Abstract
Importance
Understanding the diverse vocational functioning profiles of individuals with disabilities is crucial for effective, person-centered practice in vocational rehabilitation.
Objective
To identify latent profiles of vocational functioning on the basis of Work Rehabilitation Questionnaire (WORQ) scores of individuals with disabilities in Turkey and to investigate demographic predictors of profile membership.
Design
Cross-sectional study using online survey methods.
Setting
Online data collection.
Participants
A total of 522 adults (67.8% male), ages 18–64 yr, literate, and possessing a health report confirming a disability rating of more than 40% were recruited.
Outcomes and Measures
Latent profile analysis was used to identify distinct vocational functioning profiles. Multinomial logistic regression examined predictors of profile membership. Latent profiles were derived from participant scores on the WORQ subdomains: Emotion, Cognition, Dexterity, and Mobility. Predictors included gender, education, and work experience.
Results
Three distinct latent profiles were identified: Class 1 (n = 199), with the lowest scores across all subdomains; Class 2 (n = 83), with higher Emotion and Cognition scores but lower Dexterity and Mobility scores; and Class 3 (n = 240), with higher Dexterity and Mobility scores but lower Emotion and Cognition scores. Prior work experience significantly predicted membership likelihood between profiles (p = .031).
Conclusions and Relevance
Individuals with disabilities exhibit distinct vocational functioning profiles, highlighting significant heterogeneity beyond diagnostic labels. These findings underscore the need for individualized assessment and intervention in vocational rehabilitation, tailoring approaches to profile characteristics. The profiles can guide goal setting and intervention planning, although further research is needed to explore links with specific diagnoses and employment outcomes.
Plain-Language Summary
Understanding the different work-related strengths and challenges people with disabilities face is important to help them succeed in employment. This study identified three common patterns, or profiles, of individuals with disabilities on the basis of their self-reported emotional, thinking, physical movement, and fine motor skills related to work. One group had lower scores overall, another had stronger emotional and thinking skills but weaker physical skills, and the third had stronger physical skills but weaker emotional and thinking skills. Knowing these profiles can help occupational therapists tailor vocational rehabilitation programs to better meet each person’s specific needs, focusing on the areas in which they need the most support to find and keep meaningful work.
This study identified three common patterns, or profiles, of individuals with disabilities on the basis of their self-reported emotional, thinking, physical movement, and fine motor skills related to work.
Work is one of the most basic parameters of existence and self-realization in society. Individuals often define themselves by their work in social interactions. Although the specific value placed on labor differs from society to society, it has always been highly valued (Martela & Pessi, 2018). Although it is generally accepted that having a job or entering the labor force raises a person’s social standing and financial circumstances, the phenomenon of unemployment is linked to the ideas of dysfunction and insufficiency (Ross, 2013). From an occupational therapy perspective, work is a fundamental area of occupation, deeply intertwined with identity, well-being, and community participation. However, because of disability-related employment regulations and employers’ attitudes, people with disabilities often experience difficulties at the beginning of their employment path (Yelin & Trupin, 2003).
Vocational rehabilitation (VR) services are provided for people with disabilities to enable their entrance into professional life and employment and to maintain their professional life in a sustainable way (Waddell et al., 2008). VR practices consist of two basic stages: first, comprehensively evaluating the individual’s vocational functions and, second, creating an individualized VR intervention program for them based on the results of this evaluation. For VR services to be carried out efficiently for all individuals with disabilities, it is of great importance to correctly evaluate their occupational functions and functionality levels (Franche & Krause, 2002). VR interventions are planned in consideration of functionality levels, personal and cultural characteristics, individual capacity, demographics, and various other factors; therefore, these programs have a complex and multifaceted structure (Escorpizo et al., 2011).
Considering the complex and multifaceted nature of VR, it is necessary to determine individuals’ functionality levels, plan the intervention in accordance with their goals, and predict their employment results in a realistic way (Saltychev et al., 2013). An evaluation based on a biopsychosocial model could respond to the need for a comprehensive evaluation, which stands out in the complex structure of VR (Escorpizo et al., 2011; Garton et al., 2016).
