title: Use of a structured functional evaluation process for independent medical evaluations of claimants presenting with disabling mental illness: rationale and design for a multi-center reliability study.
abstract: Work capacity evaluations by independent medical experts are widely used to inform insurers whether injured or ill workers are capable of engaging in competitive employment. In many countries, evaluation processes lack a clearly structured approach, standardized instruments, and an explicit focus on claimants' functional abilities. Evaluation of subjective complaints, such as mental illness, present additional challenges in the determination of work capacity. We have therefore developed a process for functional evaluation of claimants with mental disorders which complements usual psychiatric evaluation. Here we report the design of a study to measure the reliability of our approach in determining work capacity among patients with mental illness applying for disability benefits.
  
  
  
  We will conduct a multi-center reliability study, in which 20 psychiatrists trained in our functional evaluation process will assess 30 claimants presenting with mental illness for eligibility to receive disability benefits [Reliability of Functional Evaluation in Psychiatry, RELY-study]. The functional evaluation process entails a five-step structured interview and a reporting instrument (Instrument of Functional Assessment in Psychiatry [IFAP]) to document the severity of work-related functional limitations. We will videotape all evaluations which will be viewed by three psychiatrists who will independently rate claimants' functional limitations. Our primary outcome measure is the evaluation of claimant's work capacity as a percentage (0 to 100 %), and our secondary outcomes are the 12 mental functions and 13 functional capacities assessed by the IFAP-instrument. Inter-rater reliability of four psychiatric experts will be explored using multilevel models to estimate the intraclass correlation coefficient (ICC). Additional analyses include subgroups according to mental disorder, the typicality of claimants, and claimant perceived fairness of the assessment process.
  
  
  
  We hypothesize that a structured functional approach will show moderate reliability (ICC ≥ 0.6) of psychiatric evaluation of work capacity. Enrollment of actual claimants with mental disorders referred for evaluation by disability/accident insurers will increase the external validity of our findings. Finding moderate levels of reliability, we will continue with a randomized trial to test the reliability of a structured functional approach versus evaluation-as-usual.
authors.affiliation: Division Evidence-based Insurance Medicine, University Hospital Basel, Spitalstrasse 8 + 12, CH-4031, Basel, Switzerland.|Department Clinical Research, University of Basel, Spitalstrasse 8 + 12, CH-4031, Basel, Switzerland.
authors.forename: Monica
authors.initials: M
authors.lastname: Bachmann
authors.affiliation: Division Evidence-based Insurance Medicine, University Hospital Basel, Spitalstrasse 8 + 12, CH-4031, Basel, Switzerland.|Department Clinical Research, University of Basel, Spitalstrasse 8 + 12, CH-4031, Basel, Switzerland.
authors.forename: Wout
authors.initials: W
authors.lastname: de Boer
authors.affiliation: Division Evidence-based Insurance Medicine, University Hospital Basel, Spitalstrasse 8 + 12, CH-4031, Basel, Switzerland.|Department Clinical Research, University of Basel, Spitalstrasse 8 + 12, CH-4031, Basel, Switzerland.|Basel Institute for Clinical Epidemiology & Biostatistics, University Hospital Basel, Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schandelmaier
authors.affiliation: School of Applied Psychology, Institute Humans in Complex Systems, Olten, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Leibold
authors.affiliation: Swiss Society of Insurance Psychiatry, SGVP, Basel, Switzerland.
authors.forename: Renato
authors.initials: R
authors.lastname: Marelli
authors.affiliation: Institute of Medical Disability Evaluations of Central Switzerland, Lucerne, Switzerland.
authors.forename: Joerg
authors.initials: J
authors.lastname: Jeger
authors.affiliation: Department of Insurance Psychiatry, Swiss Accident Insurance Fund, Lucerne, Switzerland.|Private practice for Psychiatry and Psychotherapy, Lucerne, Switzerland.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Hoffmann-Richter
authors.affiliation: Psychiatric University Clinic of Basel, Basel, Switzerland.
authors.forename: Ralph
authors.initials: R
authors.lastname: Mager
authors.affiliation: Institute for Medical Disability Evaluation Interlaken, Lucerne, Switzerland.
authors.forename: Heinz
authors.initials: H
authors.lastname: Schaad
authors.affiliation: Department Clinical Research, University of Basel, Spitalstrasse 8 + 12, CH-4031, Basel, Switzerland.|Clinical Trial Unit, University Hospital Basel, Basel, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zumbrunn
authors.affiliation: Division Evidence-based Insurance Medicine, University Hospital Basel, Spitalstrasse 8 + 12, CH-4031, Basel, Switzerland.|Department Clinical Research, University of Basel, Spitalstrasse 8 + 12, CH-4031, Basel, Switzerland.
authors.forename: Nicole
authors.initials: N
authors.lastname: Vogel
authors.affiliation: Zurich Office of the Swiss National Disability Insurance, Zurich, Switzerland.|Private practice, Wetzikon, Switzerland.
authors.forename: Oskar
authors.initials: O
authors.lastname: Bänziger
authors.affiliation: Department of Clinical Epidemiology and Biostatics, McMaster University, Hamilton, ON, Canada.|The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada.|Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Busse
authors.affiliation: School of Applied Psychology, Institute Humans in Complex Systems, Olten, Switzerland.
authors.forename: Katrin
authors.initials: K
authors.lastname: Fischer
authors.affiliation: Division Evidence-based Insurance Medicine, University Hospital Basel, Spitalstrasse 8 + 12, CH-4031, Basel, Switzerland. regina.kunz@usb.ch.|Department Clinical Research, University of Basel, Spitalstrasse 8 + 12, CH-4031, Basel, Switzerland. regina.kunz@usb.ch.
authors.forename: Regina
authors.initials: R
authors.lastname: Kunz
mesh_terms: D006801:Humans; D000070536:Independent Medical Evaluation; D018868:Insurance, Disability; D001523:Mental Disorders / Q000175:diagnosis*; D011570:Psychiatry; D015203:Reproducibility of Results; D012107:Research Design; D014938:Work Capacity Evaluation
keywords: Disability and Health; Disability evaluation (MeSH); Disability insurance (MeSH); Evidence-based medicine (MeSH); Insurance Medicine (not MeSH); International Classification of Functioning; Mental disorders (MeSH); Psychiatry (MeSH); Reliability (not MeSH; Work capacity evaluation (MeSH); related MeSH-term: reproducibility of results)