Community initiatives that address specific features of the social environment and street-level environment may increase community participation of older adults.

The intervention did not have an effect on work limitations but reduced work loss. The intervention can be delivered by trained rehabilitation therapists.

Objective Older adults with knee osteoarthritis (OA) who live in environments with mobility barriers may be at greater risk of developing participation restrictions, defined as difficulties in engagement in life situations. We investigated the risk of participation restriction over 5 years due to self-reported environmental features among older adults with knee OA. Methods Participants from the Multicenter Osteoarthritis Study (MOST) self-reported participation at baseline, 30 months, and 60 months using the Instrumental Role subscale of the Late Life Disability Index (LLDI). Data on self-reported environmental features were from the Home and Community Environment questionnaire administered in the MOST-Knee Pain & Disability study, an ancillary study of MOST. The relative risks of developing participation restriction at 60 months, indicated by an LLDI score <67.6/100, due to reported high community mobility barriers and high transportation facilitators were calculated using robust Poisson regression, adjusting for covariates. Results Sixty-nine (27%) of the 322 participants developed participation restriction by 60 months. Participants reporting high community mobility barriers at baseline had 1.8 times the risk [95% CI: 1.2, 2.7] of participation restriction at 60 months, after adjusting for covariates. Self-report of high transportation facilitators at baseline resulted in a reduced but statistically non-significant risk of participation restriction at 60 months [RR: 0.7, 95%CI: 0.4, 1.1]. Conclusions Higher perceived environmental barriers impact the risk of long-term participation restriction among older adults with or at risk of knee OA. Approaches aimed at reducing the development of participation restrictions in this population should consider decreasing environmental barriers.

Objective To systematically rate the evidence on the measurement properties of work functioning instruments for people with arthritis and other rheumatological conditions. Methods A systematic review was conducted through a structured search to identify the quality of articles describing studies of assessment development and studies of their psychometric properties. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used to appraise the included studies. Finally, an evidence synthesis was performed to combine findings. Results Nine arthritis-specific work outcome assessments were identified; 17 articles examining the psychometric properties of these instruments were identified and their quality was reviewed. Quality of studies was highly variable. The evidence synthesis showed that the Work Limitations Questionnaire had the strongest quality evidence of internal consistency and content validity (including structural validity and hypothesis testing), followed by the Work Instability Scale. None of the instruments had strong quality evidence of criterion validity or responsiveness. Conclusion Considering the high variability and the low quality of the literature, we recommend that instrument developers integrate a full psychometric assessment of their instruments, including responsiveness and criterion validity, and consult guidelines (i.e., COSMIN) in reporting their findings.

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