AB0774 Impact of standardised education program on the accuracy of modified rodnan skin scoring in patients with systemic sclerosis
Authors: J.W. Park, J.-B. Jun, L. Czirják, Y. Allanore, M. Matucci-Cerinic, E.B. Lee
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Modified Rodnan skin score (mRSS) has been used as not only a primary outcome in many clinical trials, but also as an important surrogate marker of disease activity in patients with systemic sclerosis (SSc). Therefore, establishment of well-organised training program of mRSS is essential for the proper management of patients. Recently, Scleroderma Clinical Trials Consortium and the World Scleroderma Foundation published the recommendation for 2-phase mRSS training and emphasised assessing scoring accuracy after the training. <h3>Objectives</h3> To investigate the effect of modified Rodnan skin scoring (mRSS) education on improving its accuracy <h3>Methods</h3> Ten rheumatologists (6 professors and 4 fellows) received an education program composed of video education and live demonstration by master instructor (Marco Matucci-Cerinic) at (Seoul in June, 2017). Physicians measured mRSS of 8 patients with SSc 1) before the education, 2) after the video education and 3) after live demonstration without any clinical information of the patients. Accuracy of skin scoring was estimated by the difference from the pre-defined gold-standard score measured by master instructor. Change in accuracy of mRSS during the education course was analysed using linear mixed model. Intra-observer reliability of the mRSS and its change was assessed by intraclass correlation coefficient (ICC). <h3>Results</h3> The number of SSc patients ever experienced by each physician was significantly higher in the professors than fellows but the number of mRSS ever performed was comparable between the two groups. Median (IQR) skin score measured by master instructor was 10.5 (9.0). Mean (SD) difference between skin scores by physicians and master instructor was 7.7 (9.5) units. In the univariable analysis, video education significantly reduced the difference from the gold-standard score (β=−1.96, 95% CI −3.83 to −0.10) whereas live demonstration did not showed additional enhancement in scoring skill. Effect of education program was significantly different according to the physician's status and patient's disease type (diffuse vs. limited). In addition, male patient, shorter disease duration and higher gold-standard skin score was associated with more accurate skin scoring irrespective of the education. In the multivariable analysis where above clinical factors were adjusted, video education also led to significantly accurate skin scoring (table 1). When the educational effect was stratified by individual site of examination, face and distal extremities showed greater enhancement of scoring accuracy whereas difference from gold-standard score in proximal extremities was rather increased. ICC of physicians' skin scores was acceptable over all scoring times (0.63 to 0.88) but was not significantly changed after the education. <h3>Conclusions</h3> The mRSS education program can significantly enhance the accuracy of mRSS, which is mainly achieved by video education. <h3>Reference</h3> [1] Khanna D, Furst DE, Clements PJ, et al. Standardization of the modified Rodnan skin score for use in clinical trials of systemic sclerosis. J Scleroderma Relat Disord2017;2(1):11–18. doi: 10.5301/jsrd.5000231 <h3>Disclosure of Interest</h3> None declared