Skip to main content
Top
Published in: Journal of Occupational Rehabilitation 3/2017

Open Access 01-09-2017

Limitations to Work-Related Functioning of People with Persistent “Medically Unexplained” Physical Symptoms: A Modified Delphi Study Among Physicians

Authors: K. H. N. Weerdesteijn, F. G. Schaafsma, A. J. van der Beek, J. R. Anema

Published in: Journal of Occupational Rehabilitation | Issue 3/2017

Login to get access

Abstract

Purpose The purpose of this study was to obtain consensus among physicians of several medical specialties on the level of limitations to work-related functioning of people with persistent “medically unexplained” physical symptoms (PPS). Methods A modified Delphi study was conducted with 15 physicians of five different medical specialties. The study involved two email rounds and one meeting. In each round, the physicians prioritized the level of limitations in 78 work-related functioning items for four different PPS cases. These items were based on the Dutch Functional Ability List, national guidelines and scientific literature regarding the International Classification of Functioning. Results In all four cases, the physicians reached consensus on the level of limitations to work-related functioning in 49 items. The physicians reported the highest number and level of limitations for PPS of the back and lower extremities, but they reported hardly any limitations for PPS of the abdomen and genitals. For PPS of the head, they reported mainly limitations to personal and social functioning; for PPS of the neck, back and upper or lower extremities, they reported mainly limitations to dynamic movements and static postures. The physicians could not reach consensus on limitations in the category of working hours. Conclusion Physicians reached consensus on the level of limitations in a substantial part of work-related functioning items for PPS. There was a difference in the number and severity of limitations between different cases of PPS. The assessment of functioning seems to be based more on the specific impairment than on the disease.
Appendix
Available only for authorised users
Literature
1.
go back to reference Morton LK, Elliott A, Cleland J, Deary V, Burton C. A taxonomy of explanations in a general practitioner clinic for patients with persistent “medically unexplained” physical symptoms. Patient Educ Couns. 2016; doi:10.1016/j.pec.2016.08.015. Morton LK, Elliott A, Cleland J, Deary V, Burton C. A taxonomy of explanations in a general practitioner clinic for patients with persistent “medically unexplained” physical symptoms. Patient Educ Couns. 2016; doi:10.​1016/​j.​pec.​2016.​08.​015.
3.
go back to reference Picariello F, Ali S, Moss-Morris R, Chalder T. The most popular terms for medically unexplained symptoms: the views of CFS patients. J Psychosom Res. 2015;78:420–6.CrossRefPubMed Picariello F, Ali S, Moss-Morris R, Chalder T. The most popular terms for medically unexplained symptoms: the views of CFS patients. J Psychosom Res. 2015;78:420–6.CrossRefPubMed
4.
go back to reference Nimnuan C, Hotopf M, Wessely S. Medically unexplained symptoms: an epidemiological study in seven specialities. J Psychosom Res. 2001;51(1):361–7.CrossRefPubMed Nimnuan C, Hotopf M, Wessely S. Medically unexplained symptoms: an epidemiological study in seven specialities. J Psychosom Res. 2001;51(1):361–7.CrossRefPubMed
5.
go back to reference Steinbrecher N, Koerber S, Frieser D, Hiller W. The prevalence of medically unexplained symptoms in primary care. Psychosomatics. 2011;52(3):263–71.CrossRefPubMed Steinbrecher N, Koerber S, Frieser D, Hiller W. The prevalence of medically unexplained symptoms in primary care. Psychosomatics. 2011;52(3):263–71.CrossRefPubMed
6.
go back to reference Jackson JL, Passamonti M. The outcomes among patients presenting in primary care with a physical symptom at 5 years. J Gen Intern Med. 2005;20(11):1032–7.CrossRefPubMedPubMedCentral Jackson JL, Passamonti M. The outcomes among patients presenting in primary care with a physical symptom at 5 years. J Gen Intern Med. 2005;20(11):1032–7.CrossRefPubMedPubMedCentral
7.
