Work Ability Index

Kaija TuomiJuhani IlmarinenAntti JahkolaLea KatajarinneArto Tulkki

Finnish Institute of Occupational HealthHelsinki 1998

Working Group

Juhani Ilmarinen, departmental director, Finnish Institute of Occupational HealthAntti Jahkola, head occupational health physician, The Finnish Post LtdLea Katajarinne, trainer (occupational health care), Finnish Institute ofOccupational HealthArto Tulkki, secretary of the project, Pension Foundation of The Finnish Post LtdKaija Tuomi, special researcher, Finnish Institute of Occupational Health

Computer programmeJorma Seitsamo, researcher, Finnish Institute of Occupational Health

Editors: Sirkka Rautoja and Rauni PietiläinenGraphic designer: Tuula Solasaari-PekkiTranslator: Georgianna Oja

2nd revised editionISBN 951-802-202-X

ISSN 0357-5519

Maintaining work ability – a challengefor occupational health care!

The ability to work is the basis of well-being for all of us. Nevertheless, our workability will deteriorate unless we take care of it. Many factors affect work ability,and we can influence several of them through our own activity. We caninfluence both our own life-style and our work environment.

Work ability cannot be measured objectively with a single instrument. It alwaysrequires an assessment based on data obtained from several different sources.A worker's own concept of his or her work ability is as important as theevaluations of experts. Together the evaluations provide the best overall pictureof work ability.

The work ability index is a product of research meant for practical use inoccupational health care as an aid to help maintain work ability. It depicts theworker's own assessment of his or her work ability. Its agreement with theresults of clinical examinations has proved to be good (Eskelinen et al. 1991). Inlarge follow-up studies of the Finnish Institute of Occupational Health the workability index has also reliably predicted changes in work ability in differentoccupational groups.

The work ability index is meant to support the worker. It can be used at an earlystage to help ensure the correct measures are taken to maintain work ability.The work ability index helps to determine which workers need the support ofoccupational health care. In this manner optimal conditions can be establishedto prevent a premature decrease in work ability.

The work ability index is an instrument to be used in occupational health care. Itis easy and quick to use, it is reproducible, the results are received quickly, andit can be used for follow-up at both the individual and group level. Its data areconfidential, and at the individual level the data are used only for occupationalhealth care purposes.

The work ability index forms the basis for further measures. If needed,occupational health personnel can, in cooperation with the worker, draw up anindividual program to help maintain work ability. The professional skill of safetypersonnel and management may be needed to help decrease risk factors atwork, and the employer's support is needed to ensure any psychological andeconomic conditions. Activities to maintain work ability result in benefits to boththe employee and the employer.

It pays to maintain and work toward improving work ability at all phases ofworklife. The factors that weaken work ability begin to accumulate in middle ageand are seen in workers from about 45 years of age. Investing in themaintenance of work ability and functional capacity produces results already in afew years. Improved functional capacity remains with workers as they retire andenter the third phase of their life, the "third age". The "third age" can represent ameaningful, independent and active 10–20 years of life after retirement. Thequality of retirement life remains good, and society benefits through lower healthcare expenses.

1What isthe work ability index?

The work ability index is an instrument to be used in occupational health care. Itreveals how well a worker is able to perform his or her work. The work abilityindex can be used as one of the methods for assessing work ability in healthexaminations and workplace surveys.

The work ability index is determined on the basis of the answers to a series ofquestions (form on pages 25–28) which take into consideration the physical andmental demands of work and the worker's health status and resources. Theworker fills out the questionnaire before his or her interview with an occupationalhealth professional, who collects any missing information in consultation with theworker when needed. The occupational health professional rates the responsesaccording to the instructions, the result being a score of 7–49. The designatedvalue depicts the worker's own concept of his or her work ability, and, accordingto it, the work ability level and the objectives of any measures needed to betaken are classified as follows:

points work ability objective of measures________________________________________________________________ 7–27 poor restore work ability28–36 moderate improve work ability37–43 good support work ability44–49 excellent maintain work ability

With the aid of the questionnaire the occupational health professional is able, atan early stage, to identify workers and work environments which need measuresof support. Measures directed toward restoring work ability or additionalevaluations of work ability are needed by those whose work ability is poor(maximum score 27). For those whose work ability is moderate (score 28–36),measures to help improve work ability are recommended. Workers with a goodwork ability index (score 37–43) should receive instructions on how to maintaintheir work ability. Those whose work ability is excellent (44–49) should also beinformed about which work and life-style factors maintain work ability and whichfactors weaken it. The effects of the measures taken can be followed by havingworkers fill out the questionnaire in conjunction with periodic healthexaminations or other types of screening procedures.