The Work Rehabilitation Questionnaire (WORQ; Finger et al., 2014) is a scale developed to meet this need, based on the International Classification of Functioning, Disability and Health (World Health Organization, 2001). The WORQ is used to determine the vocational functionality level of individuals who will benefit from VR services in a comprehensive manner. To date, it has been translated into German, Portuguese, Russian, Taiwanese, Dutch, and Turkish and is actively used in these countries (Aran et al., 2021; Finger et al., 2014; Husmann et al., 2020; Vermeulen et al., 2019). With the WORQ, it is possible to plan VR programs and return-to-work processes for individuals. Another benefit of the WORQ’s comprehensive structure is that it enables the creation of an individualized occupational profile related to individuals’ occupational capacities and functionality levels. WORQ is currently used to evaluate vocational performances of individuals with disabilities (Finger et al., 2014). However, because the scale can be used with people with a wide range of diagnoses, the outcomes might be heterogeneous. Modeling the possible groups according to individuals’ different vocational functions, especially for different disability groups, might present a good opportunity to enable the realistic determination of employment targets (Finger et al., 2014; Husmann et al., 2020). Latent profile analysis (LPA) is used to identify classes on the basis of the response to continuous variables (Collins & Lanza, 2009). LPA, which mainly focuses on the likelihood that participants will belong to a specific latent profile, is a person-centered approach that aims to determine the latent factors. LPA also allows researchers to understand the differences between groups that have similar patterns of variation by examining individual differences rather than total or mean scores. Therefore, a person-centered approach such as LPA is valuable for occupational therapy practitioners and researchers because it can reveal distinct subgroups within a heterogeneous population of individuals with disabilities, moving beyond variable-centered analyses to understand patterns of strengths and challenges relevant to occupational performance in work (Wang & Hanges, 2011).
We used LPA to identify what types of vocational performance are most meaningful to individuals. The main aim of this study was to (1) determine the number of latent profiles on the vocational functionality level and (2) investigate the independent variables that affect the probability of belonging in a specific latent profile.
Method
This study protocol was approved by the Ethics Committee of Trakya University (Report No. 2021.02.13).
Participants
Participants were recruited from the existing databases of the Hacettepe University Vocational Rehabilitation Center and those of the job and vocational counselors of the Turkish Employment Agency. Using these databases, we randomly selected potential participants, and obtained their contact information, including email addresses and telephone numbers. An online form of the WORQ–Turkish (WORQ–TR) was created in Google Forms and then sent directly via email and WhatsApp to these individuals. The first page of the online form included a detailed consent form, in which details of the study, how the collected data would be used, and how data anonymity would be ensured were described. Participants who had a health report with a disability rating above 40% (according to Turkish Disability Act; Law No. 5378, 2005), were ages 18 to 64 yr, and were able to understand written instructions and information (literate) were included in the study.
Instruments
Each participant who agreed to participate and met the inclusion criteria filled out the WORQ–TR. The WORQ–TR is the validated Turkish version of the WORQ, as adapted and verified by Aran et al. (2021), and was therefore the instrument used for data collection in this study.
The WORQ provides a thorough evaluation of occupational functions. The questionnaire essentially has two parts: The first section gathers data on the person’s abilities linked to their line of work, and the second part gathers data on the challenges they face at work. The first section includes 17 questions that cover both general and sociodemographic information about the individual’s working status. Detailed information is collected about the individual’s occupation, employment status, past work environment, and other situations that may affect work performance.
The second section, which is designed to address job performance in four dimensions, Emotion, Dexterity, Mobility, and Cognition, consists of 42 questions. It examines the level of functionality and functionality problems experienced by the individual in the context of work. By examining these characteristics, it provides a thorough evaluation of the respondent’s strengths and challenges in several areas of work.
It is significant to note that 10 of the 42 questions in the second portion of the WORQ pertain to various health issues, such as hearing loss or skin issues. Furthermore, two items focus on assessing visual skills. Although these 12 items are not included in the calculation of subtest scores, they provide valuable information about specific health-related concerns that may affect work performance (Finger et al., 2014).
As noted earlier, the WORQ was translated into Turkish by Aran et al. (2021), who reported excellent internal consistency (Cronbach’s α = .906), good time-invariance (intraclass correlation coefficient = .811), and favorable structural validity with high model fit. These statistical measures demonstrate the questionnaire’s robustness and reliability in assessing individuals’ work-related capabilities and challenges.
Statistical Analysis
LPA was conducted using Mplus (Version 8.6; Muthén & Muthén, 2017) to identify distinct subgroups of participants based on their response patterns across the four WORQ subdomains (Emotion, Cognition, Dexterity, Mobility). LPA is a different type of growth mixture model that is specifically used for continuous variables. According to Tein et al. (2013), LPA is mainly used to identify a set of discrete and nonoverlapping latent classes of individuals by using the response patterns to a set of profile indicators; it also includes model testing that determines the best-fitting model by comparing multiple models with the different number of profiles (Tein et al., 2013). A variety of goodness-of-fit indices were used to determine the number of latent profiles, such as the Akaike information criterion (AIC), Bayesian information criterion (BIC), and the sample-size-adjusted BIC (SABIC). BIC is considered the common fit index for determining latent profiles (Nylund et al., 2007), along with a comprehensive evaluation of AIC and SABIC. Moreover, the entropy index is also estimated as an indicator of the certainty between the different profiles. Entropy with a higher value is expected for better determination of profiles. In addition, the bootstrap likelihood ratio test (BLRT) and the Lo–Mendell–Rubin test were also calculated to compare models using the likelihood ratio (Vermunt, 2024). The α level for statistical significance was set at p < .05.
