An observer-participant study in primary care of assessments of inability to work in immigrant patients with ongoing sick leave.
OBJECTIVE
To explore the factors related to doctors' assessments of incapacity to work (IW).


METHODS
Two general practitioners and 49 men and 102 women aged 20-45 years with ongoing sick leave.


METHODS
The doctors saw all the patients jointly and discussed their emotions afterwards. Mental status, psychosocial stress, pain behaviour, tender structures, mobility and self-rated inability to work were assessed. Finally, the doctors separately rated the degree (0-100%) of reduced capacity for vocational work (DRCW). The inter-rater agreement was measured by kappa statistics. Prevalence odds ratios (OR) with 95% confidence intervals (95% CI) for IW (75-100% DRCW) were calculated by logistic regression.


RESULTS
The patients were immigrants working in service. All reported pain, 53.7% had much psychosocial stress, 74.8% said they were unable to work and 22.5% were depressed. We were often touched by their life stories. The women had many tender-structure locations and many men had restricted mobility. Two-thirds (67.5%) had pain behaviour. The kappa value on the DRCW was 0.73. A third of the men (38.8%) and 26.5% of the women were assessed as having IW. The raters disagreed only in a few cases. Depressed men or men with pain behaviour had high ORs for IW (OR 12.8, 95% CI 3.3-68.5 and OR 5.6, 95% CI 1.5-21.1, respectively) as did women with self-rated inability to work (OR 7.0; 95% CI 1.6-32.0).


CONCLUSIONS
Factors not clearly related to function had determined doctors' assessments of IW.
Löfvander
Monica
M
Department of Clinical Sciences, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden. monica.lofvander@rinkeby.vsso.sll.se
Engström
Alf
A
D000328:Adult; D004641:Emigration and Immigration; D005194:Family Practice / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D018582:Sick Leave; D013548:Sweden; D014938:Work Capacity Evaluation