类风湿关节炎中医生和护士进行关节压痛和肿胀计数的一致性。
Agreement of Physicians and Nurses Performing Tender and Swollen Joint Counts in Rheumatoid Arthritis.
作者信息
Amity Christine L, Schlenk Elizabeth A, Gold Kenneth N, Eckels Marisa M, Mohan Niveditha, Balasubramani G K, Wisniewski Stephen R, Levesque Marc C, Starz Terence W
机构信息
From the *School of Nursing, University of Pittsburgh; †School of Medicine, University of Pittsburgh; ‡University of Pittsburgh Medical Center; and §Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; and ∥AbbVie, Worcester, MA.
出版信息
J Clin Rheumatol. 2016 Jan;22(1):30-4. doi: 10.1097/RHU.0000000000000324.
OBJECTIVE
The aims of this study were to assess the agreement of physicians and nurses performing tender and swollen joint counts (TJCs/SJCs) in rheumatoid arthritis (RA) and identify factors that might influence their examinations including patient age, sex, race, RA disease duration, body mass index, RA disease activity level, comorbid fibromyalgia, comorbid osteoarthritis, and levels of acute-phase reactants.
METHODS
Seventy-two RA participants underwent TJCs/SJCs of 28 joints using a standardized protocol by 2 nurses and 2 rheumatologists. Demographic, laboratory, radiographic, and clinical data were obtained to assess the influence of these factors on TJCs/SJCs. Intraclass correlations (ICCs) among examiners were determined for TJCs/SJCs. Nurse-physician differences and agreement of individual joints were evaluated using Cohen κ. Analysis of variance was performed to detect differences in means between examiners for TJCs/SJCs. Intraclass correlation and Fisher Z tests were used to identify factors influencing TJCs/SJCs.
RESULTS
Agreement was strong among these nurses and physicians for total TJCs/SJCs (ICC = 0.84/ICC = 0.79, respectively). κ was best for hand joint tenderness and poorest for shoulder swelling. Some significant differences in mean TJCs/SJCs were found between examiners. Fibromyalgia significantly reduced agreement of both TJCs and SJCs. Agreement of TJC was significantly reduced when patients had lower disease activity, greater work impairment, lower mental health quality of life, and elevated erythrocyte sedimentation rate, whereas female sex, assessor's perception of but not radiographic hand osteoarthritis, and elevated C-reactive protein significantly reduced agreement for SJC.
CONCLUSIONS
Strong agreement was found among nurses and physicians for total 28-joint counts, with agreement at individual joints being stronger for tenderness than swelling. Fibromyalgia significantly reduced ICCs of TJCs/SJCs.
目的
本研究旨在评估医生和护士对类风湿关节炎（RA）患者进行压痛和肿胀关节计数（TJCs/SJCs）的一致性，并确定可能影响其检查结果的因素，包括患者年龄、性别、种族、RA病程、体重指数、RA疾病活动水平、合并纤维肌痛、合并骨关节炎以及急性期反应物水平。
方法
72名RA参与者按照标准化方案，由2名护士和2名风湿病学家对28个关节进行TJCs/SJCs检查。获取人口统计学、实验室、影像学和临床数据，以评估这些因素对TJCs/SJCs的影响。确定检查者之间TJCs/SJCs的组内相关系数（ICC）。使用Cohen κ评估护士与医生之间的差异以及各个关节的一致性。进行方差分析以检测检查者之间TJCs/SJCs均值的差异。使用组内相关分析和Fisher Z检验来确定影响TJCs/SJCs的因素。
结果
这些护士和医生在总的TJCs/SJCs方面一致性很强（ICC分别为0.84/ICC为0.79）。κ值在手关节压痛方面最佳，在肩部肿胀方面最差。检查者之间在TJCs/SJCs均值上存在一些显著差异。纤维肌痛显著降低了TJCs和SJCs的一致性。当患者疾病活动度较低、工作障碍较大、心理健康生活质量较低以及红细胞沉降率升高时，TJC的一致性显著降低，而女性、评估者对而非影像学手部骨关节炎的认知以及C反应蛋白升高显著降低了SJC的一致性。
结论
护士和医生在28个关节的总计数方面一致性很强，各个关节压痛的一致性强于肿胀。纤维肌痛显著降低了TJCs/SJCs的ICC值。
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