title: Limitations to Work-Related Functioning of People with Persistent "Medically Unexplained" Physical Symptoms: A Modified Delphi Study Among Physicians.
abstract: Purpose The purpose of this study was to obtain consensus among physicians of several medical specialties on the level of limitations to work-related functioning of people with persistent "medically unexplained" physical symptoms (PPS). Methods A modified Delphi study was conducted with 15 physicians of five different medical specialties. The study involved two email rounds and one meeting. In each round, the physicians prioritized the level of limitations in 78 work-related functioning items for four different PPS cases. These items were based on the Dutch Functional Ability List, national guidelines and scientific literature regarding the International Classification of Functioning. Results In all four cases, the physicians reached consensus on the level of limitations to work-related functioning in 49 items. The physicians reported the highest number and level of limitations for PPS of the back and lower extremities, but they reported hardly any limitations for PPS of the abdomen and genitals. For PPS of the head, they reported mainly limitations to personal and social functioning; for PPS of the neck, back and upper or lower extremities, they reported mainly limitations to dynamic movements and static postures. The physicians could not reach consensus on limitations in the category of working hours. Conclusion Physicians reached consensus on the level of limitations in a substantial part of work-related functioning items for PPS. There was a difference in the number and severity of limitations between different cases of PPS. The assessment of functioning seems to be based more on the specific impairment than on the disease.
authors.affiliation: Department of Public and Occupational Health, The EMGO+ Institute for Health and Care Research, VU University Medical Center (VUmc), van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. k.weerdesteijn@vumc.nl.|Research Center for Insurance Medicine (KCVG), AMC-UMCG-UWV-VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. k.weerdesteijn@vumc.nl.|Department of Social Medical Affairs (SMZ), Dutch Social Security Agency (UWV), La Guardiaweg 94-114, 1043 DL, Amsterdam, The Netherlands. k.weerdesteijn@vumc.nl.
authors.forename: K H N
authors.identifier: http://orcid.org/0000-0002-7594-5936
authors.initials: KHN
authors.lastname: Weerdesteijn
authors.affiliation: Department of Public and Occupational Health, The EMGO+ Institute for Health and Care Research, VU University Medical Center (VUmc), van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.|Research Center for Insurance Medicine (KCVG), AMC-UMCG-UWV-VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: F G
authors.initials: FG
authors.lastname: Schaafsma
authors.affiliation: Department of Public and Occupational Health, The EMGO+ Institute for Health and Care Research, VU University Medical Center (VUmc), van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.|Research Center for Insurance Medicine (KCVG), AMC-UMCG-UWV-VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: van der Beek
authors.affiliation: Department of Public and Occupational Health, The EMGO+ Institute for Health and Care Research, VU University Medical Center (VUmc), van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.|Research Center for Insurance Medicine (KCVG), AMC-UMCG-UWV-VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: J R
authors.initials: JR
authors.lastname: Anema
mesh_terms: D032921:Consensus; D003697:Delphi Technique; D004185:Disability Evaluation; D004651:Employment / Q000706:statistics & numerical data*; D006801:Humans; D000071896:Medically Unexplained Symptoms; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: Delphi technique; Functional limitations; Insurance, disability assessment; Medically unexplained symptoms; Persistent physical symptoms