The index can also be used to predict the threat of disability in the near future. Itwas developed by the Finnish Institute of Occupational Health in its follow-upstudy of ageing municipal workers, and it was found to predict the incidence ofwork disability for a group of 50-year-olds. Almost two-thirds of the persons inthe group with poor work ability according to the index were granted a workdisability pension during the 11-year follow-up (table 1). However, more thanone-third of those who were able to continue to work in the same occupationthroughout the follow-up and who had a poor work ability rating initially wereable to improve their work ability (table 2).

The work ability index was constructed in conjunction with a follow-up study ofageing municipal workers in 1981 so that the 15% of the workers with the worstwork ability score formed the poor category and the 15% with the best workability formed the excellent category. The moderate and good classificationswere divided by the median, in other words, the number of points dividing thedistribution of the work ability index in half.

TABLE 1.Work disability pensioning of municipal workers between the ages of 50 and 62years according to their work ability index at approximately 50 years of age(Tuomi 1995)

Work ability index Number of Retired on disability pensionat approx. 50 years workersa

of age Number %________________________________________________________________Men poor 287 187 65.2 moderate 710 287 40.4 good 728 203 27.9 excellent 359 64 17.8

all 2084 714 35.6________________________________________________________________Women poor 359 215 59.9 moderate 934 311 33.3 good 1098 204 18.6 excellent 470 60 12.8

all 2861 790 27.6________________________________________________________________aThe figures exclude those who died or received an old-age pension during the follow-up.

TABLE 2.The work ability index at approximately 50 years of age and improvement in thework ability of municipal workers who continued to work in the same occupationduring the 4-year follow-up in 1981–85 and the 11-year follow-up in 1981–92:percentance of those whose work ability score had increased from a lowercategory to some of the higher categories

Work ability index Approx. 55 years of age Approx. 58 years of ageat approx. 50 yearsof age in 1981 Number of Work Number of Work

subjects ability subjects abilityimproved, % improved, %

______________________________________________________________________Men poor 118 37.3 8 20.0 moderate 430 15.4 54 11.1 good 542 6.8 142 7.8 excellent 288 a 104 a______________________________________________________________________Women poor 147 34.0 8 62.5 moderate 625 16.0 105 15.2 good 803 5.0 241 3.7 excellent 359 a 159 a_____________________________________________________________________a None of the workers had moved to a higher category because this category is the highestpossible.

2Calculating the work ability index

The work ability index covers seven items, each of which is evaluated with the use ofone or more questions (table 3). It is calculated by summing the points received foreach item according to table 3. In the calculation it is especially important that thescore for item 2 (work ability in relation to the demands of the job) be weightedaccording to the following instructions and that the final scores for items 3 (number ofcurrent diseases diagnosed by a physician) and 7 (mental resources) be determinedaccording to the instructions in table 3. The best possible rating on the index is 49points and the worst is 7 points. All the questions in the questionnaire must beanswered before the index can be calculated. Half points in the final scores arerounded off to the next whole number (e.g., 28.5 is rounded to 29 points).

