29 Exploring the concept inability to work fulltime in the context of work disability assessments by health status, but also by personal factors (physiology, coping abilities, motivation, training), and environmental factors (individual workload, safety requirements, home situation). Frequently exceeding one’s maximum may lead to long-term health complaints and negative health effects, indicating a need to recover from physical and mental work efforts for a shorter or longer period of time. A physician stated, “Research shows that people make more mistakes, get tired and have more problems concentrating if they work longer than nine consecutive hours without a break” (Ph9). A patient representative said, “In earlier days, and nowadays in some countries, people worked from sunrise to sunset, and then went to sleep. That’s exhausting, and that’s why these people didn’t get very old” (Pa3). Operationalization of inability to work fulltime into measurable indicators Indicators of inability to work fulltime We found three relevant measurable indicators to assess inability to work fulltime: fatigue, cognitive impairments, and problems in functioning in- and outside work. Patient representatives of patients with somatic diseases mentioned more physical indicators (“slow recovery”, “specific disease-related complaints like pain and dyspnea”) while those representing patients with mental disease mentioned more cognitive indicators (“execution of complex tasks”, “overview of situations”, “coping with emotions”, and “environmental stimuli”). Fatigue. Fatigue was reported as an important indicator of inability to work fulltime. Patient representatives stated that people with inability to work fulltime “lack the energy” (Pa8, Pa1, Pa7), and “run into all kinds of barriers” (Pa8, Pa4). Physicians stated that these people “feel unable to work the whole day” (Ph8), that “they can’t accomplish anything anymore after six hours of work” (Ph8). Cognitive impairments. Physicians stated that people with inability to work fulltime “can’t cope any longer” (with a full day’s work) (Ph5), that they “need more time to understand things” (Ph2). Participants also mentioned that people with inability to work fulltime have problems with cognitive and complex tasks, stating that they “forget” (Pa7), “make mistakes” (Ph1, Ph2, Ph4, Ph10), “have no overview” (Pa4, Pa2, Pa3), and “have fewer problemsolving abilities” (Pa5). Some also mentioned emotional complaints as indicators of inability to work fulltime, such as “irritability” (Pa4, Pa5), “less able to cope with conflicts” (Pa4), and “mental decompensation” (Pa5). 2
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