Abstract
Eighty nine British and Australian rheumatologists took part in a study to discover how accurately they could describe their procedures for measuring disease severity in rheumatoid arthritis. The relative importance they attached to different clinical and laboratory variables showed a very wide variation, and these stated policies were generally poor at predicting their actual judgments when assessing 'paper patients' (r2 = 39%). Policies based on equal weighting of all variables, while also poor predictors (r2 = 41%), were nevertheless superior to their stated policies for 49 respondents. Policies calculated by judgment (linear regression) analysis were much more successful predictors (R2 = 73%). Unhurried, detailed interviews with four experienced rheumatologists provided carefully considered statements of assessment policy, but these also were poor predictors of routine assessments of outpatients (r2 = 34%) compared with policies calculated by clinical judgment analysis, even when these were applied to new data (R2 = 88%).
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bombardier C., Tugwell P., Sinclair A., Dok C., Anderson G., Buchanan W. W. Preference for endpoint measures in clinical trials: results of structured workshops. J Rheumatol. 1982 Sep-Oct;9(5):798–801. [PubMed] [Google Scholar]
- Byron M. A., Mowat A. G. Corticosteroid prescribing in rheumatoid arthritis--the fiction and the fact. Br J Rheumatol. 1985 May;24(2):164–166. doi: 10.1093/rheumatology/24.2.164. [DOI] [PubMed] [Google Scholar]
- Kirwan J. R., Chaput De Saintonge D. M., Joyce C. R., Currey H. L. Clinical judgement analysis--practical application in rheumatoid arthritis. Br J Rheumatol. 1983 Aug;22(3 Suppl):18–23. doi: 10.1093/rheumatology/xxii.suppl_1.18. [DOI] [PubMed] [Google Scholar]
- Kirwan J. R., Chaput de Saintonge D. M., Joyce C. R., Currey H. L. Clinical judgment in rheumatoid arthritis. I. Rheumatologists' opinions and the development of 'paper patients'. Ann Rheum Dis. 1983 Dec;42(6):644–647. doi: 10.1136/ard.42.6.644. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kirwan J. R., Chaput de Saintonge D. M., Joyce C. R., Currey H. L. Clinical judgment in rheumatoid arthritis. III. British rheumatologists' judgments of 'change in response to therapy'. Ann Rheum Dis. 1984 Oct;43(5):686–694. doi: 10.1136/ard.43.5.686. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kirwan J. R., Currey H. L. Clinical judgment in rheumatoid arthritis. IV. Rheumatologists' assessments of disease remain stable over long periods. Ann Rheum Dis. 1984 Oct;43(5):695–697. doi: 10.1136/ard.43.5.695. [DOI] [PMC free article] [PubMed] [Google Scholar]