Desired development of a guideline for complaints that are difficult to objectify
“It is now known that Covid-19 can lead to long-term complaints with significant limitations. These are not always easy to objectify or factual information is lacking. The development of a guideline of complaints that are difficult to objectify for occupational health and insurance medical practice is desirable in order to arrive at an adequate assessment of the resilience of long-Covid patients.”
“There is no crystallized scientific framework for the assessment of Long COVID, especially when patients present with complaints that are difficult to objectify. Therefore, there seems to be a significant risk of inter-doctor variation that can lead to undesirable differences in the final assessment and undesirable consequences for the awarding of benefits.”
Development of knowledge and guidelines
The lack of adequate guidelines presents occupational and insurance physicians with a challenge in gaining a foothold when assessing work capacity and, in particular, a limitation on working hours. Therefore, it is necessary to develop a practical guide. Recently, the NVAB drafted a guide on recovery and reintegration after COVID and the post-acute consequences. This guide does not specifically focus on assessing work capacity. However, it does refer to the ICF model. 2 Due to the limited number of (heterogeneous) studies, there is little evidence on how to approach the assessment of work capacity in cases of symptoms that are difficult to objectify. Long COVID is not the first, and certainly will not be the last, disease to present with symptoms that are difficult to objectify. Therefore, it is desirable to develop a general guideline that provides a foothold for such conditions. For now and with an eye to the future.
In addition to long covid, one can think of, for example: chronic fatigue syndrome, whiplash, fibromyalgia, Q fever, Lyme and fatigue after cancer. It is important that professional assessors play a prominent role in this, whereby one does not only think in terms of diagnosis or curative treatment options. In line with this, setting up scientific research aimed at the assessment and resilience of the long covid patient is important. In this way, disease-specific information can be included in a general guideline for complaints that are difficult to objectify. Evidence-based information can then be translated into so-called evidence-based practice in the consultation room in the longer term. This is necessary to arrive at an adequate social-medical assessment and to reduce the risk of potential inter-doctor variation. In addition, it is important to realize that insurance physicians are not 'alone'. “You can always seek advice from the C-support expertise centre, but organising specific case discussions – whether or not with each other – and collecting 'anchor case studies' can also be helpful.”
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“For the time being, insurance physicians must rely on existing legislation and regulations, current knowledge and evidence, and their practical experience. Building a scientific basis is necessary. Developing a general guideline for assessing resilience in the case of complaints that are difficult to objectify can be helpful in this regard. A joint initiative with occupational health seems obvious in this regard.”
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