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Otte T, Decuman S, Gelade W, Duyver C. Perceptions of medical advisers on ICF core-sets’ use for evaluating work incapacity related to back pain in French-speaking Belgium. Work 2022; 74:1401-1418. [PMID: 36502361 DOI: 10.3233/wor-210247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND: There is willingness in Europe to implement the use of a biopsychosocial model such as the International Classification of Functioning, Disability and Health (ICF) for assessing work incapacity. OBJECTIVE: A preliminary study was conducted to investigate the perceptions of medical advisers on the value of structuring clients’ biopsychosocial information in an ICF-based report. METHOD: A sample (n = 101) received a perception questionnaire after watching two comparative videos based on a clinical case. Questions relating to work incapacity were also asked. The data was analysed using quantitative methods. Comments were also collected. RESULTS: Before knowing the ICF-based report, 61.96% of the respondents believed a return to work seems possible by providing adapted work or a different job. There is an increase of 8.69 pp (p-value: 0.077) after reading the report. Opening up the initial sample to more insurance physicians (n = 119), the difference is more significant (p-value: 0.012). Also, 71.9% of respondents believe they have a better view of the client’s biopsychosocial situation after reading the report. Respondents recognise the clinical and diagnostic relevance of ICF but say it cannot be used at the moment for various reasons, such as the time required or the need for a multidisciplinary team and effective coordination. Older respondents are less enthusiastic about the appropriateness of using ICF. CONCLUSION: The respondents identify an added value in having a biopsychosocial based-report. After learning about the report, more physicians see opportunities for professional re-integration than before. The medical advisers and their team must be strengthened and receive a clear role in order to empower them.
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Affiliation(s)
- Thomas Otte
- Department of Disability Benefits, Belgian National Institute for Health and Disability Insurance, Brussels, Belgium
| | - Saskia Decuman
- Department of Disability Benefits, Belgian National Institute for Health and Disability Insurance, Brussels, Belgium
| | - Wouter Gelade
- Center for Research in the Economics of Development, University of Namur, Namur, Belgium
| | - Corentin Duyver
- Centre Académique de Médecine Générale, Université catholique de Louvain, Brussels, Belgium
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Deng Q, Wang Y, Liu W. Using Multilevel Structural Equation Modeling (MSEM) to Identify the Predictors and Influencing Mechanism of Technology Use Among Chinese Physicians: An Example from Des-Gamma-Carboxy Prothrombin (DCP). Healthc Policy 2022; 15:59-70. [PMID: 35082541 PMCID: PMC8785222 DOI: 10.2147/rmhp.s344923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background Since expanding the use of appropriate and effective health technologies will greatly benefit the diagnosis and treatment of some major diseases at an early stage, understanding the mechanism of technology use is crucial for its successful implementation. Few previous studies focused on the healthcare providers and involved multi-facets factors at individual, technical, organizational, and environmental levels. Purpose To examine the influencing mechanism of technology use among Chinese physicians by integrating multilevel factors, Des-gamma-Carboxy Prothrombin (DCP) was taken as an example. Methods Through multistage random sampling, a cross-sectional questionnaire survey was conducted among physicians in charge of direct use of DCP of sampled secondary and tertiary hospitals. Since the sample data comprised two hierarchical levels (physicians and hospitals), multilevel structural equation modeling was used to link five aspects of factors with physicians’ technology use and estimate the effects. Results Totally, 229 physicians completed the investigation. The use of DCP appears to be at a relatively low level. Intra-class coefficients of the null model (unadjusted baseline model) suggested that physicians’ DCP use has a significant variation between hospitals. The final model identified that value cognition (B = 0.447, P < 0.01), experienced organizational practice (B = 0.203, P < 0.05), and perceived organizational atmosphere (B = −0.237, P < 0.01) contributed directly to physicians’ DCP use. Additionally, technical assessment, perceived organizational atmosphere, and perceived environmental pressure had indirect impacts on physicians’ DCP use that were mediated by value cognition and experienced organizational practice (P < 0.05). Conclusion This study incorporated and determined the significant direct or indirect role of value cognition, technical assessment, experienced organizational practice, perceived organizational atmosphere, and perceived environmental pressure. This influencing mechanism with integrated multilevel factors could serve as a theoretical basis for tailoring interventions to promote technology use among Chinese physicians.
