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Int J Rheum Dis. 2019 Jan;22(1):96-102. doi: 10.1111/1756-185X.13433. Epub 2018 Nov 5.

Impact of EUSTAR standardized training on accuracy of modified Rodnan skin score in patients with systemic sclerosis.

Author information

1
Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
2
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
3
Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
4
Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
5
Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea.
6
Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
7
Division of Rheumatology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
8
Division of Rheumatology, Department of Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea.
9
Division of Rheumatology, Department of Internal Medicine, SNU Boramae Medical Center, Seoul, Korea.
10
Department of Rheumatology and Immunology, University of Pecs, Pecs, Hungary.
11
Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France.
12
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
13
Department of Geriatric Medicine, Division of Rheumatology, AOUC, Florence, Italy.

Abstract

OBJECTIVES:

To investigate the impact of European Scleroderma Trials and Research (EUSTAR) standardized training on the accuracy of modified Rodnan skin score (mRSS) in patients with systemic sclerosis (SSc).

METHODS:

Eight SSc patients (four diffuse, four limited) and 10 physicians (4 fellows, 6 professors) were included. Gold-standard mRSS was performed by a senior instructor. Training comprised a video presentation and a live demonstration. Each physician performed mRSS with no clinical information in all patients: (a) before training; (b) after video session; and (c) after live demonstration. Primary outcome was the change in scoring accuracy, which was defined as the difference from the gold-standard skin score, as analyzed using a linear mixed model.

RESULTS:

Mean (standard deviation) difference from the gold-standard score in all measurements by participants before the training was 7.7 (9.5). Completion of training significantly enhanced mRSS accuracy (adjusted β = -7.61; 95% CI: -11.91 to -3.32). This was largely attributable to the video presentation (adjusted β = -5.47; -9.16 to -1.78), although the live demonstration was associated with numerical reduction in the difference from the gold-standard score (adjusted β = -2.15; -5.84 to 1.55). Effect of training was prominent in fellows whereas professors showed an increase in the difference from gold-standard score after training (P value for interaction <0.001). The intraclass correlation coefficient for physician skin scores was acceptable. However, no significant change was observed after training.

CONCLUSION:

New EUSTAR standardized mRSS training significantly enhanced mRSS accuracy, especially in participant with less previous experience in skin scoring.

KEYWORDS:

disease activity score; education; scleroderma; systemic sclerosis

PMID:
30398033
DOI:
10.1111/1756-185X.13433
[Indexed for MEDLINE]

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