42 Chapter 3 common adjustment was reducing the number of work hours per week [18]. In a review exploring work-related problems in multiple sclerosis, higher disease duration was found to be a determinant of reduction in number of hours worked per week [19]. In the Netherlands, to compensate for income loss, long-term sick listed workers with a limited ability to work due to chronic disease, may apply for disability benefit. The ability to work, including the number of hours per day and per week the claimant is able to work, is evaluated by insurance physicians (IPs) from the Dutch Social Security Institute (SSI). In the Dutch social security system, a limitation of working hours due to chronic disease usually results in partial disability. In this paper we introduce the term Work Endurance, i.e. the physical and mental ability of a person to sustain working activities in hours per day and hours per week. A professional guideline has been introduced recently to support Dutch IPs in their assessment of the number of hours a claimant is able to work per day and per week [20]. This expert-based guideline includes three indications to consider a claimant’s work endurance as being limited: general energy deficit, reduced availability for work due to medical treatment and prevention of future health deterioration. Despite the availability of this guideline Dutch IPs experience difficulties in assessing possible limitation of working hours among disability benefit claimants, e.g. regarding the number of working hours considered to be normal and whether psychosocial factors should be taken into account [21]. A Dutch study showed that 48% of disability benefit claimants were assessed by IPs using the guideline as having a limitation of working hours and granted partial disability benefit [22]. Another Dutch study among IPs showed large inter-doctor variation in limitation of working hours as disability assessment outcome [23]. In western countries the evaluation of work disability is typically performed by medical examiners who report their findings to social insurance [24,25]. It is known that in different countries different elements are included in the assessment of disability benefits [8,24] and it is unknown if the ability to work a number of hours per day and per week is assessed in all countries. Scientific publications on assessing work endurance in social insurance in European countries and information about whether the assessment of work endurance is part of the assessment of disability benefit are lacking. For international comparison more research about the assessment of work endurance as an important aspect of disability assessment in European countries is warranted [24,26]. We studied if and how in European countries work endurance is assessed as part of the overall disability benefit assessment. Our main question is: “Is work endurance assessed as part of the application of disability benefit?”. If yes: “Are professional evidence-based guidelines for the assessment of work
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