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Objective: This study explores the effectiveness of using the International Classification of Functioning, Disability and Health (ICF) as a coding framework to document work-related disability information in sick leave certificates, focusing on depression and fibromyalgia in Sweden., Design: A qualitative ICF linking study was conducted, mapping information from 200 certificates per diagnosis to ICF., Methods: ICF linking rules were followed strictly. The coverage of ICF and ICF Core Sets was evaluated, proposing additional ICF categories when relevant categories were not included. Saturation of ICF categories was considered achieved if no new categories appeared in the last 5 certificates., Results: The study found high ICF coverage (85% for depression, 78% for fibromyalgia) in capturing work-related disability information. However, there was limited coverage in ICF Core Sets due to an excess of ICF categories in the Core Sets. Also, 2 additional relevant ICF categories for depression and 3 for fibromyalgia were identified., Conclusion: This study confirms that the International Classification of Functioning, Disability and Health is suitable for coding work-related disability in sick leave certificates. However, the identified limitations in ICF Core Sets highlights the need for context-specific subsets to enhance their relevance for depression and fibromyalgia in work-related disability.

Background: The purpose of this study was to test the feasibility of International Classification of Functioning, Disability and Health (ICF) and to explore the distribution, including gender differences, of health problems and disabilities as reflected in long-term sickness absence certificates., Methods: A total of 433 patients with long sick-listing periods, 267 women and 166 men, were included in the study. All certificates exceeding 28 days of sick-listing sent to the local office of the Swedish Social Insurance Administration of a municipality in the Stockholm area were collected during four weeks in 2004-2005. ICD-10 medical diagnosis codes in the certificates were retrieved and free text information on disabilities in body function, body structure or activity and participation were coded according to ICF short version., Results: In 89.8% of the certificates there were descriptions of disabilities that readily could be classified according to ICF. In a reliability test 123/131 (94%) items of randomly chosen free text information were identically classified by two of the authors. On average 2.4 disability categories (range 0-9) were found per patient; the most frequent were 'Sensation of pain' (35.1% of the patients), 'Emotional functions' (34.1%), 'Energy and drive functions' (22.4%), and 'Sleep functions' (16.9%). The dominating ICD-10 diagnostic groups were 'Mental and behavioural disorders' (34.4%) and 'Diseases of the musculoskeletal system and connective tissue' (32.8%). 'Reaction to severe stress and adjustment disorders' (14.7%), and 'Depressive episode' (11.5%) were the most frequent diagnostic codes. Disabilities in mental functions and activity/participation were more commonly described among women, while disabilities related to the musculoskeletal system were more frequent among men., Conclusions: Both ICD-10 diagnoses and ICF categories were dominated by mental and musculoskeletal health problems, but there seems to be gender differences, and ICF classification as a complement to ICD-10 could provide a better understanding of the consequences of diseases and how individual patients can cope with their health problems. ICF is feasible for secondary classifying of free text descriptions of disabilities stated in sick-leave certificates and seems to be useful as a complement to ICD-10 for sick-listing management and research.