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Affiliation(s)
- Qingwen Deng
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, 350122, People’s Republic of China
- School of Public Health, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Yueqin Wang
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, 350122, People’s Republic of China
| | - Wenbin Liu
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, 350122, People’s Republic of China
- Correspondence: Wenbin Liu, Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, 350122, People’s Republic of China, Tel +86 13799983766, Email
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Boersema HJ, Hoekstra T, Abma F, Brouwer S. Inability to Work Fulltime, Prevalence and Associated Factors Among Applicants for Work Disability Benefit. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:796-806. [PMID: 33710457 PMCID: PMC8558289 DOI: 10.1007/s10926-021-09966-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 06/02/2023]
Abstract
Purpose Inability to work fulltime is an important outcome in the assessment of workers applying for a disability benefit. However, limited knowledge is available about the prevalence and degree of the inability to work fulltime, the associations between disease-related and socio-demographic factors with inability to work fulltime and whether the prevalence and the associations differ across disease groups. Methods Anonymized register data on assessments of workers with residual work capacity (n = 30,177, age 48.8 ± 11.0, 53.9% female) applying for a work disability benefit in 2016 were used. Inability to work fulltime was defined as being able to work less than 8 h per day. Results The prevalence of inability to work fulltime was 39.4%, of these 62.5% could work up to 4 h per day. Higher age (OR 1.01, 95% CI 1.01-1.01), female gender (OR 1.45, 95% CI 1.37-1.52), higher education (OR 1.44, 95% CI 1.33-1.55) and multimorbidity (OR 1.06, 95% CI 1.01-1.11) showed higher odds for inability to work fulltime. Highest odds for inability to work fulltime were found for diseases of the blood, neoplasms and diseases of the respiratory system. Within specific disease groups, different associations were identified between disease-related and socio-demographic factors. Conclusion The prevalence and degree of inability to work fulltime in work disability benefit assessments is high. Specific chronic diseases are found to have higher odds for inability to work fulltime, and associated factors differ per disease group.
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Affiliation(s)
- Henk-Jan Boersema
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Groningen, The Netherlands.
- Research Center for Insurance Medicine, Amsterdam, The Netherlands.
- The Dutch Social Security Institute: the Institute for Employee Benefits Schemes (UWV), Amsterdam, The Netherlands.
| | - Tialda Hoekstra
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Groningen, The Netherlands
- Research Center for Insurance Medicine, Amsterdam, The Netherlands
| | - Femke Abma
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Groningen, The Netherlands
- Research Center for Insurance Medicine, Amsterdam, The Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Groningen, The Netherlands
- Research Center for Insurance Medicine, Amsterdam, The Netherlands
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Weerdesteijn KHN, Schaafsma FG, Louwerse I, Huysmans MA, Van der Beek AJ, Anema JR. Does self-perceived health correlate with physician-assessed functional limitations in medical work disability assessments? J Psychosom Res 2019; 125:109792. [PMID: 31421326 DOI: 10.1016/j.jpsychores.2019.109792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/23/2019] [Accepted: 08/01/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Our purpose was to obtain information about the correlation between workers' self-perceived health and physician-assessed functional limitations. We also studied whether this correlation differed between workers with subjective health complaints that cannot (SHC) and those that can be explained (non-SHC) by a well-defined medical disease. METHODS Baseline data of 2040 participants from a prospective cohort study were used for this study. These participants answered a questionnaire on their self-perceived health and received a medical work disability assessment during which physicians reported functional limitations. Pearson correlation analyses were used to calculate correlations between 4 functional limitation factors and 11 self-perceived health factors. For correlations with coefficients ≥0.30, linear regression analyses were performed to assess possible differences between participants with SHC (n = 363) and those with non-SHC (n = 1677). RESULTS We found correlations ≥0.30 between two functional limitation factors and six self-perceived health factors for all participants. SHC participants showed lower correlations than the non-SHC participants between the physical functional limitation and the SF-36 self-perceived physical health factors (-0.49, 95% CI -0.56 to -0.41 vs. -0.60, 95% CI -0.62 to -0.57) and between the mental functional limitation and the SF-36 self-perceived mental health factors (-0.30, 95% CI -0.39 to -0.20 vs. -0.40, 95% CI -0.44 to -0.36). CONCLUSION Self-perceived health showed overall low to moderate correlations with physician-assessed functional limitations. Some of these correlations were lower for workers with SHC than for those with non-SHC. This may indicate that physicians rely slightly more on well-defined medical complaints within medical work disability assessments.