TABLE 3.Items covered by the work ability index, the number of questions used to evaluateeach item, and the scoring of the responses

Item Number of Scoring of the responsesquestions

_____________________________________________________________________________

1 current work ability compared 1 0–10 points with the lifetime best (value circled in the questionnaire)

2 work ability in relation 2 score weighted according to the nature to the demands of the job of the work (formula for the calculation

appears on the next page)

3 number of current diseases 1 at least 5 diseases = 1 point diagnosed by a physician (list of 51 3 diseases = 3 points

diseases) 4 diseases = 2 points2 diseases = 4 points1 disease = 5 pointsno disease = 7 points(only diseases diagnosedby a physician are counted)

4 estimated work impairment 1 1–6 points due to diseases (value circled in the questionnaire;

the worst value should be chosen)

5 sick leave during the past year 1 1–5 points (12 months) (value circled in the questionnaire)

6 own prognosis of work ability 1 1, 4 or 7 points two years from now (value circled in the questionnaire)

7 mental resources 3 the points of the question series (note: item 7 refers to the are added together and the sum worker's life in general, both is modified as follows: at work and during leisure time) sum 0–3 = 1 point

sum 4–6 = 2 pointssum 7–9 = 3 pointssum 10–12 = 4 points

_____________________________________________________________________________

Item 2 (ability in respect to demands): weighting of the response

In item 2 work ability is assessed in relation to both the physical and mental demands of thejob. The response to the question is weighted according to whether the work is primarilyphysical or mental. The term "work ability score" refers to the number of the responsecircled in the questionnaire.

For physically demanding work, for example, auxiliary, installation and home care work the work ability score for the physical demands of the job is multiplied by 1.5 the work ability score for the mental demands of the job is multiplied by 0.5.

For mentally demanding work, for example, office, teaching and administrative work the work ability score for the physical demands of the job is multiplied by 0.5 the work ability score for the mental demands of the job is multiplied by 1.5.

For work that is both physically and mentally demanding, for example, nursing,transport, dental and kitchen supervision work, the work ability score remains unchanged.

Example of the weighting of the response

Suppose that the respondent circled alternative 3 for the physical demands of his or her joband alternative 5 for the mental demands of the job.

If he or she has a physically demanding job, item 2 is calculated as follows:(3 x 1.5) + (5 x 0.5), that is 4.5 + 2.5 = 7.

If his or her job is mentally demanding, item 2 is calculated as follows:(3 x 0.5) + (5 x 1.5), that is 1.5 + 7.5 = 9.

If he or she has a job that is both physically and mentally demanding, item 2 is calculatedas follows:3 + 5 = 8.

3Example of how to determinethe work ability index

A construction supervisor whose job is basically mentally demanding will serve as theexample. When the supervisor filled out the work ability questionnaire the first time, he was50 years old and had separated from his wife the preceding autumn. A physician haddiagnosed hypertension, and he had hurt his back on a construction site the precedingwinter. He considered himself somewhat overweight, and he sometimes had stomachtrouble. In spite of his problems, his work ability index was good, score of 38.

The supervisor's work ability index was determined from his responses to the questionnaireas follows:

Item Response Score___________________________________________________________________________

1 current work ability compared score 7 7 with the lifetime best

2 work ability in relation work ability in relation to 7 because the job was to the demands of the job physical demands: 2 primarily mental work:

work ability in relation to (2 x 0.5) + (4 x 1.5)mental demands: 4 = 1 + 6 = 7

3 number of current diseases diagnosed injury to the back 4 diagnosed by a physician and hypertension

(2 diseases =score of 4)(own opinion: digestiveproblems and overweight,but these did not receivepoints because they were notdiagnosed by a physician)

4 estimated work impairment score 5 (able to work 5 due to disease but it causes symptoms)

5 sick leave during the past year score 4 (less than 9 days) 4 (12 months)

6 own prognosis of work ability score 7 (rather certain) 7 two years from now

7 mental resources enjoys daily tasks: 3 4active and alert: 4full of hope for the future: 3 ____total points: 10,so the score is 4

____________________________________________________________________Total score 38

Work ability index 38, good

4Reference values

How can the reference values be used?

The reference values used for the work ability index have been taken from severalinvestigations, and more data are continually being gathered. The reference valuesgiven on pages 13–15 present the averages and percentages of different categories ofwork ability index according to gender, age and occupation (tables 4–7).

The reference values can be used, for example, for the following comparisons: What is the work ability of the employees in your own workplace at the age of 50, 55

and 58 years in comparison with the average work ability of municipal workers andother occupational groups at the same age?