go back to reference Khan AA, Khan A, Harezlak J, Tu W, Kroenke K. Somatic symptoms in primary care: etiology and outcome. Psychosomatics. 2003;44(6):471–8.CrossRefPubMed Khan AA, Khan A, Harezlak J, Tu W, Kroenke K. Somatic symptoms in primary care: etiology and outcome. Psychosomatics. 2003;44(6):471–8.CrossRefPubMed
8.
go back to reference Harris AM, Orav EJ, Bates DW, Barsky AJ. Somatization increases disability independent of comorbidity. J Gen Intern Med. 2009;24(2):155–61.CrossRefPubMed Harris AM, Orav EJ, Bates DW, Barsky AJ. Somatization increases disability independent of comorbidity. J Gen Intern Med. 2009;24(2):155–61.CrossRefPubMed
9.
go back to reference Loengaard K, Bjorner JB, Fink PK, Burr H, Rugulies R. Medically unexplained symptoms and the risk of loss of labor market participation—a prospective study in the Danish population. BMC Public Health. 2015;15:844.CrossRefPubMedPubMedCentral Loengaard K, Bjorner JB, Fink PK, Burr H, Rugulies R. Medically unexplained symptoms and the risk of loss of labor market participation—a prospective study in the Danish population. BMC Public Health. 2015;15:844.CrossRefPubMedPubMedCentral
10.
go back to reference Knudsen AK, Henderson M, Harvey SB, Chalder T. Long-term sickness absence among patients with chronic fatigue syndrome. Br J Psychiatry. 2011;199(5):430–1.CrossRefPubMed Knudsen AK, Henderson M, Harvey SB, Chalder T. Long-term sickness absence among patients with chronic fatigue syndrome. Br J Psychiatry. 2011;199(5):430–1.CrossRefPubMed
11.
go back to reference Hoedeman R, Blankenstein AH, Krol B, Koopmans PC, Groothoff JW. The contribution of high levels of somatic symptom severity to sickness absence duration, disability and discharge. J Occup Rehabil. 2010;20(2):264–73.CrossRefPubMedPubMedCentral Hoedeman R, Blankenstein AH, Krol B, Koopmans PC, Groothoff JW. The contribution of high levels of somatic symptom severity to sickness absence duration, disability and discharge. J Occup Rehabil. 2010;20(2):264–73.CrossRefPubMedPubMedCentral
12.
go back to reference Norrmen G, Svardsudd K, Andersson DK. How primary health care physicians make sick listing decisions: the impact of medical factors and functioning. BMC Fam Pract. 2008;9:3.CrossRefPubMedPubMedCentral Norrmen G, Svardsudd K, Andersson DK. How primary health care physicians make sick listing decisions: the impact of medical factors and functioning. BMC Fam Pract. 2008;9:3.CrossRefPubMedPubMedCentral
13.
go back to reference Roelen CA, Koopmans PC, Groothoff JW. Subjective health complaints in relation to sickness absence. Work. 2010;37(1):15–21.PubMed Roelen CA, Koopmans PC, Groothoff JW. Subjective health complaints in relation to sickness absence. Work. 2010;37(1):15–21.PubMed
14.
go back to reference Rask MT, Rosendal M, Fenger-Gron M, Bro F, Ornbol E, Fink P. Sick leave and work disability in primary care patients with recent-onset multiple medically unexplained symptoms and persistent somatoform disorders: a 10-year follow-up of the FIP study. Gen Hosp Psychiatry. 2015;37(1):53–9.CrossRefPubMed Rask MT, Rosendal M, Fenger-Gron M, Bro F, Ornbol E, Fink P. Sick leave and work disability in primary care patients with recent-onset multiple medically unexplained symptoms and persistent somatoform disorders: a 10-year follow-up of the FIP study. Gen Hosp Psychiatry. 2015;37(1):53–9.CrossRefPubMed
15.
go back to reference Stenager EN, Svendsen MA, Stenager E. Disability retirement pension for patients with syndrome diagnoses. A registry study on the basis of data from the Social Appeal Board. Ugeskr Laeger. 2003;165(5):469–74.PubMed Stenager EN, Svendsen MA, Stenager E. Disability retirement pension for patients with syndrome diagnoses. A registry study on the basis of data from the Social Appeal Board. Ugeskr Laeger. 2003;165(5):469–74.PubMed
16.
go back to reference Schwegler U, Anner J, Boldt C, Glassel A, Lay V, De Boer WE, et al. Aspects of functioning and environmental factors in medical work capacity evaluations of persons with chronic widespread pain and low back pain can be represented by a combination of applicable ICF Core Sets. BMC Public Health. 2012;12:1088.CrossRefPubMedPubMedCentral Schwegler U, Anner J, Boldt C, Glassel A, Lay V, De Boer WE, et al. Aspects of functioning and environmental factors in medical work capacity evaluations of persons with chronic widespread pain and low back pain can be represented by a combination of applicable ICF Core Sets. BMC Public Health. 2012;12:1088.CrossRefPubMedPubMedCentral
