颞下颌关节紊乱病研究诊断标准。II：I轴诊断及选定临床测量指标的可靠性
The Research Diagnostic Criteria For Temporomandibular Disorders. II: reliability of Axis I diagnoses and selected clinical measures.
作者信息
Look John O, John Mike T, Tai Feng, Huggins Kimberly H, Lenton Patricia A, Truelove Edmond L, Ohrbach Richard, Anderson Gary C, Shiffman Eric L
机构信息
School of Dentistry, University of Minnesta, Minneapolis, Minnesota 55455, USA.
出版信息
J Orofac Pain. 2010 Winter;24(1):25-34.
AIMS
The primary aim was to determine new estimates for the measurement reliability of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms. A second aim was to present data on the reliability of key clinical measures of the diagnostic algorithms.
METHODS
Kappa (k), computed by generalized estimate equation procedures, was selected as the primary estimate of interexaminer reliability. Intersite reliability of six examiners from three study sites was assessed annually over the 5-year period of the RDC/TMD Validation Project. Intrasite reliability was monitored throughout the validation study by comparing RDC/TMD data collections performed on the same day by the test examiner and a criterion examiner.
RESULTS
Intersite calibrations included a total of 180 subjects. Intersite reliability of RDC/TMD diagnoses was excellent (k > 0.75) when myofascial pain diagnoses (Ia or Ib) were grouped. Good reliability was observed for discrete myofascial pain diagnoses Ia (k = 0.62) and Ib (k = 0.58), for disc displacement with reduction (k = 0.63), disc displacement without reduction with limited opening (k = 0.62), arthralgia (k = 0.55), and when joint pain (IIIa or IIIb) was grouped (k = 0.59). Reliability of less frequently observed diagnoses such as disc displacements without reduction without limited opening, and osteoarthrosis (IIIb, IIIc), was poor to marginally fair (k = 0.31-0.43). Intrasite monitoring results (n = 705) approximated intersite reliability estimates. The greatest difference in paired estimates was 0.18 (IIc).
CONCLUSION
Reliability of the RDC/TMD protocol was good to excellent for myofascial pain, arthralgia, disc displacement with reduction, and disc displacement without reduction with limited opening. Reliability was poor to marginally fair for disc displacement without reduction without limited opening and osteoarthrosis.
目的
主要目的是确定颞下颌关节紊乱病研究诊断标准（RDC/TMD）轴I诊断算法测量可靠性的新估计值。第二个目的是呈现诊断算法关键临床测量指标的可靠性数据。
方法
通过广义估计方程程序计算的kappa（k）被选为检查者间可靠性的主要估计值。在RDC/TMD验证项目的5年期间，每年评估来自三个研究地点的六名检查者的站点间可靠性。在整个验证研究中，通过比较测试检查者和标准检查者在同一天进行的RDC/TMD数据收集来监测站点内可靠性。
结果
站点间校准共纳入180名受试者。当肌筋膜疼痛诊断（Ia或Ib）合并时，RDC/TMD诊断的站点间可靠性极佳（k>0.75）。对于离散的肌筋膜疼痛诊断Ia（k=0.62）和Ib（k=0.58）、可复性盘移位（k=0.63）、不可复性盘移位伴开口受限（k=0.62）、关节痛（k=0.55）以及当关节疼痛（IIIa或IIIb）合并时（k=0.59），观察到良好的可靠性。对于较少见的诊断，如不可复性盘移位不伴开口受限和骨关节炎（IIIb、IIIc），可靠性较差至勉强尚可（k=0.31-0.43）。站点内监测结果（n=705）接近站点间可靠性估计值。配对估计值的最大差异为0.18（IIc）。
结论
RDC/TMD方案对于肌筋膜疼痛、关节痛、可复性盘移位以及不可复性盘移位伴开口受限的可靠性良好至极佳。对于不可复性盘移位不伴开口受限和骨关节炎，可靠性较差至勉强尚可。
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