163 General discussion groups, exploration at diagnosis group level contains more detail. We therefore performed two studies on the prevalence and associations of inability to work fulltime: in the diagnosis groups cancer and mental disorders. These studies provided additional, as well as varying, findings on the effect of diagnosis groups and socio-demographic variables. We recommend further studies regarding diagnosis level to provide information to insurance physicians, clients and others (like occupational and treating physicians) with assessment of individual cases. Implications and recommendations for policy and practice Several implications and recommendations can be drawn, based on the findings in this thesis. First, our evidence on the conceptualization and operationalization of the concept, the prevalence of inability to work fulltime and related sociodemographic and disease-related factors, could be added to the existing professional guideline, and/or used in the development of training and education to improve evidence-based practice among assessors. This could, in turn, help to reduce the inter-rater variation among insurance physicians. Furthermore, our results could be included in disease-specific or multidisciplinary protocols, guidelines, frameworks, and taxonomies used by related professions, both national and international. Patient organizations could also incorporate our findings in the information they supply to their patient members. The findings that the diagnoses impacting energy levels and cognitive functioning (e.g., blood-related diseases, respiratory diseases, nervous diseases and specific mental disorders) are related to higher risks of inability to work fulltime, can help insurance physicians to more easily identify those applicants at risk. In addition, because the impact of these debilitating symptoms on daily functioning, and functioning at work, can be great, we recommend including a structural and uniform evaluation of symptoms like fatigue, cognitive impairments and restrictions in daily functioning in the assessment of inability to work fulltime. As concluded in chapter 2, data about these symptoms can be gathered by a combination of methods, such as selfreport measures, more objective measures like exercise tests, or observations during daily functioning, and trial placements. The complexity and variable nature of the concept implies that these symptoms should not be measured only by a single method at a single time point, but should be monitored over a longer period of time. Taking into account personal- and environmental factors that may influence someone’s ability to work fulltime at a specific point in time, and the reality that circumstances may change over time, one should consider repeated assessments over time, especially when change is to be expected. We recommend beginning to monitor these symptoms during the sick leave period, prior to assessment of the work disability benefit. For 8
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