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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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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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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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Broersen JPJ, Mulders HPG, Schellart AJM, van der Beek AJ. The identification of job opportunities for severely disabled sick-listed employees. BMC Public Health 2012; 12:156. [PMID: 22394686 PMCID: PMC3311569 DOI: 10.1186/1471-2458-12-156] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 03/06/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Work disability is a major problem for both the worker and society. To explore the work opportunities in regular jobs of persons low in functional abilities, we tried to identify occupations low in task demands. Because of the variety of functional abilities and of the corresponding work demands, the disabled persons need to be classified by type of disability in a limited number of subgroups. Within each subgroup, occupations judged suitable for the most seriously disabled will be selected as having a very low level of the corresponding task demands. These occupations can be applied as reference occupations to assess the presence or absence of work capacity of sick-listed employees in regular jobs, and as job opportunities for people with a specific type of functional disability. METHODS Registered data from 50,931 disability assessments within the Dutch social security system were used in a second order factor analysis to identify types of disabilities in claimants for a disability pension. Threshold values were chosen to classify claimants according to the severity of the disability. In the disability assessment procedure, a labour expert needs to select jobs with task demands not exceeding the functional abilities of the claimant. For each type of disability, the accessible jobs for the subgroup of the most severely disabled claimants were identified as lowest in the corresponding demand. RESULTS The factor analysis resulted in four types of disabilities: general physical ability; autonomy; psychological ability; and manual skills. For each of these types of disablement, a set of four to six occupations low in task demands were selected for the subgroup of most severely disabled claimants. Because of an overlap of the sets of occupations, 13 occupations were selected in total. The percentage of claimants with at least one of the occupations of the corresponding set (the coverage), ranged from 84% to 93%. An alternative selection of six occupations for all subgroups with even less overlap had a coverage ranging from 84% to 89% per subgroup. CONCLUSION This study resulted in two proposals for a set of reference occupations. Further research will be needed to compare the results of the new method of disability assessment to the results of the method presently used in practice.
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Affiliation(s)
- Jake PJ Broersen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands
- Research Centre for Insurance Medicine, collaboration between AMC-UMCG-UWV-VUmc, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands
| | - Henny PG Mulders
- Research Centre for Insurance Medicine, collaboration between AMC-UMCG-UWV-VUmc, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands
- Knowledge Centre of the Employee Insurance Authority, La Guardiaweg 36-162, NL-1043 DJ Amsterdam, The Netherlands
| | - Antonius JM Schellart
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands
- Research Centre for Insurance Medicine, collaboration between AMC-UMCG-UWV-VUmc, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands
| | - Allard J van der Beek
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands
- Research Centre for Insurance Medicine, collaboration between AMC-UMCG-UWV-VUmc, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands
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Schellart AJM, Mulders H, Steenbeek R, Anema JR, Kroneman H, Besseling J. Inter-doctor variations in the assessment of functional incapacities by insurance physicians. BMC Public Health 2011; 11:864. [PMID: 22077926 PMCID: PMC3276607 DOI: 10.1186/1471-2458-11-864] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 11/14/2011] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to determine the - largely unexplored - extent of systematic variation in the work disability assessment by Dutch insurance physicians (IPs) of employees on long-term sick leave, and to ascertain whether this variation was associated with the individual characteristics and opinions of IPs. Methods In March 2008 we conducted a survey among IPs on the basis of the 'Attitude - Social norm - self-Efficacy' (ASE) model. We used the ensuing data to form latent variables for the ASE constructs. We then linked the background variables and the measured constructs for IPs (n = 199) working at regional offices (n = 27) to the work disability assessments of clients (n = 83,755) and their characteristics. These assessments were carried out between July 2003 and April 2008. We performed multilevel regression analysis on three important assessment outcomes: No Sustainable Capacity or Restrictions for Working Hours (binominal), Functional Incapacity Score (scale 0-6) and Maximum Work Disability Class (binominal). We calculated Intra Class Correlations (ICCs) at IP level and office level and explained variances (R2) for the three outcomes. A higher ICC reflects stronger systematic variation. Results The ICCs at IP level were approximately 6% for No Sustainable Capacity or Restrictions for Working Hours and Maximum Work Disability Class and 12% for Functional Incapacity Score. Background IP variables and the measured ASE constructs for physicians contributed very little to the variation - at most 1%. The ICCs at office level ranged from 0% to around 1%. The R2 was 11% for No Sustainable Capacity or Restrictions for Working Hours, 19% for Functional Incapacity Score and 37% for Maximum Work Disability Class. Conclusion Our study uncovered small to moderate systematic variations in the outcome of disability assessments in the Netherlands. However, the individual characteristics and opinions of insurance physicians have very little impact on these variations. Our findings provided no indications of other reasons for these variations. They may be related to different work routines or to different views on the workload of a 'normal' employee. If so, they could be reduced by well-developed and comprehensively implemented guidelines. Therefore, further research is needed.
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Affiliation(s)
- Antonius J M Schellart
- VU University Medical Center, Department of Public and Occupational Health/EMGO Institute for Health, Amsterdam, the Netherlands.
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