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The EUSTAR model for teaching and implementing the modified Rodnan skin score in systemic sclerosis
László Czirják1, Zoltán Nagy, Martin Aringer
1Department of Immunology and Rheumatology, University of Pécs, H-7621 Pécs, Irgalmasok u. 1, Hungary. laszlo.czirjak@aok.pte.hu
Annals of the Rheumatic Diseases
|January 20, 2007
Summary
Repeated teaching significantly improves the consistency of the modified Rodnan skin score test for rheumatologists. This standardization is crucial for reliable clinical trials in systemic sclerosis (SSc).
Area of Science:
- Rheumatology
- Clinical Trials
- Medical Education
Background:
- The modified Rodnan skin score (mRSS) is vital for assessing skin involvement in systemic sclerosis (SSc).
- Standardization of mRSS is essential for reliable multicenter clinical trials.
- Variability in mRSS performance can impact study outcomes.
Purpose of the Study:
- To assess the effectiveness of teaching interventions for performing the mRSS.
- To evaluate the learning curves of both experienced scleroderma specialists and young rheumatologists.
- To determine the impact of repeated training on mRSS consistency.
Main Methods:
- Conducted international "teaching courses for teachers" with scleroderma experts.
- Organized an international course for 90 young rheumatologists using 18 SSc patients.
- Performed local repeated training courses for 5-9 rheumatologists with 6-7 SSc patients each.
Main Results:
- Experts achieved good to excellent intraclass correlation coefficients (ICC) (0.865 and 0.710).
- Initial training for 90 young rheumatologists showed a coefficient of variation (CV) of 35% and a within-patient standard deviation (SD) of 5.4.
- Repeated local teaching improved ICC from 0.496 to 0.722, with intraobserver CV around 20% and within-patient SD between 2.5-2.9.
Conclusions:
- Standardization of skin scoring across centers is necessary for clinical trials.
- Repeated teaching effectively reduces intraobserver variability and within-patient SD in mRSS.
- At least one repeated teaching course is recommended for inexperienced rheumatologists.
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