Low Inter-Rater Reliability in Traditional Chinese Medicine for Female Infertility

Abstract

Background Treatment of patients according to individual pattern diagnoses is an important feature of acupuncture rooted in traditional Chinese medicine (TCM). Little is known about the reliability of TCM pattern diagnoses. Objective To examine in a cross-sectional study the inter-rater reliability of TCM diagnoses and acupuncture point selection.Methods 30 infertile and 24 previously pregnant women were examined for TCM patterns by two acupuncturists. An operational interview guide related to gynaecology was used. The acupuncturists independently decided on the TCM patterns (categorised as excess, defi ciency and merged patterns) and the prescription of acupuncture points. Kappa Statistics were used in the analyses. Results 39 different TCM patterns and 36 different acupuncture points were used. For the choice of acupuncture points, poor to no agreement was found. Moderate to fair agreement was seen in excess/defi ciency and merged patterns. Perfect match to moderate agreement on treatment was obtained when choosing meridians given certain TCM patterns. Conclusions The low agreement on diagnoses indicates that acupuncturists follow individual pattern differentiation processes. The selection of acupuncture points seem to be closely related to the choice of TCM pattern diagnoses. The results indicate that the poor reliability in the diagnoses and thus treatment received by a patient will vary individually, which in turn is a challenge for clinical trials of acupuncture. INTRODUCTION Acupuncture is commonly used as an adjunct to in vitro fertilisation (IVF).1 Although IVF and acupuncture is an active area of research, 1 2 the results of studies are diffi cult to interpret and compare because of a large variation in diagnostic criteria for patient inclusion and in the choice of acupuncture points.1 This has been emphasised as a major obstacle for systematic reviews in this area. 3 4 Individualised pattern diagnoses (based on signs and symptoms) and treatment according to their individual patterns are important features of acupuncture rooted in traditional Chinese medicine (TCM). [5][6][7][8] To ensure consistent and optimal treatment the pattern diagnoses must be reliable, but only a few studies have assessed the reliability of diagnostic data collected during a TCM examination. 9O'Brien and Birch reviewed studies of the reliability of traditional East Asian medicine diagnoses and concluded that reliability of pattern diagnoses and treatment was low. 10 Reliability has been studied for different patient groups using a wide range of research designs. Some studies have examined how several clinicians diagnose and suggest treatment for one or only a few patients, 11 12 whereas others have compared pairs of clinicians examining a number of patients. 13 The results of these studies show no consistent pattern. A relatively good agreement has been reported for TCM diagnoses while suggestions for acupuncture points have shown greater variation. 12 Most of the studies report percentage agreement and sometimes the...

Traditional Chinese Medicine Patterns and Recommended Acupuncture Points in Infertile and Fertile Women

“…Consequently we reported low inter-rater reliability on the TCM pattern diagnosed by the two acupuncturists in our previous paper. 16 We identifi ed other TCM patterns occurring more often among infertile women, than those described by Maciocia. 10 One factor contributing to this discrepancy might be that the acupuncturists used the four diagnostic methods of inquiry, 10 15 and were not asked to diagnose according to a list of options on a diagnosis form.…”

“…Consequently we reported low inter-rater reliability on the TCM pattern diagnosed by the two acupuncturists in our previous paper. 16 We identifi ed other TCM patterns occurring more often among infertile women, than those described by Maciocia.…”

“…16 Therefore, the main analyses are based on merged TCM pattern diagnoses of both acupuncturists, and data obtained on the frequency of the united patterns for each participant. A participant was given a diagnosis if at least one acupuncturist had given the TCM pattern diagnosis.…”

Acupuncture and Methylphenidate Drugs in Adults with Attention Deficit Hyperactivity Disorder: A Pilot Study of Self-Reported Symptoms

“…The diagnoses and principles of treatment tend to vary between acupuncturists [7], and it is advantageous to gather a consensus diagnosis with other acupuncturists. This was considered to be beyond the scope of this pilot trial.…”

Acupuncture and Constitutional Diagnosis: Where Now?

“…3 More recently, Birkefl et and colleagues found low reliability for some TCM diagnoses in patients with infertility, though agreement on Liver patterns was 96%. 4 In the linked study, Mist and colleagues also found an overall reliability of over 96% in patients with a diagnosis of fi bromyalgia. 5 In this study, two acupuncturists made independent diagnoses using standardised information from questionnaire replies and medical history.…”