Gerçek CAN, Aydan KÖKEN AVŞAR, Sinem Burcu KOCAER, Gökçe KENAR, Dilek SOLMAZ, Fatoş ÖNEN, Süleyman Serdar KOCA, Ali AKDOĞAN, Merih BİRLİK

Sklerodermada Modifiye Rodnan Cilt Skoru Değerlendirilmesinin Eğitim Kursu Sonuçları

Amaç: Sklerodermalı hastalarda deri kalınlığının değerlendirilmesi için genellikle modifiye Rodnan Cilt Skoru (mRCS) kullanılmaktadır. Literatürde mRCS eğitim kurslarının etkinliğine dair farklı veriler mevcuttur. Çalışmamızın amacı romatoloji yan dal asistanlarına uygulanan mRCS eğitim kursunun etkinliğinin değerlendirilmesidir. Gereç ve Yöntem: Çalışmaya 10 romatoloji yan dal asistanı dahil edildi. Katılımcılara skleroderma konusunda deneyimli 3 romatoloji uzmanı tarafından, deri tutulumu ve mRCS değerlendirilmesini içeren 1 saatlik teorik eğitim verildi. Ardından 1 saat süreyle 4 hasta üzerinde pratik eğitim uygulandı. Katılımcılar 2 hasta üzerinde eğitim öncesi ve sonrası 17 bölgeyi içerecek ve toplam skor 0-51 aralığında olacak şekilde kağıt form üzerinde skorlama yaptılar. Daha sonra eğitim öncesi ve sonrası mRCS için gözlemciler arası güvenilirlik, sınıf içi korelasyon katsayısı (intraclass correlation, ICC) analizi ile değerlendirildi. Eğitim öncesi ve sonrası 12 ayrı Rodnan skor bölgesine göre uyumun Fleiss’s kappa ile değerlendirilmesi yapıldı. Bulgular: mRCS skoru için ICC değeri eğitim öncesi 0,867 [%95 güven aralığı (GA): 0,625-1,00, p=0,05], eğitim sonrası 0,905 (%95 GA: 0,045-1,00, p=0,02) olarak hesaplandı. Tek tek Rodnan skor bölgelerine bakıldığında eğitim sonrasında bir kısmında uyumda artış gözlendi, bir bölgede değişim olmazken, bir kısmında ise uyumda azalma tespit edildi. Sonuç: Bu çalışma göstermektedir ki, mRCS, eğitim kursları ile kolaylıkla aktarılabilen etkin bir skorlamadır.

Training Course Results of the Assessment of Modified Rodnan Skin Score in Scleroderma

Aim: Modified Rodnan Skin Score (mRSS) is generally used to assess skin involvement in patients with scleroderma. There are conflicting data on the effectiveness of mRSS training courses in previous studies. The aim of this study to evaluate the effectiveness of a mRSS training course applied to rheumatology minor residents. Materials and Methods: Ten rheumatology minor residents were included in the study. The participants were given a 1-hour theoretical training including skin involvement in scleroderma and mRSS evaluation, by three experienced rheumatology specialists. Then training continued with performing mRSS on 4 patients with scleroderma for 1 hour. Participants made scores on a paper form on 2 patients before and after the training, including 17 regions, and the total score was between 0 and 51. Inter- observer reliability for pre- and post-training was evaluated with intra-class correlation coefficient (ICC) analysis. Agreement was evaluated with Fleiss’s kappa according to 12 different score regions before and after the training. Results: The ICC was detected as 0.867 [95% confidence interval (CI): 0.625-1.00, p=0.05] before the training, and 0.905 (95% CI: 0.045-1.00, p=0.02) after the training. When the regions of mRSS were evaluated individually, an increase in agreement was observed in some of the scores while there was no change in one region and a decrease in agreement was observed in some. Conclusion: This study has shown that mRSS is an effective scoring that can be easily conveyed with training courses.

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