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Affiliation(s)
- Kristel H N Weerdesteijn
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands; Research Center for Insurance Medicine (KCVG), AMC-UMCG-UWV-VUmc, PO Box 7057, 1007, MB, Amsterdam, the Netherlands; Department of Social Medical Affairs (SMZ), The Dutch Social Security Institute: The Institute for Employee Benefits Schemes (UWV), La Guardiaweg 94-114, 1043, DL, Amsterdam, the Netherlands.
| | - Frederieke G Schaafsma
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands; Research Center for Insurance Medicine (KCVG), AMC-UMCG-UWV-VUmc, PO Box 7057, 1007, MB, Amsterdam, the Netherlands
| | - Ilse Louwerse
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands; Research Center for Insurance Medicine (KCVG), AMC-UMCG-UWV-VUmc, PO Box 7057, 1007, MB, Amsterdam, the Netherlands; Department of Social Medical Affairs (SMZ), The Dutch Social Security Institute: The Institute for Employee Benefits Schemes (UWV), La Guardiaweg 94-114, 1043, DL, Amsterdam, the Netherlands
| | - Maaike A Huysmans
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands; Research Center for Insurance Medicine (KCVG), AMC-UMCG-UWV-VUmc, PO Box 7057, 1007, MB, Amsterdam, the Netherlands
| | - Allard J Van der Beek
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands; Research Center for Insurance Medicine (KCVG), AMC-UMCG-UWV-VUmc, PO Box 7057, 1007, MB, Amsterdam, the Netherlands
| | - Johannes R Anema
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands; Research Center for Insurance Medicine (KCVG), AMC-UMCG-UWV-VUmc, PO Box 7057, 1007, MB, Amsterdam, the Netherlands
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Kunz R, von Allmen DY, Marelli R, Hoffmann-Richter U, Jeger J, Mager R, Colomb E, Schaad HJ, Bachmann M, Vogel N, Busse JW, Eichhorn M, Bänziger O, Zumbrunn T, de Boer WEL, Fischer K. The reproducibility of psychiatric evaluations of work disability: two reliability and agreement studies. BMC Psychiatry 2019; 19:205. [PMID: 31266488 PMCID: PMC6607597 DOI: 10.1186/s12888-019-2171-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 06/04/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Expert psychiatrists conducting work disability evaluations often disagree on work capacity (WC) when assessing the same patient. More structured and standardised evaluations focusing on function could improve agreement. The RELY studies aimed to establish the inter-rater reproducibility (reliability and agreement) of 'functional evaluations' in patients with mental disorders applying for disability benefits and to compare the effect of limited versus intensive expert training on reproducibility. METHODS We performed two multi-centre reproducibility studies on standardised functional WC evaluation (RELY 1 and 2). Trained psychiatrists interviewed 30 and 40 patients respectively and determined WC using the Instrument for Functional Assessment in Psychiatry (IFAP). Three psychiatrists per patient estimated WC from videotaped evaluations. We analysed reliability (intraclass correlation coefficients [ICC]) and agreement ('standard error of measurement' [SEM] and proportions of comparisons within prespecified limits) between expert evaluations of WC. Our primary outcome was WC in alternative work (WCalternative.work), 100-0%. Secondary outcomes were WC in last job (WClast.job), 100-0%; patients' perceived fairness of the evaluation, 10-0, higher is better; usefulness to psychiatrists. RESULTS Inter-rater reliability for WCalternative.work was fair in RELY 1 (ICC 0.43; 95%CI 0.22-0.60) and RELY 2 (ICC 0.44; 0.25-0.59). Agreement was low in both studies, the 'standard error of measurement' for WCalternative.work was 24.6 percentage points (20.9-28.4) and 19.4 (16.9-22.0) respectively. Using a 'maximum acceptable difference' of 25 percentage points WCalternative.work between two experts, 61.6% of comparisons in RELY 1, and 73.6% of comparisons in RELY 2 fell within these limits. Post-hoc secondary analysis for RELY 2 versus RELY 1 showed a significant change in SEMalternative.work (- 5.2 percentage points WCalternative.work [95%CI - 9.7 to - 0.6]), and in the proportions on the differences ≤ 25 percentage