Abstract
BackgroundMedical work capacity evaluations play a key role in social security schemes because they usually form the basis for eligibility decisions regarding disability benefits. However, the evaluations are often poorly standardized and lack transparency as decisions on work capacity are based on a claimant’s disease rather than on his or her functional capacity. A comprehensive and consistent illustration of a claimant’s lived experience in relation to functioning, applying the International Classification of Functioning, Disability and Health (ICF) and the ICF Core Sets (ICF-CS), potentially enhances transparency and standardization of work capacity evaluations. In our study we wanted to establish whether and how the relevant content of work capacity evaluations can be captured by ICF-CS, using disability claimants with chronic widespread pain (CWP) and low back pain (LBP) as examples.MethodsMixed methods study, involving a qualitative and quantitative content analysis of medical reports. The ICF was used for data coding. The coded categories were ranked according to the percentage of reports in which they were addressed. Relevance thresholds at 25% and 50% were applied. To determine the extent to which the categories above the thresholds are represented by applicable ICF-CS or combinations thereof, measures of the ICF-CS’ degree of coverage (i.e. content validity) and efficiency (i.e. practicability) were defined.ResultsFocusing on the 25% threshold and combining the Brief ICF-CS for CWP, LBP and depression for CWP reports, the coverage ratio reached 49% and the efficiency ratio 70%. Combining the Brief ICF-CS for LBP, CWP and obesity for LBP reports led to a coverage of 47% and an efficiency of 78%.ConclusionsThe relevant content of work capacity evaluations involving CWP and LBP can be represented by a combination of applicable ICF-CS. A suitable standard for documenting such evaluations could consist of the Brief ICF-CS for CWP, LBP, and depression or obesity, augmented by additional ICF categories relevant for this particular context. In addition, the unique individual experiences of claimants have to be considered in order to assess work capacity comprehensively.
Highlights
Medical work capacity evaluations play a key role in social security schemes because they usually form the basis for eligibility decisions regarding disability benefits
We found that the relevant content of medical work capacity evaluations involving chronic widespread pain (CWP) and low back pain (LBP) can be captured to a considerable, albeit not perfect, extent by a combination of applicable ICF Core Sets (ICF-CS)
The relevant aspects of functioning and environmental factors in the reports were either represented by the ICF-CS for the index conditions (CWP, LBP) or for major co-morbidities. In both groups of reports and for both relevance thresholds, a combination of the ICF-CS analyzed showed substantially higher coverage ratios than the condition-specific ICF-CS, i.e. they represented the relevant aspects of medical work capacity evaluations involving CWP and LBP to a higher extent
Summary
Medical work capacity evaluations play a key role in social security schemes because they usually form the basis for eligibility decisions regarding disability benefits. A comprehensive and consistent illustration of a claimant’s lived experience in relation to functioning, applying the International Classification of Functioning, Disability and Health (ICF) and the ICF Core Sets (ICF-CS), potentially enhances transparency and standardization of work capacity evaluations. Even though the process of disability evaluation varies between countries, medical work capacity evaluations usually play a crucial role in deciding on a claimant’s eligibility for benefits provided by national disability insurance schemes. As a basis for comprehensive disability evaluations, a suitable standard should allow the description of relevant experiences unique to the individual, complementing the whole process of evaluation [12]
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