Results
The final sample (N = 522) consisted of 67.8% men and 32.2% women. The mean age of the participants was 34.65 yr (SD = 9.12). A total of 29.9% of the participants were high school graduates, and 72.2% had at least 1 yr working experience.
Profile Analysis
On the basis of the findings (Table 1), the three-profile model demonstrated the best fit, as evidenced by its lowest BIC values and statistically significant BLRT_p values (p < .05). Nevertheless, it is important to note that although the entropy values were notably high for a four-profile solution, the BIC values did not reach statistical significance. Consequently, the appropriate approach was to establish a three-class model to represent the latent profiles of participants.
Profile Analysis
Note. The latent profile analyses did not converge when the class number was greater than 4, so further estimates are not included here. AIC = Akaike information criterion; BIC = Bayesian information criterion; BLRT = bootstrap likelihood ratio test p value; LMR_p = Lo–Mendell–Rubin likelihood ratio test p value; NPar = number of estimated parameters; SABIC = sample-size-adjusted BIC.
Three different latent classes were identified; Class 1 (n = 199) had the lowest scores on all four WORQ-TR subtests; Class 2 (n = 83) had high scores on Emotion and Cognition, whereas Dexterity and Mobility scores were lower; vice versa, Class 3 (n = 240) had high scores on Dexterity and Mobility, whereas Emotion and Cognition scores were low (Table 2). Additional information regarding the demographic data across the three classes is given in Table 3. To examine the predictive significance of the demographic variables on WORQ profiles, multinomial logistic regression (MLR) was used. The MLR outcomes for the profiles can be found in Table 4. The reference category for comparison purposes was set as moderate, because it was determined on the basis of having the highest number of participants within each category (McNulty, 2021).
WORQ–TR Domain Scores Across Three Classes
Note. N = 522. WORQ–TR = Work Assessment Questionnaire–Turkish
Gender, Age, Work Experience, and Income Across Three Classes
Multinominal Logistic Regression Results Predicting Classes
Note. EDU = education; High = Class 3; JOB = employment history; JSUP = job support from peers, boss, etc.; SUP = support from family; Medium = Class 2.
* p < .05.
The results indicated that work experience was a significant predictor of the transition between profiles. The analysis showed that work experience was a strong factor in determining whether the sample moved from a low profile to a moderate one.
Discussion
The purpose of this study was to test whether distinct vocational profiles of individuals with disabilities emerge on the basis of WORQ–TR Cognition, Dexterity, Mobility, and Emotion scores with LPA. Additionally, the associations between subtypes were investigated in terms of education, gender, employment history, family support, and job support.
This study’s findings support the current literature regarding the heterogeneity of individuals with disabilities. In recent years, interest has increased in the identification of subgroups of different causes of disability based on various characteristics, such as activities of daily living limitations, comorbidities, and psychosocial factors. This study investigated subgroups of individuals on the basis of their WORQ–TR scores, with the resulting three classes. These findings are consistent with previous research on disability subgroups, which has identified similar patterns of functional limitations among individuals with disabilities (Carlesso et al., 2018; Rabey et al., 2016).
The combination of motor functions, muscle strength, mobility, hand coordination, dexterity, and other physical abilities plays a crucial role in achieving independence in daily activities. Furthermore, these abilities are equally vital for employment prospects, vocational performance, and the integration of diverse work skills (Chini et al., 2022). Specifically, work-related motor skills hold significant value in terms of enhancing employability for individuals with disabilities (Benner et al., 2017; Lipskaya-Velikovsky et al., 2019). Class 3 was characterized by high scores on Dexterity and Mobility but low scores on Emotion and Cognition, and the individuals in this class had slightly higher levels of education and work history than those in Class 1, which had the lowest scores in all domains, suggesting that, among individuals with disabilities, employability may be related to motor skills (Keyserling, 2000; Lipskaya-Velikovsky et al., 2019; Ratzon et al., 2011).
After graduating from vocational school, individuals with disabilities are mostly employed in jobs that require motor skills such as reaching, bending, and grasping (Wu & Chen, 2007; Zikl et al., 2012). It is important to master motor skills to be employed and to have good work performance (Kao & Wang, 2017; Ratzon et al., 2011). In this study, Class 3 already had higher scores in the physical domains of the WORQ–TR; additionally, the participants might have achieved improvements in motor skills through education and past work experience.
