Original research| Volume 102, ISSUE 4, P633-644, April 2021

An Evaluation of the Structural Validity of the Work Limitation Questionnaire Using the Rasch Model

Published:December 09, 2020DOI:



      To investigate the targeting, scaling, and structural validity of the Work Limitation Questionnaire (WLQ) using Rasch analysis.


      Secondary data analysis.


      Tertiary care hospital.


      The data were sourced from an upper limb specialty clinic of injured workers using the convenience sampling method and from a national randomized controlled trial investigating 2 surgical options for rotator cuff repair by formal, randomized selection (N=315).


      Not applicable.

      Main Outcome Measures

      Work Limitation Questionnaire 25-item version (WLQ-25). The WLQ contains 25 items measuring a client’s ability to perform specific job demands on a 5-point ordinal response scale ranging from 0 (difficulty none of the time) to 4 (difficulty all the time). The average of all 25 items is used as the total score, ranging from 0 to 4, where higher index scores indicate greater difficulty performing daily work. Subscales were used to assess time management, physical demands (PD), mental-interpersonal demands, and output demands.


      The Rasch analyses performed on the dataset included the test of fit of residuals, ordering of item thresholds, Person separation index, differential item functioning (DIF), dependency, and unidimensionality. The partial credit model was selected for the current Rasch analysis because the likelihood ratio test was significant at both the overall questionnaire and the subscale level (P<.001). The WLQ-25 did not fit with the Rasch model (χ2=1715.58; df=125; P<.001) and most of the thresholds were disordered. A series of steps were undertaken to improve the fit statistic, including item reduction (6 items) and response merging (9 items). DIF was absent in the revised scale based on sex, age, full- or part-time employment, and type of employment. Only 3 revised subscales, namely the PD, mental demands, and interpersonal demands subscales, demonstrated acceptable fit to the Rasch model.


      The WLQ-25 demonstrated substantial misfit from the Rasch model, which could not be fully mediated. The revised PD, mental demands, and interpersonal demands subscales could be used to assess these constructs.


      List of abbreviations:

      DIF (differential item functioning), IP (interpersonal demands), LD (local dependency), MD (mental demands), MI (mental-interpersonal demands), PCA (principal component analysis), PD (physical demands), PSI (person separation index), OD (output demands), OMERACT (Outcome Measures in Rheumatology), TM (time management), WLQ-25 (Work Limitation Questionnaire 25-item version)
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        • Lerner D.J.
        • Amick 3rd, B.C.
        • Malspeis S.
        • Rogers W.H.
        A national survey of health-related work limitations among employed persons in the United States.
        Disabil Rehabil. 2002; 22: 225-232
        • Lerner D.
        • Amick 3rd, B.C.
        • Rogers W.H.
        • Malspeis S.
        • Bungay K.M.
        The Work Limitations Questionnaire: a self-administered instrument for assessing on-the-job work disability.
        Med Care. 2001; 39: 72-85
        • Burton W.N.
        • Pransky G.
        • Conti D.J.
        • Chen C.Y.
        • Edington D.W.
        The association of medical conditions and presenteeism.
        J Occup Environ Med. 2004; 46: 38-45
        • Lohaus D.
        • Habermann W.
        Presenteeism: a review and research directions.
        Hum Resour Manag Rev. 2019; 29: 43-58
        • Baldwin M.L.
        • Butler R.J.
        Upper extremity disorders in the workplace: costs and outcomes beyond the first return to work.
        J Occup Rehabil. 2006; 16: 303-323
      1. Workplace Safety and Insurance Board. Workplace Safety and Insurance Board 2018 annual report [Internet]. Available at: Accessed December 30, 2020.

