Table 1 Characteristics of included studies
From: Assessing work capacity – reviewing the what and how of physicians’ clinical practice
Authors Year of publication Country | Aim | Study design Year of data collection Method for analysis | Informants Sampling method | Main findings relating to our research question |
|---|---|---|---|---|
Foley et al. [25] UK/Ireland | Explore the information seeking process in GPs’ fitness for work consultations. | Questionnaire with open-ended questions regarding vignettes presenting different hypothetical fitness for work consultations (physical or psychological complaint, +/− social problem and/or request for/reluctance to sick leave). 2011 Thematic analysis and content analysis | 62 general practitioners (25 men, 37 women) Random sample | GPs seek different information depending on diagnosis. |
Krohne & Brage [29] Norway | Examine GPs’ experiences of new rules regarding functional assessments in sickness certification. | Focus group discussions 2003–2004 Systematic text condensation | 23 general practitioners (19 men, 4 women) Recruitment through a medical association, outside the influence of the authors. | The functional assessment was described by GPs as an implicit part of the medical examination which was difficult to describe. Lack of objective measures required trust in the patient’s story, which depended on several factors. |
Krohne & Brage [26] Norway | Investigate how GPs conceptualize functioning in relation to sickness certification. | Focus group discussions 2003–2004 Systematic text condensation | 23 general practitioners (19 men, 4 women) Recruitment through a medical association, outside the influence of the authors. | Functioning was understood as a complex construct including both physical, social and mental ability. However, in clinical practice, physical ability was emphasized. |
Meershoek et al. [27] The Netherlands | Examine the ways physicians assess the eligibility of clients for sickness and disability benefits. | Ethnographic study with > 500 observations of consultations between physicians and patients. The physicians were also interviewed. - Inductive content analysis as in grounded theory | 20 insurance physicians - | The assessment of eligibility for sickness benefits is a reasoning rather than a measurement. A medical diagnosis is insufficient for assessing work ability. Both medical and social aspects are taken into consideration. |
Nilsing et al. [30] Sweden | Investigate what aspects, according to the ICF* model, physicians consider when assessing a patient’s functioning and work ability. *International Classification of Functioning, Disability and Health | Analysis of descriptions of the patient’s functioning in sickness certificates 2007 Mixed methods: Content analysis with ICF as a conceptual framework; various statistical analyses | 475 sickness certificates Consecutive collection of all certificates in a new sick-leave period during 2 weeks. | Overall, functioning was described mostly as bodily impairments. Limitations in activity and participation were mentioned to a lesser extent and environmental factors almost not at all. Which aspects were considered was related to diagnosis and physician specialty/affiliation. |
Nilsing et al. [28] Sweden | Explore primary health care professionals’ experiences of the sick leave process. | Semi-structured focus group discussions 2011 Qualitative content analysis | 18 health care professionals in primary health care: 6 physicians, 3 physiotherapists, 4 occupational therapists and 5 counsellors Purposive sampling | Work capacity in conditions based on clinical findings was found easy to assess due to the physicians’ medical competence, while in subjective conditions it was described as either having trust in the patient’s story or as guessing. Lack of knowledge of work place factors added to the insecurity. |
Slebus et al. [31] The Netherlands | Examine what aspects, according to the ICF* model, physicians consider when assessing work capacity *International Classification of Functioning, Disability and Health | Telephone interviews: participants answered three questions regarding work capacity assessment of a certain patient category (musculoskeletal, psychiatric or ‘other’). 2005 Content analysis with ICF as a conceptual framework | 60 insurance physicians Random sample | The physicians predominantly considered aspects of body function and participation, while personal and environmental factors were not often mentioned. Different aspects were considered important depending on diagnosis. |
Soklaridis et al. [32] Canada | Explore FPs views on handling work disability assessments, challenges when assessing work ability and ways to improve the process. | Semi-structured in-depth interviews - Descriptive phenomenologic approach | Six family physicians - | The work ability assessment was seen as a complex process where psychosocial factors need to be considered. |
Stahl et al. [33] Sweden | Examine the relationship between professionals in Swedish interdisciplinary rehabilitation teams, focusing on the definitions and uses of the concept of work ability. | 1. Semi-structured focus groups 2. Individual interviews 2006–2007 Qualitative content analysis | 1. Twelve interdisciplinary teams at primary health care centres (PHCCs), 66 participants in total. The teams normally include physician, occupational therapist, physiotherapist, medical social worker and social insurance officer. 2. The twelve managers of the PHCCs where the interdisciplinary teams were located. Purposive sampling | The physicians have a holistic view on work capacity and include both medical and non-medical factors in their assessment. This view is not shared by the Social Insurance Agency (who decides on the right to benefits), which creates tension. Meeting the patient seldom and briefly, as well as lacking knowledge of the patient’s work place hampers the assessment. Collaboration with other health professionals (occupational therapists, physiotherapists) might improve the assessment. |
Stigmar et al. [34] Sweden | Describe physicians’ experiences and perceptions of work capacity and how it can be assessed. | Individual interviews 2007–2008 Qualitative content analysis | 14 physicians from different specialties (6 primary health care, 3 occupational health, 3 orthopaedic surgery, 2 rehabilitation) Purposive sampling | Assessing work capacity was seen as something vague. Physicians mainly relied on the patient’s story when assessing work capacity. Mutual trust was seen as necessary for a successful assessment. Participants agreed that non-medical factors affect work capacity but disagreed on whether they could be included in the assessment. |
Sturesson et al. [35] Sweden | Explore physician and occupational therapist views on work capacity and experiences of work capacity assessments. | Focus groups 2008 Qualitative content analysis | 14 physicians (9 general practitioners and 5 physicians at the Swedish social insurance agency) and 23 occupational therapists from primary health care and rehabilitation - | Physicians described work capacity as a complex phenomenon affected by many interacting factors and unique for every individual. They expressed difficulties assessing work ability due to lack of instruments, and did not fully agree on which factors should be included in the assessment. |
Wynne-Jones et al. [36] UK | Explore general practitioners’ and physiotherapists’ perceptions of sickness certification in patients with back pain problems. | Semi-structured telephone interviews - Thematic analysis (using constant comparative method) | 11 general practitioners and 6 physiotherapists Random sample from respondents to another study who consented to further contact (general practitioners) and snowball sampling (physiotherapists). | The general practitioners rarely initiated discussions about work problems and when they did, they rarely used structured measures. Due to lack of training and skills in occupational health and limited knowledge of the work place physicians felt ill-equipped to offer practical advice and were unsure whether sick leave was in the patient’s best interest. |