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Gignac MA, Sutton D, Badley EM. Arthritis symptoms, the work environment, and the future: measuring perceived job strain among employed persons with arthritis. Arthritis Rheum. 2007 Jun 15;57(5):738-47. [Pub Med ID 17530672]


To develop a measure of job strain related to differing aspects of working with arthritis and to examine the demographic, illness, work context, and psychosocial variables associated with it.



Study participants were 292 employed individuals with osteoarthritis (N=105), inflammatory arthritis (N=151), or both (N=36). Participants were from wave 3 of a 4-wave longitudinal study examining coping and adaptation efforts used to remain employed. Participants completed an interview-administered structured questionnaire, including a Chronic Illness Job Strain Scale (CIJSS) and questions on demographic (e.g., age, sex), illness and disability (e.g., disease type, pain, activity limitations), work context (e.g., job type, job control), and psychosocial variables (e.g., arthritis-work spillover, co-worker/managerial support, job perceptions). Principal component analysis and multiple linear regression were used to analyze the data.


A single factor solution emerged for the CIJSS. The scale had an internal reliability of 0.95. Greater job strain was reported for future uncertainty, balancing multiple roles, and difficulties accepting the disease than for current workplace conditions. Participants with inflammatory arthritis, more frequent severe pain, greater workplace activity limitations, fewer hours of work, less coworker support, and greater arthritis-work spillover reported greater job strain.



The findings underscore the diverse areas that contribute to perceptions of job strain and suggest that existing models of job strain do not adequately capture the stress experienced by individuals working with chronic illnesses or the factors associated with job strain. Measures similar to the CIJSS can enhance the tools researchers and clinicians have available to examine the impact of arthritis in individuals’ lives.


List of Tables and Figures (in the publication)

  • Table 1. Sample characteristics.
  • Table 2. Chronic illness job strain scale items assessing the degree of perceived stress.
  • Table 3. Chronic illness job strain scale inter-item correlations and scale internal consistency.
  • Table 4. Multivariate unstandardized and standardized regression coefficients for explanatory variables by chronic illness job strain.
  • No figures for this paper.

Selected Tables from the Publication (with interpretation)

Multivariate unstandardized (b) and standardized (B) regression coefficients for explanatory variables by chronic illness job strain.i

        Variables R2 changeii b ß P
Demographic variables 0.00
  Age -0.13 -0.09 0.08
Sexiii 0.88 0.03 0.59
Illness related variables 0.44
OA -4.14 -0.15 0.01
Both OA and IA -5.27 -0.11 0.02
Joints affected -5.38 -0.08 0.12
Fatigue 1.29 0.12 0.06
Severe pain 2.02 0.17 0.00
Workplace activity limitations 0.13
Work context variables 0.03
Job fieldv
Health, science, art, sport -1.70 -0.06 0.23
Sales and service 1.52 0.04 0.38
Trades and transportation 1.00 0.02 0.69
Average hours of work per week -0.15 -0.10 0.05
Control over work schedule -0.56 -0.05 0.25
Drug benefitsvi 5.52 0.16 0.10
Extended health benefitsvi -4.32 -0.13 0.16
Psychological scales 0.12
Job perceptions -0.00 -0.00 0.98
Arthritis-work spillover 1.07 0.39 0.00
Manager-supervisor support -0.11 -0.03 0.53
Coworker support -0.47 -0.18 0.00
Total R2 0.72

Table 4 shows the results of the multivariate analysis which differs in several ways from previous work on job strain with healthy adults. Similar to workplace studies, work hours were related to overall perceptions of stress. In this study, however, participants working fewer hours reported greater job strain compared to participants working more hours. This may be because arthritis limited the ability of some participants to work the hours they wanted. Other work context factors such as job type, control over the work schedule, job perceptions, and perceptions of managerial support were not significantly associated with job strain. Sex and age were also not related to perceived stress. Instead, arthritis-type pain and workplace activity limitations were the largest contributors to understanding the variance in job strain. A trend also existed for fatigue associated with greater strain. Psychosocial perceptions were also important, with those perceiving they had less support from co-workers and those perceiving difficulties balancing arthritis and work reporting greater job strain. These findings suggest that factors associated with job strain among those with chronic illness are largely different from those of healthy adults.

Supplementary Tables (with interpretation)

Supplementary Table 1: Chronic Illness Job Strain Scale (CIJSS) by age and sex at T3.