        • Verstappen S.M.M.
        • Lacaille D.
        • Boonen A.
        • et al.
        Considerations for evaluating and recommending worker productivity outcome measures: an update from the OMERACT worker productivity group.
        J Rheumatol. 2019; 46: 1401-1405
        • Gignac M.A.M.
        • Badley E.M.
        • Lacaille D.
        • Cott C.C.
        • Adam P.
        • Anis A.H.
        Managing arthritis and employment: making arthritis-related work changes as a means of adaptation.
        Arthritis Care Res. 2004; 51: 909-916
        • Gilworth G.
        • Chamberlain M.A.
        • Harvey A.
        • et al.
        Development of a work instability scale for rheumatoid arthritis.
        Arthritis Rheum. 2003; 49: 349-354
        • Tang K.
        • Beaton D.E.
        • Gignac M.A.M.
        • Bombardier C.
        Rasch analysis informed modifications to the Work Instability Scale for Rheumatoid Arthritis for use in work-related upper limb disorders.
        J Clin Epidemiol. 2011; 64: 1242-1251
        • Koopman C.
        • Pelletier K.R.
        • Murray J.F.
        • et al.
        Stanford Presenteeism Scale: health status and employee productivity.
        J Occup Environ Med. 2002; 44: 14-20
        • Lerner D.
        • Reed J.I.
        • Massarotti E.
        • et al.
        The Work Limitations Questionnaire’s validity and reliability among patients with osteoarthritis.
        J Clin Epidemiol. 2002; 55: 197-208
        • Arumugam V.
        • MacDermid J.C.
        • Grewal R.
        Content analysis of work limitation, Stanford Presenteeism, and Work Instability Questionnaires using International Classification of Functioning, Disability, and Health and Item Perspective Framework.
        Rehabil Res Pract. 2013; 2013: 614825
        • Tang K.
        • Pitts S.
        • Solway S.
        • Beaton D.
        Comparison of the psychometric properties of four at-work disability measures in workers with shoulder or elbow disorders.
        J Occup Rehabil. 2009; 19: 142-154
        • Tang K.
        • Beaton D.E.
        • Boonen A.
        • Gignac M.A.M.
        • Bombardier C.
        Measures of work disability and productivity: Rheumatoid Arthritis Specific Work Productivity Survey (WPS-RA), Workplace Activity Limitations Scale (WALS), Work Instability Scale for Rheumatoid Arthritis (RA-WIS), Work Limitations Questionnaire (WLQ), and Work Productivity and Activity Impairment Questionnaire (WPAI).
        Arthritis Care Res (Hoboken). 2011; 63: S337-S349
        • Beaton D.E.
        • Wright J.G.
        • Katz J.N.
        • et al.
        Development of the QuickDASH: comparison of three item-reduction approaches.
        J Bone Jt Surg. 2005; 87: 1038-1046
        • Walker T.J.
        • Tullar J.M.
        • Diamond P.M.
        • Kohl H.W.
        • Amick B.C.
        Validity and reliability of the 8-item Work Limitations Questionnaire.
        J Occup Rehabil. 2017; 27: 576-583
        • Tamminga S.J.
        • Verbeek J.H.A.M.
        • Frings-Dresen M.H.W.
        • De Boer A.G.E.M.
        Measurement properties of the Work Limitations Questionnaire were sufficient among cancer survivors.
        Qual Life Res. 2014; 23: 515-525
        • Allaire S.H.
        Measures of adult work disability: the Work Limitations Questionnaire (WLQ) and the Rheumatoid Arthritis Work Instability Scale (RA-WIS).
        Arthritis Rheum. 2004; 49: S85-S89
        • Walker N.
        • Michaud K.
        • Wolfe F.
        Work limitations among working persons with rheumatoid arthritis: results, reliability, and validity of the work limintations questionnaie in 836 patients.
        J Rheumatol. 2005; 32: 1006-1012
        • Tang K.
        • Beaton D.E.
        • Amick 3rd, B.C.
        • Hogg-Johnson S.
        • Côté P.
        • Loisel P.
        Confirmatory factor analysis of the Work Limitations Questionnaire (WLQ-25) in Workers' Compensation Claimants with chronic upper-limb disorders.
        J Occup Rehabil. 2013; 23: 228-238
        • Nilsson Å.L.
        • Tennant A.
        Past and present issues in Rasch analysis: the Functional Independence Measure (FIMTM) revisited.
        J Rehabil Med. 2011; 43: 884-891
        • Packham T.
        • Macdermid J.C.
        Measurement properties of the patient-rated wrist and hand evaluation: Rasch analysis of responses from a traumatic hand injury population.
        J Hand Ther. 2013; 26: 216-224
        • Cano S.J.
        • Barrett L.E.
        • Zajicek J.P.
        • Hobart J.C.
        Beyond the reach of traditional analyses: using Rasch to evaluate the DASH in people with multiple sclerosis.
