scholarly journals Intra-Rater and Inter-Rater Reliability of Tongue Coating Diagnosis in Traditional Chinese Medicine Using Smartphones: Quasi-Delphi Study

10.2196/16018 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e16018 ◽  
Author(s):  
Zhi Chun Wang ◽  
Shi Ping Zhang ◽  
Pong Chi Yuen ◽  
Kam Wa Chan ◽  
Yi Yi Chan ◽  
...  
Keyword(s):  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Delphi Method ◽  
Delphi Study ◽  
Classification Scheme ◽  
Tongue Coating ◽  
Rater Reliability ◽  
Tongue Diagnosis ◽  
Image Inspection ◽  
Image Set

Background There is a growing trend in the use of mobile health (mHealth) technologies in traditional Chinese medicine (TCM) and telemedicine, especially during the coronavirus disease (COVID-19) outbreak. Tongue diagnosis is an important component of TCM, but also plays a role in Western medicine, for example in dermatology. However, the procedure of obtaining tongue images has not been standardized and the reliability of tongue diagnosis by smartphone tongue images has yet to be evaluated. Objective The first objective of this study was to develop an operating classification scheme for tongue coating diagnosis. The second and main objective of this study was to determine the intra-rater and inter-rater reliability of tongue coating diagnosis using the operating classification scheme. Methods An operating classification scheme for tongue coating was developed using a stepwise approach and a quasi-Delphi method. First, tongue images (n=2023) were analyzed by 2 groups of assessors to develop the operating classification scheme for tongue coating diagnosis. Based on clinicians’ (n=17) own interpretations as well as their use of the operating classification scheme, the results of tongue diagnosis on a representative tongue image set (n=24) were compared. After gathering consensus for the operating classification scheme, the clinicians were instructed to use the scheme to assess tongue features of their patients under direct visual inspection. At the same time, the clinicians took tongue images of the patients with smartphones and assessed tongue features observed in the smartphone image using the same classification scheme. The intra-rater agreements of these two assessments were calculated to determine which features of tongue coating were better retained by the image. Using the finalized operating classification scheme, clinicians in the study group assessed representative tongue images (n=24) that they had taken, and the intra-rater and inter-rater reliability of their assessments was evaluated. Results Intra-rater agreement between direct subject inspection and tongue image inspection was good to very good (Cohen κ range 0.69-1.0). Additionally, when comparing the assessment of tongue images on different days, intra-rater reliability was good to very good (κ range 0.7-1.0), except for the color of the tongue body (κ=0.22) and slippery tongue fur (κ=0.1). Inter-rater reliability was moderate for tongue coating (Gwet AC2 range 0.49-0.55), and fair for color and other features of the tongue body (Gwet AC2=0.34). Conclusions Taken together, our study has shown that tongue images collected via smartphone contain some reliable features, including tongue coating, that can be used in mHealth analysis. Our findings thus support the use of smartphones in telemedicine for detecting changes in tongue coating.

scholarly journals Intra-Rater and Inter-Rater Reliability of Tongue Coating Diagnosis in Traditional Chinese Medicine Using Smartphones: Quasi-Delphi Study (Preprint)

2019 ◽  
Author(s):  
Zhi Chun Wang ◽  
Shi Ping Zhang ◽  
Pong Chi Yuen ◽  
Kam Wa Chan ◽  
Yi Yi Chan ◽  
...  
Keyword(s):  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Delphi Method ◽  
Delphi Study ◽  
Classification Scheme ◽  
Tongue Coating ◽  
Rater Reliability ◽  
Tongue Diagnosis ◽  
Image Inspection ◽  
Image Set

BACKGROUND There is a growing trend in the use of mobile health (mHealth) technologies in traditional Chinese medicine (TCM) and telemedicine, especially during the coronavirus disease (COVID-19) outbreak. Tongue diagnosis is an important component of TCM, but also plays a role in Western medicine, for example in dermatology. However, the procedure of obtaining tongue images has not been standardized and the reliability of tongue diagnosis by smartphone tongue images has yet to be evaluated. OBJECTIVE The first objective of this study was to develop an operating classification scheme for tongue coating diagnosis. The second and main objective of this study was to determine the intra-rater and inter-rater reliability of tongue coating diagnosis using the operating classification scheme. METHODS An operating classification scheme for tongue coating was developed using a stepwise approach and a quasi-Delphi method. First, tongue images (n=2023) were analyzed by 2 groups of assessors to develop the operating classification scheme for tongue coating diagnosis. Based on clinicians’ (n=17) own interpretations as well as their use of the operating classification scheme, the results of tongue diagnosis on a representative tongue image set (n=24) were compared. After gathering consensus for the operating classification scheme, the clinicians were instructed to use the scheme to assess tongue features of their patients under direct visual inspection. At the same time, the clinicians took tongue images of the patients with smartphones and assessed tongue features observed in the smartphone image using the same classification scheme. The intra-rater agreements of these two assessments were calculated to determine which features of tongue coating were better retained by the image. Using the finalized operating classification scheme, clinicians in the study group assessed representative tongue images (n=24) that they had taken, and the intra-rater and inter-rater reliability of their assessments was evaluated. RESULTS Intra-rater agreement between direct subject inspection and tongue image inspection was good to very good (Cohen κ range 0.69-1.0). Additionally, when comparing the assessment of tongue images on different days, intra-rater reliability was good to very good (κ range 0.7-1.0), except for the color of the tongue body (κ=0.22) and slippery tongue fur (κ=0.1). Inter-rater reliability was moderate for tongue coating (Gwet AC2 range 0.49-0.55), and fair for color and other features of the tongue body (Gwet AC2=0.34). CONCLUSIONS Taken together, our study has shown that tongue images collected via smartphone contain some reliable features, including tongue coating, that can be used in mHealth analysis. Our findings thus support the use of smartphones in telemedicine for detecting changes in tongue coating.

