title: A trial of proficiency of nerve conduction: greater standardization still needed.
abstract: BACKGROUND
  The aim of this study was to test the proficiency (accuracy among evaluators) of measured attributes of nerve conduction (NC).
  
  
  METHODS
  Expert clinical neurophysiologists, without instruction or consensus development, from 4 different medical centers, independently assessed 8 attributes of NC in 24 patients with diabetes mellitus (DM) on consecutive days.
  
  
  RESULTS
  No significant intraobserver differences between days 1 and 2 were found, but significant interobserver differences were seen. Use of standard reference values did not correct for these observed differences.
  
  
  CONCLUSIONS
  Interobserver variability was attributed to differences in performance of NC. It was of sufficient magnitude that it is of concern for the conduct of therapeutic trials. To deal with interrater variability in therapeutic trials, the same electromyographers should perform all NC assessments of individual patients or, preferably, NC procedures should be more standardized. A further trial is needed to test whether such standardization would eliminate interobserver variability.
authors.affiliation: Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Dyck
authors.forename: James W
authors.initials: JW
authors.lastname: Albers
authors.forename: James
authors.initials: J
authors.lastname: Wolfe
authors.forename: Charles F
authors.initials: CF
authors.lastname: Bolton
authors.forename: Nancy
authors.initials: N
authors.lastname: Walsh
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Klein
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Zafft
authors.forename: James W
authors.initials: JW
authors.lastname: Russell
authors.forename: Karen
authors.initials: K
authors.lastname: Thomas
authors.forename: Jenny L
authors.initials: JL
authors.lastname: Davies
authors.forename: Rickey E
authors.initials: RE
authors.lastname: Carter
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Melton
authors.forename: William J
authors.initials: WJ
authors.lastname: Litchy
mesh_terms: D000200:Action Potentials / Q000502:physiology; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000503:physiopathology*; D004568:Electrodiagnosis / Q000379:methods / Q000592:standards*; D006801:Humans; D007600:Judgment; D009431:Neural Conduction / Q000502:physiology*; D011930:Reaction Time / Q000502:physiology; D012015:Reference Standards; D013997:Time Factors
keywords: clinical trial; diabetic sensorimotor polyneuropathy; nerve conduction; proficiency; standard reference value