A Comparison Standard for Assessing the Adapted Version of the Brazilian Functionality Index

Abstract

This study aimed to determine the best method of achieving consensus between examiners and workers with disabilities
in Brazil regarding their perceived severity of the disability and eligibility for an early retirement pension. We analyzed the agreement among evaluators’ perceptions to create a reference standard for the classification of the disability severity of applicant workers with disabilities. Pairs of expert physicians and social workers applied a computer index and then assigned their perceived level of severity, independent of the computer classification. The analysis included 17,350 applicants aged 18 to 76 years. The best-perceived agreement represented the ideal comparison standard for validating the index. The severity perceptions of the evaluators and the workers with disabilities yielded agreement tables portraying the perceived disability severity. Physicians and social workers demonstrated the most significant level of agreement (weighted kappa: 0.2351, 95% confidence interval: 0.2229–0.2473), and the combination of their assessments provided the best standard. From what it appears, this is the first time that this method has been used to create a reference standard. Evaluators’ perceptions of disability severity formed the basis for choosing a standard to further analyze the index’s accuracy and validity.