12 research outputs found
Towards comprehensive and transparent reporting: context-specific additions to the ICF taxonomy for medical evaluations of work capacity involving claimants with chronic widespread pain and low back pain
Disability evaluation : a place for the international classification of functioning disability and health?
Individuals
who
are
sick
and
unable
to
work
may
receive
wage
replacement
benefits
from
social
insurance.
To
receive
wage
replacement
or
support
for
return
to
work,
the
work-Ââdisabled
person
has
to
undergo
a
disability
evaluation
for
social
insurance.
Medical
reports
of
disability
evaluation
are
criticised
for
lack
of
standardisation
and
transparency
in
European
countries.
The
international
classification
of
Functioning,
Disability
and
Health
(ICF)
was
developed
by
the
World
Health
Organisation
to
express
the
situation
of
people
with
disability
evaluation.
However,
it
is
unclear
whether
the
ICF
framework
and/or
the
ICF
classification
can
reproduce
the
content
of
medical
reports
because
it
was
not
developed
for
disability
evaluation.
The
objectives
of
this
thesis
are:
(1)
to
study
if
the
content
in
medical
reports
of
disability
evaluation
is
similar
across
European
countries;
(2)
to
investigate
if
and
how
the
ICF
framework
and
classification
can
depict
the
content
of
medical
reports;
and
finally
(3),
to
study
what
extent
the
ICF
framework
and
classification
can
depict
in
practice
the
content
in
medical
reports.
This
thesis
consists
of
four
different
studies:
1)
a
survey
on
the
content
of
summary
and
conclusion
of
medical
reports
in
15
different
European
countries,
2)
a
conceptual
study
assessing
the
ICF
framework
and
classification
in
medical
reports,
3)
an
empirical
study
linking
72
Swiss
medical
reports
to
categories
of
the
ICF
classification
and
investigating
if
existing
ICF
core
sets
for
specific
health
condition
might
be
used
for
medical
reports,
and
4)
a
content
validation
of
the
EUMASS
Core
Set
in
6
European
countries.
Different
European
countries
have
different
ways
to
organize
disability
evaluation,
but
medical
reports
in
social
security
contain
similar
key
features
among
European
countries:
(1)
health
condition,
(2)
work
capacity,
(3)
socio-Ââmedical
history,
(4)
feasibility
of
interventions,
(5)
prognosis
of
disability,
(6)
causality,
(7)
consistency
of
the
situation
of
the
claimant,
and
(8)
legal
disability.
The
ICF
classification
is
not
implemented
in
disability
evaluation
in
social
insurance
but
attempts
are
underway.
The
ICF
was
not
developed
for
disability
evaluation
but
we
can
use
some
elements
of
it.
The
ICF
framework
allows
medical
experts
to
describe
the
claimant
in
a
bio-Ââpsycho-Ââsocial
manner
and
thereby
fits
the
current
thinking
about
disability.
The
ICF
classification
covers
work
capacity
to
some
extent:
What
a
person
is
able
and
unable
to
do
can
be
depicted
in
general
terms
(such
as
carry,
sit,
walk)
but
current
ICF
categories
run
short
of
typical
descriptions
of
work
capacity
(such
as
overhead
working,
change
positions).
The
7
other
key
features
of
medical
reports
in
social
security
are
more
cumbersome
to
cover
or
cannot
be
covered
at
all
by
the
ICF
classification
as
they
require
specifications
of
categories
or
new
aspects
to
be
included
in
the
ICF,
such
as
describing
relations
of
time
and
cause
and
effect.
The
ICF
classification
with
its
1424
categories
is
not
practicable
for
daily
routine.
Therefore
researchers
started
to
develop
core
sets:
purpose
specific
abstracts
of
the
ICF.
The
study
on
the
validation
of
the
EUMASS
core
set
shows
that
such
a
core
set
might
be
a
good
for
making
medical
reports
more
transparent.
I
conclude
that
it
is
possible
that
ICF
categories
about
work
capacity
help
promote
standardized
presentation
and
enhance
transparency
in
disability
evaluation
in
social
insurance.
More
research
is
necessary
to
clarify
the
optimal
way
of
development
of
one
or
more
core
sets.
Given
that
the
labour
markets
and
the
health
conditions
between
European
countries
might
not
be
completely
different,
medical
examiners
could
join
efforts
in
developing
a
core
set
that
is
applicable
in
all
European
countries.
Such
a
core
set
would
also
facilitate
exchange
of
information
among
European
countries
and
allow
for
comparison
and
collaboration.
