Presentation M O6
M O6 (Oral Presentation):
Predicting improvement of functioning in disability claimants
- Coronel Institute of Occupational Health, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, the Netherlands
- Research Center for Insurance Medicine, The Netherlands
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, The Netherlands
- Social Security Institute, the Netherlands
- Department of Health Sciences, VU University, Amsterdam, The Netherlands
In the Netherlands, disability claimants are assessed by insurance physicians of the Social Security Institute after two years of sick leave. Identifying those disability claimants whose functioning may improve is important as they may benefit from return-to-work interventions. Perceptions of the disability claimant about the likelihood and time of future improvement may be a valuable source of information for this prognosis. The aim of this study is to i) assess and compare the accuracy of predictions of functional improvements by claimants and insurance physicians and ii) study whether the accuracy differs between subgroups of claimants with mental or somatic health conditions.
We used data from the PREDIS cohort study. Following the assessment of the disability claim (n=375) and after one year follow up (T1, n=276) data on functioning were obtained from respondents by self-report questionnaire (WHODAS 2.0). The prediction of improvement of functioning within one year (yes/no) was compared to the actual occurrence of relevant improvement one year later (improvement exceeding the standard error of measurement; yes/no). Accuracy of predictions were assessed by sensitivity, specificity, and Area Under the receiver operating Curves (AUC). Mixed logistic regression was conducted to explore differences in accuracy between claimants with mental and somatic conditions.
One third (32%) of the disability claimants improved relevantly. The predictions of the claimants had a sensitivity of 0.72 and a specificity of 0.21. IPs' predictions showed a lower sensitivity (0.52), but a higher specificity (0.47). The AUCs were fairly similar for insurance physicians (0.61) and claimants’ (0.62). We found no statistically significant differences in the accuracy of the predictions in claimants with mental or somatic health conditions by either insurance physicians (OR 1.7; CI 0.8-3.6) or claimants (OR 1.2; CI 0.63-2.1).
Improvements of functioning are not uncommon in a group of disability claimants with various diagnoses. Both insurance physicians and disability claimants were only able to predict improvements with low levels of accuracy. Alternative ways to screen for eligibility for re-assessments, such as the use of self report instruments over time, should be considered.
Monday September 29
10:45 - 12:15 Morning Concurrent Sessions (M O1 - M O12 and Seminar 1)
Session: Predictors of Work Disability