  Male Female
Age group N Mean Std Dev Min Max N Mean Std Dev Min Max
Below 40 8 31.750 19.352 15 68 17 28.118 10.682 15 55
40-49 19 30.842 13.434 15 58 50 37.960 14.168 15 69
50-59 23 33.130 14.467 15 60 106 34.731 14.278 15 64
60+ 18 32.833 13.334 16 57 51 27.180 10.185 15 53

Supplementary Table 1 shows the mean and standard deviation of the CIJSS by age and sex. Men’s scores seem to be quite consistent across the age groups; however, the women’s scores on the CIJSS seem to increase at age 40 and then decline significantly once over the age of 60 years.

Supplementary Table 2: Chronic Illness Job Strain Scale (CIJSS) by age at T3.

Age group N Mean Std Dev Min Max
Below 40 25 29.280 13.722 15 68
40-49 69 36.000 14.236 15 69
50-59 129 34.441 14.268 15 64
60+ 69 28.677 11.283 15 57

Supplementary Table 2 shows the mean and standard deviation of the CIJSS by age. Overall scores seem to increase at age 40, and then decline significantly at age 60 years or over. Thus, job strain seems to be the worst between ages 40-60 years, which may be when job and family demands are at their highest.

Supplementary Table 3: Chronic Illness Job Strain Scale (CIJSS) by age and working status at T3.

  Full-time Part-time
Age group N Mean Std Dev Min Max N Mean Std Dev Min Max
Below 40 21 30.000 14.286 15 68 4 25.500 11.091 18 42
40-49 61 36.197 14.641 15 69 8 34.500 11.339 15 53
50-59 105 33.913 13.876 15 64 24 36.708 15.958 16 61
60+ 42 31.073 12.705 15 57 27 25.037 7.542 15 41

Supplementary Table 3 shows the mean and standard deviation scores of the CIJSS by age and working status (i.e., either full or part-time employment). The sample size is quite small for the part-time employment group, so these results must be interpreted with caution. The scores for the full-time group seem to peak in the 40-49 age group, and then steadily decrease. Job strain seems to be the worst at this stage of life. In the part-time employment group, the scores seem to peak in the 40-60 age group, again, not very different from those who work full-time. It is difficult to get a clear picture, without considering other factors such as disease severity and pain, which may be the cause of part-time hours.

Supplementary Table 4: Chronic Illness Job Strain Scale (CIJSS) by diagnosis of arthritis at T3.

Diagnosis N Mean Std Dev Min Max
IA 105 33.848 13.204 15 62
OA 151 32.074 13.920 15 68
Both 36 34.417 15.206 15 69

Supplementary Table 4 demonstrates the relationship between job strain and diagnosis of arthritis (osteoarthritis versus inflammatory, or both). The means are quite similar, as the level of pain and fatigue are likely more influential on job strain than the actual type of musculoskeletal disease. N.B. We have to be careful with interpretation as diagnosis was significant after controlling for pain and fatigue in the multivariate analysis.

Supplementary Table 5: Chronic Illness Job Strain Scale (CIJSS) by Arthritis Pain at T3.

Pain in past month N Mean Std Dev Min Max
No days 85 23.702 8.149 15 52
A few days 81 31.225 12.262 15 61
Some days 64 38.302 12.539 15 69
Most days 42 41.548 14.641 15 68
All days 20 44.650 14.489 20 64

Supplementary Table 5 examines the level of job strain by number of reported days of arthritis pain. This is clearly a strong linear relationship, with job strain increasing with the number of reported days of pain.

Supplementary Table 6: Chronic Illness Job Strain Scale (CIJSS) by arthritis fatigue at T3.

Fatigue in past month N Mean Std Dev Min Max
No days 65 22.703 8.801 15 54
A few days 48 26.333 10.031 15 54
Some days 76 33.297 11.832 15 62
Most days 62 40.226 12.634 20 69
All days 40 45.800 13.107 18 68

Supplementary Table 6 and Figure 1 demonstrate the linear relationship between job strain and arthritis fatigue; that is, as fatigue increases, so does level of job strain.

Figure 1: Mean scores on the CIJSS by number of days fatigue and pain were reported.

  1. Note: OA = osteoarthritis; IA = inflammatory arthritis.
  2. R2 change values identify the unique contribution to the variance of each block of variables. Total adjusted R2=0.69.
  3. Reference category: male sex.
  4. Reference category: IA.
  5. Reference category: business, finance, administration.
  6. Reference category: Yes.