ORIGINAL ARTICLE The Utility of Measuring Sexual Disability for Predicting 1-Year Return to Work Douglas P. Gross, PhD, Heidi Knupp, MScOT, Shaniff Esmail, PhD ABSTRACT. Gross DP, Knupp H, Esmail S. The utility of measuring sexual disability for predicting 1-year return to work. Arch Phys Med Rehabil 2011;92:1870-4. Objective: To explore sexual disability in injured workers undergoing rehabilitation. Specifically, we investigated (1) fac- tors associated with high ratings of sexual disability, (2) factors associated with noncompletion of the sexual disability ques- tionnaire, and (3) the association between sexual disability and future recovery. Design: Historical cohort study with 1-year follow-up. Setting: Workers’ compensation rehabilitation facility. Participants: Workers’ compensation claimants (N=1078) undergoing return-to-work assessment. Ratings of sexual dis- ability were measured using the Sexual Behavior item of the Pain Disability Index. Other demographic, clinical, and occu- pational factors also were collected. Intervention: Not applicable. Main Outcome Measures: Outcomes included administrative indicators of timely and sustained recovery and return to work. Results: Of subjects included in analysis, 18.5% did not complete the Sexual Behavior item. Claimants were less likely to complete if they were women, older, and single; had lower salaries, injury diagnoses other than sprain/strain, and fewer health visits before assessment; and reported lower recovery expectations. Higher levels of sexual disability were associated with higher levels of overall pain and disability, as well as being in a married/common law relationship. After adjusting for injury duration, the Sexual Behavior item was not associ- ated significantly with any recovery measure or claims outcome. Conclusions: A response bias exists in Canadian injured workers asked to complete a sexual disability rating. In those completing the questionnaire, higher sexual disability was as- sociated most closely with higher pain severity and higher disability. Perceptions of sexual disability did not contribute to predicting recovery, which supports replacement of this item for use within this and related contexts. Key Words: Disability; Musculoskeletal injury; Prediction; Rehabilitation; Return to work; Sexuality; Workers’ Compen- sation. © 2011 by the American Congress of Rehabilitation Medicine W ORK-RELATED musculoskeletal conditions have a va- riety of adverse health effects on those experiencing them. 1,2 Injury often affects physical functioning, as well as mental and social quality of life and well-being. 3,4 Previous surveys of injured workers also have highlighted difficulties, with sleep disturbances, depression, lowered self-esteem, and sexual problems. 5 In a study of individuals with back pain, the most common work-related condition, Strunin and Boden 6 reported that up to 28% of both men and women reported difficulty having sex. Previous quality-of-life studies have identified sexual health as an important component of overall well-being, and quality of life correlated significantly with working capacity. 7 How- ever, no research specifically examined the association be- tween reported sexual dysfunction and working capacity after work-related injury. Beyond a negative impact on quality of life, it is possible that sexual dysfunction feeds forward onto the disabling condition, leading to exacerbations of pain, per- ceived disability, and associated depression. This worsening in turn may impact negatively on overall recovery and return to work. It currently is unknown how perceived sexual dysfunc- tion impacts on an injured worker’s ability to work or overall perceived disability. A common measure used to rate perceived disability is the Pain Disability Index (PDI). 8 The PDI is a self-report ques- tionnaire on which patients rate their level of disability on a series of 7 items using Likert scales ranging from 0 (no dis- ability) to 10 (complete disability). There is evidence of con- struct validity of the PDI as a measure of perceived disability in injured workers. 9 Among the 7 PDI items is Sexual Behav- ior, in which individuals rate their “frequency and quality of one’s sex life.” Anecdotally, clinicians reported that many injured workers do not complete this item and found it intru- sive. Little research specifically explored the clinical useful- ness of the information gained from the PDI Sexual Behavior item in injured workers. If the item does not contribute mean- ingfully to clinical decisions in some contexts, it may be possible to modify the PDI to make it more satisfactory for patients. Alternatively, the item may identify an important barrier to recovery and return to work. We studied the Sexual Behavior item of the PDI in a pop- ulation of injured workers undergoing return-to-work assess- ment. Specifically, we explored 3 main questions: (1) What demographic, clinical, or occupational factors are associated with high ratings of perceived sexual disability measured by using the PDI in workers’ compensation claimants? (2) Given that a substantial proportion of claimants do not complete the sexual disability item of the PDI, what factors are associated From the Departments of Physical Therapy (Gross) and Occupational Therapy (Esmail), University of Alberta, Edmonton; and Workers’ Compensation Board of Alberta Millard Health (Gross, Knupp), Edmonton, Alberta, Canada. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organi- zation with which the authors are associated. Reprints requests to Douglas P. Gross, PhD, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, Alberta, Canada T6G 2G4, e-mail: dgross@ualberta.ca. 0003-9993/11/9211-00374$36.00/0 doi:10.1016/j.apmr.2011.06.020 List of Abbreviations OPP Organizational Policies and Procedures PDI Pain Disability Index VAS visual analogue scale WCB Workers’ Compensation Board 1870 Arch Phys Med Rehabil Vol 92, November 2011