Interviews for the assessment of long-term incapacity for work: a study on adherence to protocols and principles

ABSTRACT: BACKGROUND: Social insurance assessments for long-term incapacity for work are performed by Social Insurance Physicians (SIPs) who rely on interviews with claimants as an important part of the process. These interviews, however, are susceptible to bias. For that reason, in the Netherlands three protocols have been developed to conduct these interviews and make them more reliable: the Interview of methodic assessment (IMA), the Disability Assessment Structured Interview (DASI) and the Multi-causal Analysis (MCA). These protocols are expert- and practice-based. In order to further develop and ground these protocols more firmly with scientific evidence, it is useful to know to what extent the protocols are adhered to by practitioners. METHODS: We compared the protocols with one another and with the ICF and biopsychosocial approaches. The protocols describe semi-structured interviews with comparable but not identical topics. Protocols also give instructions of how to handle the situation of assessment in social insurance. All protocols prescribe an argumentative assessment, which implies that the client's opinion on his capacity for work, and his arguments, need to be determined and assessed. We developed a questionnaire to elicit the adherence SIPs have to the protocols and their underlying principles and topics, and conducted a survey among 155 experienced SIPs in the Netherlands. RESULTS: Ninety-eight SIPs returned a completed questionnaire (64 %). All respondents used some form of protocol: 23% reported to use IMA, 12 % DASI and 22% MCA, whilst 42% reported to have constructed their own mix. We found no significant relationship between training and the use of a particular protocol. Ninety percent of the SIPs use a semi-structured interview. Ninety-five percent of SIPs recognise their role in having to verify what the claimant says and eighty-three percent feel the need to establish a good relationship (p=0.019). Twelve topics are basically always addressed by over 80% of the respondents and six topics by between 44 and 80%. The claimant's opinion of being fit for his own work or other work, and his claim of incapacity and his health arguments for that claim, reach 100%. A description of claimants' previous work reaches 99%. CONCLUSIONS: Our study indicates that there is professional consensus among experienced Dutch SIPs about the principle of argumentative assessment, the principle of conducting a semi-structured interview and the most crucial interview topics. This consensus can be used to further develop a protocol for interviewing in the assessment of incapacity for work in social insurance. Such a protocol can improve the quality of the assessments in terms of transparency and reproducibility, as well as enabling clients to better prepare themselves for the assessments, which would make their position more equal with that of the SIP