Limitations to Work-Related Functioning of People with Persistent "Medically Unexplained" Physical Symptoms: A Modified Delphi Study Among Physicians.
K H N Weerdesteijn, F G Schaafsma, A J van der Beek and 1 others
PMID 27761689WHAT IT FOUND
Physicians agreed on work-related limitations for 49 of 78 items across four persistent unexplained physical symptom cases.
Back and lower limb symptoms had the most severe movement and posture limits. Working hours stayed unresolved.
Key findings
01Physicians reached consensus on 49 of 78 work-related functioning items for all four persistent unexplained physical symptom cases.
02Experts reached consensus on 68 items for head symptoms, 65 for neck and upper extremity symptoms, 72 for abdomen or genitals, and 64 for back and lower extremity symptoms.
03No consensus was reached on working-hours limitations; insurance physicians said they had to use strict rules, while other physicians said reduced hours could be treatment and a return-to-work tool.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The findings are expert consensus about written cases, not measurements from patients with persistent unexplained physical symptoms. Only 15 physicians participated, and 3 of 18 invited physicians declined, so the panel may not represent all physicians. The four case vignettes did not include co-morbidities, other medical or non-medical factors, or real consultation information. Some experts were unfamiliar with the Functional Ability List, and 21 items were not fully assessed by one or two experts in the first round. No consensus was reached on working-hours limitations, so the study does not settle how reduced hours should be used.
Declared interests
The supplied text states that the Dutch Social Security Agency funded the study.
The easy way to misread this
Do not read the consensus list as proof that any treatment reduces limitations or that working-hours limits are appropriate. The study used written cases and expert opinion, not patient outcomes, and no consensus was reached on working hours.