Impairment due to Contextual Factors: External Assessment and Self-Assessment of Rehabilitants in Psychosomatic Rehabilitation

Abstract

In addition to an existing external assessment tool for the ICF-based assessment of the impairment of rehabilitation patients due to environmental and personal contextual factors, a self-assessment tool was developed and used for rehabilitation patients in a psychosomatic rehabilitation clinic. The aim was to compare the assessment of the impairment by contextual factors rated by the external assessment and by the rehabilitation patients on the other hand. Furthermore, the aim of the study was to obtain initial indications of the applicability of the newly designed self-evaluation instrument. A sample of N=103 rehabilitation patients was examined via both the external and the self-evaluation tools. A comparative evaluation of the assessment of the external assessor and the rehabilitants' assessments was carried out using measures of assessor agreement (Cohen's Kappa, percentual agreement). The results were set in relation to the data of the routine assessment of the rehabilitation facility (Eta-Coefficient). The external assessor and the rehabilitants get to different results in their assessment of the extent of impairment by individual contextual factors. For eight of the 15 context factors, there was only a moderate degree of agreement between the assessors (Cohen's Kappa). The percentage of non-agreement between rating of the external assessor and self-assessment lies between approx. 20% and up to approx. 40% of the cases for the majority of the context factors. Whether or not there is an impairment across all contextual factors (overall measure) was answered non-concordantly in just under a third of the cases. Mostly moderate correlations were found between the context factors classified as particularly relevant in the self-evaluation tool and scales of psychometric survey (e. g. BDI-II). This result provides a first indication of the convergent validity of the self-report tool. More attention should be paid to a supplementary assessment of impairment by contextual factors via the rehabilitation patient's self-assessment in addition to the external assessment. There is a need for further research with regard to the development of the self-assessment tool presented.