Schellart Antonius J M, Zwerver Feico, Anema Johannes R, Van der Beek Allard J
Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
BMC Res Notes. 2013 Jun 7;6:225. doi: 10.1186/1756-0500-6-225.
In the current study we report on the effects of an implementation strategy in the form of a training programme on the assessed work limitations of a client with depression by insurance physicians (IPs) participating in a RCT. These assessed work limitations of a client were in the form of scores on the List of Functional Abilities (LFA).
We conducted a randomised controlled trial (RCT) for IPs in which we compared the intervention of a specially developed training programme with the usual methods of implementation and training currently used. The outcome was the mean sum score and the inter-rater reliability (Intraclass Correlation Coefficient, ICC) of the LFA scores. These LFA scores were scored by the IPs participating in the RCT for the work limitations of the cases presented in different videos, two videos before the training and two after the training of the intervention group.
At baseline, the intervention group (IG) consisted of 21 IPs and the control group (CG) of 19. For one participant of the IG and for one of the CG the LFAs of the two case reports after training were not available. Before training the sum scores for the first case report did not differ significantly between the groups, while the mean sum score was higher in the IG than in the CG for the second case report. For both case reports after training a higher score was found in the IG than in the CG. The inter-rater reliability measured for the two case reports before training was about the same in the IG and the CG: 0.64 and 0.65, respectively. For the two case reports after training, the ICC was higher in the IG than in the CG: 0.69 and 0.54, respectively. This difference was not significant however.
It would appear that the implementation of a specially designed training programme on guidelines for depression may lead to greater inter-rater reliability in the assessments by insurance physicians of the work limitations of clients with depression. It is, however, important to note that insurance physicians who receive training may find more work limitations than those who do not.
Netherlands' Trial Register NTR1863.
在本研究中，我们报告了一项以培训计划形式存在的实施策略，对参与随机对照试验（RCT）的保险医师评估的抑郁症患者工作受限情况的影响。这些由保险医师评估的患者工作受限情况以功能能力清单（LFA）上的分数形式呈现。
我们为保险医师开展了一项随机对照试验，将专门制定的培训计划干预措施与当前使用的常规实施和培训方法进行比较。结果是LFA分数的平均总分和评分者间信度（组内相关系数，ICC）。这些LFA分数由参与RCT的保险医师针对不同视频中呈现病例的工作受限情况进行评分，干预组在培训前有两个视频，培训后有两个视频。
在基线时，干预组（IG）由21名保险医师组成，对照组（CG）由19名组成。干预组的一名参与者和对照组的一名参与者在培训后两份病例报告的LFA数据不可用。培训前，两组在第一份病例报告的总分上没有显著差异，而在第二份病例报告中，干预组的平均总分高于对照组。培训后两份病例报告中，干预组的分数均高于对照组。培训前两份病例报告的评分者间信度在干预组和对照组中大致相同，分别为0.64和0.6。培训后两份病例报告中，干预组的ICC高于对照组，分别为0.69和0.54。然而，这种差异并不显著。
看来，实施一项关于抑郁症指南的专门设计培训计划，可能会使保险医师在评估抑郁症患者工作受限情况时，评分者间信度更高。然而，需要注意的是，接受培训的保险医师可能比未接受培训的医师发现更多的工作受限情况。
荷兰试验注册NTR1863。
