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Workstyle measure: Short Form

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 Occupational Medicine Advance Access published December 15, 2005
Occupational Medicine
doi:10.1093/occmed/kqi197

Development of a short form of the Workstyle

measure
Michael Feuerstein1,2 and Rena A. Nicholas1
...................................................................................................................................................................................

Background ‘Workstyle’, or how a worker behaviourally, cognitively and physiologically responds to increased or
stressful work demands, has been proposed to help explain the link between ergonomic and psy-
chosocial factors in work-related upper limb disorder symptoms and disorders (WRULD).
...................................................................................................................................................................................

Aim To describe the psychometric properties of a shortened version of the original Workstyle measure.
...................................................................................................................................................................................

Methods Factor analyses of the Workstyle measure items were conducted to reduce the number of total items.
Each of the subscales was then further reduced by randomly selecting half of the items within each
subscale. Additionally, two subscales from the original survey (Pain/Tension and Numbness/
Tingling) were eliminated because they were not used to calculate the original workstyle total score
in order to reduce the influence of current symptoms on an individual’s total score.
...................................................................................................................................................................................

Results The Workstyle Short Form was reduced to 32 items. Cronbach’s a was 0.89 and the test–retest
reliability was r 5 0.88, P , 0.01, for the total score. The short form score was significantly
correlated with the full workstyle total score, r 5 0.98, P , 0.01. Higher total workstyle scores were
significantly associated with pain, functional limitations and adverse mental and physical health.
...................................................................................................................................................................................

Conclusion The Workstyle Short Form demonstrated acceptable psychometric properties. These findings in-
dicate its potential utility in research on WRULD.
...................................................................................................................................................................................
Key words Ergonomics; job stress; occupational; pain; risk factors; upper limb symptoms; workstyle; WRULD.
...................................................................................................................................................................................

Introduction factors interact to affect the development, exacerbation

Work-related upper limb disorder (WRULD) includes
a heterogeneous group of symptoms and conditions in-
volving the muscles, nerves and tendons of the upper
limb that are developed, exacerbated and/or maintained
by the workplace [1]. Research into the aetiology and
course of WRULD has indicated that medical conditions,
adverse biomechanical exposures, work organizational
factors, work demands and individual psychosocial vari-
ables all play a role in the onset and maintenance of
WRULD [1,2]. The presence of these risk factors and
their interactions have been shown to be important when
considering the course of WRULD and developing ap-
propriate interventions [3,4]. ‘Workstyle’ is proposed as
a mechanism by which ergonomic and psychosocial risk
1
Department of Medical and Clinical Psychology, Uniformed Services
University of the Health Sciences, Bethesda, MD, USA.
2
Department of Preventive Medicine and Biometrics, Uniformed Services
University of the Health Sciences, Bethesda, MD, USA.
Correspondence to: Michael Feuerstein, Department of Medical and Clinical
Psychology, Uniformed Services University of the Health Sciences,
4301 Jones Bridge Road, Bethesda, MD 20814, USA. Tel: 13012959677;
fax: 13012953034; e-mail: mfeuerstein@usuhs.mil
and/or maintenance of upper limb pain and functional
limitations [5,6].
Workstyle is characterized as an individual’s response
to increased work demands. These increased demands
can lead to heightened levels of physiological and psycho-
logical arousal, which may interact with specific physical
and psychosocial risk factors in the workplace. The indi-
vidual’s physiological reactivity, overt behaviour and cog-
nitive appraisals are components of his/her workstyle
which, when work demands or job stress are high, may
lead to ‘risky’ biomechanical and cognitive work-related
processes [6]. Examples are awkward postures, failure to
rest or take breaks, high personal work expectations and
ignoring and/or tolerating existing symptoms in order to
keep working. Repeated elicitation of this adverse work-
style and concomitant physiological stress reactions may
result in the development and/or maintenance of
WRULD. It has been proposed that workstyle responses
can exacerbate symptoms because workers respond in
a way that increases exposure to biomechanical risk fac-
tors while reducing the likelihood of symptom relief [5,6].
Preliminary investigation into the role of workstyle re-
lated to WRULD has been promising [7–9] but limited

