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Type: Journal article
Title: Development of prediction models of stress and long-term disability among claimants to injury compensation systems: a cohort study
Author: McFarlane, A.
Spittal, M.
O'Donnell, M.
Studdert, D.
Citation: BMJ Open, 2018; 8(4):1-10
Publisher: BMJ Journals
Issue Date: 2018
ISSN: 2044-6055
Statement of
Matthew J Spittal, Genevieve Grant, Meaghan O’Donnell, Alexander C McFarlane, David M Studdert
Abstract: Objectives: We sought to develop prognostic risk scores for compensation-related stress and long-term disability using markers collected within 3 months of a serious injury. Design: Cohort study. Predictors were collected at baseline and at 3 months postinjury. Outcome data were collected at 72 months postinjury. Setting: Hospitalised patients with serious injuries recruited from four major trauma hospitals in Australia. Participants: 332 participants who made claims for compensation for their injuries to a transport accident scheme or a workers’ compensation scheme. Primary outcome measures: 12-item WHO Disability Assessment Schedule and 6 items from the Claims Experience Survey. Results: Our model for long-term disability had four predictors (unemployed at the time of injury, history of a psychiatric disorder at time of injury, post-traumatic stress disorder symptom severity at 3 months and disability at 3 months). This model had good discrimination (R2=0.37) and calibration. The disability risk score had a score range of 0–180, and at a threshold of 80 had sensitivity of 56% and specificity of 86%. Our model for compensation-related stress had five predictors (intensive care unit admission, discharged to home, number of traumatic events prior to injury, depression at 3 months and not working at 3 months). This model also had good discrimination (area under the curve=0.83) and calibration. The compensation-related stress risk score had score range of 0–220 and at a threshold of 100 had sensitivity of 74% and specificity of 75%. By combining these two scoring systems, we were able to identify the subgroup of claimants at highest risk of experiencing both outcomes. Conclusions: The ability to identify at an early stage claimants at high risk of compensation-related stress and poor recovery is potentially valuable for claimants and the compensation agencies that serve them. The scoring systems we developed could be incorporated into the claims-handling processes to guide prevention-oriented interventions.
Keywords: Humans; Disability Evaluation; Prognosis; Prospective Studies; Stress, Psychological; Forecasting; Adolescent; Adult; Aged; Middle Aged; Disabled Persons; Workers' Compensation; New South Wales; South Australia; Victoria; Male; Young Adult
Rights: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
RMID: 0030086844
DOI: 10.1136/bmjopen-2017-020803
Grant ID:
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