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Effectiveness of Standardized Disability Assessment for Service-Connected Posttraumatic Stress Disorder

Marx BP, Speroff T, Owen RR, Jackson JC, Greevy R, Rosen MI, Murdoch M, Sayer N, Shane A, Sinnott PA. Effectiveness of Standardized Disability Assessment for Service-Connected Posttraumatic Stress Disorder. Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 18; National Harbor, MD.

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Objectives: We compared a standardized disability assessment (SDA) which included the World Health Organization Disability Assessment Scale (WHODAS-II) to a non-standardized disability assessment (nSDA) during a compensation and pension examination for service-related PTSD. We hypothesized that the SDA would enhance the thoroughness of information resulting in greater correspondence between clinicians' and Veterans' rating of functional impairment. Methods: A cluster randomized controlled trial at 6 VA medical centers compared SDA examinations (n = 176) with nSDA (n = 208) for service-related PTSD. Independent PTSD assessment experts reviewed recordings of the disability examinations and rated the completeness, accuracy, and consistency of the examiners' functional assessments. These independent raters also provided a Global Assessment of Functioning (GAF) score for each examination, whenever possible, and these GAF scores were compared with those given by the compensation and pension examiners. Immediately after the examination, Veterans completed a self-report measure of functional impairment. Results: Overall, the standardized assessment of functioning with the WHODAS-II produced a more thorough assessment. Independent experts were unable to provide a rating for DSM-IV PTSD Criterion F (symptoms cause significant distress or functional impairment) for 69% of the nSDA group examinations versus only 12% for the SDA group examinations (p < 0.001). The examiners' mean GAF did not differ between the two study groups: 56 11 for SDA and 54 9 for nSDA. Study groups also did not differ on Veterans' self-assessment of functional impairment: nSDA mean 43 16 vs. SDA mean 43 17. The correlation between the independent experts' GAF and Veterans' FI selfreport was r = .50 in the SDA group and r = .30 in the nSDA group. The difference between these correlation coefficients was statistically significant in a mixed model analysis accounting for Veterans clustered within examiner (p = 0.047). Implications: Standardized disability assessments for service-related PTSD incorporating the WHODAS-II were more thorough than assessments conducted using non-standardized methods. SDA also resulted in greater correspondence between self-reported functioning and experts' assessment of functional impairment. Impacts: The use of measures with strong psychometric properties and instructions for standardized use would improve the quality and accuracy of the assessment of functional impairment in the PTSD disability examination.

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