Seminar Presentation 4-1

4-1 (Presentation within Topical Seminar 4):
Development of an instrument assessing recovery expectations in patients with mental health disorders

Presented by: Shanil Ebrahim

Seminar Details

Part of Topical Seminar 4: Psychosocial Factors Involved in the RTW Process
Tuesday September 30


Ebrahim S1,2,3,4, Malachowski C5, Kamal el Din M6, Montoya L7, Mulla S2, Bance S8, Guyatt GH1,9, Busse JW1,2

  1. Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
  2. Department of Anesthesia, McMaster University, Hamilton, Canada
  3. Department of Medicine, Stanford University, Stanford, USA
  4. Department of Anaesthesia & Pain Medicine, The Hospital for Sick Children, Toronto, Canada
  5. Department of Medicine, McMaster University, Hamilton, Canada
  6. Ain Shams University, Faculty of Medicine, Cairo, Egypt
  7. University Health Network, Toronto, Canada
  8. Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, Canada
  9. Department of Medicine, McMaster University, Hamilton, Canada



Our analysis of a Canadian disability insurance claims database showed that of those approved for long-term disability benefits, 31.6% suffer from a primary diagnosis of a mental health disorder. Negative patient recovery expectations are associated with worse outcome. Measures assessing patient’s expectations of recovery can help with early identification of individuals at risk of prolonged recovery. Our objectives were: 1) complete a systematic review to identify measures that currently assess expectations of recovery, and 2) using the results from the review, develop an instrument assessing recovery expectations in individuals receiving wage replacement disability benefits secondary to mental health disorders.


We completed electronic searches of MEDLINE and PsycInfo to June 2013 to identify primary studies evaluating patient expectations about recovery in any clinical condition. Reviewers screened titles and abstracts of identified citations, screened full text of potentially eligible studies, and extracted data from all eligible studies. Using the results from the review and input from content experts (psychologists, occupational therapists, methodologists and insurance administrators), we developed items for an instrument assessing recovery expectations in individuals who are receiving disability benefits secondary to a mental health disorders.


Of 12,599 unique citations, 43 studies were eligible. Studies reported on 12 different measurements and 30 individual items assessing expectations of recovery that evaluated an association with a measure of recovery. Seventy-three percent (n=11) of studies using a formal measure reported some measurement properties with 4 reporting an assessment of both reliability and validity. Fourteen (33%) studies assessed the association of expectations about recovery with return to work. We developed a 26-item instrument that will be presented at WDPI 2014.


Only one-third of all articles assessing recovery expectations used a formally developed measure. Of these measures, only a quarter reported both indicators of the quality of measuring an instrument—validity and reliability. Our instrument will aim to assess limitations of existing measures through formal testing and validation.