Regina Kunz

University of Basel / University Hospital Basel · Dept. of Clin. Research / EbIM Evidence-based Insurance Medicine

Zusammenfassung. Kürzlich hat ein Cochrane-Review das aktuelle Wissen über die Auswirkungen von Massnahmen zur Unterstützung depressiver Patienten bei der Rückkehr zur Arbeit zusammengefasst. Die Evidenzbasis – 45 randomisierte, kontrollierte Studien – war umfangreich und führte häufig zu einer mittelgradigen oder sogar hohen Robustheit der Evidenz...

Zusammenfassung. In der gegenwärtigen Praxis von medizinischen IV- und anderen Rentenbegutachtungen fehlt Versicherten in der Schweiz eine Möglichkeit, routinemässig Rückmeldung darüber zu geben, inwieweit sie sich durch die Gutachter respekt- und würdevoll behandelt fühlten. Dies scheint aber gelegentlichen Beschwerden zufolge nicht immer gegeben....

Objective Synthesising evidence of the effects of interventions to improve work participation among people with health problems is currently difficult due to heterogeneity in outcome measurements. A core outcome set for work participation is needed. Study design and setting Following the Core Outcome Measures in Effectiveness Trials methodology, w...

Background Work participation is important for health and can be considered as engagement in a major area of life which is of significance for most people, but it can also be thought of as fulfilling or discharging a role. Currently, academic research lacks a comprehensive classification of work participation outcomes. The International Classificat...

Purpose Heterogeneity in work participation (WP) outcomes measurements hampers large scale evidence synthesis in systematic reviews of trials. In this survey we explore authors’ reasons for choosing specific WP outcomes and their measurement methods, including employment status, absence from work, at-work productivity loss, and employability. Metho...

Background Coordination of return to work (RtW) is implemented in many countries, but a Cochrane review found no considerable effect on workers’ sick leave compared to usual care. The aim of the study is to analyse how the evidence from this review can be used for decisions about (de-)implementing RtW coordination in a country-specific setting, usi...

Background: Work participation is important for health and can be considered as engagement in a major area of life which is of significance for most people, but it can also be thought of as fulfilling or discharging a role. Currently, academic research lacks a comprehensive classification of work participation outcomes. The International Classifica...

Objective: Insurers frequently commission medical experts to estimate the degree of the remaining work capacity (RWC) in claimants for disability benefits. The social functioning scale Mini-ICF-APP allows for a rating of activity and participation limitations in thirteen capacity domains, considered as particularly relevant for work ability. The c...

Objective: To perform a European survey of the evidence needs and training demands of insurance medicine professionals related to professional tasks and evidence-based practice. Design: International survey. Subjects: Professionals working in insurance medicine. Methods: Experts designed an online questionnaire including 26 questions related...

Background Coordination of return-to-work (RtW) with the aim to decrease sick leave in many countries. Compared to usual care, a Cochrane review found RtW coordination to have no considerable effect on sick leave. The aim of the study is to find out how the evidence from this review can be used for decisions about (de-)implementing RtW coordination...

Adrian Verbel, Jan Hoving, Peter A. Bülow, Regina Kunz Surgical or conservative treatment for impingement of the rotator cuff? Cochrane Corner

Background There are currently no tools for assessing claimants’ perceived fairness in work disability evaluations. In our study, we describe the development and validation of a questionnaire for this purpose. Method In cooperation with subject-matter experts of Swiss insurance medicine, we developed the 30-item Basel Fairness Questionnaire (BFQ)....

Objective Functional evaluations establish functional and work (in-)capacities in the context of disability assessments and are increasingly recommended as a modern technique for work disability assessments. The RELY (Reliable disability EvaLuation in psychiatrY)-studies introduced semi-structured functional interviews in real-life assessments of c...

Objectives: This article provides updated GRADE guidance about how authors of systematic reviews and health technology assessments (HTA) and guideline developers can rate the certainty of evidence (also known as quality of the evidence or confidence in the estimates) of a body of evidence addressing test accuracy (TA) on the domains imprecision, i...

Objectives: This article provides updated GRADE guidance about how authors of systematic reviews and health technology assessments (HTA) and guideline developers can assess the results and the certainty of evidence (also known as quality of the evidence or confidence in the estimates) of a body of evidence addressing test accuracy (TA). Study des...

Background: Expert psychiatrists conducting work disability evaluations often disagree on work capacity (WC) when assessing the same patient. More structured and standardised evaluations focusing on function could improve agreement. The RELY studies aimed to establish the inter-rater reproducibility (reliability and agreement) of 'functional evalu...

Importance Harms and benefits of opioids for chronic noncancer pain remain unclear. Objective To systematically review randomized clinical trials (RCTs) of opioids for chronic noncancer pain. Data Sources and Study Selection The databases of CENTRAL, CINAHL, EMBASE, MEDLINE, AMED, and PsycINFO were searched from inception to April 2018 for RCTs o...

