Cho Pauline, Chan Chetwyn C H
Department of Optometry & Radiography, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR, China.
Optom Vis Sci. 2003 Dec;80(12):820-5. doi: 10.1097/00006324-200312000-00012.
This study evaluated interexaminer agreement in the measurement of tear volume using the phenol red thread (PRT) test on Hong Kong-Chinese subjects. The effect of an intensive training session on interexaminer agreement was also investigated.
Three postgraduate students without an optometry background were introduced to the use of the PRT test. After a general introduction (including a demonstration and some practice among themselves), the examiners collecting the first set of data from 38 subjects. They were then given an intensive 30-min training that involved strict standardization of instructions/procedures and practice. PRT values were collected from 27 subjects (four subjects participated in both phases of the study) after the intensive training.
Significant differences were found among the examiners before and after the intensive training, which was mainly due to examiner 1, who consistently obtained relatively lower mean PRT values in both testing sessions. The intraclass correlation values estimated for all examiners were 0.35 and 0.58 before and after the training session, respectively. The 95% limits of agreement after the training session ranged from -14.8 to 8.0 mm/15 s between examiners 1 and 3, who showed the largest difference, and from -8.8 to 9.3 mm/15 s between examiners 2 and 3, who showed the smallest difference. The latter pair also showed the most significant increase in agreement after the intensive training (intraclass correlation value increase from 0.29 to 0.65), although no significant differences in the PRT results were found between the two examiners before and after training.
Our results suggest that the interexaminer agreement of PRT results is influenced by both examiner- and training-specific factors. Intensive training is important for ensuring the highest consistency among examiners. The moderate interexaminer agreement suggests that clinicians should seek a substantial difference in tear volume when making decisions regarding interventions for their Hong Kong-Chinese patients.
本研究评估了在香港华裔受试者中使用酚红棉线（PRT）试验测量泪液量时检查者之间的一致性。还研究了强化培训课程对检查者之间一致性的影响。
三名没有验光背景的研究生被介绍使用PRT试验。在进行了一般性介绍（包括演示和他们之间的一些练习）之后，检查者从38名受试者中收集了第一组数据。然后他们接受了30分钟的强化培训，其中包括严格规范指导/程序和练习。强化培训后从27名受试者（4名受试者参与了研究的两个阶段）收集PRT值。
在强化培训前后检查者之间发现了显著差异，这主要是由于检查者1，其在两个测试阶段始终获得相对较低的平均PRT值。培训前后所有检查者估计的组内相关值分别为0.35和0.58。培训后一致性的95% 界限在差异最大的检查者1和3之间为 -14.8至8.0 mm/15秒，在差异最小的检查者2和3之间为 -8.8至9.3 mm/15秒。后一组在强化培训后一致性也有最显著的提高（组内相关值从0.29增加到0.65），尽管在培训前后两名检查者之间的PRT结果没有发现显著差异。
我们的结果表明，PRT结果的检查者之间的一致性受检查者特定因素和培训特定因素的影响。强化培训对于确保检查者之间的最高一致性很重要。检查者之间的中度一致性表明，临床医生在为其香港华裔患者做出干预决策时应寻求泪液量的实质性差异。