What is the percentage of workers with a poor work ability in your own workplace incomparison with the results of municipal workers, construction workers, andindustrial workers?

On the basis of the comparison, you can determine if the work ability of the workers inyour own workplace deviates from the reference values. Of primary importance is todetermine how many workers have a poor work ability in different occupationsaccording to age group. Measures should especially be directed towards the workerswith poor work ability because a large proportion of these workers may becomedisabled to work within the next few years if proper supportive measures are not taken.When the work ability indices are checked and supportive measures are considered,different occupational and job groups should be taken into account.

As a result of the work ability follow-up, occupational health personnel can establishtheir own reference values for clients on the basis of their follow-ups (group follow-upform). The work ability distribution of the clients by age and occupation will form themost important reference values for occupational health personnel. The mostimportant task of occupational health personnel is to follow the changes in work abilityon the individual and group level (for example, departmental, age or occupationalgroup) and evaluate the effectiveness of the measures that have been taken.

TABLE 4.Means of the work ability indices of 50- , 55- and 58-year-old men and women currently in municipaloccupations according to work content (physically demanding, mentally demanding or a combination of both)and profile group

Gender/work content/ Age (years)profile group 50 55 58_____________________________________________Men 35 34 34_____________________________________________Physically demanding work 34 33 31auxiliary work 33 33 31 unskilled assistants painters construction workers and streetsweepers park workers laborersinstallation work 35 33 31 fire fighters janitors mechanics and pipe fitters car mechanics carpenters electricians_________________________________________Combination of physicallyand mentally demanding work 34 34 33transport work 34 34 32 machine operators bus drivers other transport workersdump work 33 33 ..dental work 37 38 ..nursing work 35 36 .. psychiatric nurses_________________________________________Mentally demanding work 39 36 36administrative work 40 38 37 social workers office supervisorstechnical supervision 38 35 36 fire chiefs supervisors at construction sitesphysician's work 44 41 40teaching work 38 35 34 vocational school teachers secondary school teachers

_________________________________________

Gender/work content/ Age (years)profile group 50 55 58_________________________________________Women 36 35 34_________________________________________Physically demanding work 34 32 32auxiliary work 34 33 31 cleaners hospital aides kitchen helpers construction workers and streetsweepers park workershome care work 34 31 33 bathers domestic helpers and housekeepers

_________________________________________Combination of physicallyand mentally demanding work 37 35 34kitchen supervision 36 34 30dental work 39 37 38nursing work 37 35 34 child care workers practical nurses psychiatric nurses specialized nurses other nurses_________________________________________Mentally demanding work 39 35 35office work 38 36 35 drafting personnel typists clerksadministrative work 40 37 36 social workers head ward nurses head nurses office supervisorsphysician's work 40 39 38teaching work 38 35 35 vocational school teachers secondary school teachers day care center teachers_________________________________________

TABLE 5.Percentage of 50-, 55- and 58-year-old municipal workers in the work ability categoriesaccording to the workers' gender and whether the work is physically demanding, mentallydemanding or a combination of both (Ilmarinen 1988, Ilmarinen et al. 1995)

Age gender/ Physically Physically and Mentallywork ability demanding mentally demandingindex* work demanding work work

______________________________________________________________________________50 years Menof age poor 18 20 9

moderate 40 38 21good 32 32 39excellent 10 10 31

Womenpoor 21 10 6moderate 40 34 24good 30 40 46excellent 9 16 24

______________________________________________________________________________55 years Menof age poor 19 18 8

moderate 47 42 37good 28 31 43excellent 6 9 12

Womenpoor 22 14 10moderate 52 42 39good 22 31 41excellent 4 9 10

______________________________________________________________________________58 years Menof age poor 26 21 13

moderate 50 44 37good 20 25 31excellent 4 10 19

Womenpoor 28 15 15moderate 44 47 39good 21 27 34excellent 7 11 12

______________________________________________________________________________

TABLE 6.Percentage of construction workersa in the work ability categories according to theirage (based on data from Matikainen et al. 1993)

Work ability Age, yearsindex* 40–44 45–49 50–54 55–59 60–65______________________________________________________________________________poor 2.4 2.8 7.0 13.5 15.7moderate 13.1 13.8 29.3 34.6 41.2good 60.3 64.9 52.1 44.2 35.3excellent 24.2 18.5 11.6 7.7 7.8______________________________________________________________________________total, % 100.0 100.0 100.0 100.0 100.0total, n 252 254 242 156 51a Occupational groups: carpenters, building men, measuring carpenters, cement and concrete workers, renovators, pipe fitters, bricklayers, tilers, truck drivers.