17.
go back to reference Anner J, Kunz R, Boer W. Reporting about disability evaluation in European countries. Disabil Rehabil. 2014;36(10):848–54.CrossRefPubMed Anner J, Kunz R, Boer W. Reporting about disability evaluation in European countries. Disabil Rehabil. 2014;36(10):848–54.CrossRefPubMed
18.
go back to reference Robinson JP, Turk DC, Loeser JD. Pain, impairment, and disability in the AMA guides. J Law Med Ethics. 2004;32(2):315–26.CrossRefPubMed Robinson JP, Turk DC, Loeser JD. Pain, impairment, and disability in the AMA guides. J Law Med Ethics. 2004;32(2):315–26.CrossRefPubMed
20.
go back to reference Stucki G. International Classification of Functioning, Disability, and Health (ICF): a promising framework and classification for rehabilitation medicine. Am J Phys Med Rehabil. 2005;84(10):733–40.CrossRefPubMed Stucki G. International Classification of Functioning, Disability, and Health (ICF): a promising framework and classification for rehabilitation medicine. Am J Phys Med Rehabil. 2005;84(10):733–40.CrossRefPubMed
21.
go back to reference Anema JR, Van Der Giezen AM, Buijs PC. Ineffective disability management by doctors is an obstacle for return-to-work: a cohort study on low back pain patients sicklisted for 3–4 months. Occup Environ Med. 2002;59(11):729–33.CrossRefPubMedPubMedCentral Anema JR, Van Der Giezen AM, Buijs PC. Ineffective disability management by doctors is an obstacle for return-to-work: a cohort study on low back pain patients sicklisted for 3–4 months. Occup Environ Med. 2002;59(11):729–33.CrossRefPubMedPubMedCentral
22.
go back to reference Elms J, O’Hara R, Pickvance S, Fishwick D, Hazell M, Frank T, et al. The perceptions of occupational health in primary care. Occup Med (Lond). 2005;55(7):523–7.CrossRef Elms J, O’Hara R, Pickvance S, Fishwick D, Hazell M, Frank T, et al. The perceptions of occupational health in primary care. Occup Med (Lond). 2005;55(7):523–7.CrossRef
23.
go back to reference Swartling MS, Alexanderson KA, Wahlstrom RA. Barriers to good sickness certification—an interview study with Swedish general practitioners. Scand J Public Health. 2008;36(4):408–14.PubMed Swartling MS, Alexanderson KA, Wahlstrom RA. Barriers to good sickness certification—an interview study with Swedish general practitioners. Scand J Public Health. 2008;36(4):408–14.PubMed
24.
go back to reference Asbring P, Narvanen AL. Ideal versus reality: physicians perspectives on patients with chronic fatigue syndrome (CFS) and fibromyalgia. Soc Sci Med. 2003;57(4):711–20.CrossRefPubMed Asbring P, Narvanen AL. Ideal versus reality: physicians perspectives on patients with chronic fatigue syndrome (CFS) and fibromyalgia. Soc Sci Med. 2003;57(4):711–20.CrossRefPubMed
25.
go back to reference Nilsen S, Werner EL, Maeland S, Eriksen HR, Magnussen LH. Considerations made by the general practitioner when dealing with sick-listing of patients suffering from subjective and composite health complaints. Scand J Prim Health Care. 2011;29(1):7–12.CrossRefPubMedPubMedCentral Nilsen S, Werner EL, Maeland S, Eriksen HR, Magnussen LH. Considerations made by the general practitioner when dealing with sick-listing of patients suffering from subjective and composite health complaints. Scand J Prim Health Care. 2011;29(1):7–12.CrossRefPubMedPubMedCentral
26.
go back to reference Amris K, Waehrens EE, Jespersen A, Bliddal H, Danneskiold-Samsoe B. Observation-based assessment of functional ability in patients with chronic widespread pain: a cross-sectional study. Pain. 2011;152(11):2470–6.CrossRefPubMed Amris K, Waehrens EE, Jespersen A, Bliddal H, Danneskiold-Samsoe B. Observation-based assessment of functional ability in patients with chronic widespread pain: a cross-sectional study. Pain. 2011;152(11):2470–6.CrossRefPubMed
27.
go back to reference Spanjer J. Urenbeperking bij SOLK: literatuuronderzoek. TBV. 2015;23:399–403.CrossRef Spanjer J. Urenbeperking bij SOLK: literatuuronderzoek. TBV. 2015;23:399–403.CrossRef
