170 Appendix SUMMARY The central concept of this thesis is the ‘Inability to Work Fulltime’, assessed as part of the work disability benefit assessment in the Dutch social security system. With the studies in this thesis, we aim to expand the knowledge on the concept by exploring, conceptualizing and operationalizing 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 will provide stepping stones toward establishing clear evidence regarding inability to work fulltime. The overall aim has been broken down into three research questions: 1. What does the concept inability to work fulltime entail, and how can this be measured? 2. What is the prevalence of inability to work fulltime and what are associated socio-demographic and disease-related factors? 3. What is the association between inability to work fulltime and having paid employment one year after the work disability benefit assessment? In Chapter 1, we provided a general introduction describing the societal background of this thesis and introduced the concept of inability to work fulltime as an outcome of work disability benefit assessments in social security setting. Insurance physicians performing work disability benefit assessments report unclarity about the concept inability to work fulltime, despite the existence of a professional guideline. Especially for inability to work fulltime, a low inter-doctor agreement is reported. Therefore, we aimed to explore, conceptualize and operationalize inability to work fulltime in the context of work disability benefit assessments. To explore what the concept inability to work fulltime entails and how it can be measured, we interviewed insurance and occupational physicians as well as representatives from patient organizations on their knowledge, experience and views about inability to work fulltime and its assessment. From this qualitative study, described in Chapter 2, we learned that inability to work fulltime is considered a complex concept to operationalize, strongly individually determined and variable. It depends not only on health related factors, but also on personal and environmental factors. Three important indicators were mentioned: fatigue, cognitive impairments and restrictions in functioning in- and outside work. Participants mentioned a combination of self-assessment, assessment interviews, testing and assessment in the actual work setting and measuring at different time points as a suitable method to assess inability to work fulltime. In Chapter 3 we conducted a survey among expert physicians performing work disability benefit assessment in European countries to inventory their experiences and views on inability to work fulltime and its assessment.
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