( Lancet . 2018;391:1197–204) Among patients who undergo lumbar puncture, up to 35% return to the hospital with a postdural puncture headache, which is caused by continuing leakage of the cerebrospinal fluid (CSF) from the dural defect created by the spinal needle. Conventional needles are most frequently used in clinical practice by nonanesthesiol...

Little is known about how claimants experience disability assessments. While a variety of patient satisfaction instruments reflect the quality of medical care, no such tool exists for the assessment of work disability. In disability assessment, fairness is a central component of the claimants’ satisfaction with the assessment. We therefore develope...

Both practitioners and patients need to know if an intervention is effective and safe. Following the evidence-based medicine (EBM) approach research questions about interventions should be structured according to PICO (Patient, Intervention, Comparator, Outcome).

Under the flag of insurance medicine, many physicians seem to do comparable work in different European countries. For a large part, their work has to do with sick leave and work disability, fields with major societal impact and implications. Unlike most clinical disciplines, insurance medicine does not have any distinct property that is valid in al...

Objective: To provide guidance on how systematic review authors, guideline developers, and health technology assessment practitioners should approach the use of the risk of bias in non-randomized studies of interventions (ROBINS-I) tool as part of GRADE's certainty rating process. Study design and setting: Iterative discussions, testing in syste...

Background Atraumatic needles have been proposed to lower complication rates after lumbar puncture. However, several surveys indicate that clinical adoption of these needles remains poor. We did a systematic review and meta-analysis to compare patient outcomes after lumbar puncture with atraumatic needles and conventional needles. Methods In this...

Background To limit long-term sick leave and associated consequences, insurers, healthcare providers and employers provide programmes to facilitate disabled people’s return to work. These programmes include a variety of coordinated and individualised interventions. Despite the increasing popularity of such programmes, their benefits remain uncertai...

Background: To limit long-term sick leave and associated consequences, insurers, healthcare providers and employers provide programmes to facilitate disabled people's return to work. These programmes include a variety of coordinated and individualised interventions. Despite the increasing popularity of such programmes, their benefits remain uncert...

Objectives: To explore agreement among healthcare professionals assessing eligibility for work disability benefits. Design: Systematic review and narrative synthesis of reproducibility studies. Data sources: Medline, Embase, and PsycINFO searched up to 16 March 2016, without language restrictions, and review of bibliographies of included studies....

Appendix 2: Determination of overall generalisability

Appendix 3: Studies reporting use of instrument with instrument referenced

Appendix 4: Full details of performance and findings of included studies

Appendix 1: Search strategy

To explore associations between care workers' health and implicit rationing of care. Diverse studies have linked impaired health to reduced work performance – a factor measured through omission of required tasks. This cross-sectional study gathered data from 3239 care workers in 162 Swiss nursing homes. Data were analyzed via a linear logistic regr...

Background: Work capacity evaluations by independent medical experts are widely used to inform insurers whether injured or ill workers are capable of engaging in competitive employment. In many countries, evaluation processes lack a clearly structured approach, standardized instruments, and an explicit focus on claimants' functional abilities. Eva...

Background: Certifying physicians play a key role in the management of sickness absence and are often provided with guidelines. Some of these guidelines contain statements on expected sickness absence duration, according to diagnosis. We were interested in exploring the evidence base of these statements. Methods: We identified guidelines through...

Background: Worker productivity is central to the success of organizations such as healthcare institutions. However, both absenteeism and presenteeism impair that productivity. While various hospital studies have examined the prevalence of presenteeism and absenteeism and its associated factors among care workers, evidence from nursing home settin...

Questions under study: Studies from several countries (Scandinavia, United Kingdom) report that general practitioners (GPs) experience problems in sickness certification. Our study explored views of Swiss GPs towards sickness certification, their practice and experience, professional skills and problematic interactions with patients. Methods: We...

Questions: In Switzerland, evaluation of work capacity in individuals with mental disorders has come under criticism. We surveyed stakeholders about their concerns and expectations of the current claim process. Methods: We conducted a nationwide online survey among five stakeholder groups. We asked 37 questions addressing the claim process and t...

In diesem Kapitel wird die Anwendung der Internationalen Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) in der Begutachtung thematisiert. Die ICF steht seit der Publikation im Jahre 2001 auf der Agenda von Praktikern und Wissenschaftlern. In dieser Zeit wurde sehr viel über die ICF publiziert, die Umsetzung in die Praxis je...

The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) has recommended that trialists evaluating treatments for chronic pain should consider reporting nine patient-important outcome domains. We examined the extent to which clinical trials evaluating the effect of opioids for chronic non-cancer pain (CNCP) report ou...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of return to work coordination programmes for workers on sick leave compared with usual practice.

Background Patient satisfaction is crucial for the acceptance, use, and adherence to recommendations from teleconsultations regarding health care requests and triage services. Objectives Our objectives are to systematically review the literature for multidimensional instruments that measure patient satisfaction after teleconsultation and triage an...

