Reliability and Validity of the Tender and Swollen Joint Counts and the Modified Rodnan Skin Score in Early Diffuse Cutaneous Systemic Sclerosis: Analysis from the Prospective Registry of Early Systemic Sclerosis Cohort

Gordon, Jessica; Girish, G; Berrocal, Veronica J.; Zhang, Meng; Hatzis, Christopher; Assassi, Shervin; Bernstein, Elana J.; Domsic, Robyn T.; Hant, Faye N.; Hinchcliff, Monique; Schiopu, Elena; Steen, Virginia D.; Frech, Tracy; Khanna, Dinesh

doi:10.3899/jrheum.160654

Cited by 16 publications

(18 citation statements)

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“…The coefficient of variation (CV) was on the higher end of the range in our study (39%‐56%) compared to other studies (11.8%‐54%) despite acceptable within‐patient SD for both inter‐ and intra‐observer variability. This could be due to the lower median skin score of five in our patients compared to mean scores of 8.6‐20.7 reported in other studies, resulting in a larger CV for minimal variation in SD (since CV is derived from SD divided by the mean).…”

Section: Discussioncontrasting

confidence: 80%

“…We report intra‐observer variability on the same group of patients examined 2 days after the initial training session. This would have reduced recall bias compared to the study by Gordon et al, where patients were re‐examined on the same day with an intra‐observer variability of 0.94 . In the studies by Clements et al and Czirjak et al patients were re‐examined 2‐8 weeks later to quantitate intra‐observer variability and the intra‐observer within‐patient SD was found to be 2.5‐2.9.…”

Section: Discussionmentioning

confidence: 96%

“…The global average and representative area techniques are recommended as they are likely more sensitive to change than the maximum score technique . The intra‐observer variability has been shown consistently by various studies to be lower than inter‐observer variability . It is therefore recommended that the same assessor evaluates the patient throughout a trial to reduce measurement variability.…”

Section: Discussionmentioning

confidence: 99%

“…We computed the inter‐ and intra‐observer variability using a linear mixed model with an intercept term, a random effect for the patient, a random effect for the scorer, and a random effect for the interaction of patient and scorer, as previously described . Inter‐observer variability was calculated for the 52 trainees in the evaluation phase and intra‐observer variability was calculated for the 14 trainees and two experts who returned 2 days later for repeat scoring.…”

Section: Methodsmentioning

confidence: 99%

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Evaluation of Scleroderma Clinical Trials Consortium training recommendations on modified Rodnan skin score assessment in scleroderma

Low

Berrocal

et al. 2019

Int J of Rheum Dis

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Aim The modified Rodnan skin score (mRSS) is a validated outcome measure for skin thickness in systemic sclerosis (SSc). Training has been shown to reduce variability in the measurement of mRSS. Our objective was to assess the inter‐ and intra‐observer variability of mRSS scoring using the proposed recommendations for training by the Scleroderma Clinical Trials Consortium (SCTC) and World Scleroderma Foundation (WSF). Method Fifty‐two trainees and eight adult SSc patients participated in the SSc skin scoring workshop that was conducted in two sessions by four teachers. Each session, attended by 26 trainees, had a teaching and evaluation phase. The teaching phase comprised of: (a) lecture on mRSS scoring; (b) video demonstration of mRSS scoring; and (c) live demonstration of mRSS on one SSc patient. In the evaluation phase, each trainee independently assessed the mRSS in four SSc patients. For intra‐observer reliability, 14 trainees re‐assessed the mRSS of two SSc patients whom they had previously examined. We computed the inter‐ and intra‐observer variability using a linear mixed model. Results For the evaluation phase, 34 (65.4%) trainees were within five units of the established teachers' score in 3 out of 4 patients. Overall, the whole group had acceptable inter‐observer variability (intra‐class correlation coefficient [ICC] = 0.71, mean = 8.64 and within‐patient standard deviation [SD] = 4.25). The intra‐observer ICC was 0.85 and within‐patient SD was 2.73. Conclusion There was good inter‐observer and excellent intra‐observer reliability. This is the first study examining the training of assessors using the SCTC/WSF recommendations and our results support the importance of standardized training for skin scoring.

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Section: Discussioncontrasting

confidence: 80%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Evaluation of Scleroderma Clinical Trials Consortium training recommendations on modified Rodnan skin score assessment in scleroderma

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Berrocal

et al. 2019

Int J of Rheum Dis

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“…Furthermore, this low reliability of physical examination cannot be limited to the visual examination alone. Auscultation finding were also inconsistent among physicians (27), the palpable ratings may not be reliable (28), and interrater reliability of olfactory and taste sense was only moderate to good (29).…”

Section: Data Analysis and Statisticsmentioning

confidence: 99%

Interexaminer reliability of pharyngeal injection and palatine tonsillar hypertrophy in a pediatric emergency department

Hwang

Jung

Park

et al. 2019

The American Journal of Emergency Medicine

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Effect of Training on Patient Self‐Assessment of Joint Counts in Rheumatoid Arthritis: A Systematic Review

Tam

Hazlewood

Barber

2021

ACR Open Rheumatology

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Objective. Patient self-assessed joint counts, if accurate and reliable, could potentially serve as a useful clinical assessment tool in rheumatoid arthritis (RA). This systematic review examines the effect of patient training on the inter-rater reliability of joint counts between patients and clinicians.Methods. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was performed in PubMed, Embase, Cochrane Library, and CINAHL for articles that incorporated patient training and measured the reliability of patient self-assessed joint counts in RA. Articles were included if they reported on the inter-rater reliability between patient and clinician joint counts in both trained and untrained patients with RA. Data were extracted on characteristics of patients, structure and components of the training interventions, joint count reliability of patients with and without training, and patient feedback on training interventions. The relevant data were summarized and described.Results. Multiple training methods have been studied (n = 5), including in-person sessions run by rheumatologists and instructional videos on the joint examination. Overall, training improved the reliability of patient self-joint counts, with more marked improvement in reliability of swollen joint counts than tender joint counts. Patients had positive feedback when surveyed on their experiences with training. Conclusion.Various training modalities (in-person and video-based) may be effective at improving reliability of patient self-joint counts. More research is needed on this topic, with potential areas for future research including 1) comparison between the efficacy of different modalities of training, and 2) impact of patient factors (education level and disease severity) on the efficacy of training.

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Reliability and Validity of the Tender and Swollen Joint Counts and the Modified Rodnan Skin Score in Early Diffuse Cutaneous Systemic Sclerosis: Analysis from the Prospective Registry of Early Systemic Sclerosis Cohort

Cited by 16 publications

References 16 publications

Evaluation of Scleroderma Clinical Trials Consortium training recommendations on modified Rodnan skin score assessment in scleroderma

Evaluation of Scleroderma Clinical Trials Consortium training recommendations on modified Rodnan skin score assessment in scleroderma

Interexaminer reliability of pharyngeal injection and palatine tonsillar hypertrophy in a pediatric emergency department

Effect of Training on Patient Self‐Assessment of Joint Counts in Rheumatoid Arthritis: A Systematic Review

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