Effects of questionnaire-based diagnosis and training on inter-rater reliability among practitioners of traditional Chinese medicine.

Full Abstract

OBJECTIVE: To investigate whether a training process that focused on a questionnaire-based diagnosis in Traditional Chinese Medicine (TCM), and developing diagnostic consensus, would improve the agreement of TCM diagnoses among 10 TCM practitioners evaluating patients with temporomandibular joint disorder (TMJD). DESIGN AND SETTING: Evaluation of a diagnostic training program at the Department of Family and Community Medicine, University of Arizona, Tucson, Arizona, and the Oregon College of Oriental Medicine, Portland, Oregon. SUBJECTS: Screened participants for a study of TCM for TMJD. PRACTITIONERS: Ten (10) licensed acupuncturists with a minimum of 5 years licensure and education in Chinese herbs. METHODS: A training session using a questionnaire-based diagnostic form was conducted, followed by waves of diagnostic sessions. Between sessions, practitioners discussed the results of the previous round of participants with a focus on reducing variability in primary diagnosis and severity rating of each diagnosis: 3 waves of 5 patients were assessed by 4 practitioner pairs for a total of 120 diagnoses. At 18 months, practitioners completed a recalibration exercise with a similar format with a total of 32 diagnoses. These diagnoses were then examined with respect to the rate of agreement among the 10 practitioners using inter-rater correlations and kappas. RESULTS: The inter-rater correlation with respect to the TCM diagnoses among the 10 practitioners increased from 0.112 to 0.618 with training. Statistically significant improvements were found between the baseline and 18 month exercises (p < 0.01). CONCLUSIONS: Inter-rater reliability of TCM diagnosis may be improved through a training process and a questionnaire-based diagnosis process. The improvements varied by diagnosis, with the greatest congruence among primary and more severe diagnoses. Future TCM studies should consider including calibration training to improve the validity of results.

Author information

Author/s: Mist, Scott (S); Ritenbaugh, Cheryl (C); Aickin, Mikel (M);

Affiliation: Oregon College of Oriental Medicine, Portland, OR, USA.

Grants: U01 AT 002570 (Agency:NCCAM NIH HHS)

Journal and publication information

Publication Type: Journal Article; Research Support, N.I.H., Extramural; Validation Studies

Journal: Journal of alternative and complementary medicine (New York, N.Y.) (J Altern Complement Med), published in United States. (Language: eng)

Reference: 2009-Jul; vol 15 (issue 7) : pp 703-9

Dates: Created 2009/07/09; Completed 2009/10/20;

PMID: 19538100, status: MEDLINE (last retrieval date: 10/20/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article
(including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.