Evaluation of A Clinical Decision Support Tool for Selecting Optimal Rehabilitation Intervention for Injured Workers Open Access
- Other title
Work Assessment Triage Tool
Clinical Decision Support Tool
- Type of item
- Degree grantor
University of Alberta
- Author or creator
- Supervisor and department
Gross, Douglas P (Faculty of Rehabilitation Medicine)
- Examining committee member and department
Woodhouse, Linda J (Faculty of Rehabilitation Medicine)
Armijo-Olivo, Susan (Faculty of Rehabilitation Medicine)
Faculty of Rehabilitation Medicine
- Date accepted
- Graduation date
Master of Science
- Degree level
Objective: To evaluate the concurrent validity of a newly developed clinical decision support tool (Work Assessment Triage Tool, WATT) by comparing the rehabilitation interventions determined using the WATT with the current gold standard–clinician recommendations.
Methods: This is a secondary data analysis study. Data were collected in a clinical trial conducted previously at the Workers’ Compensation Board of Alberta rehabilitation facility. A variety of statistical methods were used to compare recommendations for rehabilitation strategies determined using the WATT, clinician recommendations, actual programs claimants undertook and return-to-work outcomes. Analyses included percent agreement, crosstabs, and likelihood ratios.
Results: Percent agreement between clinician recommendations and WATT recommendations were low (r = 0.19) to moderate (r = 0.46). The WATT does not appear to improve upon clinician recommendations as only half of the RTW claimants whose actual rehabilitation programs did not match those of the clinician recommendations, matched recommendations identified using WATT.
Discussions: Contrary to internal validation demonstrating that the WATT outperformed clinician recommendations; results of the external validation of the WATT were not as promising. Findings do not provide evidence of concurrent validity of the WATT against the current gold standard. Four possible reasons could explain the results: (1) important differences were observed in claimant characteristics between the original WATT development data and our validation dataset; (2) insufficient data for claimants who failed RTW and those with successful RTW whose actual rehabilitation program did not match with the clinician recommendations; (3) data processing techniques that were used to overcome rehabilitation class imbalance when building the WATT, which may contribute to errors in the WATT recommendations; (4) clinician recommendations conflicted somewhat with existing evidence as some rehabilitation programs that were highly supported by research evidence (i.e. workplace interventions) were rarely recommended by clinicians in our validation dataset.
Conclusion: WATT recommendations do not concur with clinician recommendations. With respect to concurrent validity, no conclusion can be drawn as to which method, WATT or clinician judgment, provides better recommendations for return-to-work in actual practice. Further research is needed to resolve this uncertainty.
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