Sjobbema Christiaan, van der Mei Sijrike, Cornelius Bert, van der Klink Jac, Brouwer Sandra
a Department of Health Sciences, Community and Occupational Medicine , University Medical Center Groningen, University of Groningen , The Netherlands.
b Social Security Institute , Amsterdam , The Netherlands.
Disabil Rehabil. 2018 Aug;40(16):1943-1952. doi: 10.1080/09638288.2017.1323024. Epub 2017 May 11.
In the Dutch social security system, insurance physicians (IPs) assess participatory behaviour as part of the overall disability claim assessment. This study aims to explore the views and opinions of IPs regarding participatory behaviour as well as factors related to inadequate participatory behaviour, and to incorporate these factors in the International Classification of Functioning, Disability and Health (ICF) biopsychosocial framework.
This qualitative study collected data by means of open-ended questions in 10 meetings of local peer review groups (PRGs) which included a total of 78 IPs of the Dutch Social Security Institute. In addition, a concluding discussion meeting with 8 IPs was organized.
After qualitative data analyses, four major themes emerged: (1) participation as an outcome, (2) efforts of disability benefit claimants in the process of participatory behaviour, (3) beliefs of disability benefit claimants concerning participation, and (4) recovery behaviour. Identified factors of inadequate participatory behaviour covered all ICF domains, including activities, environmental, and personal factors, next to factors related to health condition and body functions or structures. Outcomes of the discussion meeting indicated the impossibility of formulating general applicable criteria for quantifying and qualifying participatory behaviour.
Views of IPs on disability benefit claimants' (in)adequate participatory behaviour reflect a broad biopsychosocial perspective. IPs adopt a nuanced tailor-made approach during assessment of individual disability benefit claimants' participatory behaviour and related expected activities aimed at recovery of health and RTW. Implications for Rehabilitation Within a biopsychosocial perspective, it is not possible to formulate general criteria for the assessment of participatory behaviour for each unique case. Individual disability benefit claimant characteristics and circumstances are taken into account. To optimize the return-to-work (RTW) process, insurance physicians (IPs) assess participatory behaviour according to the International Classification of Functioning, Disability and Health, including medical, personal, and environmental factors. Some aspects within the concept of participatory behaviour extend beyond the boundaries of the domain where IPs operate because opinions in society on personal and societal responsibility influence participatory behaviour.
在荷兰社会保障体系中，保险医师在整体残疾索赔评估中会对参与行为进行评估。本研究旨在探讨保险医师对参与行为的看法和意见，以及与参与行为不足相关的因素，并将这些因素纳入《国际功能、残疾和健康分类》（ICF）的生物心理社会框架。
本定性研究通过在10次地方同行评审小组（PRG）会议上提出开放式问题来收集数据，这些会议共有荷兰社会保障研究所的78名保险医师参加。此外，还组织了一次有8名保险医师参加的总结讨论会议。
经过定性数据分析，出现了四个主要主题：（1）作为结果的参与；（2）残疾福利申领者在参与行为过程中的努力；（3）残疾福利申领者对参与的信念；（4）康复行为。确定的参与行为不足的因素涵盖了ICF的所有领域，包括活动、环境和个人因素，以及与健康状况、身体功能或结构相关的因素。讨论会议的结果表明，制定用于量化和界定参与行为的通用适用标准是不可能的。
保险医师对残疾福利申领者参与行为是否充分的看法反映了广泛的生物心理社会视角。在评估个体残疾福利申领者的参与行为以及旨在恢复健康和重返工作岗位的相关预期活动时，保险医师采用细致入微的量身定制方法。对康复的启示在生物心理社会视角下，不可能为每个独特案例制定评估参与行为的通用标准。会考虑个体残疾福利申领者的特征和情况。为了优化重返工作岗位（RTW）流程，保险医师根据《国际功能、残疾和健康分类》评估参与行为，包括医学、个人和环境因素。参与行为概念中的某些方面超出了保险医师工作领域的界限，因为社会对个人和社会责任的看法会影响参与行为。
