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Scleroderma, myositis and related syndromes
AB0644 RESULTS OF A TRAINING COURSE FOR CALCULATION OF THE MODIFIED RODNAN SKIN SCORE IN SCLERODERMA
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  1. Gerçek Can1,
  2. Aydan Köken Avşar1,
  3. Sinem Burcu Kocaer1,
  4. Gökçe Kenar2,
  5. Dilek Solmaz3,
  6. Handan Yarkan-Tuğsal4,
  7. Duygu Temiz Karadağ5,
  8. Neslihan Gökçen6,
  9. Servet Yolbaş7,
  10. Hakan Babaoglu8,
  11. Alper Yıldırım9,
  12. Müçteba Enes Yayla10,
  13. İlyas Ercan Okatan10,
  14. Alper Sarı11,
  15. Didem arslan Taş12,
  16. Fatos Onen1,
  17. Süleyman Serdar Koca13,
  18. Ali Akdoğan11,
  19. Merih Birlik1
  1. 1Dokuz Eylul University Faculty of Medicine, Rheumatology, Izmir, Turkey
  2. 2Mardin Devlet Hastanesi, Rheumatology, Mardin, Turkey
  3. 3Izmir Katip Çelebi University, Rheumatology, Izmir, Turkey
  4. 4Ağrı Devlet Hastanesi, Rheumatology, ağrı, Turkey
  5. 5Çanakkale Devlet Hastanesi, Rheumatology, Çanakkale, Turkey
  6. 6Çukurova University, Rheumatology, adana, Turkey
  7. 7Inonu Universitesi, Rheumatology, Elazığ, Turkey
  8. 8Gazi University, Rheumatology, ankara, Turkey
  9. 9Erciyes University, Rheumatology, Kayseri, Turkey
  10. 10Ankara University, Rheumatology, ankara, Turkey
  11. 11Hacettepe University, Rheumatology, ankara, Turkey
  12. 12Çukurova Üniversitesi, Rheumatology, adana, Turkey
  13. 13Firat University, Rheumatology, Elazığ, Turkey

Abstract

Background: Scleroderma is a connective tissue disease that is characterized by fibrosis of the skin.The modified Rodnan Skin Score (mRSS) is a measure generally used to assess the skin thickness in patients with scleroderma.Data on the effectiveness of the mRSS training courses differ in the literature.

Objectives: The objective of our study was to evaluate the effectiveness of the mRSS training course in rheumatology fellows in the rheumatology departments.

Methods: The study included 6 fellows from the departments of rheumatology.Participants were given a 1-hour-long theoretical training, including dermal involvement, and mRSS assessment by 3 rheumatology experts experienced in scleroderma, which was followed by an applied training on 4 patients for one-hour.Participants scored two patients before and after training on a form, which included 17 domains with a total score-range between “0” and “51”. Then using the SPSS15 software program, inter-rater reliability was assessed with intraclass correlation(ICC) analysis for both pre- and post-training mRSS.Fleiss’ kappa was used to measure the degree of agreement according to 12 Rodnan score areas before and after the training.

Results: The ICC value for pre-training and post-training total Rodnan scores was 0.867 (95% CI-0.625-1.00, P=0.05), and 0.905(95% CI 0.045-1.00, P=0.02), respectively. Individual analysis of score areas showed that after the training there was an increase in degree of agreement in some of these areas, while there was no difference in one area, and it decreased in others (Table 1).

Figure

Conclusion: Several studies have demonstrated the applicability, reliability, and validity of mRSS, a measure of dermal involvement, and that evaluation of the score requires experience, and an attentive learning process.In the literature, the inter-rater ICC values during previous training courses are reported to range between 0.378 and 0.92(1). These studies show differences in terms of the number and experience of participants, number of patients, course-length, and repeated courses. Similar to the observation by Ionescu et al(2), the pre-training inter-observer ICC value was very high(0.867), and it increased to 0.905 after the training. Presence of an increase in some areas, and reduction in some others in individual analysis of areas after the training may suggests the need for repeated training. Our limitations were low number of participants and patients. We obtained very good inter-rater ICC values in the mRSS training course given to rheumatology fellows; however we may benefit from new studies for optimization of these conclusions by increasing the numbers of trainees, patients, and the lenght of courses.

References [1] Czirjak, L., et al., the EUSTAR model for teaching and implementing the modified Rodnan skin score in systemic sclerosis. Ann Rheum Dis, 2007.

[2] Ionescu, R., et al., Repeated teaching courses of the modified Rodnan skin score in systemic sclerosis. Clin Exp Rheumatol, 2010.

Disclosure of interests: None declared

https://doi.org/10.1136/annrheumdis-2019-eular.6609

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