title: Inter- and Intra-Observer Reliability of Modified Rodnan Skin Score Assessment in Thai Systemic Sclerosis Patients: A Validation for Multicenter Scleroderma Cohort Study.
abstract: BACKGROUND
  Assessment of the severity of skin tightness by the modified Rodnan skin score (mRSS) for systemic sclerosis (SSc) has been found feasible, valid, and reliable. Despite being a major clinical outcome, it has not yet been validated by Scleroderma Research Group.
  
  
  OBJECTIVE
  To (a) determine the inter-observer variability vis-à-vis mRSS assessment by members ofthe Scleroderma Research Group before and after mRSS-assessment training by an experienced rheumatologist and (b) determine intra-observer variability.
  
  
  METHODS
  Between June and August 2013, we conducted a descriptive study of Thai adult SSc patients and all rheumatologists in the Scleroderma Research Group at Srinagarind Hospital, Khon Kaen University, Northeast Thailand. Eleven rheumatologists assessed the mRSS of 22 SSc patients three times (i.e., before and after training, and eight weeks after training). The intra-class correlation coefficient (ICC) and its 95% CI were estimated at week 8 after training.
  
  
  RESULTS
  The mean and standard deviation (SD) of mRSS for inter-observer variability analysis was slightly decreased from before training, after training (by an experienced rheumatologist), and at week 8 after training (17.3 ± 11.9, 16.5 ± 11.1, and 16.2 ± 10.3, respectively). Intra-observer variability had moderate agreement before training (ICC 0.59; 95% CI 0.38-0.78), which increased to good agreement after training and at week 8 after training (ICC 0.60; 95% CI 0.42-0.76 vs. 0.68; 95% CI 0.53-0.82, respectively).
  
  
  CONCLUSIONS
  Inter-observer variability for mRSS assessment decreased after training and the reduction persisted for eight weeks after training. The ICC rose from moderate agreement at baseline to good agreement at the end of the study. The mRSS assessment by members of the Scleroderma Research Group was reliable.
authors.forename: Chingching
authors.initials: C
authors.lastname: Foocharoen
authors.forename: Bandit
authors.initials: B
authors.lastname: Thinkhamrop
authors.forename: Ajanee
authors.initials: A
authors.lastname: Mahakkanukrauh
authors.forename: Siraphop
authors.initials: S
authors.lastname: Suwannaroj
authors.forename: Sittichai
authors.initials: S
authors.lastname: Netwijitpan
authors.forename: Kwanleutai
authors.initials: K
authors.lastname: Sripavatakul
authors.forename: Wiriya
authors.initials: W
authors.lastname: Chuealee
authors.forename: Bodin
authors.initials: B
authors.lastname: Boottam
authors.forename: Patapong
authors.initials: P
authors.lastname: Towiwat
authors.forename: Patcharawan
authors.initials: P
authors.lastname: Seubmee
authors.forename: Kittikorn
authors.initials: K
authors.lastname: Daungkum
authors.forename: Darunee
authors.initials: D
authors.lastname: Kongpan
authors.forename: Jintara
authors.initials: J
authors.lastname: Mangkala
authors.forename: Ratanavadee
authors.initials: R
authors.lastname: Nanagara
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010808:Physical Examination; D015203:Reproducibility of Results; D012595:Scleroderma, Systemic / Q000175:diagnosis*; D012867:Skin / Q000473:pathology*; D011795:Surveys and Questionnaires; D013785:Thailand