1. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc The assessment of work endurance in EUMASS member states Henk-Jan Boersema EUMASS congres 2016 slide 1

2. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Conflict of Interest Disclosure Form NAME : H.J.M. Boersema DISCLOSURE x I have no potential conflict of interest to report SSI supports RCIM and is my employer slide 2

3. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Co-researchers Bert Cornelius MD PhD, Wout de Boer MD PhD, Prof. Jac van der Klink MD PhD, Prof. Sandra Brouwer PHD slide 3 The assessment of work endurance in EUMASS member states

4. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Introduction Chronic disease limits o workability, including working hours¹ Restriction of normal working hours impacts o employability o income o benefit² Definition of Work Endurance (WE) Ability to sustain working activities over certain period of time, expressed in hours/day and hours/week. ¹Varekamp, 2010; Munir, 2005; Torp, 2012; Raggi, 2015; ²Ward, 2015; Leijten, 2015; slide 4

5. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Insurance physicians (IPs) assess WE¹ Substantial inter-doctor variation² Little research on methods to assess restricted WE³ slide 5 ¹ EUMASS, 2008; ² Schellart, 2013; Spanjer, 2001; ³ De Boer, 2007; Spanjer, 2011; Otto, 2011 Assessment of WE

6. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Aim To explore WE and related aspects in European countries Research questions is WE assessed as part of the application of disability benefit? are formal rules and guidelines used to assess WE? what causes are considered to be acceptable for restricting WE? which methods are used to measure WE? slide 6

7. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Design Survey Period: June 2014 – Feb 2015 Sample 19 EUMASS member states represented by 35 IPs Instruments 2 self structured questionnaires 24 semi-structured questions and 19 open ended questions slide 7 Methods

8. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc approached: n=19 response 2 nd round: n=10 slide 8 Results response 1 st round: n=16

9. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Results yesno Assessment of WE part of disability assessment 133 slide 9

10. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc slide 10 Results yesno Formal rules/guidelines106

11. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Formal rules/guidelines Guideline for assessment of WE in the Netherlands Expert based Three indications General energy deficit Prevention of future health deterioration Reduced availability due to medical treatment slide 11

12. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Indications for restriction WECountries (n=10) General energy deficit7 Prevention of future health deterioration5 Reduced availability due to medical treatment6 slide 12 Results

13. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc slide 13 Accepted causes

14. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Top 3 Musculoskeletal, connective tissue Mental, behavioural disorders Circulatory system Other Endocrine, nutritional, metabolic Respiratory system Digestive system Nervous system slide 14 ¹ ICD-10 Diseases¹ associated with restricted WE

15. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc General energy deficit Musculoskeletal, connective tissue Mental, behavioural disorders Reduced availability Neoplasms Mental, behavioural disorders Prevention Musculoskeletal system, connective tissue Mental and behavioural disorders slide 15 Disease-specific¹ indications to restrict WE ¹ ICD-10

16. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Assessment of WE in EUMASS countries Semi structured interview Ergometric test Functional capacity evaluation Psychological test Clinical test Assessment by center for rehabilitation Self report questionnaire slide 16

17. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc CountrySemi- structured Interview Ergometric test Functional capacity evaluation Psychological test Clinical test Assessment Rehabilitation center Self-report question naire Other Belgium Croatia Czech Rp Finland France Germany Italy Norway Poland Romania Slovakia Slovenia Sweden Switzerland Netherlands UK Assessment methods per country Not usedUsedNot assessed slide 17

18. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc MeanSDRange Semi structured interview6,41,55-9 Ergometric test8,51,55-9 Functional capacity evaluation8,32,05-10 Psychological test7,32,02-10 Clinical test8,12,05-10 Assessment rehabilitation centre7,71,95-9 Self report questionnaire4,12,40-8 slide 18 Rating¹ of assessment methods ¹ Rating 0-10; n=10 countries

19. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Conclusions in most countries the assessment of WE is part of the overall work disability assessment use of professional guidelines to assess WE is limited physical and mental disorders are accepted causes top 3: musculo-skeletal, mental, cardiovascular across countries methods to assess WE differ objective methods to assess WE rate higher than subjective methods slide 19

20. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Thank you for your attention Any questions or remarks? Henk-Jan Boersema h.j.m.boersema@umcg.nl slide 20