TABLE 7.Percentage of workers in a middle-sized industrial enterprise in the work abilitycategories according to their age (based on data from Ilmarinen et al. 1996)

Work ability Age yearsindex* 20–29 30–39 40–49 50–59 60–64 total______________________________________________________________________________poor – – 1.2 8.3 25.0 2.8moderate 1.6 6.3 11.3 21.7 37.5 12.2good 26.5 41.3 40.9 43.9 25.0 40.1excellent 71.9 52.4 46.6 26.1 12.5 44.9______________________________________________________________________________total, % 100.0 100.0 100.0 100.0 100.0 100.0total, n 64 126 338 158 8 683

*categories of the work ability index:poor = 7–27 pointsmoderate = 28–36 pointsgood = 37–43 pointsexcellent = 44–49 points

5Practical follow-up measures

Occupational health care personnel can use the work ability index in their overall assessmentof a worker's work ability and functional capacity. They consider whether, in addition to thework ability index, other evaluations, such as tests measuring physical or mental function orlaboratory tests, are needed.

Once a reliable assessment of a worker's work ability has been made, the occupational healthpersonnel can determine the measures and recommendations needed to support this workability and develop the worker's job, work conditions and work community (employee's feed-back form and follow-up form for actions taken). The need for supportive measures dependson the worker's work ability and functional capacity and on his or her work conditions.

If the worker's work ability is excellent, the occupational health personnel should explainwhich work and life-style factors help maintain and which help weaken his or her work ability.The worker is urged to continue to avoid or decrease the factors which weaken work ability.

Attempts to strengthen a good work ability are supported, and it is determined whether theworker's work and life-style have features to help strengthen work ability or whether they havecharacteristics that threaten it.

If work ability is moderate, an effort should be made to increase the worker's own initiatives topromote his or her work ability (diet, exercise, sleep and rest, social activities, and otherhobbies and study). In addition a worker may need medical rehabilitation. Often a worker alsoneeds measures to develop his or her professional knowledge and to increase and diversifyhis or her occupational skill. In addition any risks in the work or work environment and workorganization and problems with supervisors should be corrected.

If work ability is poor, the prerequisites and possibilities for rehabilitation should bedetermined and also whether the worker's work ability can be restored by correcting thehazards found in his or her work or work environment and by remodelling the workorganization to make it more efficient. Possibilities such as job rotation, change in tasks, freework shifts and other individual solutions should be considered.

The work ability index is a concrete aid to the creation of an overall picture of a worker's workability and functional capacity and the factors affecting them. An individual worker's workability index or the mean index of a group can be checked at suitable intervals (worker'sfollow-up form). In this manner the prerequisites for supporting an employee's work ability andfunctional capacity are improved, and through this effort the productivity of the enterprise,among other things, is increased. At the same time occupational health personnel have thepossibility to develop work methods and cooperation with management, personneladministrators, foremen, and occupational safety and health groups.

Activities to maintain work ability require cooperation between all the concerned parties.

For the follow-up of work ability and the assessment of associated supporting measures, thefollowing system supporting work ability has been constructed:

determination of the work abilityindex and examination made bya health care professional

other examinations

overall assessment of work abilityand functional capacity

occupational health measures

follow-up of measures

work ability index interview by health care professional,examination of general health status, etc

laboratory and other examinations other examinations, for example,focusingon physical andpsychological functional capacity

on the individual level on the work group level (for example,departmental, age or occupational group)

feedback on work ability and functional capacity instructions for maintaining andstrengthening work ability

activities to maintain and strengthen work ability improving the work load and work environment