points WCalternative.work between two experts (p = 0.008). Patients perceived the functional evaluation as fair (RELY 1: mean 8.0; RELY 2: 9.4), psychiatrists as useful. CONCLUSIONS Evidence from non-randomised studies suggests that intensive training in functional evaluation may increase agreement on WC between experts, but fell short to reach stakeholders' expectations. It did not alter reliability. Isolated efforts in training psychiatrists may not suffice to reach the expected level of agreement. A societal discussion about achievable goals and readiness to consider procedural changes in WC evaluations may deserve considerations.
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Affiliation(s)
- Regina Kunz
- Department of Clinical Research, Evidence-based Insurance Medicine, University of Basel, University Hospital, 4031 Basel, Switzerland
| | - David Y. von Allmen
- Department of Clinical Research, Evidence-based Insurance Medicine, University of Basel, University Hospital, 4031 Basel, Switzerland
| | - Renato Marelli
- Swiss Society of Insurance Psychiatry, SGVP, 4051 Basel, Switzerland
- Private Practice for Psychiatry, 4051 Basel, Switzerland
| | - Ulrike Hoffmann-Richter
- Swiss National Accident Insurance Funds, 6004 Luzern, Switzerland
- Private Practice for Psychiatry and Psychotherapy, 6004 Lucerne, Switzerland
| | - Joerg Jeger
- Institute of Medical Disability Evaluations of Central Switzerland, 6003 Lucerne, Switzerland
| | - Ralph Mager
- Swiss Society of Insurance Psychiatry, SGVP, 4051 Basel, Switzerland
- Psychiatric University Hospital Basel, 4002 Basel, Switzerland
| | - Etienne Colomb
- French-Speaking Swiss Association of Practitioners in Medical Expertise (ARPEM), 1025 St Sulpice, Switzerland
| | - Heinz J. Schaad
- Institute for Medical Disability Evaluation Interlaken, 3800 Unterseen, Switzerland
| | - Monica Bachmann
- Department of Clinical Research, Evidence-based Insurance Medicine, University of Basel, University Hospital, 4031 Basel, Switzerland
| | - Nicole Vogel
- Department of Clinical Research, Evidence-based Insurance Medicine, University of Basel, University Hospital, 4031 Basel, Switzerland
| | - Jason W. Busse
- Department of Anaesthesia, McMaster University, Hamilton, L8S 4K1 ON Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University Hamilton, Hamilton, L8S 4K1 ON Canada
| | | | - Oskar Bänziger
- Zuerich Office of the Swiss National Disability Insurance, 8005 Zürich, Switzerland
| | - Thomas Zumbrunn
- Department of Clinical Research, Evidence-based Insurance Medicine, University of Basel, University Hospital, 4031 Basel, Switzerland
| | - Wout E. L. de Boer
- Department of Clinical Research, Evidence-based Insurance Medicine, University of Basel, University Hospital, 4031 Basel, Switzerland
| | - Katrin Fischer
- Institute Humans in Complex Systems, School of Applied Psychology, University of Applied Sciences Northwestern Switzerland, 4600 Olten, Switzerland
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Canela C, Buadze A, Dube A, Jackowski C, Pude I, Nellen R, Signorini P, Liebrenz M. How Do Legal Experts Cope With Medical Reports and Forensic Evidence? The Experiences, Perceptions, and Narratives of Swiss Judges and Other Legal Experts. Front Psychiatry 2019; 10:18. [PMID: 30814957 PMCID: PMC6381858 DOI: 10.3389/fpsyt.2019.00018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/11/2019] [Indexed: 11/17/2022] Open
Abstract
Expert scientific knowledge, including medical knowledge, is relevant for the legal profession and can strongly influence rulings and sentencing in criminal law, civil law, and insurance law. The way in which this medical evidence is understood and evaluated thus has an impact both on individuals and on society as a whole. It enters legal procedures in various forms, for example, as expert witness statements and/or as a legal expert's own acquired medical knowledge. On the other hand, a legal expert may be confronted with expert medical opinions that differ in quality or content and thus have to decide which ones to follow. The aim of this qualitative study was to investigate legal experts' perceptions, experiences, and narratives regarding medical knowledge, particularly