165 General discussion with early identification of those at risk. For this purpose the above-mentioned study could provide relevant information. Third, in this thesis as well as in other research in this field, the perspectives of workers with an inability to work fulltime have been underrepresented. Their experience, needs, preferences and views are important for understanding inability to work fulltime and its consequences, as well as for providing data for an evidence-based guideline for assessment [18]. Fourth, further knowledge is needed to explore the working mechanisms on the association of inability to work fulltime for future work status to understand how and for who this effect occurs. Finally, efforts should be targeted at transferring the knowledge from this thesis to practice. Identifying the best ways to implement our findings, and helping insurance physicians to adhere to guidelines and protocols [19], are important to achieve the overall aim -- to help people with health problems to make the best possible use of their potential to work. To achieve this goal, a valid and reliable assessment of inability to work fulltime is an important prerequisite. General conclusions This thesis is the first to focus on assessment of inability to work fulltime in work disability benefit settings. It adds knowledge regarding the operationalization of the concept of inability to work fulltime, and its prevalence as well as associated factors, and provides directions on how and when to measure. We found that inability to work fulltime is a complex concept, and one that varies over time. A person’s type of disease, age, gender, and educational level are associated with inability to work fulltime, as are disorders resulting in energy deficits, and impairments in cognition and general functioning. However, we found no evidence that inability to work fulltime affected having paid employment one year later. The implications and recommendations presented in this thesis provide important knowledge for building the evidence for assessment of inability to work fulltime by the insurance physician. 8
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