The
application
of
such
an
international
core
set
may
still
be
different
between
countries
as
legal
disability
processes
of
disability
evaluation
are
different
among
European
countries
Reporting about disability evaluation in European countries
PURPOSE: To compare the official requirements of the content of disability evaluation for social insurance across Europe and to explore how the International Classification of Functioning, Disability and Health is currently applied, using the rights and obligations of people with disabilities towards society as frame of reference. METHODS: Survey. We used a semi-structured questionnaire to interview members of the European Union of Medicine in Assurance and Social Security (EUMASS), who are central medical advisors in social insurance systems in their country. We performed two email follow-up rounds to complete and verify responses. RESULTS: Fifteen respondents from 15 countries participated. In all countries, medical examiners are required to report about a claimant's working capacity and prognosis. In 14 countries, medical reports ought to contain information about socio-medical history and feasible interventions to improve the claimant's health status. The format of medical reporting on working capacity varies widely (free text, semi- and fully structured reports). One country makes a reference to the ICF in their reports on working capacity, others consider doing so. CONCLUSION: Official requirements on medical reporting about disability in social insurance across Europe follow the frame of four features: work capacity, socio-medical history, feasibility of intervention and prognosis of disability. There is an increasing trend to make formal or informal reference to the ICF in the reports about working capacity. The four features and the ICF may provide common references across countries to describe disability evaluation, facilitating national and international research. Implications for Rehabilitation Reporting about disability in social insurance in different countries is about work capacity, social medical history, feasibility of intervention and prognosis of disability. Formats of reporting on work capacity vary among countries, from free text to semi-structured report forms to fully structured and scaled report forms of working capacity. The ICF could serve as a reference for describing work capacity, provided the ICF contains all necessary categories
Toward standardised documentation in psychiatric evaluations: identifying functioning aspects and contextual factors in psychiatric reports of Swiss disability claimants with chronic widespread pain
QUESTIONS UNDER STUDY: In Switzerland, psychiatric evaluations are crucial for deciding on eligibility of disability benefits for claimants with chronic widespread pain (CWP). However, the poor standardisation and low transparency of such evaluations have been criticised. Standardisation and transparency may be enhanced by comprehensive functioning documentation using the International Classification of Functioning, Disability and Health (ICF). We applied the ICF as a reference frame to determine a list of functioning aspects and contextual factors commonly reported in psychiatric work capacity evaluations of Swiss disability claimants with CWP. METHODS: We conducted a retrospective qualitative and quantitative content analysis of 24 psychiatric reports of claimants with CWP by using the ICF taxonomy and a personal factor categorisation for data coding. Coded categories were considered candidate items for standardised documentation in psychiatric evaluations involving CWP if they passed a predetermined threshold based on their relative frequency across reports. RESULTS: A total of 71 second level ICF and personal factor categories passed the threshold. In total, 21 categories referred to the ICF component personal factors, 19 to body functions, 18 to activities and participation, and 13 to environmental factors. CONCLUSIONS: The list of ICF and personal factor categories we determined in this study addresses concepts commonly reported in psychiatric evaluations of medical work capacity involving CWP. It can serve as a starting point in developing a standard for comprehensive functioning documentation in the present context
Toward transparent documentation in medical work capacity evaluations: identifying personal factors in medical reports on Swiss disability claimants with chronic widespread pain
The aim of this study was to determine personal factors that are reported in medical work capacity evaluations of Swiss disability claimants with chronic widespread pain. A mixed-methods study, involving a retrospective qualitative and quantitative secondary analysis of the content of medical reports, was carried out. Two personal factor categorizations (the Geyh categorization and the Grotkamp categorization) were used for coding and specifying the personal factors in the reports. The most relevant personal factor categories were determined by calculating their relative frequency across reports and setting a relevance threshold. Using the Geyh categorization, 27 personal factor categories passed the relevance threshold and six of them appeared in all medical reports. Applying the Grotkamp categorization, 32 personal factor categories passed the threshold and four of them showed up in all reports. The most relevant personal factors identified in medical reports on Swiss disability claimants with chronic widespread pain refer to biographical, occupational, and educational background, behavior patterns as well as personal feelings and cognitions. The development of a standardized documentation involving these personal factors could contribute to more transparency and better comparability of medical work capacity evaluations
Evaluation of work disability and the international classification of functioning, disability and health: what to expect and what not
