Physicians’ perspectives and future vision on disability assessments by phone during the COVID-19 pandemic: a cross-sectional survey

Background: Physicians, who perform disability assessments for the Dutch Social Security Institute, were urged to conduct phone consultations from their homes to prevent the spread of COVID-19. The purpose of the study was to evaluate the perspectives of physicians regarding phone consultations during the COVID-19 pandemic. Additionally, to explore physicians’ views on a more widespread future use of phone consultations in the context of work disability assessments. Methods: An electronic survey conducted from June to August 2020 included 41 statements categorized into themes previously identified in both the literature on physicians’ phone consultations and emerging from daily practice. All 1081 physicians working at the Dutch Social Security Institute were invited by e-mail to participate in the survey. Participants indicated on a 5-point Likert scale whether they strongly disagreed, disagreed, neither agreed nor disagreed, agreed or strongly agreed with the statements. The collected data were analysed using descriptive statistics. Results: In general, physicians had become accustomed to perform phone consultations. Negative experiences included difficulties in getting an impression of patients and assessing patients’ functional limitations. About half of physicians found that phone consultations took more effort, 61% asked more questions due to no direct patient observations. According to 67%, it is mostly necessary to perform an in-person consultation to adequately assess functional limitations of a patient with persistent medically unexplained physical symptoms. A great majority did not prefer telephone consultations to in-person consultations. However, more than half of physicians perceive a greater preference for phone consultations in the future than previously. 56% thought that replacement of in-person consultations with phone consultations in the future might lead to more complaints. Conclusions: Perspectives and future views varied among physicians performing disability assessments by phone. A majority of physicians experienced difficulties with different aspects of the assessment. Despite these difficulties, most physicians support to continue the wider use of phone consultations. To improve remote disability assessments it is required to gain more insights into conditions under which a phone assessment can be as diligent as an in-person assessment

Erworbene Hirnschädigung und Teilhabe am Arbeitsleben: Eine interdisziplinäre Leitlinie aus den Niederlanden - Prozess und Inhalt

This article discusses the Dutch interdisciplinary guideline 'Acquired brain injury and work participation'. Its development follows the methodology of evidence-based medicine and supports all professionals involved in the vocational re-integration of workers with traumatic (e.g., traffic accident) and non-traumatic (e.g., stroke) acquired brain injury

“Acquired brain injury and return to work”: the feasibility of a training program for insurance physicians

Purpose: To study the feasibility (limited efficacy, acceptability, and implementation) of a training program for insurance physicians. Methods: Limited efficacy was evaluated over time (T0–T2) by conducting knowledge question tests using realistic case scenarios, analyzed by non-parametric Friedman and Wilcoxon signed-rank tests. Acceptability was evaluated by asking participants to agree or disagree with statements; for example, the knowledge was “relevant,” “useful,” or “appropriate.” Answers were analyzed using descriptive statistics. Open-ended questions were used to ask participants what, in their opinion, were the facilitators of and barriers to implementing the knowledge taught. Their answers were coded and categorized. Results: Fifty-one IPs participated in the study. Concerning limited efficacy: the median values of the knowledge scores increased significantly over time and between time points from 16 (T0) to 21 (T1) and 32 (T2), p < 0.00. Concerning acceptability: 46 of 47 respondents perceived the training program to be “relevant,” “useful,” and “appropriate”; 44 respondents intended to use it in practice. Concerning implementation: participants reported “training” and “utility” as examples of facilitators and “lack of time,” for example, as a barrier. Conclusion and implications: The feasibility (limited efficacy, acceptability, implementation) of the training program is demonstrated; the training program can be applied in practice.Implications for rehabilitation The “acquired brain injury and return to work” training programme can be applied in postgraduate teaching and continuing medical education for insurance physicians. Interactive teaching methods including realistic case scenarios with a link to practice are recommended to provide insurance physicians the opportunity to learn to apply and discuss new knowledge and effectively improve insurance physicians’ knowledge. Implementation of a training programme for insurance physicians can be facilitated if a brief summary of the imparted knowledge is available. Barriers, such as “other occupational healthcare and paramedical professionals being unfamiliar with the imparted knowledge” need to be addressed when implementing the “acquired brain injury and return to work” training programme

Prognostic factors of return to work after traumatic or non-traumatic acquired brain injury

