Standardization of joint examination technique leads to a significant decrease in variability among different examiners.
OBJECTIVE
To reduce the amount of variability among assessors, we conducted joint examination standardization seminars in conjunction with multicenter clinical trials for patients with rheumatoid arthritis (RA). The examination techniques used were based on the recommendations of the European League Against Rheumatism (EULAR).


METHODS
To evaluate the effect of standardization, participants at the seminars examined a given patient with RA before and after they were made familiar with the EULAR examination technique. The number of tender and swollen joints as well as the variance among the examiners before and after the training were compared. Joints were rated positive or negative for tenderness and swelling without grading.


RESULTS
Overall, 553 individuals from a variety of countries in Europe, North America, Asia, and Australia participated. Examiners included different kinds of health professionals, mainly physicians and nurses. We found a substantial variance among examiners before the training in the standardized method. This variance could be significantly reduced by the training. We also found that the number of joints considered active was markedly reduced after the training.


CONCLUSIONS
Standardized joint examination training significantly reduces variability among different assessors.
Unit for Rheumatology, Ludwig-Maximilians-University, Munich, Germany. mathias.gruenke@med.uni-muenchen.de
Mathias
M
Grunke
Christian E
CE
Antoni
Arthur
A
Kavanaugh
Verena
V
Hildebrand
Claudia
C
Dechant
Georg
G
Schett
Bernhard
B
Manger
Monika
M
Ronneberger
D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007596:Joints / Q000503:physiopathology*; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D010808:Physical Examination / Q000379:methods / Q000592:standards*; D012015:Reference Standards; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric