Dell-Kuster Salome, Lauper Simon, Koehler Joerg, Zwimpfer Johanna, Altermatt Benedikt, Zwimpfer Tibor, Zwimpfer Leon, Young Jim, Bucher Heiner C, Nordmann Alain J
Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, CH - 4051 Basel, Switzerland.
Scand J Work Environ Health. 2014 Sep;40(5):493-501. doi: 10.5271/sjweh.3440. Epub 2014 Jun 11.
It is unclear to what extent assessments of work ability differ between disability claimants, their treating physicians, and multidisciplinary medical expert teams.
We compared assessments of work ability for consecutive disability claimants referred to a multidisciplinary assessment center in Switzerland over a 4-year period. Assessments were made for the last job (LJ) prior to claiming a disability benefit and an alternative job (AJ) thought to suit the claimant's physical and mental abilities. Mean differences (MD) in percentage work ability between assessments from claimants, physicians, and experts were then estimated in a linear regression model.
The 3562 claims made during the study period were mostly due to musculoskeletal and depressive disorders. Assessments differed little between claimants and physicians [LJ MD 1.3% (95% confidence interval [95% CI] 0.5-2.2%); AJ MD 11% (95% CI 10-12%)]. Experts on average assessed a claimant's work ability higher than either the claimant or physician, particularly in the AJ [MD between expert and claimant 57% (95% CI 56-58%) and between expert and physician 46% (95% CI 45-48%)].
Assessments of work ability differed substantially between experts in multidisciplinary medical teams and both claimants and their treating physicians. A careful evaluation of the disability assessment process is needed in an effort to reduce disagreement between expert teams and treating physicians and so improve acceptance of the process.
尚不清楚残疾索赔人、其主治医生和多学科医学专家团队对工作能力的评估在多大程度上存在差异。
我们比较了在4年期间被转介到瑞士一个多学科评估中心的连续残疾索赔人的工作能力评估。对申领残疾福利之前的最后一份工作（LJ）以及被认为适合索赔人身心能力的替代工作（AJ）进行了评估。然后在一个线性回归模型中估计索赔人、医生和专家评估之间工作能力百分比的平均差异（MD）。
研究期间提出的3562项索赔大多是由于肌肉骨骼疾病和抑郁症。索赔人和医生之间的评估差异不大[LJ的MD为1.3%（95%置信区间[95%CI]0.5 - 2.2%）；AJ的MD为11%（95%CI 10 - 12%）]。专家平均评估索赔人的工作能力高于索赔人或医生，特别是在AJ方面[专家与索赔人之间的MD为57%（95%CI 56 - 58%），专家与医生之间的MD为46%（95%CI 45 - 48%）]。
多学科医学团队中的专家与索赔人及其主治医生对工作能力的评估存在很大差异。需要对残疾评估过程进行仔细评估，以减少专家团队与主治医生之间的分歧，从而提高对该过程的接受度。