Class 2, characterized by high scores on Emotion and Cognition but low scores on Dexterity and Mobility, did not have differences in education levels or work history compared with Class 1. This suggests that emotional and cognitive functioning may be important for employability among individuals with disabilities regardless of educational or work background. Previous research has also found that emotional and cognitive functioning are important for employment outcomes among individuals with disabilities (Grauwmeijer et al., 2012; Wong et al., 2019). Emotional and cognitive skills such as self-monitoring, self-regulation, attention, memory, and coping with occupational demands are required to perform many jobs (Ownsworth & Shum, 2008; Wong et al., 2019).
These findings highlight the need for interventions that focus on improving emotional and cognitive functioning among individuals with disabilities, particularly those in Class 2, who may struggle with certain aspects of work or employment because of their low Dexterity and Mobility scores. Such interventions may include psychotherapy, cognitive–behavioral therapy, and VR programs that address emotional and cognitive barriers to employment for individuals in Class 3.
In the context of individualized interventions, each intervention focusing on increasing employability will differ according to client characteristics. Therefore, it is necessary to design personalized skill development programs. This is supported by research from Tran et al. (2021), who deduced that the causal factors of the most effective intervention approach for job seekers with disabilities were motivation, education, and work capacity, shedding light on areas of development for individuals. Our findings suggest that employability among individuals with disabilities is complex and multidimensional and that interventions must address a range of factors, including motor skills, emotional functioning, and cognitive functioning to improve employment outcomes and quality of life. Importantly, our findings suggest that education level and work history are important predictors of subgroup membership. Participants with a higher education level and those who had worked before were less likely to be in Class 1. This is consistent with previous research that has found a positive association between education level, employment, and functional status among individuals with disabilities (Boman et al., 2015; Cheatham & Randolph, 2022).
Employment history and work experience are the main predictors of being in Class 1 or 2. Significant results can be explained by the common context in which discrimination against individuals with disabilities is present in the country, enabling individuals with moderate to severe disabilities to obtain employment through familiar connections. However, the extent of our knowledge regarding the specific job descriptions and assigned responsibilities is limited. As a result, differences in work duration may arise. In addition to our clinical experience in VR, as well as the related literature, participants with better skills or less disability might be selective about employment, which might result differences between employment history and experience (Kurt, 2020; Mustafa, 2018).
Limitations
In this study, we did not gather information about participants’ disability type. We believe this is a minor limitation; however, it would be better to know how the type of disability affects the classification of participants’ vocational outcomes. Additionally, we did not know individuals’ current employment status at the time of data collection. Rather, individuals with an employment history who met the other inclusion criteria were included regardless of whether they were currently employed at the time of data collection. Current employment status would have been a valuable variable to take into account during the LPA.
Implications for Occupational Therapy Practice
These findings offer several considerations for occupational therapists working in VR and supporting individuals with disabilities in achieving their work goals: ▪ Assessment should move beyond global functioning scores to identify individual profiles of strengths and challenges across emotional, cognitive, dexterity, and mobility domains related to work, potentially using the WORQ as part of a comprehensive occupational profile. ▪ Intervention planning can be tailored on the basis of profile membership. For individuals resembling Class 3 (high motor and low emotion cognition), therapists may need to emphasize strategies for emotional regulation, coping, social skills, and executive functions within the work context. ▪ For individuals similar to Class 2 (high emotion cognition and low motor skills), interventions might focus more on task modification, environmental adaptation, assistive technology, or targeted motor skill development relevant to desired occupations. ▪ Individuals in Class 1 (lower scores across all domains) likely require comprehensive, multifaceted interventions addressing foundational skills, confidence building (volition), routine development (habituation), and performance capacities across all areas. ▪ Occupational therapists should consider the potential impact of work history, as suggested by the analysis, recognizing that individuals with less experience may require more intensive support regardless of their specific skill profile. ▪ Using these profiles can help therapists set more realistic, client-centered goals and advocate for appropriate supports and accommodations in the workplace.
Conclusion
Overall, our findings have important implications for the design and delivery of interventions and services for individuals with disabilities. Our results bring individualization to the fore with respect to applications to improve working capacity. By identifying distinct subgroups of individuals with disabilities, one can better tailor interventions. Additionally, our findings suggest that interventions and services should be tailored to the specific needs of individuals on the basis of their education level and work history. Further research is needed to validate and extend our findings, particularly with other populations and other measures of disability. Research may also explore the potential interaction effects between these domains, as well as other factors such as social support and stigma, while also taking into account current employment status of individuals with disabilities to further improve interventions and services for them.
Footnotes
Acknowledgments
We extend our sincere gratitude to all the individuals who participated in this study. Their willingness to share their experiences and time was invaluable to the completion of this research.