Joshua W Little1, Thomas J Grieve2, Gregory D Cramer3, Jeffrey A Rich4, Evelyn E Laptook5, Joseph P D Stiefel6, Kathleen Linaker7. 1. Assistant Professor, Center for Anatomical Science and Education, Department of Surgery, Saint Louis University School of Medicine, St Louis, MO. 2. Instructor, Department of Clinical Sciences, National University of Health Sciences, Lombard, IL. 3. Professor and Dean of Research, Research Department, National University of Health Sciences, Lombard, IL. Electronic address: gcramer@nuhs.edu. 4. Radiologist, Northwestern Health Sciences University, Bloomington, MN. 5. Assistant Professor, National University of Health Sciences, Lombard, IL. 6. President, National University of Health Sciences, Lombard, Ill. 7. Dean, Center for Life and Health Sciences, Mohawk Valley Community College, Utica, NY.
Abstract
OBJECTIVE: This study tested the reliability of a 5-point ordinal scale used to grade the severity of degenerative changes of zygapophyseal (Z) joints on standard radiographs. METHODS: Modifications were made to a Kellgren grading system to improve agreement for grading the severity of osteoarthritic changes in lumbar Z joints. These included adding 1 grade of no degeneration, multiple radiographic views, and structured examiner training. Thirty packets of radiographic files were obtained, which included representation of all 5 grades including no degeneration (0) and Kellgren's 4-point (1-4) joint degeneration classification criteria. Radiographs were digitized to create a radiographic atlas that was given to examiners for individual study and blinded evaluation sessions. Intrarater and interrater agreement was determined by weighted κ (κw) from the examination of 79 Z joints (25 packets). RESULTS: Using the modified scale and after training, examiners demonstrated a moderate-to-substantial level of interrater agreement (κw = 0.57, 0.60, and 0.68). Intrarater agreement was moderate (κw = 0.42 and 0.54). CONCLUSIONS: The modified Kellgren 5-point grading system provides acceptable intrarater and interrater reliability when examiners are adequately trained. This grading system may be a useful method for future investigations assessing radiographic osteoarthritis of the Z joints.
OBJECTIVE: This study tested the reliability of a 5-point ordinal scale used to grade the severity of degenerative changes of zygapophyseal (Z) joints on standard radiographs. METHODS: Modifications were made to a Kellgren grading system to improve agreement for grading the severity of osteoarthritic changes in lumbar Z joints. These included adding 1 grade of no degeneration, multiple radiographic views, and structured examiner training. Thirty packets of radiographic files were obtained, which included representation of all 5 grades including no degeneration (0) and Kellgren's 4-point (1-4) joint degeneration classification criteria. Radiographs were digitized to create a radiographic atlas that was given to examiners for individual study and blinded evaluation sessions. Intrarater and interrater agreement was determined by weighted κ (κw) from the examination of 79 Z joints (25 packets). RESULTS: Using the modified scale and after training, examiners demonstrated a moderate-to-substantial level of interrater agreement (κw = 0.57, 0.60, and 0.68). Intrarater agreement was moderate (κw = 0.42 and 0.54). CONCLUSIONS: The modified Kellgren 5-point grading system provides acceptable intrarater and interrater reliability when examiners are adequately trained. This grading system may be a useful method for future investigations assessing radiographic osteoarthritis of the Z joints.
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