41 The assessment of work endurance in disability evaluations across European countries INTRODUCTION Recent updates of the global burden of disease studies by the World Health Organization show that in the general population chronic diseases account for 76.6% of years lost to disability [1,2]. In the workforce across European countries the proportion of employed persons reporting chronic diseases has increased from 19.3% in 2010 to 20.8% in 2014 [3,4]. In 2011, 19% of persons aged 15–64 years in Europe reported to have some physical and/or mental activity limitation at work, in 38% of cases caused by chronic disease [5]. Apart from specific disease symptoms and health complaints, chronic disease is likely to be associated with reduced physical and mental energy level and activity limitations, eventually limiting work performance in general and the ability to work fulltime in particular [3,6,7]. Almost 25% of persons with chronic health problems work part-time compared with 14% of those without disability [8]. On average they work fewer hours than the general population and they more often work part-time compared to healthy workers due to differences in fatigue and emotional exhaustion [9–11]. The International Classification of Functioning, Disability and Health (ICF) is a useful framework to map associations between chronic disease and physical and/or mental activity limitation at work [12]. The ICF defines disability as an umbrella term for impairments in body functions and structures, limitations of activities, and restrictions of participation. Reduced physical and mental energy level are classified in the ICF-domain Body functions and structures with the term (impairments in) Energy level. Also classified in that domain is the physical ability to sustain activities with the term General physical endurance. The construct Inability to work full time is not specifically classified in the ICF. In our study, energy deficits include both reduced physical and mental energy levels. This is in accordance to the disability assessment procedures in social security setting, and also to the definition of Philips (2015) [13] i.e. “the psychophysiological condition needed for physical activity or mental processing over time in and out of the actual workplace.” Reduction of working hours is a frequently applied work accommodation for workers with a chronic disease having difficulty to work fulltime, improving the match between work demands and work capacity [14,15]. In a sample of individuals with a chronic disease eligible for a rehabilitation program, the most preferred and realised work accommodations included fewer working hours [16]. In a population of employees with a chronic disease, the need for adjusting working times was reported by 6.2% of all employees, and by 11.0% of those with mental disorders [14]. In a representative sample of workers with various chronic somatic diseases, reduced working hours were most frequently mentioned as work adjustment in 5.8% of cases. In that study 58.8% reported problems at work related to physical endurance and weariness [17]. In a study among working cancer survivors, the most 3
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