27 Exploring the concept inability to work fulltime in the context of work disability assessments Both physicians and patient representatives mentioned that with age, people have a reduced capacity to bear physical and cognitive strain, need more recovery time, and are less resilient. However, physicians also described a learning curve over time, involving the development of more (cognitive) skills that may compensate for this reduced physical capacity; as one physician stated: “The physical capacities may decline somewhat over the years, but you can make up for that with things like increased skills” (Ph7). Variability due to underlying disease. Participants mentioned that variation in severity and complaints, the effect of treatment and training, and personal and external factors may affect a person’s ability to work fulltime. The type of disease was often mentioned as a variable factor related to, and a potential indicator of, the impaired ability to perform working activities; examples were severe heart failure and chronic renal insufficiency. However, they stressed that not only having the disease (the diagnosis) itself causes inability to work fulltime, but also the course of the disease. Physicians remarked, “Even some people with depression are able to work” (Ph1), and “We all know that a well-known feature of all kinds of depressive disorders is that they fluctuate” (Ph3). Additionally, most participants mentioned treatment and rehabilitation as factors influencing the number of hours a person can work. For example, cancer treatments and time-consuming kidney dialyses were mentioned as significant barriers to being able to work fulltime. However, cancer rehabilitation, sports, cognitive training, and stepwise functional recovery were mentioned as factors that positively influence inability to work fulltime, regardless of the person’s diagnosis. A physician stated: “Well, work ability varies with the clinical picture, the health condition, whether the condition is active, and whether there are treatment options now or in the future” (Ph2). Dimensions of inability to work fulltime Disease and personal factors. Besides the type of disease, several personal factors were mentioned as key dimensions of the inability to work fulltime. Physicians reported further psychological factors, such as a person’s (in)ability to cope, as well as motivations and orientation in life, as important aspects that influence the number of hours a person can work. Patient representatives mentioned an improved lifestyle (e.g., smoking cessation, more exercise), positive orientation and goals in life, the choice to work self-employed, having self-confidence, and coping with the disease to be of influence. One physician said: “Some people just get hung up on it; others don’t” (Ph3). One patient representative stated: “Some people just want to achieve a higher ability to work because it has to do with certain personal life goals” (Pa9). 2
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