Methods for Assessment of Interrater Reliability for Diagnosis and Intervention in Traditional Chinese Medicine Studies
Traditional medicines experienced an increasing interest in theoretical, experimental, and clinical research since its recognition in the Alma-Ata Declaration. Particularly, Chinese medicine (CM) was developed by a society geographic, social, and cultural
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Methods for Assessment of Interrater Reliability for Diagnosis and Intervention in Traditional Chinese Medicine Studies Arthur Sá Ferreira and Ingrid Jardim Azeredo Souza Oliveira
Abstract Traditional medicines experienced an increasing interest in theoretical, experimental, and clinical research since its recognition in the Alma-Ata Declaration. Particularly, Chinese medicine (CM) was developed by a society geographic, social, and culturally different from the Western community during the last 3000 years. The diagnostic process of CM has a unique feature: patterns, the counterpart of Western diseases, are identified through a process named pattern differentiation. The collection of clinical manifestations of an individual is obtained using four examinations known as inspection, auscultation-olfaction, inquiry, and palpation. As a corollary, CM diagnosis is considered as subjective because only the five senses are used to gather meaningful clinical data and must be interpreted by an expert; no equipment or diagnostic exam was developed for collecting data for pattern differentiation until the last decades. Pattern differentiation comprises a procedure subjected to errors as any other diagnostic system, but this variability in diagnosis might have consequences: different patterns might lead to distinct treatment choices such as herbs or acupoints selection. In contrast with Western medicine that has treatment protocols for various diseases, there are no defined protocols of acupoints for patterns because of the personalized aspect of CM’s diagnostic process and the possibility of selecting acupoints using a variety of criteria. Therefore, it is important to assess simultaneously the amount of agreement—mainly among different raters—for CM diagnosis and the diagnostic accuracy for pattern differentiation to determine the validity of this traditional system in both clinical and research scenarios. In this sense, high interrater agreement (i.e. the degree to which raters achieve identical results when performing the same assessment under similar conditions) and diagnostic accuracy (i.e. the rate of correct diagnosis) are important characteristics of any model used for health classification. Previous studies investigated the agreement for pattern differentiation and/or for acupuncture prescription, A.S. Ferreira (&) I.J.A.S. Oliveira Laboratory of Computational Simulation and Modeling in Rehabilitation, Augusto Motta University Center, Rio de Janeiro, RJ, Brazil e-mail: [email protected] I.J.A.S. Oliveira e-mail: [email protected] © Springer Science+Business Media Singapore 2016 S. Leung and H. Hu (eds.), Evidence-based Research Methods for Chinese Medicine, DOI 10.1007/978-981-10-2290-6_7
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A.S. Ferreira and I.J.A.S. Oliveira
though they present important limitations either from the traditional or scientific perspective. A lack of calculating and reporting statistical measures of agreement or a lack of investigating the relationship between diagnosis and therapeutic prescription was observed. Final
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