Document Detail

Chronological reading of radiographs in rheumatoid arthritis increases efficiency and does not lead to bias.
MedLine Citation:
PMID:  23349128     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To evaluate the difference between chronological and random sequence reading in a series of radiographs with 11 years' follow-up. In addition, the influence of the starting point and length of series was evaluated.
METHODS: Two experienced readers independently and repeatedly scored digitised radiographs of 62 patients at time points 0, 2, 5, 8 and 11 years of follow-up from the COBRA follow-up database according to the Sharp/van der Heijde method. A linear mixed model was fitted to the data.
RESULTS: Over 11 years the mean scores increased by 3.8 points per year. Compared to random reading, chronological reading resulted in a slightly increased progression rate of 0.4 points per year (p=0.008) and a lower standard error of the mean total progression rate of 0.30 (compared to 0.35 for random reading). Over 11 years, this results in a small difference in progression estimates of about five points, but a highly relevant difference of over 25% of patients needed in a study to find a difference in radiological outcome between two groups. Reading of short series, or series including a baseline radiograph, results in a significantly higher yearly progression rate compared to reading of long series, or series not including a baseline measurement.
CONCLUSIONS: Chronological reading of radiographs is preferred above random reading, due to decreased variability around the estimation of the progression rate; this increased efficiency translates into smaller sample sizes, or increased power to detect small differences. For studies with long-term follow-up, the same two readers should read all radiographs, including baseline.
Lilian H D van Tuyl; Désirée van der Heijde; Dirk L Knol; Maarten Boers
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2013-01-24
Journal Detail:
Title:  Annals of the rheumatic diseases     Volume:  73     ISSN:  1468-2060     ISO Abbreviation:  Ann. Rheum. Dis.     Publication Date:  2014 Feb 
Date Detail:
Created Date:  2014-01-01     Completed Date:  2014-02-19     Revised Date:  2014-05-12    
Medline Journal Info:
Nlm Unique ID:  0372355     Medline TA:  Ann Rheum Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  391-5     Citation Subset:  IM    
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MeSH Terms
Arthritis, Rheumatoid / radiography*
Chronology as Topic
Databases, Factual
Disease Progression
Follow-Up Studies
Middle Aged
Observer Variation
Severity of Illness Index

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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