The aim of this study was to evaluate the inter-rater reliability of pulse-diagnosis as performed by Traditional Korean Medicine (TKM) clinicians. A total 658 patients with stroke who were admitted into Korean oriental medical university hospitals were included. Each patient was seen by two TKM-experts for an examination of the pulse signs – pulse diagnosis is regularly used by practitioners of TKM and Traditional Chinese Medicine (TCM), and is entirely different from what conventional doctors do when they feel the pulse of a patient. Inter-observer reliability was assessed using three methods: simple percentage agreement, the kappa value, and the AC(1) statistic. The kappa value indicated that the inter-observer reliability in evaluating the pulse signs ranged from poor to moderate, whereas the AC(1) analysis suggested that agreement between the two experts was generally high (with the exception of ‘slippery pulse’). The kappa value indicated that the inter-observer reliability was generally moderate to good (with the exceptions of ‘rough pulse’ and ‘sunken pulse’) and that the AC(1) measure of agreement between the two experts was generally high.ということで、Edzard Ernst:は、脈診を"だうじんぐマシン"と同類だと評した。
この研究の目的は、韓国伝統医学治療師によって実行される脈診の観察者間信頼性を評価することである。韓国東洋医大病院に入院した脳卒中患者658名を対象とした。各患者は2名の韓国伝統医学治療師によって脈診された。脈診は韓国伝統医学及び中国伝統医療で日常的に使われ、通常医療の医師が脈を診るのとは全く別物である。観察者間信頼性は、一致率と、カッパ統計量とAC(1)統計量を使って評価された。カッパ統計量は低〜中の脈状について観察者間信頼性を示し、AC(1)統計量は高い脈状(滑脈を除いて)の一致を示した。カッパ統計量は澁脈と沈脈を除き、観察者間信頼性が並〜良であることを示し、AC(1)統計量は2名の韓国伝統医学治療師の脈診の一致度が高いことを示した。
Based on these findings, the authors drew the following conclusion: “Pulse diagnosis is regarded as one of the most important procedures in TKM… This study reveals that the inter-observer reliability in making a pulse diagnosis in stroke patients is not particularly high when objectively quantified. Additional research is needed to help reduce this lack of reliability for various portions of the pulse diagnosis.”
これらの結果に基づき、著者たちは次のように結論した。「脈診は韓国伝統医学における最重要の手順の一つである。… 本研究は、客観的に評価すると、脳卒中患者についての脈診の観察者間信頼性が特に高くないことを示した。この脈診の信頼性の欠如の対策に、さらなる研究が必要である。」
This indicates, I think, that the researchers (who are themselves practitioners of TCM!) are not impressed with the inter-rater reliability of the most commonly used diagnostic tool in TCM/TKM. Imagine this to be true for a commonly used test in conventional medicine; imagine, for instance, that one doctor measuring your blood pressure produces entirely different readings than the next one. Hardly acceptable, don’t you think?
これは、思うに、（自身が韓国伝統医学治療師である）研究者たちは、韓国伝統医学や中国伝統医学で広く用いられている診断法の観察者間信頼性の低さに、何の印象も受けていないことを示している。これが、通常医療の診断法だったらどうだろうか？ 例えば、ある医者が計測した血圧値が、別の医師が計測した血圧値と全然違っていたら。それは、とても、受け入れられないだろう。
[Edzard Ernst: "Alternative diagnostic techniques: like bogus bomb-detectors?" (2014/05/13) on EdzardErnst.com]
In a way, invalid diagnostic tests are akin to bogus bomb-detectors: both are techniques to identify a problem.
ある意味、この使えない診断法は、いんちき爆発物検出器と同類である。いずれも問題があることがわかっている。
なお、その研究のAbstractは以下の通り:
Ko MM et al.:"Interobserver reliability of pulse diagnosis using Traditional Korean Medicine for stroke patients.", J Altern Complement Med. 2013 Jan;19(1):29-34.
OBJECTIVES:
The aim of this study was to evaluate the reliability between observers with regard to pulse signs that are observed by Traditional Korean Medicine (TKM) clinicians.
METHODS:
A total 658 patients with stroke who were admitted into Oriental medical university hospitals from February 2010 through December 2010 were included in this study. Each patient was seen independently by 2 experts from the same department for an examination of the pulse signs. Interobserver reliability was measured using three methods: simple percentage agreement, the κ value, and the AC(1) statistic.
RESULTS:
The κ value indicated that the interobserver reliability in evaluating the pulse signs of the subjects ranged from poor to moderate, whereas the AC(1) analysis revealed that agreement between the 2 experts was generally high (with the exception of slippery pulse). The κ value indicated that the interobserver reliability for assessing subjects who garnered the same opinion between the raters was generally moderate to good (with the exceptions of rough pulse and sunken pulse) and that the AC(1) measure of agreement between the 2 experts was generally high.
CONCLUSIONS:
Pulse diagnosis is regarded as one of the most important procedures in TKM, despite the aforementioned limitations. This study reveals that the interobserver reliability in making a pulse diagnosis in stroke patients is not particularly high when objectively quantified. Additional research is needed to help reduce this lack of reliability for various portions of the pulse diagnosis.
