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Description of functioning in sickness certificates
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
2011 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 5, 508-516 p.Article in journal (Refereed) Published
Abstract [en]

Aims: Sickness certificates are to provide information on a disease and its consequences on the patients functioning. This information has implications for the patients rights to sickness benefits and return-to-work measures. The objective of this study was to investigate the description of functioning in sickness certificates according to WHOs International Classification of Functioning, Disability, and Health (ICF), and to describe the influence of patients age, gender, diagnostic group, and affiliation of certifying physician. Method: A content analysis of written statements regarding how the disease limits the patients functioning with ICF as a framework was performed in 475 sickness certificates, consecutively collected in Ostergotland County, Sweden. Results: Musculoskeletal diseases (MSD) were the largest diagnostic group, followed by mental disorders (MD). Certificates were mainly issued from physicians at hospitals and in primary health care (PHC). ICF was applicable for classifying statements regarding functioning in 311 certificates (65%). The distribution of components was 58% body functions, 26% activity, and 7% participation. The descriptions were primarily restricted to the use of at least one component; namely, body functions. Subgroup analysis showed that descriptions of activity and participation were more common in certificates for MD and MSD, or those issued by PHC physicians. A multiple regression analysis with the activity component as dependent variable confirmed the results by showing that activity was related to both diagnosis and affiliation. Conclusions: In a consecutive sample of sickness certificates, it was shown that information on functioning is scarce. When functioning was described, it was mainly body oriented.

Place, publisher, year, edition, pages
Sage , 2011. Vol. 39, no 5, 508-516 p.
Keyword [en]
International Classification of Functioning; Disability; and Health; mental disorders; musculoskeletal diseases; physicians assessment of work capacity; sick leave
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-69815DOI: 10.1177/1403494811399954ISI: 000292539900009OAI: oai:DiVA.org:liu-69815DiVA: diva2:433544
Note
The final, definitive version of this paper has been published in: Scandinavian Journal of Public Health, (39), 5, 508-516, 2011. Emma Nilsing, Elsy Söderberg, Helena Normelli and Birgitta Öberg, Description of functioning in sickness certificates http://dx.doi.org/10.1177/1403494811399954 by SAGE Publications Ltd, All rights reserved. http://www.uk.sagepub.com/ Available from: 2011-08-10 Created: 2011-08-08 Last updated: 2017-12-08
In thesis
1. The Sick Leave Process: Sick Leave Guidelines, Sickness Certificates, and Experiences of Professionals
Open this publication in new window or tab >>The Sick Leave Process: Sick Leave Guidelines, Sickness Certificates, and Experiences of Professionals
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Decisions on entitlement to sickness benefits and return to work interventions have substantial impact on individuals’ lives and on society. In most Western European countries, such decisions are based on sickness certificates, which should provide information on how a disease or injury reduces the individual’s work ability. These are challenging and complex assessments. In 2008, guidelines for the management of sick leave were implemented in Sweden, emphasizing early assessments of work ability and return to work, and increasing the quality demands of sickness certificates by underscoring descriptions of activity limitations related to work. The overall aim of this thesis was to gain a deeper knowledge of the sick leave process with special emphasis on the content of sickness certificates and primary health care (PHC) professionals’ experiences with the process. Specific aims were to compare the quality of sickness certificates regarding descriptions of functioning by the use of WHO’s International Classification of Functioning, disability, and health (ICF), as well as the prescribed interventions before versus after implementation of the Swedish sick leave guidelines.

The thesis comprises three studies. A cross-sectional design was used in studies I and II, which included 475 and 501 new sickness certificates consecutively collected in Östergötland County, Sweden, in 2007 and 2009, respectively. Text on functioning was analysed with a deductive content analysis using the ICF. Study III was an exploratory study using data from four semi-structured focus group discussions with a purposeful sample of PHC professionals (n=18) in Östergötland County. An inductive content analysis was used in this study.

The thesis comprises three studies. A cross-sectional design was used in studies I and II, which included 475 and 501 new sickness certificates consecutively collected in Östergötland County, Sweden, in 2007 and 2009, respectively. Text on functioning was analysed with a deductive content analysis using the ICF. Study III was an exploratory study using data from four semi-structured focus group discussions with a purposeful sample of PHC professionals (n=18) in Östergötland County. An inductive content analysis was used in this study.

An overall conclusion drawn from this thesis is that patient functioning and needs might not be adequately communicated in the sick leave process. Despite the implementation of sick leave guidelines, this information is limited in sickness certificates and the collaboration is poor among the involved stakeholders, i.e., health care, the social insurance office, the employer and the OHS. The basis for decisions on entitlement to sickness benefits could be improved by including a description of the patients’ activity limitations or participation restrictions related to work demands. One way to enhance the decision basis might be to use the available team competencies at the PHC.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 75 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1354
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-89838 (URN)978-91-7519-689-3 (ISBN)
Public defence
2013-04-05, Aulan, Hälsans Hus ingång 16, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2013-03-08 Created: 2013-03-08 Last updated: 2013-03-08Bibliographically approved

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Nilsing, EmmaSöderberg, ElsyNormelli, HelenaÖberg, Birgitta

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PhysiotherapyFaculty of Health SciencesDivision of Preventive and Social Medicine and Public Health ScienceDepartment of Clinical and Experimental MedicineCentre for Public Health Sciences
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