164 Chapter 8 example, data reported by the occupational health service and employer regarding reduced energy levels, cognitive impairments, and daily functioning, as well as efforts to return to work during the two years of sick leave prior to the work disability benefit, could be used in the insurance physician’s assessment of inability of work fulltime. We hypothesized in chapter 7 that being assessed with an inability to work fulltime could have a supportive effect for returning to, or remaining in, the labor market. However, being unable to work fulltime may also have a negative impact on work participation, as workers with a fulltime contract might not be able to re-integrate fully into their jobs. This could lead to involuntary job loss. Although we found no association between being assessed with inability to work fulltime and having paid employment one year after the assessment, we consider such an assessment to have value, in addition to the diagnosis, as it enlightens both employer and employee about the extent to which the worker is still able to work. Such insight can help the employer to better understand the sick-listed worker’s position and to provide work accommodations like adjusted working hours or tasks. For example, to include and (re-)integrate people with a work disability, work could be (re)designed and differently organized and adapted to their capacities, taking into account limitations and vulnerabilities like fatigue or cognitive impairments [17]. Further, sharing knowledge and insight with sick-listed workers about (in) ability to work fulltime can help them and their significant others (partners, family, friends) in taking more self-control in the return to work, in the end possibly contributing to sustainable returning to work. Recommendations for future research We suggest several recommendations for further research. First, for optimal assessment, more research is needed into the most reliable and valid methods to measure fatigue, cognitive impairments, and reduced functioning in the work disability benefit setting. For example, more evidence is needed on the use of real time measurements of fatigue and concentration span in daily life, preferably over time in trial situations or in real work settings, before this is implemented in the assessments. A recent study has been initiated to identify disease-generic symptoms like fatigue, pain, and cognitive impairment, which are relevant for occupational care and the assessment of work disability. In this study the researchers will measure the severity and course of these symptoms over time, embedding them in, and thus improving, occupational care and work disability benefit assessments from the start of sick leave until the onset of application for work disability pension. Second, we would advise more inclusive register studies, using detailed information on diagnosis and individual disease level, to further study the associations of the latter with inability to work fulltime and to help assessors
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