Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2007 Jul;66(7):966-9.
doi: 10.1136/ard.2006.066530. Epub 2007 Jan 18.

The EUSTAR model for teaching and implementing the modified Rodnan skin score in systemic sclerosis

László Czirják  1 , Zoltán Nagy, Martin Aringer, Gabriela Riemekasten, Marco Matucci-Cerinic, Daniel E Furst; EUSTAR
Affiliations

The EUSTAR model for teaching and implementing the modified Rodnan skin score in systemic sclerosis

László Czirják et al. Ann Rheum Dis. 2007 Jul.

Abstract

Objective: To evaluate the ability to teach scleroderma experts and young rheumatologists to perform the modified Rodnan skin score test.

Methods: Three international "teaching courses for teachers" were conducted with 6-9 experts who performed 3-9 skin score tests each. In addition, an international course for 90 young rheumatologists, in which 18 patients with systemic sclerosis (SSc) participated, was also organised. Finally, a local repeated training course for 5-9 rheumatologists was performed, in which 6-7 patients with SSc participated.

Results: When 6-9 scleroderma specialists investigated the patients, the intraclass correlation coefficient (ICC) showed "good" to "excellent" values (0.865 and 0.710, respectively). When 90 young rheumatologists were involved in one teaching course, the coefficient of variation (CV) was relatively satisfactory (35%) owing to the high number of investigators, and with a considerable within-patient SD value of 5.4. Repeated teaching of 5-9 young rheumatologists in local courses clearly improved the consistency. The ICC increased from 0.496 to a "good" level of 0.722. The within-patient SD values for intraobserver variability ranged between 2.5 and 2.9. The intraobserver CV was about 20%.

Conclusions: This study strongly supports the need for standardisation among different centres when using skin scoring for clinical trials. The intraobserver variability and within-patient SD values can be significantly reduced by repeated teaching. For inexperienced rheumatologists, at least one repeated teaching course is needed.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

References

    1. Clements P J, Hurwitz E L, Wong W K, Seibold J R, Mayes M, White B.et al Skin thickness score as a predictor and correlate of outcome in systemic sclerosis: high‐dose versus low‐dose penicillamine trial. Arthritis Rheum 2000432445–2454. - PubMed
    1. Clements P J, Lachenbruch P A, Ng S W, Simmons M, Sterz M, Furst D E. Skin score. A semiquantitative measure of cutaneous involvement that improves prediction of prognosis in systemic sclerosis. Arthritis Rheum 1990331256–1263. - PubMed
    1. Clements P J, Wong W K, Hurwitz E L, Furst D E, Mayes M, White B.et al The disability index of the health assessment questionnaire is a predictor and correlate outcome in the high dose versus low dose penicillamine is systemic sclerosis trial. Arthritis Rheum 200144653–661. - PubMed
    1. Sultan N, Pope J E, Clements P J, for the Scleroderma trials Study Group The health assessment questionnaire (HAQ) is strongly predictive of a good outcome in early diffuse scleroderma: results from an analysis of two randomized controlled trials in early diffuse scleroderma. Rheumatology 200443472–478. - PubMed
    1. Steen V D, Medsger T A, Jr, Rodnan G P. D‐penicillamine therapy in progressive systemic sclerosis (scleroderma): a retrospective analysis. Ann Intern Med 198297652–659. - PubMed

Publication types