Brandsma Wim, Larsen Meredith, Richard Charles, Ebenezer Mannam
International Nepal Fellowship, Green Pastures Hospital and Rehabilitation Centre, PO Box 5, Pokhara, Nepal.
Lepr Rev. 2004 Jun;75(2):131-4.
The World Health Organization 'disability' grading system was introduced in 1960. It is mainly used as an indicator for early diagnosis or reporting. Disability grades are usually aggregated at national levels. Comparison of data with previous years or comparison of data between programmes may show that patients report earlier for treatment, alternatively, are diagnosed earlier, that is without, or with fewer 'disabilities'. Despite its long and universal use as an epidemiological parameter, the WHO disability grading has not been the subject of reliability studies. In this study, three testers unfamiliar with the grading prior to the study each graded 65 (former) leprosy affected persons. The weighted kappa ranged from 0.87 to 0.89 (95% CI 0.73-1.00) for the highest score and from 0.90 to 0.96 (95% CI 0.90-0.99) for the EHF (Eye, Hand, Foot) score, indicating excellent reliability. The study shows that with limited training and little experience a high degree of reliability in grading 'disabilities' between testers is attainable.
世界卫生组织的“残疾”分级系统于1960年推出。它主要用作早期诊断或报告的指标。残疾等级通常在国家层面进行汇总。将数据与前几年进行比较，或者比较不同项目之间的数据，可能会发现患者更早接受治疗，或者更早被诊断出来，也就是说没有残疾，或者残疾较少。尽管世界卫生组织残疾分级作为一种流行病学参数长期广泛使用，但尚未成为可靠性研究的主题。在本研究中，三位在研究前不熟悉该分级的测试人员对65名（以前）麻风病患者进行了分级。最高评分的加权kappa值在0.87至0.89之间（95%可信区间0.73 - 1.00），EHF（眼、手、足）评分的加权kappa值在0.90至0.96之间（95%可信区间0.90 - 0.99），表明可靠性极佳。该研究表明，通过有限的培训和少量经验，测试人员之间在“残疾”分级方面可实现高度可靠性。
