Brennan P, Silman A, Black C, Bernstein R, Coppock J, Maddison P, Sheeran T, Stevens C, Wollheim F
Arthritis and Rheumatism Council Research Unit, Manchester University Medical School.
Br J Rheumatol. 1993 May;32(5):357-61. doi: 10.1093/rheumatology/32.5.357.
Three different assessment methods for the classification of Raynaud's phenomenon (RP) were compared. These were (i) a previously validated method using colour charts supplemented with a short questionnaire, (ii) answers to a questionnaire based on criteria derived from the consensus opinion of a group of clinicians, and (iii) individual clinician's assessment using standard descriptions based upon the same consensus view. We report the results of a study involving six clinicians and 30 subjects investigating the level of repeatability between the three methods and also the reliability between the six clinicians. There did not exist any overall systematic bias between the six clinicians. Further, agreement between them, as assessed by the kappa statistic, ranged from moderate to good. However, there did exist systematic bias between the results from all three of the classification approaches with agreement between them ranging from only poor to moderate. We conclude that the previously validated colour chart assessment is too insensitive to detect RP. Further, a structured questionnaire based on perceived clinician's opinion could not reproduce clinicians' classification in practice. By contrast, supplying clinicians with standard descriptions did yield a reliable classification system for RP.
比较了三种不同的用于雷诺现象（RP）分类的评估方法。这些方法分别是：（i）一种先前经过验证的方法，使用颜色图表并辅以简短问卷；（ii）基于一组临床医生共识意见得出的标准回答问卷；（iii）个体临床医生使用基于相同共识观点的标准描述进行评估。我们报告了一项涉及六名临床医生和30名受试者的研究结果，该研究调查了这三种方法之间的可重复性水平以及六名临床医生之间的可靠性。六名临床医生之间不存在任何总体系统性偏差。此外，通过kappa统计量评估，他们之间的一致性从中度到良好不等。然而，这三种分类方法的结果之间确实存在系统性偏差，它们之间的一致性仅从差到中度不等。我们得出结论，先前经过验证的颜色图表评估对于检测RP过于不敏感。此外，基于临床医生感知意见的结构化问卷在实践中无法重现临床医生的分类。相比之下，为临床医生提供标准描述确实产生了一种可靠的RP分类系统。
