Functional assessments : a study on functional ability in a population, and structured assessments in general practice
Appears in the following Collection
AbstractThere is an increasing interest in instruments that assess health status, functional status and health related quality of life. The ICF-based Norwegian Function Assessment Scale (NFAS) represents an instrument for self-reporting work-related functional ability. General practitioners (GP) are to an increasing extent being asked to assess function, in addition to disease and illness in social security claims, but they are reluctant and report difficulties.
The first aim of this study within epidemiology and social insurance medicine was to obtain population based normative data for the NFAS and further validate and test two versions of NFAS. The second aim was to implement structured functional assessments for persons with long-term sick leave in general practice in a cluster randomised controlled trial (RCT) and assess intervention effects on important GP parameters, GP sick-listing practice, and patient sick leave.
The NFAS was included in a large Norwegian population based study. Mean scores are presented by gender, age, and education. The respondents were randomised to receive the original four- or the new five-point scale version of the NFAS. The test-retest reliability of the four-point scale version and the validity for both versions were acceptable. However, the data quality, internal consistency and discriminative validity suggest that the five-point scale version should be used in future applications.
In a cluster RCT, 57 GPs were recruited and randomly assigned to an intervention or a control group. The invention GPs learned the structured functional assessment method at an introductory one-day workshop. As a result, the intervention GPs reported increased knowledge and self-efficacy towards functional assessments and patient work factors. Furthermore, they prescribed more part-time and fewer active sick leave, whereas no intervention effect was seen on GP attitudes, duration of sick leave episodes, or on prescription of vocational rehabilitation.
List of papers
Paper I Functional ability in a population: normative survey data and reliability for the ICF based Norwegian Function Assessment Scale. Østerås N, Brage S, Garratt A, Benth JS, Natvig B, Gulbrandsen P. BMC Public Health 2007, 7:278.
Paper II A randomised comparison of a four- and a five-point scale version of the Norwegian Function Assessment Scale. Østerås N, Gulbrandsen P, Garratt A, Benth JS, Natvig B, Brage S. Health and Quality of Life Outcomes 2008, 6:14
Paper III Implementing structured functional assessments in general practice for persons with long-term sick leave: a cluster randomised controlled trial. Østerås N, Gulbrandsen P, Benth JS, Hofoss D, Brage S. Accepted BMC Family Practice
Paper IV Structured functional assessments in general practice increased the use of part-time sick leave: a cluster randomised controlled trial. Østerås N, Gulbrandsen P, Kann IC, Brage S. Resubmitted