Schmukler Juan, Castrejon Isabel, Li Tengfei, Block Joel A, Pincus Theodore
Division of Rheumatology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
Rheumatol Adv Pract. 2024 Nov 6;8(4):rkae137. doi: 10.1093/rap/rkae137. eCollection 2024.
To analyse interrater reliability of four RheuMetric checklist 0-10 visual numerical scales (VNSs) of physician global assessment (DOCGL), inflammation or reversible findings (DOCINF), organ damage or irreversible findings (DOCDAM) and patient distress or findings explained by fibromyalgia, depression or anxiety (DOCDIS).
A retrospective study was performed of data from a rheumatology fellows' continuity clinic at Rush University. Each rheumatology patient seen in routine care with any diagnosis completed a multidimensional health assessment questionnaire (MDHAQ). Both the rheumatology fellow and attending rheumatologist independently completed RheuMetric estimates at the same visit for DOCGL, DOCINF, DOCDAM, DOCDIS and the proportion of DOCGL explained by each subglobal estimate (totalling 100%). Agreement between the two assessors was compared using paired -tests, Spearman correlation coefficients, intraclass correlation coefficients (ICCs), Lin's concordance correlation coefficients (LCCCs) and Bland-Altman plots.
In 112 patients, mean levels of DOCINF were highest in inflammatory diseases, DOCDAM in osteoarthritis (OA) and DOCDIS in primary fibromyalgia (FM). However, mean DOCDAM was as high as DOCINF in inflammatory diseases. No statistically significant differences were seen between scores from attending rheumatologists and fellows. Agreement within 2/10 ranged from 60% for DOCGL to 71% for DOICINF and DOCDAM. Spearman correlations were 0.49-0.65, ICCs were 0.46-0.63 and LCCCs were 0.46-0.62 between rheumatologist and fellow, indicating moderate agreement; reliability was slightly higher for each subglobal VNS than for DOCGL.
RheuMetric 0-10 DOCGL, DOCINF, DOCDAM and DOCDIS have moderate interrater reliability and are feasible in routine care to estimate patient status beyond DOCGL for improved management decisions.
分析医生整体评估（DOCGL）、炎症或可逆性表现（DOCINF）、器官损害或不可逆性表现（DOCDAM）以及患者痛苦或由纤维肌痛、抑郁或焦虑所解释的表现（DOCDIS）这四项RheuMetric检查表0至10视觉数字评分量表（VNSs）的评分者间信度。
对拉什大学风湿病专科进修医生连续性诊所的数据进行回顾性研究。在常规护理中就诊的每一位风湿科患者，无论诊断如何，均完成一份多维健康评估问卷（MDHAQ）。风湿科进修医生和主治风湿科医生在同一次就诊时独立完成对DOCGL、DOCINF、DOCDAM、DOCDIS的RheuMetric评估，以及各子整体评估所解释的DOCGL比例（总计100%）。使用配对t检验、Spearman相关系数、组内相关系数（ICC）、林氏一致性相关系数（LCCC）和Bland-Altman图比较两位评估者之间的一致性。
在112例患者中，DOCINF的平均水平在炎症性疾病中最高，DOCDAM在骨关节炎（OA）中最高，DOCDIS在原发性纤维肌痛（FM）中最高。然而，在炎症性疾病中，DOCDAM的平均水平与DOCINF一样高。主治风湿科医生和进修医生的评分之间未观察到统计学上的显著差异。评分在2/10范围内的一致性，DOCGL为60%，DOICINF和DOCDAM为71%。风湿科医生和进修医生之间的Spearman相关系数为0.49 - 0.65，ICC为0.46 - 0.63，LCCC为0.46 - 0.62，表明一致性中等；每个子整体VNS的信度略高于DOCGL。
RheuMetric 0至10的DOCGL、DOCINF、DOCDAM和DOCDIS具有中等的评分者间信度，在常规护理中可行，可用于评估DOCGL之外的患者状况，以改善管理决策。
