Inter-observer agreement of the musculoskeletal system disability levels of individuals presenting at disability health boards

The classification and scoring of disability in Turkey are done within the framework of the “Regulation on Disability Assessment for Adults”. However, evaluation of disabled individuals by different physicians despite having the same disability may lead to conflicting results. This study aims to investigate the inter-observer agreement of physiatrists and orthopedists in the evaluation of patients who applied to the Disability Health Board because of musculoskeletal system pathologies. Ten people with musculoskeletal problems and four physicians, including two physical therapists and two orthopedists, were included in this study. The patients were evaluated by the physicians according to the provisions of the “Regulations for the Disability Assessment of Adults” in random order in separate rooms on the same day. The mean disability points were found to be 19.4±14.8 for physiatrist 1 (PMR1), 16.5±13.1 for PMR2, 17.9 ±14.9 for orthopedist 1 (O1), and 18.7±15.9 for O2. No statistically significant difference was determined between the 4 physicians in respect of the points given (p=0.85). The agreement between all 4 physicians was found to be 0.85 (95% CI:0.68-0.95). In the paired analyses, the ICC ranged from 0.73 to 0.96, with the lowest agreement between PMR2-O2, and the highest agreement between O1-O2. In conclusion, the results of this study showed that there was not an absolute agreement between physiatrists and orthopedists because of the complex structure in determining the disability rate of the musculoskeletal system, the fact that patient compliance is important, and that the approach of the physician can be different. For physicians participating in the Health Board to be able to provide standardization, there is a need for theoretical and patient-based training, the appropriate time to be allocated for patient evaluation, and the open points in the items of the regulation should be eliminated.

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1. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;16;390:1211-59.
2. Word report on disability. https://www.who.int/publications/i/ item/9789241564182 access date 02.01.2022.
3. Disabled and Elderly Statistics Bulletin. https://www.aile.gov.tr/ access date 02.01.2022.
4. Regulations for the Disability Assessment of Adults. https://www. resmigazete.gov.tr access date 02.01.2022.
5. Sarı IF, Tatlı S, Ünal S, et al. Evaluation of musculoskeletal disabilities in applications to the disabled medical board. J PMR Sci. Ahead of print.2021-84552.
6. Benli AR, Demir Yazıcı Ş, Yazıcı O et al. Evaluation of causes application on medical board. Konuralp Medical J. 2016;8:167-72.
7. Uysal C, Bulut M, Kaya MC, et al. Analysis of cases referred to the disability board of Dicle University hospitals. J For Med. 2013;27:1-9.
8. Sayın I, Erdur Ö, Topçu I, Kayhan FT. Health board the disability determination and otorhinolaryngology pathology and frequency in patients admitted for other reasons: an observational study. OtorhinolaryngologyForum 2011;10:87-91.
9. Ceyhan D, Yaşar T, Demirok A, et al. Causes of visual impairment in the Van city area according to the health committee’s reports. Turk J Ophthalmol. 2012;42:131-4.
10. Özbaran B, Köse S. Health committee reports for disabled children in child psychiatry practice: the last six-year experience of Ege University. Turk J Child Adolesc Ment Health. 2011;18:67-72.
11. Yektaş Ç, Kaplan SE. Evaluation of health committee reports of patients admitted to the university of child and adolescent department. Konuralp Medical J. 2017;9:228-32.
12. Çabalar M, Demirtaş Tatlıdede A, Yazar T, et al. Evaluation of the neurological disability rates in medical commission. Med j Bakirkoy. 2011;7:142-6.
13. Evlice A, Demir T, Aslan K, et al. Disability at neurological diseases. Cukurova Med J. 2014;39:566- 71. https://doi.org/10.17826/cutf.78721.
14. Nas K, Çevik R, Gür A, et al. The frequency of locomotor disabilities in Diyarbakır. Turk J Phys Med Rehab. 1999;2:8-14.
15. Terzi R, Altın F. Examination of the patient’s locomotor system disability evaluated in the board of health for disabled. Turk J Osteoporos. 2014;20:60-4.