the skills and general knowledge used in their branch of the legal profession. A total of 51 semi-structured interviews with judges and prosecutors from different courts of law and from the public prosecutor's office in six different German-speaking (Zurich, Luzern, Aagrau, Obwalden, Nidwalden, Zug) and German/French-speaking (Bern) cantons of Switzerland were conducted, coded, and analyzed using Nvivo. We used a comparison thematic approach identifying common and new themes related to the research aims. Our findings suggest that Swiss judges and prosecutors believe that possessing and developing the skills and terminology required for processing medical information is important but complex, and time-consuming for their work. Additionally, several legal experts reported that their understanding of medical evidence was limited or even non-existent. Moreover, the acquisition of skills related to the assessment of medical reports and forensic evidence appeared to be unstructured. Participants reported having no formal instruction in how to evaluate or deal with medical knowledge. The sources they used to answer questions arising appeared to be in part problematic and non-standardized (internet, newspapers, etc.). Medical literature from peer-reviewed journals was used only rarely. The findings from this study suggest that law departments might wish to evaluate whether their graduates are sufficiently equipped with scientific literacy skills and appropriate skills to evaluate medical information for their later careers. At the same time, medical knowledge pertinent to forensics published in local legal journals may be more effective in reaching the legal expert audience than in medical journals.
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Affiliation(s)
- Carlos Canela
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Anna Buadze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Anish Dube
- Department of Psychiatry and Human Behavior, UC Irvine Medical Center, Orange, CA, United States
| | - Christian Jackowski
- Department for Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Ingo Pude
- Forensic Assessment Clinic, Psychiatric Hospital Münsterlingen, Münsterlingen, Switzerland
| | - Romilda Nellen
- Department of Forensic Psychiatry, Luzerner Psychiatrie, Lucerne, Switzerland
| | - Paola Signorini
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
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van Muijen P, Schellart AJM, Duijts SFA, van der Beek AJ. The mediating role of coping between self-reported health complaints and functional limitations, self-assessed work ability and work status of long-term sick-listed cancer survivors. Eur J Cancer Care (Engl) 2018; 28:e12928. [PMID: 30273988 DOI: 10.1111/ecc.12928] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/14/2018] [Accepted: 08/22/2018] [Indexed: 12/26/2022]
Abstract
Our purpose was to investigate the possible mediating role of active coping and passive coping between self-reported health complaints and functional limitations, as assessed by an insurance physician (IP), self-assessed work ability and work status in cancer survivors on long-term sick leave. Validated questionnaires were used for self-reported health complaints, work ability and work status. The functional limitations of the respondents were transformed into scales for mental and physical limitations and limitations in working hours. Using LISREL, we constructed a model with coping in a mediating role. Active coping mediated between fewer self-reported physical limitations, more depressive symptoms, better cognitive functioning and more fatigue on the one hand, and more physical limitations and limitations in working hours on the other hand. Passive coping played no mediating role and was associated with more self-reported depressive symptoms only. More functional limitations were associated with lower self-assessed work ability of cancer survivors, and with not being at work, whereas higher self-assessed work ability was associated with being at work. Regarding the role of active and passive coping strategies in cancer survivors on long-term sick leave, more longitudinal research is needed to confirm causality.