28.
go back to reference Maeland S, Werner EL, Rosendal M, Jonsdottir IH, Magnussen LH, Lie SA, et al. Sick-leave decisions for patients with severe subjective health complaints presenting in primary care: a cross-sectional study in Norway, Sweden, and Denmark. Scand J Prim Health Care. 2013;31(4):227–34.CrossRefPubMedPubMedCentral Maeland S, Werner EL, Rosendal M, Jonsdottir IH, Magnussen LH, Lie SA, et al. Sick-leave decisions for patients with severe subjective health complaints presenting in primary care: a cross-sectional study in Norway, Sweden, and Denmark. Scand J Prim Health Care. 2013;31(4):227–34.CrossRefPubMedPubMedCentral
29.
go back to reference Wind H, Gouttebarge V, Kuijer PP, Sluiter JK, Frings-Dresen MH. The utility of functional capacity evaluation: the opinion of physicians and other experts in the field of return to work and disability claims. Int Arch Occup Environ Health. 2006;79(6):528–34.CrossRefPubMed Wind H, Gouttebarge V, Kuijer PP, Sluiter JK, Frings-Dresen MH. The utility of functional capacity evaluation: the opinion of physicians and other experts in the field of return to work and disability claims. Int Arch Occup Environ Health. 2006;79(6):528–34.CrossRefPubMed
30.
go back to reference Brage S, Donceel P, Falez F. Development of ICF core set for disability evaluation in social security. Disabil Rehabil. 2008;30(18):1392–6.CrossRefPubMed Brage S, Donceel P, Falez F. Development of ICF core set for disability evaluation in social security. Disabil Rehabil. 2008;30(18):1392–6.CrossRefPubMed
31.
go back to reference Hutchings A, Raine R, Sanderson C, Black N. A comparison of formal consensus methods used for developing clinical guidelines. J Health Serv Res Policy. 2006;11(4):218–24.CrossRefPubMed Hutchings A, Raine R, Sanderson C, Black N. A comparison of formal consensus methods used for developing clinical guidelines. J Health Serv Res Policy. 2006;11(4):218–24.CrossRefPubMed
33.
34.
go back to reference Cantrill JA, Sibbald B, Buetow S. Indicators of the appropriateness of long-term prescribing in general practice in the United Kingdom: consensus development, face and content validity, feasibility, and reliability. Qual Health Care. 1998;7(3):130–5.CrossRefPubMedPubMedCentral Cantrill JA, Sibbald B, Buetow S. Indicators of the appropriateness of long-term prescribing in general practice in the United Kingdom: consensus development, face and content validity, feasibility, and reliability. Qual Health Care. 1998;7(3):130–5.CrossRefPubMedPubMedCentral
35.
go back to reference Vonk NA, Huirne JA, Brolmann HA, van Mechelen W, Anema JR. Multidisciplinary convalescence recommendations after gynaecological surgery: a modified Delphi method among experts. BJOG. 2011;118(13):1557–67.CrossRef Vonk NA, Huirne JA, Brolmann HA, van Mechelen W, Anema JR. Multidisciplinary convalescence recommendations after gynaecological surgery: a modified Delphi method among experts. BJOG. 2011;118(13):1557–67.CrossRef
36.
go back to reference Aamland A, Malterud K, Werner EL. Patients with persistent medically unexplained physical symptoms: a descriptive study from Norwegian general practice. BMC Family Pract. 2014;15(107):1471–2296. Aamland A, Malterud K, Werner EL. Patients with persistent medically unexplained physical symptoms: a descriptive study from Norwegian general practice. BMC Family Pract. 2014;15(107):1471–2296.
39.
go back to reference Cieza A, Stucki G, Weigl M, Kullmann L, Stoll T, Kamen L, et al. ICF Core Sets for chronic widespread pain. J Rehabil Med. 2004;44:63–8.CrossRef Cieza A, Stucki G, Weigl M, Kullmann L, Stoll T, Kamen L, et al. ICF Core Sets for chronic widespread pain. J Rehabil Med. 2004;44:63–8.CrossRef
40.
go back to reference Cieza A, Stucki G, Weigl M, Disler P, Jackel W, van der Linden S, et al. ICF Core Sets for low back pain. J Rehabil Med. 2004;44:69–74.CrossRef Cieza A, Stucki G, Weigl M, Disler P, Jackel W, van der Linden S, et al. ICF Core Sets for low back pain. J Rehabil Med. 2004;44:69–74.CrossRef
41.
