title: Integrating evidence in disability evaluation by social insurance physicians.
abstract: OBJECTIVE
  The aim of this study was to explore applying the method of evidence-based medicine (EBM) to         resolve common questions in the field of disability evaluation.
  
  
  METHODS
  We used three clinical questions corresponding         to problems encountered by insurance physicians in daily practice to explore opportunities for and barriers to the         application of EBM. The questions fell under two topics: the prognosis of work ability and the effectiveness of         interventions to enhance work participation. We used the four-step EBM strategy: (i) formulation of a clinical         question, (ii) searching the literature, (iii) appraisal of the evidence, and (iv) implementation of the findings into         clinical practice. We restricted the searches to PubMed (Medline).
  
  
  RESULTS
  For rheumatoid arthritis, we found evidence         on the prognosis of work disability over a long-term period. For remaining sciatica after lumbar discectomy, we found         evidence for the stability of the limitations at this stage. For depression with co-morbid alcoholism, we found         evidence that treatment of both conditions would enhance work participation. The searches were effective and efficient.         The interpretation of the findings was hampered by a lack of consensus in the literature about outcomes such as the         concept of a poor prognosis of work ability.
  
  
  CONCLUSIONS
  The EBM strategy and methods can be used by social insurance         physicians to find and apply evidence for common questions in disability evaluation. The World Health         Organization's International Classification of Functioning, Disability, and Health (ICF) model is instrumental in         this, although more consensus on central outcome measures is needed. Further research is needed on the translation of         evidence into practice. Development of valid specific search strategies for physicians in disability evaluation would         improve the implementation of EBM.
authors.affiliation: Academic Medical Center, University of Amsterdam, Coronel Institute of Occupational Health, PO Box 22700, 1100 DE Amsterdam, the Netherlands. r.kok@amc.uva.nl
authors.forename: Rob
authors.initials: R
authors.lastname: Kok
authors.forename: Jan L
authors.initials: JL
authors.lastname: Hoving
authors.forename: Jos
authors.initials: J
authors.lastname: Verbeek
authors.forename: Frederieke G
authors.initials: FG
authors.lastname: Schaafsma
authors.forename: Frank Jh
authors.initials: FJ
authors.lastname: van Dijk
mesh_terms: D004185:Disability Evaluation; D006233:Persons with Disabilities; D019317:Evidence-Based Medicine; D006801:Humans; D012943:Social Security; D011795:Surveys and Questionnaires