scholarly journals Standardization of Syndrome Differentiation Defined by Traditional Chinese Medicine in Operative Breast Cancer: A Modified Delphi Study

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Qianqian Guo ◽  
Qianjun Chen
Keyword(s):  
Breast Cancer ◽  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Delphi Method ◽  
Delphi Study ◽  
Literature Search ◽  
Syndrome Differentiation ◽  
Response Ratio ◽  
Modified Delphi ◽  
E Mail

Objective. The aim of this study was to establish the standardization of syndrome differentiation of operative breast cancer treated with Traditional Chinese Medicine (TCM) by the modified Delphi method.Method. A literature search for standardization of syndrome differentiation of operative breast cancer was conducted and eligible articles were identified in indexed databases from 1982 to 2013. We carried out two rounds of investigation between March and October 2013 and organized 20 experts who focused on TCM or integrative medicine in breast cancer research. Experts’ judgments were collectedviaposted questionnaires or e-mail. A final evaluation was carried out after the end of both rounds.Result. The response ratio of the 1st round investigation reached 100%, and two experts were excluded due to the uncompleted questionnaire. The 2nd round investigation was completed by 18 experts in the 1st round panel board. In both rounds, the experts agreed that the stage of breast cancer defined by TCM could be divided into the perioperation period, the perichemotherapy period, the periradiotherapy period, and the consolidation period.Conclusion. We identified the feasibility and reasonability to establish the standardization of syndrome differentiation of operative breast cancer. According to the suggestions from experts in our Delphi study, we preliminarily established the TCM standard of syndrome differentiation based on different treatment stages of operative breast cancer.

scholarly journals Development and Validation of Liver Depression Type Infertility Quality of Life Scale Based on Traditional Chinese Medicine

2020 ◽  
Author(s):  
Ying Wang ◽  
Chang Liu ◽  
Xuan Wang ◽  
Mengpei Zhang ◽  
Zhiheng Wang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Delphi Method ◽  
Reliability And Validity ◽  
Scale Evaluation ◽  
Quality Scale ◽  
Quality Of Life Scale ◽  
Life Scale

Abstract Background Traditional Chinese medicine (TCM) liver depression infertility quality of life scale is developed to provide a scientific and reliable tool for TCM treatment and intervention in the treatment of liver depression patients with infertility, as well as basis and assistance for clinical decision-making.Methods Literature research method: Through the retrieval of Chinese knowledge network (CNKI), Wanfang (WANFANG), Vip (VIP), Springer, PubMed database of existing Chinese life quality scale and infertility dedicated quality of life scale, an entry pool is built with symptoms, emotional state, social function state and satisfaction as dimensions. Using the Delphi method to screen the entries. Screening entries according to the results of expert review, and evaluating the positive degree coefficient, authority degree and coordination coefficient by the experts. Using the clinical questionnaire method to screen the entries further. To form the Chinese medicine liver depression infertility life of quality scale. Scale evaluation: the reliability and validity of the scale were evaluated based on the results of the clinical questionnaire. Results After two rounds of Delphi method, there are 33 entries remained. The clinical questionnaire rescreened entries, formed the traditional Chinese medicine liver depression infertility quality of life scale containing 4 dimensions of symptoms, emotional states, social function states and satisfaction, with total of 29 entries and VAS score scale. Evaluation results: the Kronbach alpha coefficients performed well in total and each aspect. The validity of the scale: the structural efficiency evaluation results are in good agreement with the scale structure envisioned at the time of design. The relationship between the quality of life scale and the standard scale (FertiQoL International2008) showed a high absolute value.Conclusion In this study, the quality of life scale of Chinese medicine liver depression type infertility was developed by literature research, Delphi method and clinical questionnaire, with good reliability and validity of the scale evaluated. It could be used as a tool for efficacy judgment tool or quality of life evaluation in Chinese medicine treatment or intervention for patients with liver depression infertility.

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