Work disabilities and unmet needs for health care and rehabilitation among jobseekers: a community-level investigation using multidimensional work ability assessments

Figures & data

Table 1. The procedure and content of the multidimensional work ability assessment, in relation to the aspects of International Classification of Functioning, Disabilities and Health (ICF)^a.

	Focus	Source/method	Dimensions in ICF
Information collected by themultidisciplinary team	History of functioning and work ability Performance at school Performance during studentship Performance during military service Labour market trajectory	Rehabilitation counsellor appointment Theme interview Results and reports from school Definition of labour markettrajectory from documents	Activities, Participation, Environment, Personal factors
	Social performance Social network, family, Economic situation, housing conditions	Rehabilitation counsellorappointment Theme interview Sociogram	Participation, Environment
	Performance at work Basic skills in labour market(5 items) Performance at work and in work community (8 items) Health and physical capacity at work (1 item) Impression of the ability to work in the open labour market(3 items)	Supervisor and participantcomplete identical forms	Activities, Participation, Environment, Personal factors
	Personal concerns about health and work ability Health behaviour History of health, previous examinations and rehabilitation Plans for health promotion Risk factors for common illnesses Risk factors at work	Occupational health nurse appointment Previous medical records ordered after participant’s consent	Personal factors Health, disease/disorder Body functions or structures
Information collected at thephysician’s appointment(s)	Preference, perceived competence and perceived opportunities to work/study Perceived work ability Own desires and plans	Theme interview at physician appointment	Personal factors
	Diseases and disorders Psychological health Physical capacity Intelligence Impairments	Medical records of occupational nurse appointment, clinical measurements Dialogue Observation and clinicalexaminations Specialist consultations if needed	Health, disease/disorder Body functions or structures Personal factors
Interpretation and conclusions of the physician	Plans for treatment, rehabilitation or other support that could support return to work (RTW)	Physician’s suggestions based on the aforementioned evidence and findings	Health, disease/disorder
	Knowledge of the characteristics of work environment local and national labour market health and social services labour, social and health policy	Reports of workplace visits by occupational health care Experience and know-how of the physician	Environment
	functioning and work ability	Physician’s interpretation of the participant’s overall functioning and work ability after exploring all information, interviews and medical examinations	All
Documentation	Plans for further treatment, rehabilitation, other support or applying for social benefits	Physician’s suggestions based on the aforementioned documents. Medical certifications for applications for rehabilitation and other social security benefits	All

^a Modified from Ref. [23] in Finnish.

Figure 1. Study participants and the results of work ability assessment categorised into four groups.

Table 2. Descriptive characteristics across the resulting groups of work ability: type of the most disabling diagnosis (according to ICD10, one for each participant) and the types and numbers of plans made to support return to work (RTW).

	Work ability after multidimensional assessment
	Good work ability	Good work ability expected after RTW support	Able to work in thetransitional labour market only	Unable to work
	n(%)	n(%)	n(%)	n(%)
Category (by ICD10) of the single most disabling diagnosis for each participant
Musculoskeletal or trauma (M, S)	34 (28.1)	19 (40.4)	8 (29.6)	10 (28.6)
Psychiatric (F)	12 (9.9)	15 (31.9)	8 (29.6)	13 (37.1)
Endocrinological or respiratory (I, J)	14 (11.6)	6 (12.8)	2 (7.4)	6 (17.1)
Other	27 (22.3)	7 (14.9)	9 (33.3)	6 (17.1)
No diagnosis	34 (28.1)	0 (0)	0 (0)	0 (0)
Total	121 (100)	47 (100)	27 (100)	35 (100)
Plans^a made to support return to work (RTW)
Medical treatment	12 (10.1)	10 (17.5)	4 (12.5)	12 (34.3)
Physical rehabilitation	4 (3.4)	5 (8.8)	3 (9.4)	2 (5.7)
Psychotherapy	1 (0.8)	3 (5.3)	1 (3.1)	4 (11.4)
Treatment for drug abuse	1 (0.8)	0 (0)	3 (9.4)	1 (2.9)
Vocational instruction or rehabilitation	36 (30.3)	37 (64.9)	14 (43.8)	0 (0)
Studies in Finnish language	4 (3.4)	2 (3.5)	2 (6.3)	0 (0)
No plans needed	66 (51.3)	0 (0)	5 (15.6)	16 (45.7)
Total	124 (100)	57 (100)	32 (100)	35 (100)

^a 0–3 plans made (mean 0.7) per participant.

Table 3. Categorised non-medical covariates across the groups of work ability.