Published by Oxford University Press on behalf of the Society of Occupational Medicine 2005
Page 2 of 6 OCCUPATIONAL MEDICINE
by the absence of a validated measure of workstyle. To
gain a clearer understanding of workstyle’s influences and
characteristics, Feuerstein et al. [10] conducted an inves-
tigation into the components and experience of workstyle
in office workers. This generated items that were hypoth-
esized to reflect components of workstyle and developed
a self-report Workstyle measure [10]. There are 10 fac-
tors in the measure, with the following subscales: Work-
ing Through Pain, Social Reactivity, Limited Workplace
Support, Deadlines/Pressure, Self-imposed Workpace/
Workload, Breaks, Mood, Pain/Tension, Autonomic Re-
sponse and Numbness/Tingling. The full-scale Workstyle
measure demonstrated high internal consistency among
the subscales (a 5 0.61–0.91) and good test–retest re-
liability of the total score (r 5 0.90).
The 91 items in the Workstyle measure take 15 min
to complete. Because many studies employ a battery of
different surveys, it is desirable to use shortened meas-
ures of various constructs. Therefore, a shorter version
of the Workstyle measure that retains its reliability and
valid psychometric properties was developed and this
study aims to assess its reliability and consistency.
Methods
The 91 items from the original Workstyle measure were
subjected to two factor analyses (one for the categorical
items and one for the dichotomous items) to examine
their factor loadings in the context of the Workstyle mea-
sure and independently from the items excluded in the
original survey development process. Items with factor
loadings ,0.50 were excluded from the factor structure.
The total number of items for the survey was further
reduced by a random split-half sampling of the remaining
items within each subscale. Sampling was conducted
from within the subscales rather than selecting half of
the total remaining items so that the subscales would re-
tain their original proportions and representations in the
shorter survey. This was done so that the subscales with
fewer items (e.g. Autonomic Response, which had only
four items with factor loading .0.50) would not be seri-
ously underrepresented or lost entirely in the new survey.
The exception to this procedure was the Breaks subscale,
which had only two items in the original survey. Both
items were included in the short form so that this subscale
would be represented in the new survey. The random
sampling within each subscale was accomplished using
the random selection function of Statistical Package for
the Social Sciences (SPSS) version 10.0 for Windows.
The Pain/Tension and Numbness/Tingling subscales
were excluded entirely from the Workstyle Short Form
since these subscales are not used in the computation of
the total workstyle score.
The Workstyle Short Form was tested using the exist-
ing data set from the original workstyle development and
validation study [10]. Data were collected via an internet-
based survey. This study employed 282 office workers
from the Washington, DC, metro area recruited via
advertisements in local newspapers, posted fliers and
by word-of-mouth from participants who had already
completed the survey. Participants completed an online
consent form and a screening on the website. Before
accessing the test survey, participants had to meet the
following criteria: aged 21–60 years, not currently preg-
nant and had not been pregnant in the last year, employed
full time ($35 h/week), worked on a computer keyboard
for a minimum of 4 h/day and worked in the current job
for at least the past year. Participants who did not report
inclusion criteria were unable to access the test survey.
The online survey consisted of a set of questionnaires
including the workstyle items and measures of the follow-
ing: sociodemographics, work history, upper limb symp-
tom history, lifestyle, work stress, social desirability,
function and health, ergonomic exposures and the per-
centage of time spent per workplace task during the work-
day. Respondents rated their level of pain within the past
week by using a single-item visual analogue scale of pain
[11], which ranged from 0 to 10 (no pain to severe pain,
respectively) [12]. Symptoms were reported via a modi-
fied National Institute of Occupational Safety and Health
symptom survey [13,14]. Participants completed the Job
Stress subscale of the Life Stressors and Social Resources
Inventory [15], subscales of the Job Content Question-
naire [16] and questions regarding workload, workload
variability and workload exhaustion to assess perceived
work demands [17]. Function and health status were
assessed using the Upper Extremity Function Scale
[18] and the Short Form 12 Health Survey [19]. The
Job Requirements and Physical Demands Survey [20]
was used to assess ergonomic exposure in the workplace.
The Marlowe–Crowne Social Desirability Scale [21] was
included to assess social desirability or the tendency to
present oneself in what is assumed to be a socially accept-
able light. The Workstyle Short Form and its scoring are
provided in the Appendix.
All statistical analyses were conducted using SPSS
version 10.0 [22].
Results
The average age of the participants was 41 years (SD 5
10.9). The majority (76%) of these respondents were
females and most had advanced educational degrees. Par-
ticipants worked an average of 42.3 h/week (SD 5 9.9)
and had been at their current jobs for 6.2 years (SD 5
6.6). Other specific subject characteristics and their dis-
tributions by group are presented in Table 1 (available as
Supplementary data at Occupational Medicine Online).
The factor structure selection and random split-half
processes resulted in a total of 32 items for the Workstyle
 M. FEUERSTEIN AND R. A. NICHOLAS: WORKSTYLE SHORT FORM Page 3 of 6
Short Form. Of the categorical (Likert-scale) section, the
Working Through Pain subscale contained six total items
while the Social Reactivity subscale consisted of five total
items. The Limited Workplace Support and Deadlines/
Pressure subscales contained four items apiece, the Self-
imposed Workpace/Workload subscale included three
items and the Breaks subscale had two total items, as
described previously. Of the dichotomous (check box)
items section, the Mood subscale consisted of six items
and the Autonomic Response subscale consisted of two
items. Table 2 presents the short form factor structure
(available as Supplementary data at Occupational Medi-
cine Online).
The reliability of the Workstyle Short Form was exam-
ined in terms of its internal consistency and stability over
time. The measure demonstrated a high degree of inter-
nal consistency with a reliability coefficient of a 5 0.89.
Test–retest reliability was assessed by examining the cor-
relation of the baseline short form total workstyle score
with the short form total workstyle score from the surveys
completed 3 weeks after the baseline assessment. This
analysis indicated stable test–retest reliability with a cor-
relation coefficient of r 5 0.88, P , 0.01.
The Workstyle Short Form’s total workstyle score
was significantly correlated with the total workstyle score
from the original Workstyle measure, r 5 0.98, P , 0.01
[10]. The short form score demonstrated significant cor-
relations with measures of pain, r 5 0.41, P , 0.01; upper
extremity symptoms, r 5 0.33, P , 0.01; functional lim-
itation, r 5 0.43, P , 0.01; and an inverse relationship to
overall physical health, r 5 ÿ0.23, P , 0.01.
In addition to correlations between the total workstyle
score and clinical measures, trend analyses were con-
ducted to investigate the relationship of increasing work-
style scores with levels of clinical outcomes. A trend
analysis of the short form total workstyle score indicated
a significant linear trend for increasing adverse outcomes
including pain, F 5 38.53, df 5 1, P , 0.01, and func-
tional limitation, F 5 66.41, df 5 1, P , 0.01.
Discussion
The Workstyle Short Form is a reliable and valid ver-
sion of the Workstyle measure for use in studies regard-
ing WRULD. The high levels of internal consistency
and test–retest reliability indicate that the Workstyle
Short Form is reliable and stable (in the short term)
in detecting workstyle responses. Construct validity
examinations indicate that the Workstyle Short Form
captures those physiological, cognitive and behavioural
responses that are proposed as characteristics of the
workstyle concept and risk factors for the development,
exacerbation and maintenance of WRULD. The signif-
icant correlations between the Workstyle Short Form
and the Workstyle Survey indicate that the short form
is representative of, and adequately collects much of,
workstyle-related data obtained by the original survey.
The significant cross-sectional correlations with clinical
data and the linear trend for increasing adverse out-
comes with increasing Workstyle Short Form score sug-
gest that the workstyle score is associated with levels of
pain, function and symptoms. The intent of this study
was not to elaborate on causal links. This will need to
be determined in future research. The use of a conve-
nience sample could have biased the findings. Partici-
pants were not randomly drawn from a population of
office workers. The sample comprised mainly of highly
educated women in their 40s. More detail on the
participants is available [10]. Future research needs to
use a more representative sample of the workforce in
general.
The Workstyle Short Form and the original Workstyle
measure both serve a useful function in the study of
WRULD. As increasing evidence emerges for workstyle’s
contribution to the course of WRULD [7,8,23–26],
a standardized measure of workstyle may be useful for
future epidemiological and clinical research.
Conflicts of interest
The opinions and assertions contained herein are the private
views of the authors and are not to be construed as being official
or as reflecting the views of the Uniformed Services University
of the Health Sciences or the Department of Defense.
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Appendix: Workstyle Short Form
Please complete the following survey by checking the
boxes that describe your experience at work.
Part 1
Rate the degree to which each of the following items
describes you at WORK by selecting the appropri-
ate option.
1. I continue to work with pain and discomfort so that
the quality of my work won’t suffer.
2. My hands and arms feel tired during the workday.
3. I feel achy when I work at my workstation.
4. Since there is really nothing that I can do about my
pain in my hands/arms/shoulders/neck, I just have to
work through the pain.
5. There really isn’t much I can do to help myself in
terms of eliminating or reducing my symptoms in my
hands/arms/shoulders/neck.
6. My fingers/wrists/hands/arms (any one or combina-
tion) make jerky, quick, sudden movements.
7. I can’t take off from work because other people at
work will think less of me.
8. I can’t take off from work because I’d be letting down
or burdening my boss.
9. I can’t take off from work because I’d be letting down
or burdening my co-workers.
10. I can’t take off from work because it will negatively
affect my evaluations, promotions and/or job security.
11. If I take time off to take care of my health or to
exercise, my co-workers/boss will think less of me.
12. I don’t really know where I stand despite all the effort
I put into my work.
Rate the degree to which each of the following items
describes you at WORK by selecting the appropri-
ate option.
13. The boss doesn’t let you forget it if you don’t get
your work finished.
 M. FEUERSTEIN AND R. A. NICHOLAS: WORKSTYLE SHORT FORM Page 5 of 6

