Capturing case complexity: is clinician selected dose of vocational rehabilitation related to questionnaire results?

BACKGROUND: To establish an optimum dosage interdisciplinary vocational rehabilitation, it is important to be able to reliably and validly assess case complexity. Assessment of case complexity is currently clinician based because no validated means to assess case complexity is presently available. Indices assumed to associate with case complexity can contribute to the choice of dosage. The objective of this study was to explore the extent in which results of questionnaires were associated with the choice of treatment dosage in vocational rehabilitation.

METHODS: Design: cross-sectional study of observational data. The study population consisted of workers on part-time or full-time sick leave due to chronic multifactorial problems. Thousand eighty-nine patients who were referred to a privately owned organization with outpatient vocational rehabilitation centers in the Netherlands between July 2016 and March 2017 were allocated to one of the three programs based on case complexity as determined by clinicians based on clinical interview and questionnaires.

RESULTS: Questionnaires accounted for 13% of the variance in the total group, 13% in patients with chronic musculoskeletal pain (n = 662) and 29% in patients with chronic fatigue (n = 235).

CONCLUSION: The results of the questionnaires contribute little in the assessment of case complexity and dose recommendation. Implications for Rehabilitation Assessment of case complexity of patients with chronic multifactorial complaints and disability is complex. The results of this study suggest that case complexity and choice of treatment dose is slightly explained by questionnaire results. It is largely determined on heuristics developed by knowledge and experience of clinicians. No reliable and validated means to assess case complexity is presently available in the field of rehabilitation and optimum treatment dose cannot be determined transparently. Routinely collected clinical data of baseline characteristics, process measures and results are a valuable source that can be used to answer research questions.