Multicriteria decision analysis methods with 1000Minds for developing systemic sclerosis classification criteria.
OBJECTIVE
Classification criteria for systemic sclerosis (SSc) are being developed. The objectives were to develop an instrument for collating case data and evaluate its sensibility; use forced-choice methods to reduce and weight criteria; and explore agreement among experts on the probability that cases were classified as SSc.


METHODS
A standardized instrument was tested for sensibility. The instrument was applied to 20 cases covering a range of probabilities that each had SSc. Experts rank ordered cases from highest to lowest probability; reduced and weighted the criteria using forced-choice methods; and reranked the cases. Consistency in rankings was evaluated using intraclass correlation coefficients (ICCs).


RESULTS
Experts endorsed clarity (83%), comprehensibility (100%), face and content validity (100%). Criteria were weighted (points): finger skin thickening (14-22), fingertip lesions (9-21), friction rubs (21), finger flexion contractures (16), pulmonary fibrosis (14), SSc-related antibodies (15), Raynaud phenomenon (13), calcinosis (12), pulmonary hypertension (11), renal crisis (11), telangiectasia (10), abnormal nailfold capillaries (10), esophageal dilation (7), and puffy fingers (5). The ICC across experts was 0.73 [95% confidence interval (CI): 0.58, 0.86] and improved to 0.80 (95% CI: 0.68, 0.90).


CONCLUSIONS
Using a sensible instrument and forced-choice methods, the number of criteria were reduced by 39% (range, 23-14) and weighted. Our methods reflect the rigors of measurement science and serve as a template for developing classification criteria.
Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Ground Floor, East Wing, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8; Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Electronic address: Sindhu.Johnson@uhn.ca.
Sindhu R
SR
Johnson
Auckland City Hospital, Auckland, New Zealand.
Raymond P
RP
Naden
Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Jaap
J
Fransen
Rheumatology Centre, Sint Maartenskliniek, Nijmegen, The Netherlands.
Frank
F
van den Hoogen
Division of Rheumatology, Department of Medicine, St Joseph Health Care, University of Western Ontario, London, Ontario, Canada.
Janet E
JE
Pope
Division of Rheumatology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Murray
M
Baron
Rheumatology Department, University of Basel, Basel, Switzerland.
Alan
A
Tyndall
Department of Rheumatology AVC, University of Florence, Firenze, Italy; Department of BioMedicine, University of Florence, Firenze, Italy; Division of Rheumatology AOUC, Department of Medicine & Denothecentre, University of Florence, Firenze, Italy.
Marco
M
Matucci-Cerinic
Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, London, UK.
Christopher P
CP
Denton
Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland.
Oliver
O
Distler
Dipartimento di Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, Ancona, Italy.
Armando
A
Gabrielli
Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
Jacob M
JM
van Laar
The University of Texas Health Science Center at Houston, Houston, TX, USA.
Maureen
M
Mayes
Division of Rheumatology, Clinical Immunology and Allergy, Department of Medicine, Georgetown University School of Medicine, USA.
Virginia
V
Steen
Scleroderma Research Consultants, Avon, CT, USA.
James R
JR
Seibold
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Phillip
P
Clements
Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Thomas A
TA
Medsger
Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, Spain.
Patricia E
PE
Carreira
Department of Rheumatology, German Rheumatology Research Center, Leibniz Institute, Berlin, Germany.
Gabriela
G
Riemekasten
Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA; Department of Dermatology, Stanford University, Stanford, CA, USA.
Lorinda
L
Chung
Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, AL, USA.
Barri J
BJ
Fessler
Division of Rheumatology, The University of Pennsylvania, Philadelphia, PA, USA.
Peter A
PA
Merkel
Division of Rheumatology & Immunology, Department of Medicine, Medical University of South Carolina, SC, USA.
Richard
R
Silver
Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
John
J
Varga
Rheumatology A Department, Paris Descartes University, Cochin Hospital, France.
Yannick
Y
Allanore
Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic, Bad Nauheim, Germany.
Ulf
U
Mueller-Ladner
Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Madelon C
MC
Vonk
Rheumatology Department, University of Basel, Basel, Switzerland.
Ulrich A
UA
Walker
Department of Rheumatology AVC, University of Florence, Firenze, Italy; Department of BioMedicine, University of Florence, Firenze, Italy; Division of Rheumatology AOUC, Department of Medicine & Denothecentre, University of Florence, Firenze, Italy.
Susanna
S
Cappelli
Scleroderma Program, Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA.
Dinesh
D
Khanna
D035843:Biomedical Research / Q000295:instrumentation*; D032921:Consensus; D003661:Decision Support Techniques; D005240:Feasibility Studies; D006801:Humans; D015203:Reproducibility of Results; D012595:Scleroderma, Systemic / Q000145:classification* / Q000175:diagnosis
Classification criteria; Conjoint analysis; Decision analysis; Forced-choice; Scleroderma; Sensibility; Systemic sclerosis