Interrater reliability of diagnostic methods in traditional Indian ayurvedic medicine.

This study assesses the interrater reliability of Ayurvedic pulse (nadi), tongue (jivha), and body constitution (prakriti) assessments. Fifteen registered Ayurvedic doctors with 3-15 years of experience independently examined twenty healthy subjects. Subjects completed self-assessment questionnaires and software analyses for prakriti assessment. Weighted kappa statistics for all 105 pairs of doctors were computed for the pulse, tongue, and prakriti data sets. According to the Landis-Koch scale, the pairwise kappas ranged from poor to slight, slight to fair, and fair to moderate for pulse, tongue, and prakriti assessments, respectively. The average pairwise kappa for pulse, tongue, and prakriti was 0.07, 0.17, and 0.28, respectively. For each data set and pair of doctors, the null hypothesis of random rating was rejected for just twelve pairs of doctors for prakriti, one pair of doctors for pulse examination, and no pairs of doctors for tongue assessment. Thus, the results demonstrate a low level of reliability for all types of assessment made by doctors. There was significant evidence against random rating by software and questionnaire use and by the diagnosis preferred by the majority of doctors. Prakriti assessment appears reliable when questionnaire and software assessment are used, while other diagnostic methods have room for improvement.

Reliability studies of diagnostic methods in Indian traditional Ayurveda medicine: An overview.

Recently, a need to develop supportive new scientific evidence for contemporary Ayurveda has emerged. One of the research objectives is an assessment of the reliability of diagnoses and treatment. Reliability is a quantitative measure of consistency. It is a crucial issue in classification (such as prakriti classification), method development (pulse diagnosis), quality assurance for diagnosis and treatment and in the conduct of clinical studies. Several reliability studies are conducted in western medicine. The investigation of the reliability of traditional Chinese, Japanese and Sasang medicine diagnoses is in the formative stage. However, reliability studies in Ayurveda are in the preliminary stage. In this paper, examples are provided to illustrate relevant concepts of reliability studies of diagnostic methods and their implication in practice, education, and training. An introduction to reliability estimates and different study designs and statistical analysis is given for future studies in Ayurveda.

Intrarater and interrater reliability of pulse examination in traditional Indian Ayurvedic medicine.

BACKGROUND: In Ayurveda, pulse examination (nadipariksha) is an important tool to assess the status of three doshas: vata, pitta, and kapha. Long historical use has been seen as a documentation of its efficacy; however, there is a lack of a quantitative measure of the reliability of the pulse examination method. The objective of this study was to test the intrarater and interrater reliability of pulse examination in Ayurveda. METHODS: Fifteen registered Ayurvedic doctors with 3-15 years of experience examined the pulse of 20 healthy volunteers twice, for a total of 600 examinations. The examinations were performed blind and in a random order. Only the current status of dosha-specific methods of pulse examination were considered. Cohen's weighted κ statistic was used as a measure of intrarater and interrater reliability, and a hypothesis of homogeneous diagnosis (random rating) was tested. Following this, we tested whether proportions of ratings were equal between doctors. RESULTS: According to the Landis and Koch scale, the level of reliability ranged from poor to moderate. It was observed that the doctors more frequently diagnosed a combination of two doshas than a single dosha. The κ values were generally larger for experienced doctors (p = 0.04). CONCLUSION: Experience and proper training have important roles in pulse examination.

Repeatability of Pulse Diagnosis and Body Constitution Diagnosis in Traditional Indian Ayurveda Medicine.

In Ayurveda, pulse diagnosis and body constitution diagnosis have a long historical use; still, there is lack of quantitative measure of the reliability of these diagnostic methods. Reliability means consistency of information. Consistent diagnosis leads to consistent treatment and is important for clinical practice, education, and research. The objective of this study is to study the methodology to evaluate the test-retest reliability (repeatability) of pulse diagnosis and body constitution diagnosis. A double-blinded, controlled, clinical trial was conducted in Copenhagen. The same doctor, an expert in Ayurvedic pulse diagnosis, examined the pulse and body constitution of 17 healthy participants twice, in random order without seeing them. A metric on pulse and body constitution variables was developed. Cohen's weighted kappa statistic was used as a measure of intra-rater reliability. Permutation tests were used to test the hypothesis of homogeneous diagnosis (ie, the doctor's diagnosis does not depend on the subject). The hypothesis of homogeneous classification was rejected on the 5% significance level (P values of .02 and .001, respectively, for pulse and body constitution diagnosis). According to the Landis and Koch scale, values of the weighted kappa for pulse diagnosis (P = .42) and body constitution diagnosis (P = .65) correspond to "moderate" and "substantial" agreement, respectively. There was a reasonable level of consistency between 2 pulse and body constitution diagnoses. Further studies are required to quantify inter-subject and intra-subject agreement for greater understanding of reliability of pulse and body constitution diagnosis.

La medicina ayurvédica lleva mucho tiempo utilizando el diagnóstico mediante el pulso y la constitución corporal; no obstante, se sigue careciendo de medidas cuantitativas de la fiabilidad de estos métodos diagnósticos, la cual implica uniformidad de la información. Un diagnóstico coherente lleva a un tratamiento uniforme y resulta de gran importancia para la práctica clínica, la educación y la investigación.El objetivo de este estudio, un ensayo clínico controlado doble ciego llevado a cabo en Copenhagen, es analizar la metodología para evaluar la fiabilidad (repetibilidad) del diagnóstico mediante el pulso y la constitución corporal. El mismo médico, un experto en el diagnóstico ayurvédico mediante el pulso, examinó en dos ocasiones el pulso y la constitución corporal de 17 participantes sanos, en orden aleatorio y sin verlos. Se desarrolló una escala de medida de las variables de pulso y constitución corporal. Como método de la fiabilidad en el mismo evaluador se usó el valor estadístico kappa ponderada de Cohen y se usaron pruebas de permutación para probar la hipótesis de la homo-geneidad del diagnóstico (es decir, el diagnóstico del médico no depende del paciente).La hipótesis de la homogeneidad de la clasificación se rechazó al nivel de significación del 5 % (P valor de 0,02 y 0,001, respectivamente, para el diagnóstico medi-ante el pulso y la constitución corporal). Conforme a las escalas de Landis y Koch, los valores de kappa ponderada para el diagnóstico mediante el pulso (P = 0,42) y medi-ante la constitución corporal (P = 0,65) se corresponden con una concordancia "moderada" y "sustancial", respectivamente.Se produjo un nivel de uniformidad razonable entre los dos diagnósticos mediante constitución corporal y pulso, aunque se requieren más estudios para cuantificar la concordancia inter e intrapacientes con el objetivo de obtener una mayor comprensión de la fiabilidad.