Determinants of sick-leave length: still limited to diagnosis elements.
OBJECTIVE
Sickness certification implies that a health problem impairs ability to work. However, its assessment is seldom performed by physicians. Our objective was, therefore, to assess the specific influence of functional and environmental limitations on the length of sick-leave prescriptions.


METHODS
We conducted a cross-sectional study in French general teaching practices and recorded 353 initial sick-leave certifications. For each of them, the functional and environmental limitations were collected using the ATCIF questionnaire, derived from the International Classification of Functioning. Data analysis was based on a linear regression multivariate model.


RESULTS
Among the functional limitations, "pain" was the main body function impairment (22% of impairments) and "mobility" the main activity limitation (48%). An environmental barrier was identified in 39% of sick-listed patients, mainly relating to "products and technology" (20%), which refers to workplace factors. The prescription was longer in cases of activity limitations relating to "mobility" and in cases of environmental barriers relating to "products and technology". The multivariate model explained 27% of the variability of sick-leave length through diagnosis elements and only 7% through functional and contextual elements.


CONCLUSIONS
In sick-leave prescription, a functional and contextual approach, in addition to the traditional diagnosis-based approach, could better support patients' shared understanding and follow-up, and accountability towards health authorities. Implication for Rehabilitation Although sickness certification implies that a health problem impairs ability to work, decision on sick-leave length in general practice is primarily based on diagnosis. A more functional and contextual approach could better support patients' and other health professionals' shared understanding and follow-up, and accountability towards health authorities. Such evolution requires a change of paradigm in medical education, and the way of reasoning of healthcare professionals.
a Collège Universitaire de Médecine Générale , Université Lyon 1 , Lyon , France.
Yvan
Y
Lévy
b Hospices Civils de Lyon , Lyon , France.
Angélique
A
Denis
b Hospices Civils de Lyon , Lyon , France.|c UMRESTTE, Université Claude Bernard Lyon 1 , Lyon , France.
Jean-Baptiste
JB
Fassier
a Collège Universitaire de Médecine Générale , Université Lyon 1 , Lyon , France.
Nadir
N
Kellou
b Hospices Civils de Lyon , Lyon , France.|d Université de Lyon, Equipe d'Accueil HESPER 7425, F-69003 , Lyon , France.
Anne-Marie
AM
Schott
a Collège Universitaire de Médecine Générale , Université Lyon 1 , Lyon , France.|d Université de Lyon, Equipe d'Accueil HESPER 7425, F-69003 , Lyon , France.
Laurent
L
Letrilliart
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D058006:General Practice; D006801:Humans; D064702:International Classification of Functioning, Disability and Health; D008297:Male; D008875:Middle Aged; D055656:Prescriptions; D018582:Sick Leave / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013997:Time Factors
Cross-sectional study; diagnosis elements; functional elements; multivariate analysis; occupational elements; sick-leave length