Do clinicians working within the same context make consistent return-to-work recommendations?
BACKGROUND
Healthcare providers play important roles in the process of making return-to-work (RTW) recommendations, which have important consequences for injured workers and their employers. We studied the inter-rater reliability of RTW determinations between clinicians in a specific workers' compensation setting.


METHODS
Three case scenarios were given to clinicians working at one rehabilitation facility to examine consistency between clinicians in RTW recommendations. Additionally, we examined what information clinicians relied on to make decisions. Analysis included percentage agreement and other descriptive statistics.


RESULTS
Thirty-six clinicians (13 physiotherapists, 10 occupational therapists, 8 exercise therapists, and 5 physicians) responded to the questionnaire. Subjects showed a high percentage agreement regarding RTW readiness on fracture and dislocation scenarios (97.2 and 94.4%, respectively), while agreement on a back pain scenario was modest (55.6%). In all cases, more than 50% of clinicians relied on biomedical information, such as physical examination.


CONCLUSIONS
Clinicians demonstrated a high level of agreement (>94%) when making RTW recommendations for injuries with clear pathology. However, a lower level of agreement (56%) was observed for back pain where the etiology of pain and disability is often more complex. Clinicians most commonly recommended RTW with restrictions, underlining the importance of workplace accommodations and modified duties in facilitating resumption of work.
Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
Yoko
Y
Ikezawa
Michele C
MC
Battié
Jeremy
J
Beach
Douglas
D
Gross
D000328:Adult; D000416:Alberta; D004185:Disability Evaluation; D006233:Persons with Disabilities; D004651:Employment; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000534:rehabilitation*; D010818:Practice Patterns, Physicians'; D020127:Recovery of Function; D017132:Workplace