Abstract Background Individuals who are sick and unable to work may receive wage replacement benefits from an insurer. For these provisions, a disability evaluation is required. This disability evaluation is criticised for lack of standardisation and transparency. The International Classification of Functioning, Disability and Health (ICF) was developed to express the situation of people with disability. We discuss potential benefits of the ICF to structure and phrase disability evaluation in the field of social insurance. We describe core features of disability evaluation of the ICF across countries. We address how and to what extent the ICF may be applied in disability evaluation. Discussion The medical reports in disability evaluation contain the following core features: health condition, functional capacity, socio-medical history, feasibility of interventions and prognosis of work disability. Reports also address consistency, causal relations according to legal requirements, and ability to work. The ICF consists of a conceptual framework of functioning, disability and health, definitions referring to functioning, disability and health, and a hierarchical classification of these definitions. The ICF component âactivities and participationâ is suited to capture functional capacity. Interventions can be described as environmental factors but these would need an additional qualifier to indicate feasibility. The components âparticipationâ and âenvironmental factorsâ are suited to capture work requirements. The socio-medical history, the prognosis, and legal requirements are problematic to capture with both the ICF framework and classification. Summary The ICF framework reflects modern thinking in disability evaluation. It allows for the medical expert to describe work disability as a bio-psycho-social concept, and what components are of importance in disability evaluation for the medical expert. The ICF definitions for body functions, structures, activity and participation, and environmental factors cover essential parts of disability evaluation. The ICF framework and definitions are however limited with respect to comprehensive descriptions of work disability.</p
Evaluation of work disability and the international classification of functioning, disability and health: what to expect and what not
Individuals who are sick and unable to work may receive wage replacement benefits from an insurer. For these provisions, a disability evaluation is required. This disability evaluation is criticised for lack of standardisation and transparency. The International Classification of Functioning, Disability and Health (ICF) was developed to express the situation of people with disability. We discuss potential benefits of the ICF to structure and phrase disability evaluation in the field of social insurance. We describe core features of disability evaluation of the ICF across countries. We address how and to what extent the ICF may be applied in disability evaluation.; The medical reports in disability evaluation contain the following core features: health condition, functional capacity, socio-medical history, feasibility of interventions and prognosis of work disability. Reports also address consistency, causal relations according to legal requirements, and ability to work. The ICF consists of a conceptual framework of functioning, disability and health, definitions referring to functioning, disability and health, and a hierarchical classification of these definitions. The ICF component 'activities and participation' is suited to capture functional capacity. Interventions can be described as environmental factors but these would need an additional qualifier to indicate feasibility. The components 'participation' and 'environmental factors' are suited to capture work requirements. The socio-medical history, the prognosis, and legal requirements are problematic to capture with both the ICF framework and classification.; The ICF framework reflects modern thinking in disability evaluation. It allows for the medical expert to describe work disability as a bio-psycho-social concept, and what components are of importance in disability evaluation for the medical expert. The ICF definitions for body functions, structures, activity and participation, and environmental factors cover essential parts of disability evaluation. The ICF framework and definitions are however limited with respect to comprehensive descriptions of work disability
Validation of the EUMASS Core Set for medical evaluation of work disability
Objective: To perform a content validation of the EUMASS Core Set across six European social insurance systems. The EUMASS Core Set contains 20 categories to describe the functional (in-) capacity of claimants for disability benefits. Methods: We performed an exploratory, cross-sectional study. We used the EUMASS Core Set, added scales to rate the relevance of the 20 categories and added additional questions concerning comprehensiveness, usefulness and sufficiency of the instrument. Medical examiners from European countries filled in this instrument in 10 consecutive claim assessments. Results: Forty-eight medical examiners in six different countries evaluated 446 claimants. The medical examiners used all categories to describe the claimants' functional (in-) capacity. Medical examiners missed 41 different categories, often mental functions (n=17). They rated the instrument as useful in 68.4% and as sufficient in 63.2% of the claims. Perceived usefulness varied among countries, but not among disease groups. Perceived sufficiency varied among countries and disease groups. Conclusion: The EUMASS Core Set is promising for reporting about functional (in-) capacities. It contains relevant categories for disability evaluation among countries and disease groups. Adding more mental functions might make it more applicable. Medical examiners found it useful and sufficient to evaluate functional (in-) capacity.Implications for RehabilitationIn medical reports of evaluation of work disability, reporting about functional capacity is often unstructured in free text, making the reports difficult to understand.The EUMASS Core Set contains common definitions for expressing functional capacity and is expected to support taking decisions, to improve the quality of decisions and to allow national and international comparisons.Our study suggests the EUMASS core set to be comprehensive, useful and sufficient to express functional capacity in disability evaluation. © 2013 Informa UK Ltd. All rights reserved: reproduction in whole or part not permitted.SCOPUS: ar.jinfo:eu-repo/semantics/publishe