Predictive validity of general work ability assessments in the context of sickness insurance.

Abstract

ObjectiveThe activity ability assessment is a Swedish method for assessing general work ability, based on self-reports combined with an examination by specially trained physicians, and, if needed, extended assessments by occupational therapists, physiotherapists and/or psychologists. The aim of this study was to analyse the predictive validity of the activity ability assessment in relation to future sick leave.DesignAnalysis of assessments in 300 case files, in relation to register data on sick leave.SubjectsPeople on sick leave (n =300, 32% men, 68% women; mean age 48 years; assessment at mean sick leave day 249).MethodsUnivariate and multivariate statistics.ResultsSelf-rated work ability was the only factor with predictive value related to future sick leave. Physicians’ evaluations lacked predictive value, except where the person had a limitation in vision, hearing or speech that was predictive of future decisions by the Social Insurance Agency. No sex differences were identified.ConclusionThe predictive value of the activity ability assessment for future sick leave is limited, and selfrated work ability is more accurate compared with an extensive insurance medical assessment. Self-rated work ability may be more holistic compared with insurance medicine assessments, which may be overly focused on individual factors. A practical implication of this is that the inclusion of contextual factors in assessment procedures needs to be improved.LAY ABSTRACTThis study investigates whether assessments of general work ability (i.e. a person’s ability to work in any job) can predict future sick leave. The assessment method was developed in the Swedish sickness insurance system, and consists of a self-assessment, and assessments by physicians and other healthcare professionals. The results show that assessments generally fail to predict sick leave, with the exception of the person’s own assessment, which is broader and takes more aspects into account. These results can be used to improve assessment methods, where it is especially important to pay attention to a person’s whole situation.