Screening to identify people at risk of long-term incapacity: a conceptual and scientific review

Abstract

Objectives: This project aimed to review the concepts and utility of screening for the risk of long-term incapacity associated with the common, relatively minor, health complaints associated with receipt of social security benefits (predominantly musculoskeletal disorders, mental health problems, and cardio-respiratory symptoms). \n \nMethods: A systematic electronic literature search yielded existing reviews concerning clinical and psychosocial data. Alternative search strategies were required to obtain unindexed reports of large individual studies based on socio-demographic and administrative data. From some 1000 retrieved titles, 28 reviews and 31 individual studies met the selection criteria, and provided the material for a structured review. \n \nResults: The findings show there is strong evidence that both socio-demographic and clinical psychosocial data contain strong predictors for long-term incapacity, yet they do not combine into a simple, robust, and universal screening tool. Whilst screening is possible and potentially valuable, its utility is strongly dependent on timing and purpose. Socio-demographic data can be strong predictors at an early stage, but may be immutable. Psychosocial predictors are effective somewhat later, yet have the advantage of being suitable for guiding rehabilitation strategies. \n \nConclusions: There is a practical window for screening for long-term incapacity that extends between about one and six months. Socio-demographic and clinical data are interrelated, and their utility may vary over time; both may be combined into a logical and practical sequence in the screening process.

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