50 Chapter 3 DISCUSSION Our results show that work endurance is assessed as part of the overall disability assessment in a majority of countries. Work endurance is considered to be normal, if a person is able to work fulltime, ranging from 35 to 42 hours per week across countries. Limited work endurance can be described as the inability to work full time. In almost all cases work endurance is conducted by a medical examiner specialised in insurance medicine. In all countries both physical and mental disorders are accepted causes of limited work endurance. Most mentioned accepted causes are musculoskeletal diseases, mental disorders and diseases of the circulatory system. Health complaints, psychosocial and environmental factors are additionally accepted as causes of limited work endurance in some countries. In most countries indications are given to limit work endurance, general energy deficit being the most frequent. Methods to assess work endurance vary considerably across countries, objective methods rating highest. Use of expert-based professional guidelines specific for the assessment of work endurance is very limited and evidence-based guidelines do not exist at all. On items as to whether work endurance is assessed at all, causes of limited work endurance, indications to limit work endurance and methods to assess work endurance, some participants from the same country gave inconsistent answers. In almost half of countries controversies on the assessment of work endurance exist. The definition of work endurance we introduced in this paper, is confirmed by our results, showing that work endurance can be described as the physical and mental ability of a person to sustain working activities in hours per day and hours per week. Some countries seem to view work endurance from a broad perspective, including both medical and psychosocial factors. By doing so, they seem to adopt a biopsychosocial perspective as outlined in the ICF [12]. Although social security institutes in most western countries have developed new assessment procedures based on the ICF [8], the ICF is not yet a generally accepted framework to describe human functioning in disability assessment [12,29]. Use of the ICF may potentially support the assessment of work endurance by providing a point of reference for the ability of a person to work over a certain period of time. Although limited work endurance is an important aspect of work disability, in the ICF it is not specifically defined. The ICF includes only related concepts on the level of functioning, i.e. “general physical endurance” and “energy level”, respectively defined as “functions related to the general level of tolerance of physical exercise or stamina”, and as “mental functions that produce vigour and stamina” [8]. From the investigated countries it is reported that musculoskeletal diseases, mental disorders and diseases of the circulatory system are the most
RkJQdWJsaXNoZXIy MTk4NDMw