Stynes Siobhán, Konstantinou Kika, Dunn Kate M, Lewis Martyn, Hay Elaine M
Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, ST5 5BG, Staffordshire, UK.
Eur Spine J. 2016 Sep;25(9):2734-40. doi: 10.1007/s00586-015-4359-2. Epub 2015 Dec 24.
To investigate agreement and reliability among clinicians when diagnosing low back-related leg pain (LBLP) in primary care consulters.
Thirty-six patients were assessed by one of six physiotherapists and diagnosed as having either leg pain due to nerve root involvement (sciatica) or referred leg pain. Assessments were video recorded. In part one, the physiotherapists each viewed videos of six patients they had not assessed. In part two, videos were viewed by another six health professionals. All clinicians made an independent differential diagnosis and rated their confidence with diagnosis (range 50-100 %).
In part one agreement was 72 % with fair inter-rater reliability (K = 0.35, 95 % CI 0.07, 0.63). Results for part two were almost identical (K = 0.34, 95 % CI 0.02, 0.69). Agreement and reliability indices improved as diagnostic confidence increased.
Reliability was fair among clinicians from different backgrounds when diagnosing LBLP but improved substantially with high confidence in clinical diagnosis.
调查基层医疗咨询患者中，临床医生在诊断下腰相关腿痛（LBLP）时的一致性和可靠性。
36名患者由6名物理治疗师中的一名进行评估，并被诊断为因神经根受累引起的腿痛（坐骨神经痛）或牵涉性腿痛。评估过程进行了视频记录。在第一部分中，物理治疗师各自观看6名他们未评估过的患者的视频。在第二部分中，另外6名医疗专业人员观看这些视频。所有临床医生都进行了独立的鉴别诊断，并对他们诊断的信心进行评分（范围为50%-100%）。
在第一部分中，一致性为72%，评分者间信度一般（K = 0.35，95%CI 0.07，0.63）。第二部分的结果几乎相同（K = 0.34，95%CI 0.02，0.69）。随着诊断信心的增加，一致性和可靠性指标有所改善。
不同背景的临床医生在诊断LBLP时可靠性一般，但在临床诊断信心较高时显著提高。
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