Foocharoen Chingching, Thinkhamrop Bandit, Mahakkanukrauh Ajanee, Suwannaroj Siraphop, Netwijitpan Sittichai, Sripavatakul Kwanleutai, Chuealee Wiriya, Boottam Bodin, Towiwat Patapong, Seubmee Patcharawan, Daungkum Kittikorn, Kongpan Darunee, Mangkala Jintara, Nanagara Ratanavadee
J Med Assoc Thai. 2015 Nov;98(11):1082-8.
Assessment of the severity of skin tightness by the modified Rodnan skin score (mRSS) for systemic sclerosis (SSc) has been found feasible, valid, and reliable. Despite being a major clinical outcome, it has not yet been validated by Scleroderma Research Group.
To (a) determine the inter-observer variability vis-à-vis mRSS assessment by members ofthe Scleroderma Research Group before and after mRSS-assessment training by an experienced rheumatologist and (b) determine intra-observer variability.
Between June and August 2013, we conducted a descriptive study of Thai adult SSc patients and all rheumatologists in the Scleroderma Research Group at Srinagarind Hospital, Khon Kaen University, Northeast Thailand. Eleven rheumatologists assessed the mRSS of 22 SSc patients three times (i.e., before and after training, and eight weeks after training). The intra-class correlation coefficient (ICC) and its 95% CI were estimated at week 8 after training.
The mean and standard deviation (SD) of mRSS for inter-observer variability analysis was slightly decreased from before training, after training (by an experienced rheumatologist), and at week 8 after training (17.3 ± 11.9, 16.5 ± 11.1, and 16.2 ± 10.3, respectively). Intra-observer variability had moderate agreement before training (ICC 0.59; 95% CI 0.38-0.78), which increased to good agreement after training and at week 8 after training (ICC 0.60; 95% CI 0.42-0.76 vs. 0.68; 95% CI 0.53-0.82, respectively).
Inter-observer variability for mRSS assessment decreased after training and the reduction persisted for eight weeks after training. The ICC rose from moderate agreement at baseline to good agreement at the end of the study. The mRSS assessment by members of the Scleroderma Research Group was reliable.
通过改良罗德南皮肤评分（mRSS）评估系统性硬化症（SSc）的皮肤紧绷严重程度已被证明是可行、有效且可靠的。尽管它是一项主要临床指标，但尚未得到硬皮病研究组的验证。
（a）确定硬皮病研究组成员在接受经验丰富的风湿病学家进行mRSS评估培训前后，在mRSS评估方面的观察者间变异性，以及（b）确定观察者内变异性。
2013年6月至8月期间，我们对泰国成年SSc患者以及泰国东北部孔敬大学诗里拉吉医院硬皮病研究组的所有风湿病学家进行了一项描述性研究。11名风湿病学家对22例SSc患者的mRSS进行了三次评估（即培训前、培训后以及培训后8周）。在培训后第8周估计组内相关系数（ICC）及其95%置信区间。
用于观察者间变异性分析的mRSS均值和标准差（SD）在培训前、培训后（由经验丰富的风湿病学家进行）以及培训后第8周时略有下降（分别为17.3±11.9、16.5±11.1和16.2±10.3）。观察者内变异性在培训前具有中等一致性（ICC 0.59；95% CI 0.38 - 0.78），培训后及培训后第8周时提高到良好一致性（分别为ICC 0.60；95% CI 0.42 - 0.76和ICC 0.68；95% CI 0.53 - 0.82）。
培训后mRSS评估的观察者间变异性降低，且在培训后8周内持续降低。ICC从基线时的中等一致性提高到研究结束时的良好一致性。硬皮病研究组成员进行的mRSS评估是可靠的。
