How reliable is structured clinical history-takingin older adults with knee problems? Inter- and intraobserver variability of the KNE-SCI

Peat, George; Wood, Laurence; Wilkie, Ross; Thomas, Elaine; for the KNE-SCI Study Group,

doi:10.1016/S0895-4356(03)00204-X

« Previous Next »Journal of Clinical Epidemiology
Volume 56, Issue 11 , Pages 1030-1037, November 2003

How reliable is structured clinical history-takingin older adults with knee problems?

Inter- and intraobserver variability of the KNE-SCI

George Peat
- Correspondence author: Tel.: +44-(0)1782 583906; fax: +44-(0)1782 583911
Laurence Wood
Ross Wilkie
Elaine Thomas
for the KNE-SCI Study Group
- The KNE-SCI Study Group members are: Dr. Gordon Carpenter, Moorlands Medical Centre; Dr. Vince Cooper, Waterhouses Surgery; Professor Peter Croft, Primary Care Sciences Research Centre; Dr. Pete Dawes, Staffordshire Rheumatology Centre; Dr. Jane Greig, Moorlands Medical Centre; Dr. Andy Hassell, Staffordshire Rheumatology Centre; Dr. Elaine Hay, Staffordshire Rheumatology Centre & Primary Care Sciences Research Centre; Heather Lawton, Primary Care Sciences Research Centre; Dr. James Lee, Leek Health Centre; Dr. George Peat, Primary Care Sciences Research Centre; Dr. Mark Porcheret, John Kelso Practice & Primary Care Sciences Research Centre; Dr. Alyson Rees, Stockwell Surgery; Dr. Mike Shadforth, Staffordshire Rheumatology Centre; Dr. Elaine Thomas, Primary Care Sciences Research Centre.

Primary Care Sciences Research Centre, Keele University, Hornbeam Building, Staffordshire ST5 5BG, UK

Accepted 22 May 2003.

Abstract

Background and objectives

Clinical history and examination remain the cornerstones of diagnosis, prognosis, estimates of severity, and treatment selection in primary care for older adults presenting with knee pain. In this study we investigated the extent and cause of inter- and intraobserver variability of the clinical history using a structured, quantitative, clinical interview (KNE-SCI).

Methods

58 patients aged 50 years and over with current knee pain were independently interviewed by two trained observers and again by one of these observers a month later.

Results

Interobserver and intraobserver variability were found to be generally low [median agreement beyond chance (kappa)=0.71 (range: −0.03–1.00) and 0.58 (range: −0.03–1.00), respectively]. However, 9 of the 57 items demonstrated high inter- and intraobserver variability: notably subjective reports of swelling and specific aspects of pain experience and functional limitation.

Conclusion

Structured interview can reliably quantify certain clinically relevant aspects of the clinical history in older adults with knee pain, including those felt to be indicative of osteoarthritis. Its usefulness requires further investigation.

Keywords: Observer variability, Knee, Medical history taking