(ergonomic, occupational hygiene, safety) - muscular work - difficult work postures - monotonous work movements - tools and work spaces - climatic conditions - machine use - hazardous substances improving the work community and work organization

- possibilities for development - responsibility - management and supervisory work - feedback and support - use of knowledge - work schedules - lack of freedom - inspirational work improving functional capacity (physical exercise,

healthy and invigorating life-style) and promotingprofessional skill

- exercise - sleep and rest - diet and eating habits - smoking and alcohol consumption

- hobbies and other invigorating activities - maintenance and promotion of professional skill - professional and medical rehabilitation other supportive services

follow-up of work ability follow-up of work and work conditions follow-up of the occupational health personnel's activities

follow-up of feedback and realization activities

Confidentiality of the data

Data obtained with the questionnaire of the work ability index is strictly confidential, andthey are covered by the same regulations for secrecy as the activities of health careprofessionals in general. The data cannot be given to anyone not employed by theoccupational health unit, for example, the worker's employer, in a form that will reveal theidentity of the employee or employees in question. To ensure confidentiality, it isrecommended that data be presented in statistical cells comprised of 10 persons, forinstance, in age or occupational groups, when sensitive topics such as health are underconsideration.

Filling out the questionnaire of the work ability index is always voluntary. Refusing to fillout the form must not in any way negatively influence the treatment of a worker byoccupational health personnel or the employer.

Occupational health professionals can use the work ability index to help promote andmaintain work ability and to follow workers who must cope with a disability or illness atwork. It can also be used in counseling for rehabilitation and in reference to treatment orrehabilitation and the person's participation in workplace activities that maintain workability. When the questionnaire is given to a worker to be filled out, the worker must beinformed of the purpose for which the questionnaire data will be used and also how toproceed if a need for treatment or other health care is revealed. According to ethicalrules, the information must be given in written form, but should also be presentedverbally.

The work ability index is calculated from the data on the questionnaire, and a summaryis written for the worker's personal health data file. Workers are asked to give theirinformed consent for the summary and the index score to be included in their health file,and generally the data will not be added without this consent. A request for the worker'sconsent is included for this purpose at the bottom of the form. If, however, thequestionnaire data are collected for the purpose of following a worker's illness ordisability or for counseling for treatment or rehabilitation, the worker's consent is notnecessarily needed. The data can be recorded in the summary to the degree necessaryfor the activity in question. The original questionnaire form is retained with the records ofthe occupational health unit (in a form file or in a computer database), and it is keptseparate from worker's personal health data file. Occupational health professionals arepermitted access to the original detailed data when needed.

The same regulations that cover occupational health care records also cover the deliveryof the work ability summary and work ability index. When personal health care data aredelivered, the forms and corresponding computer database must remain with theoccupational health unit which collected the data.

The instructions for processing, compiling, saving, and delivering occupational healthcare records are being updated. At the same time instructions concerning thepermissible limits for retaining such documents are being drawn up, for example, fordatabases and for forms.

6Feedback and follow-up

To aid the provision of feedback to the worker, a form has been devised that bothexplains and gives instructions for activities to maintain and promote work ability. Inconjunction with the feedback, activities to promote work ability are recommended in thesample list . The back of the follow-up form for the worker contains a follow-up formmeant for the use of occupational health personnel; it has been designed to aid thefollow-up of recommended measures.

Sample list of measures to improve work ability

1 Improving the work load and the environment (ergonomics, occupational hygiene,safety)

11 decrease in muscular work111 manual carrying, lifting and moving112 standing113 work rotation114 other muscular work

12 decrease in difficult work postures and movements121 stooped and twisted or other difficult work postures122 similar repetitive movements123 other difficult postures and movements

13 improvements in tools and work spaces131 which tools?132 which work spaces?

