TY - JOUR
T1 - Reliability of hand diagrams for the epidemiologic case definition of Carpal tunnel syndrome
AU - Dale, Ann Marie
AU - Strickland, Jaime
AU - Symanzik, Jürgen
AU - Franzblau, Alfred
AU - Evanoff, Bradley
N1 - Funding Information:
Acknowledgments This study was supported by Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Grant number R01OH008017-01.
PY - 2008/9
Y1 - 2008/9
N2 - The purpose of this study was to evaluate the inter-rater reliability of hand diagrams, which are commonly used in research case definitions of carpal tunnel syndrome (CTS). To evaluate the potential of non-random misclassification of cases, we also studied predictors of rater disagreement as a function of personal and work factors, and of hand symptoms not classic for CTS. Participants in a longitudinal study investigating the development of CTS completed repeated self-administered questionnaires. Three experienced clinicians, blind to subjects' work or personal history, independently rated all hand diagrams on an ordinal scale from 0 to 3. Disagreements between ratings were resolved by consensus. Reliability was measured by the weighted kappa statistic. Logistic regression models evaluated predictors of disagreement. Three hundred and thirty-three subjects completed 494 hand diagrams. Eighty-five percent were completed by self-administered questionnaire and 15% by telephone interview. Weighted kappa values representing agreement among the three raters, were 0.83 (95% CI: 0.78, 0.87) for right hand diagrams and 0.88 (95% CI: 0.83, 0.91) for left hand diagrams. Ratings from hand diagrams obtained by telephone interview produced better agreement. Agreement among raters was not affected by subjects' personal or work factors. Disagreement among raters was associated with the presence of hand/wrist symptoms other than classic CTS symptoms. Overall, high levels of agreement were attained by independent raters of hand diagrams. Personal factors did not affect agreement among raters, but presence of non-CTS symptoms seemed to affect results and should be considered in studies focused on diverse populations with heterogeneity of upper extremity symptoms.
AB - The purpose of this study was to evaluate the inter-rater reliability of hand diagrams, which are commonly used in research case definitions of carpal tunnel syndrome (CTS). To evaluate the potential of non-random misclassification of cases, we also studied predictors of rater disagreement as a function of personal and work factors, and of hand symptoms not classic for CTS. Participants in a longitudinal study investigating the development of CTS completed repeated self-administered questionnaires. Three experienced clinicians, blind to subjects' work or personal history, independently rated all hand diagrams on an ordinal scale from 0 to 3. Disagreements between ratings were resolved by consensus. Reliability was measured by the weighted kappa statistic. Logistic regression models evaluated predictors of disagreement. Three hundred and thirty-three subjects completed 494 hand diagrams. Eighty-five percent were completed by self-administered questionnaire and 15% by telephone interview. Weighted kappa values representing agreement among the three raters, were 0.83 (95% CI: 0.78, 0.87) for right hand diagrams and 0.88 (95% CI: 0.83, 0.91) for left hand diagrams. Ratings from hand diagrams obtained by telephone interview produced better agreement. Agreement among raters was not affected by subjects' personal or work factors. Disagreement among raters was associated with the presence of hand/wrist symptoms other than classic CTS symptoms. Overall, high levels of agreement were attained by independent raters of hand diagrams. Personal factors did not affect agreement among raters, but presence of non-CTS symptoms seemed to affect results and should be considered in studies focused on diverse populations with heterogeneity of upper extremity symptoms.
KW - Carpal tunnel syndrome
KW - Case definition
KW - Hand diagrams
KW - Population based studies
KW - Reliability
UR - http://www.scopus.com/inward/record.url?scp=50249131347&partnerID=8YFLogxK
U2 - 10.1007/s10926-008-9139-y
DO - 10.1007/s10926-008-9139-y
M3 - Article
C2 - 18521726
AN - SCOPUS:50249131347
SN - 1053-0487
VL - 18
SP - 233
EP - 248
JO - Journal of Occupational Rehabilitation
JF - Journal of Occupational Rehabilitation
IS - 3
ER -