114 Chapter 6 Measures The presence of residual work capacity is based on the insurance physicians’ assessment (yes/no). If there is residual work capacity, the possible limitations in mental and physical functioning caused by the disease are indicated using the Functional Ability List (FAL) [9, 10]. The FAL is a standardized format list, based on the International Classification of Functioning (ICF), but with more detailed items. The 106 items of the FAL are categorized into six domains: personal functioning (30 items, e.g. focusing attention, dividing attention, insight into own abilities), social functioning (17 items, e.g. dealing with conflicts, working with others), dynamic movements (31 items, e.g. walking, use of hand and fingers), static posture (11 items, e.g. sitting at work, standing), adjusting to environment (13 items, e.g. working in an environment with dust, smoke, gases), and working hours (4 items, e.g. number of hours per day, working nights). For the current study, we used the data on the last domain, working hours, of the assessment. The number of working hours is reported by insurance physicians using 1 = at least eight hours per day; 2 = no more than eight hours per day; 3 = no more than roughly six hours per day; 4 = no more than roughly four hours per day; and 5 = no more than two hours per day. For the current study, being able to work eight or more hours per day (categories 1–2) was considered as normal ability to work fulltime, all else (categories 3–5) was considered as an inability to work fulltime. Socio-demographic data included gender (male/female), age, and educational level. For educational level three classes were differentiated based on the highest level of completed education: low (primary school, lower vocational education, lower secondary school), middle (intermediate vocational education, upper secondary school), and high (upper vocational education, university). Educational level is usually registered by the labour expert, and therefore only part of the assessment when an applicant has residual work capacity. Consequently, educational level is often missing for applicants without residual work capacity, and therefore left out of the analyses on residual work capacity. Insurance physicians use the Dutch Classification of Occupational Health and Social Insurance (CAS) to categorize diagnoses, derived from the International Statistical Classification of Disease and Related Health Problems (ICD-10) [20]. For generalizability, the primary, secondary and tertiary (when available) CAS-diagnoses were recoded to the 22 chapters of the ICD-10 disease groups. The type of mental and behavioural disorder was determined using the first diagnosis code. Multimorbidity was defined as having one or more additional diagnosis from a different disease group than mental and behavioural disorders.
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