21 Exploring the concept inability to work fulltime in the context of work disability assessments INTRODUCTION Social security systems generally distinguish two main aims of work disability assessment: to decide about eligibility for disability benefits, and to determine what people are still able to do regarding work [1]. Included in work disability assessment is evaluation of whether a person is (un)able to work fulltime, i.e., whether or not employment participation is partially limited due to a health problem. As being able to work is vital for a person’s economic self-sufficiency and social standing, valid assessment is of great importance. In many European countries, inability to work fulltime is recognized as an important concept in work disability assessments [2]; the concept includes the restricted number of hours per day or week a claimant is able to work due to a chronic disease and/or other accepted causes. A previous study comparing 16 European countries showed that a majority of them included assessment of inability to work fulltime (or restricted work endurance) as part of the work disability assessment [2]. If a person is not able to work fulltime it can be described as an inability to work fulltime. Across countries, the definition of fulltime ranged from 35 to 42 h per week [2]. Both physical and mental disorders are accepted causes of inability to work fulltime, with the most often mentioned causes being musculoskeletal diseases, mental disorders, and diseases of the circulatory system. Limited research indicates that in most countries a general deficit in energy was the most frequent indication for granting a limited work endurance [2]. The few existing studies that assess the hours a person is able to work demonstrate confusion regarding the meaning of the concept inability to work fulltime [2, 3]. First, in different countries the concept is assessed differently [2]; various methods are used to aid in assessment, the most common being clinical tests, functional capacity evaluations, and psychological tests. Second, high inter-doctor disagreements have been found on the outcome of assessing inability to work fulltime, questioning the credibility of the current assessment procedures [4–6]. In a previous study we found that, although 10 out of 13 countries use formal rules to assess inability to work, in the Netherlands only a professional guideline is used [2]. This guideline [7] describes the ability to work fulltime as the ability to work at least eight hours per day. The inconsistencies found between countries and physicians may be due to the lack of evidence-based guidelines, and of reliable and valid methods for assessing a person’s (in)ability to work fulltime, but are first and foremost due to the lack of a comprehensive conceptualization and operationalization of the concept. Conceptualization involves formulation of clear and concise definitions: identifying the key elements, using characteristics (non-measurable key elements) and dimensions (measurable key elements). Conceptualization is followed by operationalization: making an abstract concept measurable by 2
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