Interrater agreement in the assessment of motor manifestations of Huntington's disease
Interrater agreement in the assessment of motor manifestations of Huntington's disease
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DOI：
10.1002/mds.20332
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发表时间：
2005-03-01
影响因子：
8.6
通讯作者：
Zhao, HW
中科院分区：
文献类型：
--
作者：
Hogarth, P;Kayson, E;Zhao, HW
随着旨在延缓亨廷顿（HD）基因临床前携带者发病的实验性治疗的前景不断改善，我们评估了经验丰富的临床医生对HD运动表现的一致性，这是该人群预防性试验的相关结局指标。75名在早期HD患者评估方面有经验的临床医生和6名非临床医生观看了从美国-委内瑞拉合作HD研究项目的电影档案中汇编的录像带。要求观察员对17名高危受试者进行2-3分钟的运动检查。评定量表范围为0（正常）至4（HD特征性明确的锥体外系运动障碍）。通过加权kappa统计量测量，将量表评分为4与评分不为4进行比较，75名临床医生在明确运动异常的判断方面存在实质性一致（加权kappa = 0.67;标准误（SE）= 0.09）。非临床医生之间的一致性仅为一般（加权kappa 0.28; SE = 0.10）。即使在录像研究的人工条件下，经验丰富的临床医生也对构成HD风险受试者疾病运动表现的体征表现出实质性一致。我们希望这些发现能转化为类似水平的观察者间协议的临床试验设置涉及经验丰富的研究人员检查活的病人。(c)2004年，《运动障碍协会》。
With prospects improving for experimental therapeutics aimed at postponing the onset of illness in preclinical carriers of the Huntington's disease (HD) gene, we assessed agreement among experienced clinicians with respect to the motor manifestations of HD, a relevant outcome measure for preventive trials in this population. Seventy-five clinicians experienced in the evaluation of patients with early HD and six non-clinicians were shown a videotape compiled from the film archives of the United States-Venezuela Collaborative HD Research Project. Observers were asked to rate a 2-3-minute segment of the motor examination for each of 17 at-risk subjects. The rating scale ranged from 0 (normal) to 4 (unequivocal extrapyramidal movement disorder characteristic of HD). As measured by a weighted kappa statistic, there was substantial agreement among the 75 clinicians in the judgment of unequivocal motor abnormalities comparing scale ratings of 4 with ratings that were not 4 (weighted kappa = 0.67; standard error (SE) = 0.09). Agreement among the non-clinicians was only fair (weighted kappa 0.28; SE = 0.10). Even under the artificial conditions of a videotape study, experienced clinicians show Substantial agreement about the signs that constitute the motor manifestations of illness in subjects at risk for HD. We expect these findings to translate to a similar level of interobserver agreement in the clinical trial setting involving experienced investigators examining live patients. (c) 2004 Movement Disorder Society.