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Affiliation(s)
- Peter van Muijen
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Dutch Institute for Employee Benefits Schemes (UWV), Amsterdam, The Netherlands.,Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Antonius J M Schellart
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Dutch Institute for Employee Benefits Schemes (UWV), Amsterdam, The Netherlands.,Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Saskia F A Duijts
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Allard J van der Beek
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
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Geiger BB, Garthwaite K, Warren J, Bambra C. Assessing work disability for social security benefits: international models for the direct assessment of work capacity. Disabil Rehabil 2017; 40:2962-2970. [PMID: 28841811 DOI: 10.1080/09638288.2017.1366556] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE It has been argued that social security disability assessments should directly assess claimants' work capacity, rather than relying on proxies such as on functioning. However, there is little academic discussion of how such assessments could be conducted. METHOD The article presents an account of different models of direct disability assessments based on case studies of the Netherlands, Germany, Denmark, Norway, the United States of America, Canada, Australia, and New Zealand, utilising over 150 documents and 40 expert interviews. RESULTS Three models of direct work disability assessments can be observed: (i) structured assessment, which measures the functional demands of jobs across the national economy and compares these to claimants' functional capacities; (ii) demonstrated assessment, which looks at claimants' actual experiences in the labour market and infers a lack of work capacity from the failure of a concerned rehabilitation attempt; and (iii) expert assessment, based on the judgement of skilled professionals. CONCLUSIONS Direct disability assessment within social security is not just theoretically desirable, but can be implemented in practice. We have shown that there are three distinct ways that this can be done, each with different strengths and weaknesses. Further research is needed to clarify the costs, validity/legitimacy, and consequences of these different models. Implications for rehabilitation It has recently been argued that social security disability assessments should directly assess work capacity rather than simply assessing functioning - but we have no understanding about how this can be done in practice. Based on case studies of nine countries, we show that direct disability assessment can be implemented, and argue that there are three different ways of doing it. These are "demonstrated assessment" (using claimants' experiences in the labour market), "structured assessment" (matching functional requirements to workplace demands), and "expert assessment" (the judgement of skilled professionals). While it is possible to implement a direct assessment of work capacity for social security benefits, further research is necessary to understand how best to maximise validity, legitimacy, and cost-effectiveness.
