Peat George, Wood Laurence, Wilkie Ross, Thomas Elaine
Primary Care Sciences Research Centre, Keele University, Hornbeam Building, Staffordshire ST5 5BG, UK.
J Clin Epidemiol. 2003 Nov;56(11):1030-7. doi: 10.1016/s0895-4356(03)00204-x.
Clinical history and examination remain the cornerstones of diagnosis, prognosis, estimates of severity, and treatment selection in primary care for older adults presenting with knee pain. In this study we investigated the extent and cause of inter- and intraobserver variability of the clinical history using a structured, quantitative, clinical interview (KNE-SCI).
58 patients aged 50 years and over with current knee pain were independently interviewed by two trained observers and again by one of these observers a month later.
Interobserver and intraobserver variability were found to be generally low [median agreement beyond chance (kappa)=0.71 (range: -0.03-1.00) and 0.58 (range: -0.03-1.00), respectively]. However, 9 of the 57 items demonstrated high inter- and intraobserver variability: notably subjective reports of swelling and specific aspects of pain experience and functional limitation.
Structured interview can reliably quantify certain clinically relevant aspects of the clinical history in older adults with knee pain, including those felt to be indicative of osteoarthritis. Its usefulness requires further investigation.
对于因膝关节疼痛前来初级保健机构就诊的老年人，临床病史和检查仍是诊断、预后评估、严重程度估计及治疗选择的基石。在本研究中，我们使用结构化、定量的临床访谈（KNE-SCI）调查了临床病史中观察者间和观察者内变异的程度及原因。
58例年龄在50岁及以上且目前存在膝关节疼痛的患者由两名经过培训的观察者独立进行访谈，一个月后再由其中一名观察者再次访谈。
发现观察者间和观察者内变异总体较低[超出机遇的中位数一致性（kappa）分别为0.71（范围：-0.03至1.00）和0.58（范围：-0.03至1.00）]。然而，57项中的9项显示出较高的观察者间和观察者内变异：尤其是肿胀的主观报告以及疼痛体验和功能受限的特定方面。
结构化访谈能够可靠地量化膝关节疼痛老年人临床病史中某些与临床相关的方面，包括那些被认为指示骨关节炎的方面。其有用性需要进一步研究。
