt energetic enough to complete all my work.


They also administered the IBDDI survey, which was supplemented with and compared to other assessments of disability and quality of life, such as the World Health Organization Disability Assessment Schedule (WHODAS 2.0), the Work and Social Adjustment Scale (WSAS), the Inflammatory Bowel Disease Questionnaire (IBDQ), and the Kessler-6 (K6) distress scale.  They found that a combination of the IBDDI and modified SPS is a good prediction tool for IBD related presenteeism.


The combined results of the study showed that 37 percent of patients reported underperformance on 1 to 14 days within a 14-day period. Analysis of the surveys confirmed that there is a strong association between presenteeism and disability. Moreover, based on the outcome of the study, the scientists suggested that IBDDI can be used as a prediction tool for presenteeism, lower quality of life, and emotional distress. The impact of this study is overarching. It will increase the awareness of the professional community to IBD-related presenteeism and hopefully will promote efforts to accommodate employees with the required adjustments. In addition, the presenteeism prediction score can be incorporated by clinicians in developing a healthcare strategy.  Lastly, the study brings up the importance of patients’ self-awareness and provides an evidence-based tool for coping with the disease-related challenges in a working environment, since the presenteeism prediction test could be self-administered by people with IBD. This work highlights that many patients with IBD have work related difficulties which are often not addressed with employers as previously reported by this research group. The goal is to help patients with IBD develop coping strategies and prevent the cycle of presenteeism, decreased work productivity, and distress.

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