Abstract
Background: This study aimed to determine the best method of achieving consensus between examiners and workers with disabilities in Brazil regarding their perceived severity of the disability and eligibility for an early retirement pension. Methods: We analysed the agreement between evaluators’ perceptions to create a reference standard for the classification of the disability severity of applicant workers with disabilities. Pairs of expert physicians and social workers applied a computer index, and then assigned their perceived level of severity, independent of the computer classification. Findings: A total of 17,350 applicants aged 18 and 76 years were included in the analysis. The best-perceived agreement represented the ideal comparison standard for validating the index in the future. The severity perceptions of the evaluators and the workers with disabilities yielded three agreement tables portraying the perceived disability severity. Physicians and social workers demonstrated the greatest level of agreement (weighted kappa: 0·2351, 95% confidence interval: 0·2229–0·2473) and the combination of their assessments provided the best standard. To the best of our knowledge, this is the first time that this method has been used to create a reference standard. Evaluators’ perceptions of disability severity formed the basis for choosing a standard to further analysis the index’s accuracy and validity. Funding Statement: This work was supported by a grant from the Brazilian Ministry of Social Security (No. 44000.001814/2013-60; FUB Technical Cooperation Agreement of 11/21/2013). Declaration of Interests: We declare no competing interests. Ethics Approval Statement: This research was conducted according to Brazilian regulations and in conformance with the Principles of the Declaration of Helsinki, and the study protocol was approved by the Internal Review Board of the School of Health Sciences at the University of Brasilia, (CAAE number: 37058914.5.0000.0030). The requirement for informed consent for this database analysis was waived because the study was based on a retrospective analysis of routinely-collected data.
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