As there are no specific instruments to measure the loss in WP of individuals with Overactive Bladder Symptoms (OABS), some studies used generic questionnaires with this population. Other authors studied WP as a secondary outcome evaluated in structured questionnaires on the general impact of OABS. Additionally, some studies explored the inverse relationship, and impact of work on the emergence and severity of symptoms.
It is necessary to explore the work productivity (WP) considering the specificity of OABS. Currently, OABS can influence concentration, vigor, motivation, irritability, fatigue, and influencing the WP. Understanding the effects of OABS on production performance will allow it to be considered an occupational public health problem, taking prevention measures and control.
The objective of the current study was to evaluate the impact of OABS on the subjective (SD) and behavioral (BD) domains related to WP, using a new instrument developed and applied, with the hypothesis that employees of a public hospital with OABS will present an impact on the domains of efficiency, concentration, vigor, and irritability, lost working hours, interruptions, and compromises of work schedule.

An observational, cross-sectional analytical study was carried out with a convenience sample of employees at a public hospital from April 2019 to May 2022. The sample was based on a list provided by the institution's human resources division. Visits were made to hospital units, alternating shifts, to obtain a uniform sample of workers. This study was approved by Research Ethics Committee. Women aged 18 or over, registered as employees, active in their roles during the collection period, literate, and who agreed to participate in the research were included. Pregnant women or patients with morbidities that could trigger LUTS or affect their assessment were excluded.
The OAB-V8 questionnaire, ICIQ-OAB were used. ICIQ-OAB  was also used to classify participants into subtypes of wet (WOABS) and dry (DOABS) OABS, according to their responses to question 6a. 
To evaluate the WP of employees with OABS, a questionnaire designed by the researchers was used. The instrument consists of 16 questions, the first part contains 12 items to evaluate the impact of OABS on subjective (SD) and behavioral (BD) domains related to productivity in the previous four weeks. 
The total score for the first part varies from 0 to 36 points, with higher values indicating a greater effect of OABS on WP. The second part is composed of 4 questions, to assess the impact of each OABS symptom, separately, on productivity. 
The volunteers were asked about the storage LUTS and the impact of each of them on general productivity, quantified using a numerical scale graduated from 0  to 10.
The subjective domains related to presenteeism on the WP were based on the Rapid Instrument for Subjective Assessment of Intra-Workday Labor Productivity [1]. The questions regarding absenteeism were adapted from the Output Demands subscale of the Work Limitations Questionnaire [2] and some sub-items of the WHO-HPQ and the Work Productivity and Activity Impairment - General Health (WPAI-GH) questionnaire. 
Part 2 of the WP questionnaire was developed considering the analysis carried out in the study by Sexton et al. [3], who evaluated the work impairment score for specific urinary symptoms. The definition of presenteeism and the grading method used in this part of the instrument were adapted from the WPAI-GH. 
The outcome variable studied was WP, and the predictor variables were discomfort and severity of symptoms, as well as impairment in QoL, with the exposure variable being the diagnosis of OABS.

Of the total of 579 eligible employees, 576 participated in the study, 447 employees without OABS, 63 with DOABS, and 66 with WOABS (Figure 1). 
The sample characterization and work data of the volunteers are found in tables 1, presented by subgroup. Water intake was similar in the three groups. Urogynecological surgeries were more frequent in the OABS groups (OABS: 49.4%; DOABS: 68.3%; WOABS: 81.8%), but not significant. An association was found between some of these variables (education, UI, and use of protectors) and the OABS groups. 
Regarding questionnaire data, significant associations were found with OABS subtypes (p<0.001), from ICIQ-OAB and the ICIQ-OAB numeric scale scores, with higher values among volunteers in the WOABS group.
Table 2 presents the total score of the WP questionnaire (part 1), the total score of the WP numerical scale per urinary symptom (part 2), and the absolute and relative frequencies of SD and BD, referring to the symptom impact scores. Data on WP were collected from 45 volunteers with DOABS and 46 with WOABS. 
A significant impact was observed on the WP of employees with OABS (p=0.03), with a higher score being found with WOABS compared to volunteers with DOABS. Although there was no significant impact on WP regarding the total score of the subjective and behavioral domains (p=0.05), the analysis showed a significant association between OABS and the specific efficiency/productivity domains (p=0.03), agitation (p<0.05), and interruptions to go to the bathroom (p=0.03), with higher scores being found with WOABS (table 2). 
Furthermore, urgency and incontinenceI were symptoms with a significant impact on WP (p=0.01, p<0.001), especially in the WOABS group. 
Table 3 presents the correlations between the scores of the WP questionnaire and the OAB-V8 and ICIQ-OAB. There was a significant correlation between the discomfort of OABS, using the OAB-V8 score and the ICIQ-OAB numerical scale, and the impact on the subjective and behavioral domains of WP in both groups. Among the WOABS subtype, there was also a significant correlation between impairment in WP and the severity and impairment of symptoms on QoL (p<0.001). 
Furthermore, in both groups, a significant correlation was found between the impact on WP per specific symptom of OABS and QoL, severity p<0.001) and the discomfort, using the OAB-V8 score , and the ICIQ-OAB numerical scale (table 3).

A significant impact of OABS symptoms on WP was observed, among the domains of efficiency/productivity, agitation, and interruptions for bathroom visits, partially corroborating the hypothesis presented. Urgency and incontinence were associated with a greater impact on productive and volunteers with WOABS presented worse WP results. Furthermore, worse WP scores were correlated with greater discomfort, severity, and QoL impairment due to OABS symptoms.
Regarding the domains assessed by the WP questionnaire, the significant impact of OABS on efficiency/productivity (SD1) stands out, especially among employees with WOABS. 
The comparison of our results with the literature may be limited by several factors, including the use of different WP measurement instruments. 
The results found in the current study showed urgency and incontinence with the greatest impact on productivity. Unlike other methodologies used, which correlated with work activity and considered general LUTS, the instrument developed allows the assessment of WP by specific OABS symptoms. These data are important to expand understanding of the severity and impact of each symptom.
Among the subtypes of OABS, volunteers with WOABS presented worse WP scores, and greater impairment in QoL, discomfort, and severity of symptoms. This difference between DOABS and WOABS reinforces the need to evaluate the isolated impact of incontinence on productivity.

Employees with OABS, urinary symptoms had a negative impact on WP, mainly in aspects of efficiency/productivity, agitation, and interruptions to go to the bathroom, with worse scores among volunteers in the WOABS group. The symptoms voiding urgency and UUI had the greatest impact on WP.

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Sexton CC, Coyne KS, Vats V, Kopp ZS, Irwin DE, Wagner TH (2009) Impact of Overactive Bladder on Work Productivity in the United States: Results From EpiLUTS. The American Journal of Managed Care 15: S98-S107

Continence 12S (2024) 101549
DOI: 10.1016/j.cont.2024.101549