Medico‐legal assessment of disability in narcolepsy: an interobserver reliability study

Abstract

Impairment because of narcolepsy strongly limits job performance, but there are no standard criteria to assess disability in people with narcolepsy and a scale of disease severity is still lacking. We explored: (1) the interobserver reliability among Italian Medical Commissions making disability and handicap benefit decisions for people with narcolepsy, searching for correlations between the recognized disability degree and patients' features; (2) the willingness to report patients to the driving licence authority and (3) possible sources of variance in judgement. Fifteen narcoleptic patients were examined by four Medical Commissions in simulated sessions. Raw agreement and interobserver reliability among Commissions were calculated for disability and handicap benefit decisions and for driving licence decisions. Levels of judgement differed on percentage of disability (P < 0.001), severity of handicap (P = 0.0007) and the need to inform the driving licence authority (P = 0.032). Interobserver reliability ranged from Kappa = -0.10 to 0.35 for disability benefit decision and from Kappa = -0.26 to 0.36 for handicap benefit decision. The raw agreement on driving licence decision ranged from 73% to 100% (Kappa not calculable). Spearman's correlation between percentages of disability and patients' features showed correlations with age, daytime naps, sleepiness, cataplexy and quality of life. This first interobserver reliability study on social benefit decisions for narcolepsy shows the difficulty of reaching an agreement in this field, mainly because of variance in interpretation of the assessment criteria. The minimum set of indicators of disease severity correlating with patients' self assessments encourages a disability classification of narcolepsy.

The Humanistic and Economic Burden of Narcolepsy

“…may be exacerbated by fear of accidents, concerns about their employment, and functional limitations such as difficulty obtaining driving licensure. 5,[34][35][36][37][38][39] It seems likely that in patients with a diagnosis of narcolepsy, psychiatric conditions develop at least partly in response to, or as a comorbid component of, the condition and, as a result, these patients are not fully functional at work and have reduced quality of life. Moreover, they seek medical help from general and specialist physicians, and are admitted to inpatient and outpatient services in response to their condition and its comorbidities.…”

Revisión bibliográfica exploratoria sobre los criterios de aptitud en conductores profesionales con enfermedad psiquiátrica

“…En otro estudio realizado en Canadá 22 se analiza la competencia de los neurólogos en la emisión de la aptitud para conducir de pacientes con demencia, obteniéndose que el 74% acertó en la no aptitud de estos pacientes para la conducción, por lo que se demuestra la falta de unificación de criterios y la escasa formación de los profesionales en esta materia. En relación con la idea anterior nos planteamos la problemática expuesta en el artículo italiano sobre la aptitud en narcolepsia 19 , cuya idea podemos extrapolar al resto de patologías mentales. Nos encontramos ante una falta de unificación de criterios a la hora de, que valores medir y como interpretar los mismos.…”

Independent medical evaluation for sick-listed patients: a focus group study of GPs´ expectations and experiences

“…IMEs conducted by independent health professionals are routinely used by both public and private health insurance systems throughout the Western world to determine the functional capacity of workers who claim inability to work because of illness or injury [7–9]. However, experts assessing the same claimants often disagree regarding the ability to work [10–12]. An IME implies that, by providing a second opinion, the IME doctor intervenes in a sickness absence episode and hence in the relationship between the sick-listed patient and her GP.…”