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Table 1 Characteristics of included studies

From: Assessing work capacity – reviewing the what and how of physicians’ clinical practice

Authors
Year of publication
Country
AimStudy 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.