161 General discussion impairments, and restrictions in functioning in- and outside work as the three measurable indicators of inability to work. From the literature it is known that fatigue and cognitive impairments require special attention because they are debilitating symptoms of many diseases, for example multiple sclerosis, Parkinson’s disease, cancer, post-covid-19-syndrome, immune mediated inflammatory diseases, and mood disorders, and have great impact on daily functioning [1-9]. Daily activities like work require energy, and a need for periods of rest for recovery can restrict prolonged all-day functioning [10, 11]. Measuring these indicators could be the way forward toward reliable and valid assessments of inability to work fulltime. (See implications for research). Methodological considerations In this paragraph, we discuss the methodological issues regarding the research methods, the representativeness of the stakeholders included in the studies, and the quality of the data. Combining quantitative and qualitative methods For this thesis we used both quantitative and qualitative methods to broadly explore inability to work fulltime. We used interviews as a basis to develop a conceptual framework of inability to work fulltime; in this framework we included indicators and suggestions for assessment methods. We used survey data from key informants to explore similarities and differences in views and experiences between countries, confirming the need for more research regarding this question. We also used register data, taken from a rich pool of first WIA assessments of all applicants over an entire year. This combined use of methods allowed us to explore the concept inability to work fulltime from multiple perspectives and unravel it in-depth, and the quantitative studies provided more insight into prevalence’s and factors associated with the concept, thereby broadening our understanding and suggesting directions for further research. Included stakeholder perspectives To explore, conceptualize, and operationalize inability to work fulltime and to inventory assessment methods in the context of work disability benefit assessment, we included the perspectives of two important stakeholders: physicians and patient representatives. We included mainly physicians involved in public and private work disability insurance, and occupational health physicians with experience in both policy and practice, as well as in science and/or dealing with staff. However, as not all physicians performed assessments of inability to work fulltime on a day-to-day basis, this may have impacted our findings; the hands-on experiences of those who actively and regularly perform these assessments could have provided additional 8
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