Inter-observer agreement of the musculoskeletal system disability levels ofindividuals presenting at disability health boards

The classification and scoring of disability in Turkey are done within the framework of the “Regulation on Disability Assessment for Adults”. However, evaluation of\rdisabled individuals by different physicians despite having the same disability may lead to conflicting results. This study aims to investigate the inter-observer agreement\rof physiatrists and orthopedists in the evaluation of patients who applied to the Disability Health Board because of musculoskeletal system pathologies. Ten people with\rmusculoskeletal problems and four physicians, including two physical therapists and two orthopedists, were included in this study. The patients were evaluated by the\rphysicians according to the provisions of the “Regulations for the Disability Assessment of Adults” in random order in separate rooms on the same day. The mean disability\rpoints were found to be 19.4±14.8 for physiatrist 1 (PMR1), 16.5±13.1 for PMR2, 17.9 ±14.9 for orthopedist 1 (O1), and 18.7±15.9 for O2. No statistically significant difference was determined between the 4 physicians in respect of the points given (p=0.85). The agreement between all 4 physicians was found to be 0.85 (95% CI:0.68-0.95).\rIn the paired analyses, the ICC ranged from 0.73 to 0.96, with the lowest agreement between PMR2-O2, and the highest agreement between O1-O2. In conclusion, the\rresults of this study showed that there was not an absolute agreement between physiatrists and orthopedists because of the complex structure in determining the disability\rrate of the musculoskeletal system, the fact that patient compliance is important, and that the approach of the physician can be different. For physicians participating in\rthe Health Board to be able to provide standardization, there is a need for theoretical and patient-based training, the appropriate time to be allocated for patient evaluation,\rand the open points in the items of the regulation should be eliminated.