34 Chapter 2 Practical implications Although our exploratory work cannot deliver a totally clear definition and operationalization of inability to work fulltime, it clearly indicates areas worthy of future research and practice. The complex nature of inability to work fulltime requires comprehensive assessment methods, combining subjective and objective measures, to allow for a grasp of the multiple indicators related to the concept. This conclusion corresponds with findings in previous research on measuring complex concepts [8, 13, 14], and newly developed assessment measures in work disability settings [33]. Internal and external factors make a person’s inability to work fulltime variable, and therefore difficult to assess, especially at a single time point. To address such fluctuations, when assessing work disability we recommend measuring repeatedly, and over longer periods of time. CONCLUSION Inability to work fulltime is considered a complex concept to operationalize. It is strongly individually determined and variable, and depends not only on disease and personal factors, but also on environmental factors. We found three important measurable indicators: fatigue, cognitive impairments, and restrictions in functioning in- and outside work. To assess inability to work fulltime, participants mentioned assessment interviews, testing, and assessment in the actual work setting as the most suitable methods, and expressed a preference for the use of combined methods; they regarded self-assessment methods alone as inadequate. Taking into account the complexity of inability to work fulltime, and its possible variation, we would thus recommend using multiple methods, and at multiple time points. The results of this study provide starting points for further research on the operationalization of inability to work fulltime in the work disability context, and contribute to more credible work disability assessments. ABBREVIATIONS ICF: International Classification of Functioning, Disability and Health; FCE: Functional Capacity Evaluation
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