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Evaluation of A Clinical Decision Support Tool for Selecting Optimal Rehabilitation Intervention for Injured Workers

  • Author / Creator
    Qin, Ziling
  • 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.

  • Subjects / Keywords
  • Graduation date
    2014-11
  • Type of Item
    Thesis
  • Degree
    Master of Science
  • DOI
    https://doi.org/10.7939/R3MW28P2D
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
  • Language
    English
  • Institution
    University of Alberta
  • Degree level
    Master's
  • Department
    • Faculty of Rehabilitation Medicine
  • Specialization
    • Rehabilitation Science
  • Supervisor / co-supervisor and their department(s)
    • Gross, Douglas P (Faculty of Rehabilitation Medicine)
  • Examining committee members and their departments
    • Woodhouse, Linda J (Faculty of Rehabilitation Medicine)
    • Armijo-Olivo, Susan (Faculty of Rehabilitation Medicine)