title: Autofeedback from ultrasound images provides rapid improvement in palpation skills for identifying joint swelling in rheumatoid arthritis.
abstract: OBJECTIVE
  Joint swelling, an important factor in the classification criteria and disease activity assessment in rheumatoid arthritis (RA), renders joint palpation a necessary skill for physicians. Ultrasound (US) examination that visualizes soft tissue abnormalities is now used to assess musculoskeletal disease. We assessed the usefulness of US assessments in enhancing physical joint examination skills.
  
  
  METHODS
  We examined 1944 joints (bilateral shoulder, elbow, wrist, metacarpophalangeal joints 1-5, and knee joints) in 108 patients with RA during April-July 2011. We first physically examined and confirmed joint swelling; subsequently, the same rheumatologist conducted US examinations and multiple assessors graded the joint swelling. When the 2 results differed, we received autofeedback from the US results to improve the physical examination skills.
  
  
  RESULTS
  The sensitivities and specificities of physical examination for US-detected swollen joint, the correlation coefficient (CC) of the swollen joint counts, and the concordance rate in each patient for joint swelling sites and power Doppler (PD)-positive sites with the κ coefficients between the physical and US examinations were compared over time. We found that the sensitivity of physical examination increased by 42 percentage points (pp), while the specificity decreased by 18 pp. The average CC in June-July was greater than that in April-May. The percentage of κ coefficients > 0.8 increased from 8.8% to 17% for joint swelling and from 8.3% to 14% for PD-positive sites.
  
  
  CONCLUSIONS
  Our results suggest that autofeedback from US assessment provides quick improvement in palpation skills for identifying joint swelling in patients with RA.
authors.affiliation: Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan. miogasaw@juntendo.ac.jp
authors.forename: Michihiro
authors.initials: M
authors.lastname: Ogasawara
authors.forename: Go
authors.initials: G
authors.lastname: Murayama
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yamada
authors.forename: Takuya
authors.initials: T
authors.lastname: Nemoto
authors.forename: Michiaki
authors.initials: M
authors.lastname: Kageyama
authors.forename: Shoko
authors.initials: S
authors.lastname: Toyama
authors.forename: Makio
authors.initials: M
authors.lastname: Kusaoi
authors.forename: Shin
authors.initials: S
authors.lastname: Onuma
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kon
authors.forename: Fumio
authors.initials: F
authors.lastname: Sekiya
authors.forename: Kaoru
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Ran
authors.initials: R
authors.lastname: Matsudaira
authors.forename: Masakazu
authors.initials: M
authors.lastname: Matsushita
authors.forename: Kurisu
authors.initials: K
authors.lastname: Tada
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kempe
authors.forename: Ken
authors.initials: K
authors.lastname: Yamaji
authors.forename: Naoto
authors.initials: N
authors.lastname: Tamura
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Takasaki
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004487:Edema / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D056228:Feedback, Sensory; D005260:Female; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010173:Palpation / Q000379:methods*; D011237:Predictive Value of Tests; D013585:Synovitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult