30 Chapter 2 Restrictions in functioning in- and outside work. Most participants reported that people who cannot work fulltime have problems with functioning both in- and outside work. They emphasized the importance of having sufficient time to recover from work, and balancing work with other activities like household tasks, self-care, and social activities. For example “doing less” (Ph6), “needing a power nap” (Ph9), “being unable to do anything in the evening hours after work” (Ph3), “not being able to get out of bed” (Ph7), “going to sleep during the day” (Pa4, Pa3), “[making] mistakes in their work” (Ph9), “function[ing] less well at work when they continue to work longer” (Ph2), “[being unable to] visit friends anymore in the evening” (Pa7), and “not [being] able to go out anymore or do sports” (Pa4). Assessment methods of inability to work fulltime Quantifying the number of hours per day a person can work is seen as an enormous challenge. As one physician indicated, “It is relatively easy to determine that someone is unable to work fulltime, but when it comes to assessing the level of inability to work fulltime we are just swimming” (Ph4). After we explored how best to assess the indicators of inability to work fulltime four methods emerged: self-assessment, assessment interviews, functional testing (e.g., Functional Capacity Evaluation (FCE), psychological tests and ergometry [e.g., exertion test and VO2max-determination]), and assessment in the actual work setting. Although there was no consensus about a single best method, most participants found it insufficient to use only one instrument. Self-assessment methods alone were not regarded as a suitable measure. Patient representatives pointed out that “people with certain disorders, like depression, may have trouble realizing their own limitations” (Pa1). Physicians also stated that a client’s own estimation of functional impairments, activity limitations, and participation restrictions may need to be complemented with additional information, such as that provided by a semi-structured assessment interview. Although most physicians considered an assessment interview to be an important method, especially in combination with other methods, patient representatives found such interviews invalid. They considered the method too simplistic; as one patient representative (Pa3) stated, “the simple conversation at the social security institute doesn’t work”. They declared that the assessment interview should also include “examples of functioning and daily activities, information from treating physicians, and checking for inconsistencies” (Ph5), as well as “recovery after exertion, the personality of the client, and the psychosocial situation” (Pa7), and could be supplemented with “speaking with people next to clients, like significant others, employers or mentors” (Pa3), and gathering “information about what happened before, in the first two years of sick leave” (Pa4).
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