14 decrease in climatic hazards141 heat, cold or changes in temperature142 dryness, dampness, wetness143 other climatic hazards

15 decrease in machine hazards151 noise152 vibration153 risk of accident154 other hazards related to the use of machines

16 protection from hazardous substances161 mold or dusts162 hazardous substances, dirty conditions163 other hazardous substances

17 decrease in other hazardous work loads or work conditions

2 Improving the work community and work organization (personal relations,collaboration, management)

21 increase in possibilities to develop211 participation in planning of one's work212 training related to work tasks213 other possibilities to develop

22 increase or decrease in work-related responsibility221 possibilities to control one's work222 responsibility for other persons223 possibility to fail or take incorrect action224 other work responsibility

23 development of management and supervisory skills231 attitude of superior toward ageing232 communication233 clarification of role description234 development of other management and supervisory skills

24 development of feedback and support systems241 recognition and acknowledgement of value242 support of superior243 other development of management and supervisory tasks

25 increase or decrease in use of knowledge251 precision in the receival of information252 hurried decisions253 other use of knowledge

26 improvement of work schedules261 workbreaks262 part-time work263 other work schedules

27 decrease in lack of freedom271 rush and tight schedules272 paced work273 other work restrictions

28 increase in inspiration in work281 addition of diversity and enrichment of the work282 decrease in isolation and solitarity283 increase in contact and social relations284 increase in other forms of inspiration

29 other development of the work community and work organization

3 Improving functional capacity (physical exercise, healthy and invigorating life-style)and promoting professional skill

31 increase in physical activity311 increase in the person's general condition312 increase in musculoskeletal strength and endurance313 increase in motor and body control314 increase in flexibility315 relaxation exercises316 other physical activity

32 improvement in quality of sleep and rest

33 improvement in diet and eating habits331 meals at the workplace (recommendations)332 dietary recommendations (fat, salt, sugar)333 weight loss (goal)334 other dietary and eating habits (groups, etc)

34 decrease in smoking and alcohol consumption341 cessation of smoking342 limiting of alcohol consumption343 other recommendations for tobacco and alcohol use (groups, etc)

35 promotion of hobbies351 cultural activities (for example, music, movies, art exhibitions)352 club and association activities353 handicrafts, woodwork, and other such hobbies354 other possibilities to promote hobbies

36 maintenance and promotion of professional skills361 training and maintenance of professional skills362 complementary courses363 support for additional education364 other means to promote professional skills

37 professional and medical rehabilitation371 job retraining372 vocationally oriented medical rehabilitation373 training designed to maintain work ability374 training designed to improve work ability375 other rehabilitative activities

38 other development of the worker's work ability and functional capacity

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Tuomi K, Toikkanen J, Eskelinen L et al.: Mortality, disability and changes in occupation amongaging municipal employees. Scand J Work Environ Health 17 (1991):suppl 1, 58–66.

WORK ABILITY INDEX Worker feedback To be filled out by occupational health personnel

____________________________________________________________ ________ / ______________Surname and first names Date

work ability index score score category objective_____________________________________ 7–27 poor restore work ability28–36 moderate improve work ability37–43 good support work ability44–49 excellent maintain work ability

Recommendations:

WORK AND WORK CONDITIONS WORK COMMUNITYImprovements in work load and the Improvements in the work community andwork environment work organization(ergonomics, occupational hygiene, safety) (personal relations, collaboration, management)

_______________________________ WORK ABILITY ____________________________

_______________________________ PROMOTION ____________________________

_______________________________ ____________________________

_______________________________ ____________________________

WORKERImproving functional capacity (physical exercise, healthy and invigorating life-style) andpromoting professional skill

______________________________

______________________________

______________________________

______________________________

GOOD WORK ABILITY AND HEALTH

HIGH QUALITY OF HIGH QUALITY OFWORK AND LIFE AND WELL-BEINGPRODUCTION

GOOD ABILITY AT RETIREMENT,ACTIVE AND MEANINGFUL

"THIRD AGE"

Planned date for the next follow-up: _________/__________

WORK ABILITY INDEX Follow-up of recommendations To be filled out by occupational healthpersonnel

Surname and first names ___________________________________________________________________

Work place/work site ________________________________________________________________________

immediacy: 1 within 1 month realization: 1 entirely realized 2 within ½ year 2 partially realized 3 within 1 year 3 not realized

recommen- contents or number of imme- when to realiza- means (or cause why not succeeded)dation recommendation diacy be car- tionmade (time) (no.) ried out (no.)___________________________________________________________________________________________

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