Poor Multi-Rater Reliability in Tcm Pattern Diagnoses and Variation in the Use of Symptoms to Obtain a Diagnosis

Abstract

The results showed extensive variation and poor inter-rater reliability in TCM diagnoses. Demographic variables influenced the frequency of diagnoses and symptoms were used inconsistently to set a diagnosis. The variability shown could impede individually tailored treatment.

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“…ii. A mature and established CHM formula may be the key to high efficacy, and effective and experienced herbal formulae should be designed according to diagnostic patterns within TCM [53,54]. No paper described effects produced by a single herb to treat Infertility.…”

Commonality and Specificity of Acupuncture Point Selections

“…Previous studies have shown the interrater reliability of traditional Chinese medicine (TCM) diagnosis of a variety of diseases including prediabetes [ 16 ], cardiovascular disease [ 17 ], rheumatoid arthritis [ 18 ], and irritable bowel syndrome [ 19 ]. Further studies showed the difficulties in standardizing the TCM pattern diagnosis and the importance of collecting medical data [ 20 , 21 ]. This study further extends the previous studies in the work of collecting and standardizing traditional medicine diagnosis and treatment prescriptions by providing a larger set of data and applying data mining technique.…”

Effects of Diagnostic Errors in Pattern Differentiation and Acupuncture Prescription: A Single-Blinded, Interrater Agreement Study

“…The lack of international standards for describing each pattern's manifestation and no training before filling in questionnaires are another two potential sources of variability in diagnosis, albeit the latter condition is a close representation of the clinical scenario. Nonetheless, our results are consonant with previous ones investigating TCM agreement on diagnosis of specific zangfu patterns: slight interrater agreement (unspecified κ = 0.11; four raters) [ 8 ]; interrater agreement below chance expectations ( κ values not available; three raters) [ 9 ]; “little” agreement ( κ values not available; three raters) [ 11 ]; slight interrater agreement (Fleiss' κ = 0.112; four pairs of raters) [ 12 ]; and slight interrater agreement ( κ in range 0.014 to 0.179, eight raters) [ 15 ]. In contrast, our results were lower than those observed by Xu et al [ 16 ], who reported slight to almost perfect interrater agreement (Cohen's κ in range 0.005 to 0.801; two raters).…”

“…It is worth noticing that the above-cited studies focused on the paradigm of “pattern|disease” [ 45 ], in which few TCM patterns are studied within the context of a given disease at any stage of its natural history: irritable bowel syndrome [ 8 ], rheumatoid arthritis [ 9 ], frequent headaches [ 11 ], mixed sample of healthy participants and patients with chronic diseases [ 12 ], hypercholesterolemia [ 13 ], prediabetes [ 14 ], fertile and infertile women [ 15 ], and cardiovascular diseases [ 16 ]. This approach limits their external validity to a more general interpretation of the TCM practice.…”