Guangyi Xiong, Chongsuvivatwong Virasakdi, Geater Alan, Ming Li, Yun Zhang
Yunnan University of Traditional Chinese Medicine, Kunming-650021, Yunnan, People's Republic of China.
J Altern Complement Med. 2009 Jan;15(1):47-52. doi: 10.1089/acm.2008.0230.
The goal of the present study was to obtain a standard list of traditional Chinese medicine (TCM) symptoms and signs for screening chronic low back pain (cLBP) from a group of experts and to assess agreement and consistency among their opinions on the items of a questionnaire.
DESIGN, SETTINGS, AND SUBJECTS: The study design involved three rounds of modified Delphi technique, and it was carried out by 13 experts in orthopedics, massage, and acupuncture working in four hospitals affiliated with Yunnan University of Traditional Chinese Medicine, China.
The outcome was measured on the 5-score Likert-scale self-administered checklists.
A review of eight textbooks identified 12 pain characteristics, 11 associated factors, and 25 physical and tongue diagnostic expressions as important factors in the TCM diagnosis of cLBP. These 48 diagnostic characteristics were rated by 13 experts as "not important" to "very important" on a scale of 1-5. After three rounds of rating, 13 characteristics were eliminated from the list, with the final numbers for each group being 8, 11, and 16, respectively. Seven items based on Western medicine were also added by the experts. The intra-class correlation (ICC) coefficient for agreement among the experts was 0.2 at the end. Intra-rater, between rounds, consecutive pair-wise median kappa values were 0.53 and 0.66. Analysis of variance using items appearing in all three rounds revealed significant effects of expert and group of symptoms and signs (p < 0.001) and nonsignificant differences among scores of the same expert in the three rounds (p = 0.97). Mean score of physical and tongue expressions was significantly (p < 0.001) lower than that of all other groups of symptoms and signs.
Modern TCM experts have de-emphasized the items on physical and tongue expressions and have adopted instead those from Western medicine. Intra-expert agreement across items was low, and each expert tended to stick to her/his original opinions.
本研究的目的是从一组专家中获取用于筛查慢性下腰痛（cLBP）的中医症状和体征的标准清单，并评估他们对问卷项目意见的一致性和连贯性。
设计、设置和研究对象：本研究设计采用三轮改良德尔菲技术，由中国云南中医药大学附属四家医院的13名骨科、推拿和针灸专家进行。
结果通过5级李克特量表自评清单进行衡量。
对八本教科书的回顾确定了12个疼痛特征、11个相关因素以及25个身体和舌象诊断表现，作为中医诊断cLBP的重要因素。这48个诊断特征由13名专家按1至5级评定为“不重要”至“非常重要”。经过三轮评定，清单中删除了13个特征，每组最终数量分别为8个、11个和16个。专家们还增加了7个基于西医的项目。专家间一致性的组内相关系数（ICC）最终为0.2。评估者内、轮次间、连续两两比较的中位数kappa值分别为0.53和0.66。对三轮中均出现的项目进行方差分析显示，专家以及症状和体征组有显著影响（p<0.001），同一位专家三轮得分无显著差异（p = 0.97）。身体和舌象表现的平均得分显著低于所有其他症状和体征组（p<0.001）。
现代中医专家不再强调身体和舌象表现项目，而是采用了西医项目。各项目间专家内一致性较低，每位专家倾向于坚持自己原来的意见。
