Kurande Vrinda, Waagepetersen Rasmus, Toft Egon, Prasad Ramjee, Raturi Lokesh
Vrinda Kurande, MD (Ayurveda), is a doctoral student, Department of Health Science & Technology, Faculty of Medicine, Denmark.
Rasmus Waagepetersen, PhD, is a professor, Department of Mathematical Sciences, Denmark.
Glob Adv Health Med. 2012 Nov;1(5):36-42. doi: 10.7453/gahmj.2012.1.5.011. Epub 2012 Nov 1.
In Ayurveda, pulse diagnosis and body constitution diagnosis have a long historical use; still, there is lack of quantitative measure of the reliability of these diagnostic methods. Reliability means consistency of information. Consistent diagnosis leads to consistent treatment and is important for clinical practice, education, and research. The objective of this study is to study the methodology to evaluate the test-retest reliability (repeatability) of pulse diagnosis and body constitution diagnosis. A double-blinded, controlled, clinical trial was conducted in Copenhagen. The same doctor, an expert in Ayurvedic pulse diagnosis, examined the pulse and body constitution of 17 healthy participants twice, in random order without seeing them. A metric on pulse and body constitution variables was developed. Cohen's weighted kappa statistic was used as a measure of intra-rater reliability. Permutation tests were used to test the hypothesis of homogeneous diagnosis (ie, the doctor's diagnosis does not depend on the subject). The hypothesis of homogeneous classification was rejected on the 5% significance level (P values of .02 and .001, respectively, for pulse and body constitution diagnosis). According to the Landis and Koch scale, values of the weighted kappa for pulse diagnosis (P = .42) and body constitution diagnosis (P = .65) correspond to "moderate" and "substantial" agreement, respectively. There was a reasonable level of consistency between 2 pulse and body constitution diagnoses. Further studies are required to quantify inter-subject and intra-subject agreement for greater understanding of reliability of pulse and body constitution diagnosis.
在阿育吠陀医学中，脉诊和体质诊断有着悠久的历史应用；然而，这些诊断方法的可靠性缺乏定量衡量。可靠性意味着信息的一致性。一致的诊断会带来一致的治疗，这对临床实践、教育和研究都很重要。本研究的目的是探讨评估脉诊和体质诊断重测信度（重复性）的方法。在哥本哈根进行了一项双盲、对照临床试验。同一位医生，一位阿育吠陀脉诊专家，对17名健康参与者的脉象和体质进行了两次检查，随机顺序且不看参与者。开发了一种关于脉象和体质变量的度量方法。使用科恩加权kappa统计量作为评估评分者内信度的指标。使用置换检验来检验同质诊断的假设（即医生的诊断不依赖于受试者）。在5%的显著性水平上，同质分类的假设被拒绝（脉象诊断和体质诊断的P值分别为0.02和0.001）。根据兰迪斯和科赫量表，脉象诊断（P = 0.42）和体质诊断（P = 0.65）的加权kappa值分别对应“中等”和“高度”一致性。两次脉象和体质诊断之间存在合理程度的一致性。需要进一步研究来量化受试者间和受试者内的一致性，以便更深入地了解脉象和体质诊断的可靠性。
