13 General introduction the diagnosis, 2. reduced availability for work due to necessary treatment, and 3. an indication that an increased number of working hours will impair a person’s functioning in private life and exacerbate his/her disease symptoms. In addition, these physicians concluded that combining data from the assessment interview with additional data – such as from tests like exercise tests and Functional Capacity Evaluations, findings from significant others, and information about the subject’s personal and social situation – is necessary for adequate assessment of the inability to work fulltime. Although this professional guideline may support physicians in their assessments, it is not an evidence-based practice guideline, as is mentioned above. In an opinion article in 2011, W.C. Otto, insurance physician, policy officer, and member of the guideline development group, summarized the views and problems experienced with assessment of inability to work fulltime, and reported that insurance physicians found it difficult to perform such assessments. Problems included questions regarding the number of working hours that should be considered normal, and whether non-medical factors should also be taken into account [16]. In 2001, in a study on inter- and intraassessor reliability, Spanjer reported among insurance physicians a large spread in outcomes of assessments [17]. In another study, Spanjer et al. described inadequate agreement among physicians concerning how to assess the number of hours a patient could function per day [18]. He concluded that ‘despite the existence of a Dutch Guidelines for Hours Limitations available for insurance physicians, there remains too much scope for subjective interpretation’. This indicates that physicians need to have a more precise understanding of what the concept entails, as well as insight into other, related, factors. Providing more evidence on this topic may help insurance physicians in their assessments, and also be beneficial for workers with disabling health conditions, as well as occupational health physicians, employers, and other stakeholders involved in the field of work disability. Objective and research questions The overall aim of this thesis is therefore to explore, conceptualize and operationalize inability to work fulltime in the context of work disability benefit assessments. More research into the concept of inability to work fulltime can help to bridge an important knowledge gap in insurance medicine and provide stepping stones toward establishing clear evidence regarding inability to work fulltime. 1
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