Examiner Reliability of RDC/TMD Protocol for Multisite OPPERA Study

Objectives: The operationalized procedures of the RDC/TMD were designed to enhance examiner reliability in order to support diagnostic validity. To date, examiner reliability studies worldwide have demonstrated that adequately trained and calibrated examiners can achieve acceptable levels in performing the RDC/TMD examination. As part of a multisite study designed to assess risk factors of a clinical pain condition (see www.oppera.org), examiners were trained in a 15-20 minute protocol, with the aim of determining whether new training procedures that evolved from the RDC Reliability and Validity multi-site study would improve reliability from acceptable to excellent.

Methods: Four naïve examiners and four expert dentists participated in the training, calibration, and multiple reliability studies that also included a gold standard examiner. Two reliability studies, at one year interval, were conducted for reliability of the naïve examiners; in between, each naïve examiner and expert dentist pair participated in separate studies. A total of 92 subjects were used. Each study incorporated a rest period between examinations. Reliability (case vs non-case; myalgia; arthralgia) was assessed with Kappa statistic.

Results: The first annual calibration of examiners resulted in overall Kappa of 0.87 for classifying cases vs non-cases, with myalgia and arthralgia reliabilities at 0.83 and 0.67, respectively. Individual site calibrations resulted in Kappa of 0.9 to 1.0 in comparing each examiner-dentist pair for distinguishing cases from non-cases, and the consensus from each examiner-dentist pair, compared to the reference examiner, was 1.0 for three of the pairs. The second annual calibration resulted in notably improved Kappa of 1.0 for classifying cases vs non-cases, of 1.0 for myalgia, and 0.95 for arthralgia.

Conclusions: Systematic training and calibration protocols can yield excellent levels of reliability for distinguishing cases from non-cases and for assessing myalgia and arthralgia.

Supported by NIH NIDCR grant U01-DE17018