Development of a computer-based clinical decision support tool for selecting appropriate rehabilitation interventions for injured workers.

The purpose of this study was to develop a classification algorithm and accompanying computer-based clinical decision support tool to assist in the categorization of injured workers toward optimal rehabilitation interventions based on unique worker characteristics. Data were extracted from a Canadian provincial workers’ compensation database on all claimants undergoing work assessment between December 2009 and January 2011. Data were available on: (1) numerous personal, clinical, occupational, and social variables; (2) type of rehabilitation undertaken; and (3) outcomes following rehabilitation (receiving time loss benefits or undergoing repeat programs). Machine learning, concerned with the design of algorithms to discriminate between classes based on empirical data, was the foundation of their approach to build a classification system with multiple independent and dependent variables. The population included 8,611 unique claimants. The majority of subjects were employed (85 %) males (64 %) with diagnoses of sprain/strain (44 %). Baseline clinician classification accuracy was high (ROC = 0.86) for selecting programs that lead to successful return-to-work. Classification performance for machine learning techniques outperformed the clinician baseline classification (ROC = 0.94). The final classifiers were multifactorial and included the variables: injury duration, occupation, job attachment status, work status, modified work availability, pain intensity rating, self-rated occupational disability, and 9 items from the SF-36 Health Survey.

The use of machine learning classification techniques seems to have produced classification performance superior to clinician decision-making. The final algorithm has been integrated into a computer-based clinical decision support tool that requires additional validation in a clinical sample.