172 Appendix anxiety disorders showed lower risks of being assessed with inability to work fulltime. Age and gender were significantly associated with inability to work fulltime. In Chapter 7, the aim was to explore the association between inability to work fulltime and paid employment one year later, and to study the moderating effects of socio-demographic and disease-related factors. We conducted separate analysis for workers who were (partly) employed in a paid job at the time of assessment and for those who were not employed in a paid job. The findings showed no associations between inability to work fulltime and having paid employment one year after the work disability benefit assessment when adjusted for disease-related factors. Furthermore, there was no discrimination for age, gender and educational level either, as none of these variables moderated the associations. When we examined the associations within the disease groups, we found that for applicants working at time of assessment and diagnosed with a musculoskeletal disease, inability to work fulltime was positively associated with having paid employment one year later. For applicants not working, the association of inability to work fulltime with paid employment was moderated by having multimorbidity, in the way that for those having multiple diagnoses, inability to work fulltime decreased the chances of returning to paid employment after the work disability benefit assessment. In Chapter 8, we present and reflect on the main findings, discuss methodological considerations, describe the implications and recommendations for policy and practice, as well as recommendations for future research. We found that inability to work fulltime is a complex and in time varying concept. The type of disease, age, gender and educational level are associated with inability to work fulltime, and diagnoses resulting in energy deficits, cognitive impairments and functioning in general have stronger positive associations with inability to work fulltime. Within the studies in this thesis, we did not find evidence of an effect of inability to work fulltime on having paid employment one year later. Several implications and recommendations for policy and practice could be drawn, based on the findings in this thesis. First, the evidence on the conceptualization and operationalization, the prevalence of inability to work fulltime and related socio-demographic and disease-related factors, could be added to guidelines, protocols and used in the development of training and education for assessors to improve evidence-based practice. Second, the findings that diagnoses impacting energy levels and cognitive functioning are related with higher risk of inability to work fulltime, could be useful for insurance physicians and provide directions to develop a structural and uniform assessment of their disease-generic symptoms such as fatigue, cognitive impairments and restrictions in daily functioning. Third, the complexity and
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