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-­‐disabled 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-­‐medical 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-­‐psycho-­‐social 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 ’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. 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