Objectives Independent medical evaluations (IMEs) are a common and influential form of assessment, often influencing whether patients receive compensation for an injury or illness. To inform the evidence-base underlying IMEs, we conducted a systematic review of all primary literature conducted in North America. Method We searched CINAHL, EMBASE, ME...

In Switzerland, psychiatric evaluations of work capacity for determining a person's eligibility for disability benefits are being criticised for a lack of transparency and high inter-rater variability. The aims of this study were to learn about the current practice of psychiatrists, to explore possible sources for lack of transparency and variabili...

Randomized control trials (RCTs) stopped early for benefit (truncated RCTs) are increasingly common and, on average, overestimate the relative magnitude of benefit by approximately 30%. Investigators stop trials early when they consider it is no longer ethical to enroll patients in a control group. The goal of this systematic review is to determine...

Objective Psychiatric expertises for determining a person’s work capacity are being criticised in Switzerland. Issues of concern are lack of transparency and variation in the judgment on work capacity. The aims of this study were (1) to learn about current practice among Swiss psychiatric experts in evaluating and reporting on work capacity, (2) to...

Objective Individuals suffering an injury or illness may be eligible to receive financial compensation based on their level of impairment and an independent medical evaluation (IME) often guides this determination. Our objectives are to determine the issues authors have addressed and their viewpoints, establish where evidence allows for recommendat...

Opioids are prescribed frequently and increasingly for the management of chronic non-cancer pain (CNCP). Current systematic reviews have a number of limitations, leaving uncertainty with regard to the benefits and harms associated with opioid therapy for CNCP. We propose to conduct a systematic review and meta-analysis to summarize the evidence for...

Purpose: To compare the official requirements of the content of disability evaluation for social insurance across Europe and to explore how the International Classification of Functioning, Disability and Health is currently applied, using the rights and obligations of people with disabilities towards society as frame of reference. Methods: Surve...

Dr. Cohen presents a passionate critique of the 9(th) edition of the American College of Chest Physician Guidelines on Antithrombotic Therapy (AT9), and in particular on its methodologist authors. We believe this attack is misguided and appreciate the opportunity to respond to Dr. Cohen. Dr. Cohen objects to the use of the term patient-important. ©...

Background: Professional societies, like many other organizations around the world, have recognized the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the third of a series of 14 articles that were prepared to advise guideline developers in respiratory an...

INTRODUCTION: Professional societies, like many other organizations around the world, have recognized the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the fifth of a series of 14 articles that were prepared by an international panel to advise guideline d...

Introduction: Professional societies, like many other organizations around the world, have recognized the need to use more rigorous processes to ensure that healthcare recommendations are informed by the best available research evidence with input from appropriate stakeholders. This is the ninth of a series of 14 articles that were prepared by an...

The dramatic rise in chronically ill patients on permanent disability benefits threatens the sustainability of social security in high-income countries. Social insurance organizations have started to invest in promising, but costly return to work (RTW) coordination programmes. The benefit, however, remains uncertain. We conducted a systematic revie...

RevMan output for all outcomes including raw data. (DOCX)

Summary of findings for all outcomes. (DOCX)

Protocol. (DOCX)

PubMed search strategy. (DOCX)

Presenting continuous outcomes in Summary of Findings tables presents particular challenges to interpretation. When each study uses the same outcome measure, and the units of that measure are intuitively interpretable (e.g., duration of hospitalization, duration of symptoms), presenting differences in means is usually desirable. When the natural un...

Increased maternal weight or excessive weight gain in pregnancy is associated with adverse maternal and fetal outcomes. Existing reviews and guidelines making recommendations for interventions to manage weight gain in pregnancy are of limited value because of the small number of studies included. The best intervention that optimizes outcomes for th...

Around 50% of women of childbearing age are either overweight [body mass index (BMI) 25-29.9 kg/m(2)] or obese (BMI ≥ 30 kg/m(2)). The antenatal period provides an opportunity to manage weight in pregnancy. This has the potential to reduce maternal and fetal complications associated with excess weight gain and obesity. To evaluate the effectiveness...

Individuals who are sick and unable to work may receive wage replacement benefits from an insurer. For these provisions, a disability evaluation is required. This disability evaluation is criticised for lack of standardisation and transparency. The International Classification of Functioning, Disability and Health (ICF) was developed to express the...

To evaluate the effects of dietary and lifestyle interventions in pregnancy on maternal and fetal weight and to quantify the effects of these interventions on obstetric outcomes. Systematic review and meta-analysis. Major databases from inception to January 2012 without language restrictions. Randomised controlled trials that evaluated any dietary...

Appendix 4: Adverse outcomes

Appendix 1: Maternal and fetal clinical outcomes

Appendix 3: Clinical characteristics of included studies

Appendix 2: GRADE evidence profile