gms | German Medical Science

Background/research question: Time and again, media report anecdotal evidence about patients who feel unfairly treated in their medical evaluation of work disability. However, patient-relevant research in this field is lacking. The current literature does not reveal a reliable and valid instrument to assess the patients' experience of the disability evaluation. We developed an instrument to assess the patients' perceived fairness of the disability evaluation process and evaluate its psychometric properties.

Methods: In a first step, four experts drafted a preliminary 48-item questionnaire. After modification, the psychometric properties of the questionnaire were analysed in a sample of patients aged between 18 and 65 from four medical assessment centres in Switzerland. We investigated the internal consistency of the questionnaire using Cronbach's α coefficient. The "Cologne Patient Questionnaire" ("Kölner Patientenfragebogen", KPF, [1]) and the "Satisfaction with Life Scale" ([2]) were used to establish construct validity. The factor structure was examined via confirmatory factor analysis. In addition, the medical experts completed a 3-item-questionnaire to allow comparison of their answers with the patients' statements.

Results: In total, 305 patients (mean age 47.4 years, 62.0% female) and 436 experts returned their questionnaire. Confirmatory factor analysis revealed four factors with four items each: experts' interviewing skills, experts' behaviour towards the patients, experts' attention towards the patients and emotional aspects during the interview. Internal consistency of the instrument was high with Cronbach's α=0.91 and ranged between 0.81 and 0.85 for each of the four factors. The instrument correlated positively with the KPF-scale ‘confidence in physicians’ (r=0.84, p<0.01), while a weak correlation existed with ‘life satisfaction’ (r=0.24, p<0.01), indicating that our questionnaire measured an independent construct. On a 7-point-scale, experts perceived the evaluation slightly fairer (mean=6.1) compared to patients (mean=5.8).

Conclusion: Our questionnaire demonstrates good psychometric properties and is a suitable instrument to measure patients' experience with the process of their disability evaluation. Reliable and valid instruments in the context of evidence-based disability evaluation are needed to capture the patients' point of view. Such instruments can contribute to assure and reassure the quality of the evaluation process for work disability.

Competing interests: None.