go back to reference Grill E, Bronstein A, Furman J, Zee DS, Muller M. International Classification of Functioning, Disability and Health (ICF) Core Set for patients with vertigo, dizziness and balance disorders. J Vestib Res. 2012;22(5–6):261–71.PubMed Grill E, Bronstein A, Furman J, Zee DS, Muller M. International Classification of Functioning, Disability and Health (ICF) Core Set for patients with vertigo, dizziness and balance disorders. J Vestib Res. 2012;22(5–6):261–71.PubMed
43.
go back to reference Spanjer J. Urenbeperking bij SOLK: mediprudentie en jurisprudentie. TBV. 2015;7:304–8.CrossRef Spanjer J. Urenbeperking bij SOLK: mediprudentie en jurisprudentie. TBV. 2015;7:304–8.CrossRef
44.
go back to reference Schult ML, Ekholm J. Agreement of a work-capacity assessment with the World Health Organisation International Classification of Functioning, Disability and Health pain sets and back-to-work predictors. Int J Rehabil Res. 2006;29(3):183–93.CrossRefPubMed Schult ML, Ekholm J. Agreement of a work-capacity assessment with the World Health Organisation International Classification of Functioning, Disability and Health pain sets and back-to-work predictors. Int J Rehabil Res. 2006;29(3):183–93.CrossRefPubMed
45.
go back to reference Aaron LA, Buchwald D. A review of the evidence for overlap among unexplained clinical conditions. Ann Intern Med. 2001;134(9):868–81.CrossRefPubMed Aaron LA, Buchwald D. A review of the evidence for overlap among unexplained clinical conditions. Ann Intern Med. 2001;134(9):868–81.CrossRefPubMed
46.
go back to reference Tavel ME. Somatic symptom disorders without known physical causes: one disease with many names? Am J Med. 2015;128(10):1054–8.CrossRefPubMed Tavel ME. Somatic symptom disorders without known physical causes: one disease with many names? Am J Med. 2015;128(10):1054–8.CrossRefPubMed
47.
go back to reference Henriksson CM, Liedberg GM, Gerdle B. Women with fibromyalgia: work and rehabilitation. Disabil Rehabil. 2005;27(12):685–94.CrossRefPubMed Henriksson CM, Liedberg GM, Gerdle B. Women with fibromyalgia: work and rehabilitation. Disabil Rehabil. 2005;27(12):685–94.CrossRefPubMed
48.
go back to reference Viikari-Juntura E, Kausto J, Shiri R, Kaila-Kangas L, Takala EP, Karppinen J, et al. Return to work after early part-time sick leave due to musculoskeletal disorders: a randomized controlled trial. Scand J Work Environ Health. 2012;38(2):134–43.CrossRefPubMed Viikari-Juntura E, Kausto J, Shiri R, Kaila-Kangas L, Takala EP, Karppinen J, et al. Return to work after early part-time sick leave due to musculoskeletal disorders: a randomized controlled trial. Scand J Work Environ Health. 2012;38(2):134–43.CrossRefPubMed
49.
go back to reference Oyeflaten I, Midtgarden IJ, Maeland S, Eriksen HR, Magnussen LH. Functioning, coping and work status three years after participating in an interdisciplinary, occupational rehabilitation program. Scand J Public Health. 2014;42(5):425–33.CrossRefPubMed Oyeflaten I, Midtgarden IJ, Maeland S, Eriksen HR, Magnussen LH. Functioning, coping and work status three years after participating in an interdisciplinary, occupational rehabilitation program. Scand J Public Health. 2014;42(5):425–33.CrossRefPubMed
50.
go back to reference Shiri R, Kausto J, Martimo KP, Kaila-Kangas L, Takala EP, Viikari-Juntura E. Health-related effects of early part-time sick leave due to musculoskeletal disorders: a randomized controlled trial. Scand J Work Environ Health. 2013;39(1):37–45.CrossRefPubMed Shiri R, Kausto J, Martimo KP, Kaila-Kangas L, Takala EP, Viikari-Juntura E. Health-related effects of early part-time sick leave due to musculoskeletal disorders: a randomized controlled trial. Scand J Work Environ Health. 2013;39(1):37–45.CrossRefPubMed
Metadata
Title
Limitations to Work-Related Functioning of People with Persistent “Medically Unexplained” Physical Symptoms: A Modified Delphi Study Among Physicians
Authors
K. H. N. Weerdesteijn
F. G. Schaafsma
A. J. van der Beek
J. R. Anema
Publication date
01-09-2017
Publisher
Springer US
Published in
Journal of Occupational Rehabilitation / Issue 3/2017
Print ISSN: 1053-0487
Electronic ISSN: 1573-3688
DOI
https://doi.org/10.1007/s10926-016-9674-x

Other articles of this Issue 3/2017

Journal of Occupational Rehabilitation 3/2017 Go to the issue