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Affiliation(s)
- Ben Baumberg Geiger
- a School of Social Policy , Sociology and Social Research (SSPSSR), University of Kent , Canterbury , UK
| | - Kayleigh Garthwaite
- b Institute of Health and Society, Faculty of Medical Sciences , Newcastle University , Newcastle , UK
| | - Jon Warren
- b Institute of Health and Society, Faculty of Medical Sciences , Newcastle University , Newcastle , UK
| | - Clare Bambra
- b Institute of Health and Society, Faculty of Medical Sciences , Newcastle University , Newcastle , UK
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9
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Canela C, Schleifer R, Jeger J, Ebner G, Seifritz E, Liebrenz M. Die invalidenversicherungsrechtliche Begutachtung in der Schweiz vor dem Hintergrund der letzten Gesetzesrevision und neueren Rechtsprechung. FORENSISCHE PSYCHIATRIE PSYCHOLOGIE KRIMINOLOGIE 2015. [DOI: 10.1007/s11757-014-0302-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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van Muijen P, Duijts SFA, Bonefaas-Groenewoud K, van der Beek AJ, Anema JR. Factors associated with work disability in employed cancer survivors at 24-month sick leave. BMC Cancer 2014; 14:236. [PMID: 24693855 PMCID: PMC3976500 DOI: 10.1186/1471-2407-14-236] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 03/25/2014] [Indexed: 11/30/2022] Open
Abstract
Background Identification of factors associated with work disability in cancer survivors on long term sick leave may support these survivors in choosing effective measures to facilitate vocational rehabilitation and return to work. Therefore, this study aims to disclose factors associated with work disability in cancer survivors at 24 months of sick leave. Methods A cross sectional study was conducted. The study population consisted of employed sick-listed cancer survivors, aged between 18 and 64 years. They received a questionnaire at 24-month sick leave, the maximum period of sick leave allowed by Dutch social security legislation. Data were linked with the outcome of work disability assessment, as performed by the Dutch social security agency. A hierarchical multivariate logistic regression analysis was performed to identify factors associated with work disability. Results Data of 351 valid cases were analysed. The multivariate analysis showed that, for cancer survivors at 24-month sick leave, Dutch nationality, higher education, receiving hormone therapy, metastatic disease, physical limitations and low self-reported work ability were associated with an increased risk for work disability. Conclusions This study identified factors associated with work disability of employed cancer survivors at 24 months of sick leave. The results of the current study may serve as a starting point to investigate the course of work disability beyond the maximum period of 24 months of sick leave. In order to enhance work participation of cancer survivors beyond this term, prospective data on work disability in the Netherlands are required.
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Affiliation(s)
- Peter van Muijen
- Department of Public and Occupational Health, EMGO + Institute/VU University Medical Center, P,O, Box 7057, 1007 MB Amsterdam, The Netherlands.
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Schellart AJM, Zwerver F, Anema JR, Van der Beek AJ. The influence of applying insurance medicine guidelines for depression on disability assessments. BMC Res Notes 2013; 6:225. [PMID: 23758690 PMCID: PMC3701610 DOI: 10.1186/1756-0500-6-225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 05/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the current study we report on the effects of an implementation strategy in the form of a training programme on the assessed work limitations of a client with depression by insurance physicians (IPs) participating in a RCT. These assessed work limitations of a client were in the form of scores on the List of Functional Abilities (LFA). METHOD We conducted a randomised controlled trial (RCT) for IPs in which we compared the intervention of a specially developed training programme with the usual methods of implementation and training currently used. The outcome was the mean sum score and the inter-rater reliability (Intraclass Correlation Coefficient, ICC) of the LFA scores. These LFA scores were scored by the IPs participating in the RCT for the work limitations of the cases presented in different videos, two videos before the training and two after the training of the intervention group. RESULTS At baseline, the intervention group (IG) consisted of 21 IPs and the control group (CG) of 19. For one participant of the IG and for one of the CG the LFAs of the two case reports after training were not available. Before training the sum scores for the first case report did not differ significantly between the groups, while the mean sum score was higher in the IG than in the CG for the second case report. For both case reports after training a higher score was found in the IG than in the CG. The inter-rater reliability measured for the two case reports before training was about the same in the IG and the CG: 0.64 and 0.65, respectively. For the two case reports after training, the ICC was higher in the IG than in the CG: 0.69 and 0.54, respectively. This difference was not significant however. CONCLUSION It would appear that the implementation of a specially designed training programme on guidelines for depression may lead to greater inter-rater reliability in the assessments by insurance physicians of the work limitations of clients with depression. It is, however, important to note that insurance physicians who receive training may find more work limitations than those who do not. TRIAL REGISTRATION Netherlands' Trial Register NTR1863.
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Affiliation(s)
- Antonius J M Schellart
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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