	Work ability after multidimensional assessment
	Good work ability	Good work ability expected after RTW support	Able to work in thetransitional labour market only	Unable to work
	n = 121	n = 47	n = 27	n = 35
	n (%)	n (%)	n (%)	n (%)
Superior’s view of work performance
Satisfactory or good	108 (89.3)	32 (68.1)	12 (44.4)	6 (17.1)
Irregular or training needed	12 (9.9)	10 (21.3)	8 (29.6)	8 (22.9)
Poor investigations or support of   work ability are of extreme importance	0 (0.0)	4 (8.5)	7 (25.9)	20 (57.1)
Missing information	1 (0.8)	1 (2.1)	0 (0.0)	1 (2.9)
Participant’s self-scaling of work ability
Able to work	110 (90.9)	10 (21.3)	6 (22.2)	6 (17.1)
Restricted ability to work	9 (7.4)	31 (66.0)	17 (63.0)	11 (31.4)
Unable to work	0 (0.0)	4 (8.5)	2 (7.4)	13 (37.1)
Cannot say	0 (0.0)	1 (2.1)	1 (3.7)	3 (8.6)
Missing information	2 (1.7)	1 (2.1)	1 (3.7)	2 (5.7)
Labour market trajectory
Stable	33 (27.3)	8 (17.0)	1 (3.7)	1 (2.9)
Broken	22 (18.2)	12 (25.5)	6 (22.2)	11 (31.4)
Blocked (entry failed)	14 (11.6)	10 (21.3)	6 (22.2)	10 (28.6)
Unstable (only short contracts)	52 (43.0)	17 (36.2)	14 (51.9)	11 (31.4)
Other	0 (0)	0 (0)	0 (0)	2 (5.7)
Observed problems in social functioning
Yes^a	16 (13.2)	11 (23.4)	15 (55.6)	22 (62.9)
No	105 (86.8)	34 (72.3)	11 (40.7)	12 (34.3)
Missing information	0 (0)	2 (4.3)	1 (3.7)	1 (2.9)
Participant’s self-rated motivation to work or study (0–10, 0 = poor, 10 = good)
Preference
0–7	10 (8.3)	12 (25.5)	12 (44.4)	16 (45.7)
8–10	100 (82.6)	28 (59.6)	13 (48.1)	11 (31.4)
Missing information	11 (9.1)	7 (14.9)	2 (7.4)	8 (22.9)
Competence
0–7	12 (9.9)	20 (42.6)	19 (70.4)	19 (54.3)
8–10	98 (81.0)	20 (42.6)	6 (22.2)	8 (22.9)
Missing information	11 (9.1)	7 (14.9)	2 (7.4)	8 (22.9)
Opportunities
0–7	61 (50.4)	29 (61.7)	23 (85.2)	24 (68.6)
8–10	49 (40.5)	11 (23.4)	2 (7.4)	3 (8.6)
Missing information	11 (9.1)	7 (14.9)	2 (7.4)	8 (22.9)
Total	121 (100)	47 (100)	27 (100)	35 (100)

^a At least one of the following: sparse network, avoidance of social contact, poor housing, inability to take care of own financial tasks.

Table 4. Sensitivity and specificity scores and their 95% confidence intervals (CI) for the non-medical covariates in detecting inability to work in the open labour market (indicated as able to work in the transitional labour market only or unable to any work).

	Sensitivity %	95% CI	Specificity %	95% CI
Supervisor’s view of work performance: less than satisfactory	70.0	(56.8–81.2)	83.8	(77.4–89.1)
Participant’s self-rating: work ability restricted/unable to work/cannot say	79.3	(66.6–88.8)	72.3	(64.8–78.9)
Labour market trajectory not stable (broken/blocked/unstable)	96.7	(88.7–99.6)	24.3	(18.0–31.4)
Observed problems in social functioning*	61.0	(47.4–73.5)	83.2	(76.7–88.6)
Low self-rated preference to work or to study (0–7/0–10)	52.9	(38.5–67.1)	84.8	(78.0–90.1)
Low self-rated perceived competence to work or to study (0–7/0–10)	72.5	(58.3–84.1)	78.1	(70.7–84.5)
Low self-rated perceived opportunities to work or to study (0–7/0–10)	90.2	(78.6–96.7)	39.7	(31.9–48.0)

* At least one of the following: sparse network, avoidance of social contacts, poor housing, inability to take care of own financial tasks.

Finnish Centre for Pensions: Finnish Pension System [Internet] [cited 2016 Apr 19]. Available from: http://www.etk.fi/en/the-pension-system-2/the-pension-system/pension-benefits/

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