Johnson Sindhu R, Goek Oemer-Necmi, Singh-Grewal Davinder, Vlad Steven C, Feldman Brian M, Felson David T, Hawker Gillian A, Singh Jasvinder A, Solomon Daniel H
University Health Network, Toronto, Ontario, Canada.
Arthritis Rheum. 2007 Oct 15;57(7):1119-33. doi: 10.1002/art.23018.
To identify classification criteria for the rheumatic diseases and to evaluate their measurement properties and methodologic rigor using current measurement standards.
We performed a systematic review of published literature and evaluated criteria sets for stated purpose, derivation and validation sample characteristics, methods of criteria generation and reduction, and consideration of validity, and reliability.
We identified 47 classification criteria sets encompassing 13 conditions. Approximately 50% of the criteria sets were developed based on expert opinion rather than patient data. Of the 47 criteria sets, control samples were derived from patients with rheumatic disease in 15 (32%) sets, from patients with nonrheumatic diseases in 4 (9%) sets, and from healthy participants in 2 (4%) sets. Where patient data were used, the number of cases ranged from 20-588 and the number of controls from 50-787. In only 1 (2%) criteria set was there a distinct separation between investigators who derived the criteria set and clinicians who provided cases and controls. Authors commented on the need for individual criterion to be reliable in 5 (11%) sets, precise in 5 (11%) sets; authors noted the importance of content validity in 12 (26%) sets, and construct validity in 12 (26%) sets.
The variation in methodologic rigor used in sample selection affects the validity and reliability of the criteria sets in different clinical and research settings. Despite potential deficiencies in the methods used for some criteria development, the sensitivity and specificity of many criteria sets is moderate to strong.
确定风湿性疾病的分类标准，并使用当前的测量标准评估其测量属性和方法学严谨性。
我们对已发表的文献进行了系统综述，并评估了标准集的既定目的、推导和验证样本特征、标准生成和简化方法以及有效性和可靠性的考量。
我们确定了涵盖13种疾病的47个分类标准集。约50%的标准集是基于专家意见而非患者数据制定的。在47个标准集中，15个（32%）标准集的对照样本来自风湿性疾病患者，4个（9%）标准集的对照样本来自非风湿性疾病患者，2个（4%）标准集的对照样本来自健康参与者。在使用患者数据的情况下，病例数从20至588不等，对照数从50至787不等。只有1个（2%）标准集在推导标准集的研究人员与提供病例和对照的临床医生之间有明显区分。作者在5个（11%）标准集中提到了个别标准需要可靠，在5个（11%）标准集中提到了精确；作者在12个（26%）标准集中指出了内容效度的重要性，在12个（26%）标准集中指出了结构效度的重要性。
样本选择中使用的方法学严谨性的差异会影响不同临床和研究环境中标准集的有效性和可靠性。尽管一些标准制定方法存在潜在缺陷，但许多标准集的敏感性和特异性为中度至高度。
