1. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc ICF based instruments to assess functioning and work participation Presenter: Sandra Brouwer, prof. Social Medicine Co-authors: Femke Abma, Johan Sengers, Kyra Luijters, Jelle Straatsma, Berry van Holland University Medical Center Groningen, the Netherlands Dutch Research Center for Insurance Medicine

2. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Conflict of interest Disclosure Name: S. Brouwer I have no potential conflict of interest to report 2

3. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Shift in focus in disability benefit policies: – from assessing loss of work capacity and passive support – towards assessing remaining abilities of claimants to actively participate in work New measures in social security settings are required Work capacity assessment: from a medical towards a physical, mental and social perspective Background

4. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Dutch Social Security Institute developed Social Medical Assessment of Work Capacity (SMBA) method to assess capacity for work, ICF as framework systematic assessment of relationship between different levels of functioning including information about type of working conditions and work environment New assessment instrument

5. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Assessment process = insurance physician = labour expert Disorder Functions/impairments Activities/limitations Bottlenecks in work and work environment Solutions for work and work environment Conditions for work and work environment Specific environmental factors Wind, 2016

6. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Expert-based: insurance physicians and labour experts Applied ICF framework and approach  integrated biopsychosocial model of human functioning and disability Development procedure

7. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc From expert-based toward evidence-based: – identify important ICF-items – scientific underpinning the relationship between the ICF domains – testing utility / feasibility – psychometric properties Scientific approach

8. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Aim of study To identify important ICF factors for assessing individual’s work capacity: I. Extensive literature searches: – existing ICF-based instruments ( Abma et al, in prep ) – existing ICF-core sets (Sengers et al, in prep) II. Work capacity assessments used in other countries in social security settings

9. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Methods Systematic review – Search strategy in Medline, PsycInfo and Web of Science Inclusion of papers – reporting on (the development of) instruments based on the ICF framework – designed for the working age population (18-65 years) – for assessing and/or measuring functioning

10. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Search results 1449 hits 163 full text 62 instruments Leading studies Validation studies

11. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Instruments; n = 62 Generic; n = 25Disease specific; n = 37 Not/partially work-related; n = 18Work-related; n = 7

12. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Work participation instruments InstrumentCountry of originType# Items Measurement properties Norwegian Function Assessment Scale (NFAS) NorwayQuestionnaire39 Social Security Administration Behavioral Health (SA-BH) United StatesQuestionnaire78 Work Rehabilitation Questionnaire (WORQ) SwitzerlandQuestionnaire36 ICF-based worker checklistItalyChecklist183 ✗ Impact on Participation and Autonomy (IPA) NetherlandsQuestionnaire32 Inventory of Psychosocial Functioning (PF) United StatesSelf-report measure 80 Item bank for work performance GermanyItem bank76

13. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Norwegian Function Assessment Scale (NFAS) Aim: Assess the need for rehabilitation, adjustment of work demands among sick-listed persons and rights to social security benefits Constructs – seven domains: Walking/standing (7 items); Sitting (3 items); Holding/Picking up things (8 items); Managing (7 items); Lifting/Carrying (6 items); Senses (2 items); Cooperation/communication (6 items) Psychometrics: Cronbach’s α = 0.76 – 0.89; Weighted κ = 0.38 – 0.97; ICC = 0.79 - 0.88

14. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Social Security Administration Behavioral Health (SSA-BH) Aim: Assess work-related behavioral health functioning in an SSA claimant population Constructs – four domains: Social interactions (6 items); Mood and emotions (34 items); Self- efficacy (23 items); Behavioral control (15 items) Psychometrics: Comparative Fit Index = 0,974; Tucker-Lewis Index = 0,956

15. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Conclusions ICF-based instruments measuring functioning and participation: – 7 instruments addressing work participation – 2 instruments used in disability evaluation settings Constructs addressed in these instruments mainly on activities and participation-level; no information about type of working conditions and work environment Psychometrics limited

16. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc Sandra Brouwer sandra.brouwer@umcg.nl 16 Thank you for your attention