Walker Mary P, Williams Karen B, Wichman Brian
Department of Oral Biology and Restorative Dentistry, University of Missouri-Kansas City School of Dentistry, Kansas City, MO, USA.
Support Care Cancer. 2008 May;16(5):525-30. doi: 10.1007/s00520-007-0393-x. Epub 2008 Jan 15.
The aim of this paper was to develop, validate, and assess the reliability of a clinical index for assessing post-radiation dentition breakdown.
An expert panel of four dentists with expertise in post-radiation patient care, oral radiology, and mineralized tissues reviewed a series of clinical photographs (n = 60) depicting a wide range of post-radiation lesions varying in size, severity, and location. Based on panel input related to lesion severity rankings and cut-points along a continuum of destruction, a semiquantitative, ordinal lesion scale was developed. A companion scale was developed to account for existing restorations. The index was then reviewed by a separate panel of dental clinician/researchers for confirmation of face and content validity and was refined based on their input. Following index approval by the expert and confirmatory panels, the index was evaluated for test-retest reliability by two educator/clinicians. After a brief calibration session, examiners reviewed and independently scored a second series of lesion images (n = 60). One week later, the same examiners independently scored the same images displayed in a different order. Inter- and intra-rater reliability and agreement were assessed (Spearman r and Kappa statistic).
Respective to sessions 1 and 2, inter-rater reliability values were r = 0.97 and r = 0.98, with Kappa values of kappa = 0.93 and kappa = 0.95. Respective intra-rater reliability and agreement values were 0.99 and 0.98 (rater 1), and 0.98 and 0.95 (rater 2).
A new index was developed and subsequently demonstrated face validity and excellent inter- and intra-rater reliability for potentially evaluating the severity of post-radiation dentition breakdown.
本文旨在开发、验证并评估一种用于评估放疗后牙列破坏情况的临床指标的可靠性。
由四位在放疗后患者护理、口腔放射学和矿化组织方面具有专业知识的牙医组成的专家小组，审查了一系列临床照片（n = 60），这些照片描绘了大小、严重程度和位置各异的放疗后病变。基于专家小组关于病变严重程度排名以及破坏连续体上切点的意见，开发了一种半定量的有序病变量表。还开发了一个配套量表以考虑现有的修复情况。然后，由另一组牙科临床医生/研究人员对该指标进行审查，以确认其表面效度和内容效度，并根据他们的意见进行完善。在专家小组和确认小组批准该指标后，由两名教育工作者/临床医生对该指标进行重测信度评估。经过简短的校准环节后，检查人员对第二组病变图像（n = 60）进行审查并独立评分。一周后，相同的检查人员以不同顺序对相同的图像进行独立评分。评估了评分者间和评分者内的信度及一致性（Spearman相关系数r和Kappa统计量）。
在第1次和第2次评估中，评分者间信度值分别为r = 0.97和r = 0.98，Kappa值分别为kappa = 0.93和kappa = 0.95。评分者内信度及一致性值分别为0.99和0.98（评分者1），以及0.98和0.95（评分者2）。
开发了一种新指标，随后该指标显示出表面效度以及出色的评分者间和评分者内信度，可用于潜在地评估放疗后牙列破坏的严重程度。
