title: [Nosological and functional justifications for sick leave: a cross-sectional study in the Rhône district].
abstract: BACKGROUND
  Although sick leave has significant medical and economic stakes, justifications for sick leave are poorly known in France. Our objective was to describe the medical justifications for sick leave, in nosological, functional and contextual terms.
  
  
  METHODS
  Cross-sectional study, based on 1,143 sick leave certificates collected by the Health Insurance Fund of the Rhône district in February 2011. The medical justifications for sick leave were classified and coded in nosological terms according to the International Classification of Primary Care (ICPC-2) and in functional and contextual terms according to the "AT-CIF questionnaire", derived from the International Classification of Functioning (ICF).
  
  
  RESULTS
  Among the 1,073 sick leaves containing a medical justification (93.9%), 757 (70.5%) could be classified only according to the ICPC-2 and 316 (29.5%) according to both the ICPC-2 and the AT-CIF questionnaires. The health problems most frequently reported in sick leave justifications concerned, in order of decreasing frequency: respiratory (26.9%), psychological (13.7%), or digestive (12.1%) systems; general problems (10.7%); pregnancy (3.5%); the neurological system (2.9%). Furthermore, 346 functional deficiencies, five restrictions of activity and one environmental barrier were identified.
  
  
  CONCLUSIONS
  Sick leave certificates almost always provide justifications for sick leave in nosological terms, but in less than one third of certificates provide information in functional or contextual terms. Training practitioners to make functional and contextual assessments may allow them to more optimally decide on the indication and the duration of sick leave, and facilitate communication around the patient.
authors.affiliation: Département de médecine générale, université Claude-Bernard - Lyon 1, 8, avenue Rockefeller, 69373 Lyon cedex 08, France.
authors.forename: J
authors.initials: J
authors.lastname: Leguevaques
authors.affiliation: Service médical de l'Assurance maladie de la région Rhône-Alpes, 69003 Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Carol
authors.affiliation: Département de médecine générale, université Claude-Bernard - Lyon 1, 8, avenue Rockefeller, 69373 Lyon cedex 08, France. Electronic address: laurent.letrilliart@univ-lyon1.fr.
authors.forename: L
authors.initials: L
authors.lastname: Letrilliart
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D018582:Sick Leave / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Congés maladie; Functional and contextual limitations; General practice; Justifications nosologiques; Limitations fonctionnelles et contextuelles; Médecine générale; Nosological justifications; Sick leave