        Mult Scler J. 2011; 17: 214-222
        • Chen W.H.
        • Lenderking W.
        • Jin Y.
        • Wyrwich K.W.
        • Gelhorn H.
        • Revicki D.A.
        Is Rasch model analysis applicable in small sample size pilot studies for assessing item characteristics? An example using PROMIS pain behavior item bank data.
        Qual Life Res. 2014; 23: 485-493
        • Smith A.B.
        • Rush R.
        • Fallowfield L.J.
        • Velikova G.
        • Sharpe M.
        Rasch fit statistics and sample size considerations for polytomous data.
        BMC Med Res Methodol. 2008; 8: 33
        • MacDermid J.C.
        • Holtby R.
        • Razmjou H.
        • Bryant D.
        All-arthroscopic versus mini-open repair of small or moderate-sized rotator cuff tears: a protocol for a randomized trial [NCT00128076].
        BMC Musculoskelet Disord. 2006; 7: 25
        • Pallant J.F.
        • Tennant A.
        An introduction to the Rasch measurement model: an example using the Hospital Anxiety and Depression Scale (HADS).
        Br J Clin Psychol. 2007; 46: 1-18
        • Jerosch-Herold C.
        • Chester R.
        • Shepstone L.
        • Vincent J.I.
        • MacDermid J.C.
        An evaluation of the structural validity of the shoulder pain and disability index (SPADI) using the Rasch model.
        Qual Life Res. 2018; 27: 389-400
        • Gerber C.
        • Canonica S.
        • Catanzaro S.
        • Ernstbrunner L.
        Longitudinal observational study of reverse total shoulder arthroplasty for irreparable rotator cuff dysfunction: results after 15 years.
        J Shoulder Elbow Surg. 2018; 27: 831-838
        • Packham T.L.
        • Cappelleri J.C.
        • Sadosky A.
        • MacDermid J.C.
        • Brunner F.
        Measurement properties of painDETECT: Rasch analysis of responses from community-dwelling adults with neuropathic pain.
        BMC Neurol. 2017; 17: 48
        • Covic T.
        • Pallant J.F.
        • Conaghan P.G.
        • Tennant A.
        A longitudinal evaluation of the Center for Epidemiologic Studies-Depression scale (CES-D) in a rheumatoid arthritis population using Rasch Analysis.
        Health Qual Life Outcomes. 2007; 5: 41
        • Christensen K.B.
        • Makransky G.
        • Horton M.
        Critical values for Yen’s Q3: identification of local dependence in the Rasch model using residual correlations.
        Appl Psychol Meas. 2017; 41 (178-94)
        • Andrich D.
        • Hagquist C.
        Real and artificial differential item functioning in polytomous items.
        Educ Psychol Meas. 2015; 75: 185-207
        • Gothwal V.K.
        • Wright T.
        • Lamoureux E.L.
        • Pesudovs K.
        Psychometric properties of visual functioning index using Rasch analysis.
        Acta Ophthalmol. 2010; 88: 797-803
        • Koopmans L.
        • Bernaards C.M.
        • Hildebrandt V.H.
        • van Buuren S.
        • van der Beek A.J.
        • de Vet H.C.W.
        Improving the Individual Work Performance Questionnaire using Rasch analysis.
        J Appl Meas. 2014; 15: 160-175
        • Lamoureux E.L.
        • Pallant J.F.
        • Pesudovs K.
        • Hassell J.B.
        • Keeffe J.E.
        The impact of vision impairment questionnaire: an evaluation of its measurement properties using Rasch analysis.
        Investig Ophthalmol Vis Sci. 2006; 47: 4732-4741
        • Tavakol M.
        • Dennick R.
        Making sense of Cronbach’s alpha.
        Int J Med Educ. 2011; 2: 53-55
        • Lambert S.D.
        • Pallant J.F.
        • Boyes A.W.
        • King M.T.
        • Britton B.
        • Girgis A.
        A Rasch analysis of the Hospital Anxiety and Depression Scale (HADS) among cancer survivors.
        Psychol Assess. 2013; 25: 379-390
        • Packham T.L.
        • Cappelleri J.C.
        • Sadosky A.
        • MacDermid J.C.
        • Brunner F.
        Measurement properties of painDETECT: Rasch analysis of responses from community-dwelling adults with neuropathic pain.
        BMC Neurol. 2017; 17: 48
        • Willis G.B.
        • Artino A.R.
        What do our respondents think we’re asking? Using cognitive interviewing to improve medical education surveys.
        J Grad Med Educ. 2013; 5: 353-356
        • Weijters B.
        • Geuens M.
        • Schillewaert N.
        The individual consistency of acquiescence and extreme questionnaires.
        . 2010; 34: 105-121
        • Blome C.
        • Augustin M.
        Measuring change in quality of life: bias in prospective and retrospective evaluation.
        Value Heal. 2015; 18: 110-115