To investigate and to determine evidence of prognostic factors for return to work (RTW) after acquired brain injury (ABI). A systematic literature search was conducted in PubMed (2008-2014), applying terms for ABI and RTW. In addition, studies published after 2003 of a previous review on the same topic were added. The methodological quality of the included studies was assessed and evidence was classified. Twenty-seven studies were included. There is strong evidence that a high education level is positively associated with RTW after traumatic ABI; a low education level, unemployment and length of stay in rehabilitation are negatively associated, and a clear tendency has been deduced from the studies that conscious state in the Emergency Department is not associated with RTW. After non-traumatic ABI, there is strong evidence that independence in activities of daily living is positively associated with RTW and aetiology of stroke is not. This study confirms earlier findings that after both traumatic and non-traumatic ABI injury related factors in the Emergency Department are not associated with RTW. In addition, it provides further evidence that personal factors after traumatic ABI and activity-related factors after non-traumatic ABI are strongly associated with RTW. Implications for Rehabilitation We found strong evidence for a significant association between RTW and personal factors (education level, unemployment) after traumatic ABI, and activities of daily living (ADL) after non-traumatic ABI. We advise to focus on work-related activities during the RTW process besides ADL-training and pay attention to and support patients at risk for not returning to wor

Effective return-to-work interventions after acquired brain injury: A systematic review

To gather knowledge about effective return-to-work (RTW) interventions for patients with acquired brain injury (ABI). A database search was performed in PubMed, EMBASE, PsycINFO, CINAHL and the Cochrane Library using keywords and Medical Subject Headings. Studies were included if they met inclusion criteria: adult patients with non-progressive ABI, working pre-injury and an intervention principally designed to improve RTW as an outcome. The methodological quality of included studies was determined and evidence was assessed qualitatively. Twelve studies were included, of which five were randomized controlled trials and seven were cohort studies. Nine studies had sufficient methodological quality. There is strong evidence that work-directed interventions in combination with education/coaching are effective regarding RTW and there are indicative findings for the effectiveness of work-directed interventions in combination with skills training and education/coaching. Reported components of the most effective interventions were tailored approach, early intervention, involvement of patient and employer, work or workplace accommodations, work practice and training of social and work-related skills, including coping and emotional support. Effective RTW interventions for patients with ABI are a combination of work-directed interventions, coaching/education and/or skills training. These interventions have the potential to facilitate sustained RTW for patients with AB

Prognostic factors of return to work after traumatic or non-traumatic acquired brain injury

<div><p></p><p><i>Purpose</i>: To investigate and to determine evidence of prognostic factors for return to work (RTW) after acquired brain injury (ABI). <i>Method</i>: A systematic literature search was conducted in PubMed (2008–2014), applying terms for ABI and RTW. In addition, studies published after 2003 of a previous review on the same topic were added. The methodological quality of the included studies was assessed and evidence was classified. <i>Results</i>: Twenty-seven studies were included. There is <i>strong</i> evidence that a high education level is <i>positively</i> associated with RTW after traumatic ABI; a low education level, unemployment and length of stay in rehabilitation are <i>negatively</i> associated, and <i>a clear tendency</i> has been deduced from the studies that conscious state in the Emergency Department is <i>not</i> associated with RTW. <i>A</i>fter non-traumatic ABI, there is <i>strong</i> evidence that independence in activities of daily living is <i>positively</i> associated with RTW and aetiology of stroke is <i>not. Conclusions</i>: This study confirms earlier findings that after both traumatic and non-traumatic ABI injury related factors in the Emergency Department are <i>not</i> associated with RTW. In addition, it provides further evidence that <i>personal factors</i> after <i>traumatic</i> ABI and <i>activity-related factors</i> after <i>non-traumatic</i> ABI are strongly associated with RTW.</p><p></p><p>Implications for Rehabilitation</p><p></p><p>We found <i>strong</i> evidence for a significant association between RTW and <i>personal factors (education level, unemployment)</i> after <i>traumatic</i> ABI, and <i>activities of daily living (ADL)</i> after <i>non-traumatic</i> ABI.</p><p></p><p></p><p>We advise to focus on <i>work-related activities</i> during the RTW process besides <i>ADL-training</i> and pay attention to and support patients <i>at risk</i> for not returning to work.</p><p></p><p></p><p></p></div