Impairment due to narcolepsy strongly limits job performance, but there are no standard criteria to
assess disability in people with narcolepsy and a scale of disease severity is still lacking. We
explored: 1. the interobserver reliability among Italian Medical Commissions making disability and
handicap benefit decisions for people with narcolepsy, searching for correlations between the
recognized disability degree and patients’ features; 2. the willingness to report patients to the
driving licence authority; 3. possible sources of variance in judgement. Fifteen narcoleptic patients
were examined by four Medical Commissions in simulated sessions. Raw agreement and
interobserver reliability among Commissions were calculated for disability and handicap benefit
decisions and for driving licence decisions. Levels of judgement differed on percentage of disability
(p<0.001), severity of handicap (p=0.0007) and the need to inform the driving licence authority
(p=0.032). Interobserver reliability ranged from Kappa = - 0.10 to Kappa = 0.35 for disability
benefit decision and from Kappa = - 0.26 to Kappa = 0.36 for handicap benefit decision. The raw
agreement on driving licence decision ranged from 73% to 100% (Kappa not calculable).
Spearman’s correlation between percentages of disability and patients’ features showed correlations
with age, daytime naps, sleepiness, cataplexy and quality of life. This first interobserver reliability
study on social benefit decisions for narcolepsy shows the difficulty of reaching an agreement in
this field, mainly due to variance in interpretation of the assessment criteria. The minimum set of
indicators of disease severity correlating with patients’ self assessments encourages a disability
classification of narcolepsy.
| Identifer | oai:union.ndltd.org:unibo.it/oai:amsdottorato.cib.unibo.it:965 |
| Date | 23 April 2008 |
| Creators | Ingravallo, Francesca <1975> |
| Contributors | Cicognani, Alberto |
| Publisher | Alma Mater Studiorum - Università di Bologna |
| Source Sets | Università di Bologna |
| Language | Italian |
| Detected Language | English |
| Type | Doctoral Thesis, PeerReviewed |
| Format | application/pdf |
| Rights | info:eu-repo/semantics/openAccess |
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