14. If I bring up problem(s) to my supervisor, like a co- a measure of the cognitive/behavioural responses of work-
worker not pulling his/her weight, it won’t make any style to the workplace in general. To score this subscale,
difference anyway, so I just go ahead and do the work add the scores of the Working Through Pain, Social Re-
myself. activity, Limited Workplace Support, Deadlines/Pressure
15. It is frustrating to work for those who don’t have the and Self-imposed Workpace/Workload subscales and
same sense of quality that I do. subtract the score from the Breaks subscale.
16. I have too many deadlines and will never be able to Summary score 2—Workstyle reactivity to high work
get all my work done. demands score (Part 2): This summary score is the total
17. Even if I organize my work so that I can meet dead- of the dichotomous items factors. The reactivity to high
lines, things change and then I have to work even work demands score is believed to be representative of
harder to get my work done on time. subjective and physiological distress/arousal experienced
18. My schedule at work is very uncontrollable. during periods of high-risk workstyle. Items include the
19. I feel pressured when I’m working at my workstation. sum of the Mood and Autonomic subscales.
20. I push myself and have higher expectations than
my supervisor and others that I have to deal with at
work. 1. Individual questions should be scored according to the possible
responses listed below.
21. My co-workers don’t pull their weight and I have to
take up the slack.
Question numbers Response options Scoring values
22. Others tell me I should slow down and not work so
hard. Questions 1–24 Almost never 0
23. I take time to pause or stretch during a typical day Rarely 1
at work. Sometimes 2
24. I take breaks when I am involved in a project at my Frequently 3
workstation. Almost always 4
Questions 25–32 Blank 0
Checked 1
Scale

