Schünemann Holger J, Norman Geoff, Puhan Milo A, Ståhl Elisabeth, Griffith Lauren, Heels-Ansdell Diane, Montori Victor M, Wiklund Ingela, Goldstein Roger, Mador M Jeffery, Guyatt Gordon H
Department of Epidemiology, INFORMA Unit/CLARITY Research Group, Italian National Cancer Institute Regina Elena, Via Elio Chianesi 53, 00144 Rome, Italy.
J Clin Epidemiol. 2007 Dec;60(12):1256-62. doi: 10.1016/j.jclinepi.2007.03.010. Epub 2007 Aug 2.
Recent studies suggest that rating clinical marker states (CMS) does not improve the measurement properties of the standard gamble (SG) and only slightly improves those of the feeling thermometer (FT). The poor intrarater (test-retest) reliability of CMS may explain their meager performance. Further, lack of interrater reliability may compromise the use of CMS in interpreting health state ratings. The aim of this study was to assess the reliability of CMS ratings for the SG and the FT.
Two similar studies in patients with chronic obstructive pulmonary disease (COPD, n=91) and in patients with gastroesophageal reflux disease (GERD, n=112) provided data for this analysis. Patients rated three different CMS (mild, moderate, and severe disease) twice several weeks apart. We used generalizability theory to calculate reliability coefficients.
Test-retest reliability for CMS ratings was higher for the FT compared to the SG (COPD: 0.86 vs. 0.67; GERD: 0.86 vs. 0.67). Interrater reliability was much higher for the FT compared to the SG (COPD: 0.78 vs. 0.46; GERD: 0.71 vs. 0.26).
These results suggest that the markedly poorer reliability of CMS for the SG than the FT is driven largely by poor interrater reliability.
近期研究表明，对临床标志物状态（CMS）进行评分并不能改善标准博弈法（SG）的测量属性，仅能略微改善感觉温度计（FT）的测量属性。CMS较差的评分者内（重测）信度可能解释了其不佳的表现。此外，缺乏评分者间信度可能会影响CMS在解释健康状态评分中的应用。本研究的目的是评估CMS对SG和FT评分的信度。
两项针对慢性阻塞性肺疾病（COPD，n = 91）患者和胃食管反流病（GERD，n = 112）患者的相似研究为该分析提供了数据。患者对三种不同的CMS（轻度、中度和重度疾病）进行评分，两次评分间隔数周。我们使用概化理论来计算信度系数。
与SG相比，FT的CMS评分重测信度更高（COPD：0.86对0.67；GERD：0.86对0.67）。与SG相比，FT的评分者间信度更高（COPD：0.78对0.46；GERD：0.71对0.26）。
这些结果表明，CMS对SG的信度明显低于FT主要是由较差的评分者间信度导致的。