Almost Rarely Sometimes Frequently Almost 2. Each subscale is scored by adding the scores of all the questions
never always in that subscale.
[] [] [] [] []
Workstyle subscale Questions Summary Questions
included score included
Part 2
Working Through 1–6
Check all the behaviours/emotions/symptoms that Pain
you experience only during periods of high work Social Reactivity 7–11
Limited Workplace 12–15
demands/workload.
Support
Deadlines/Pressure 16–19
Self-imposed 20–22
Workpace/
25. Anger [ ] Workload
26. Out of control [ ] Breaks 23–24
27. Have trouble concentrating/focusing on work [ ] Workstyle (Sum of 1–22)
28. Depleted/worn-out [ ] characteristic minus (sum
29. Overwhelmed [ ] responses to of 23–24)
the workplace
30. Short fuse/irritable [ ] (Part 1)
31. Cold feet [ ] Mood 25–30
32. Cold hands [ ] Autonomic 31–32
Workstyle (Sum of
reactivity to 25–32)
Workstyle Short Form scoring procedures high work
demands
(Part 2)
There are three summary scores that can be calculated Total score (Part 1 1
as indicated below. These have different scoring routines. Part 2)*
Summary score 1—Workstyle characteristic responses
to the workplace score (Part 1): This summary score is *Workstyle score is considered ‘at risk’ if total is $28.
Page 6 of 6 OCCUPATIONAL MEDICINE
Summary score 3—Total workstyle score: This sum-
mary score is a summation of Part 1 and Part 2. It was
calculated for the purpose of differentiating groups based
on workstyle scores. This score excludes the subscale that
focuses on symptoms in response to increased work
demands. The summary score has been used in most
comparisons and predictions of group status and out-
View publication stats
comes thus far because it is assumed to be a measure of
workstyle that is not impacted by pain and symptoms, i.e.
it does not contain the subscale related to pain and other
symptoms.
According to the initial validation sample, a total
Workstyle Short Form score is considered high risk if
the score is $28.