AB0644 RESULTS OF A TRAINING COURSE FOR CALCULATION OF THE MODIFIED RODNAN SKIN SCORE IN SCLERODERMA
Authors: Gerçek Can, Aydan Köken Avşar, Sinem Burcu Kocaer, Gökçe Kenar, Dilek Solmaz, Handan Yarkan-Tuğsal, Duygu Temiz Karadağ, Neslihan Gökçen, Servet Yolbaş, Hakan Babaoglu, Alper Yıldırım, Müçteba Enes Yayla, İlyas Ercan Okatan, Alper Sarı, Didem arslan Taş, Fatos Onen, Süleyman Serdar Koca, Ali Akdoğan, Merih Birlik
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Scleroderma is a connective tissue disease that is characterized by fibrosis of the skin.The modified Rodnan Skin Score (mRSS) is a measure generally used to assess the skin thickness in patients with scleroderma.Data on the effectiveness of the mRSS training courses differ in the literature. <h3>Objectives:</h3> The objective of our study was to evaluate the effectiveness of the mRSS training course in rheumatology fellows in the rheumatology departments. <h3>Methods:</h3> The study included 6 fellows from the departments of rheumatology.Participants were given a 1-hour-long theoretical training, including dermal involvement, and mRSS assessment by 3 rheumatology experts experienced in scleroderma, which was followed by an applied training on 4 patients for one-hour.Participants scored two patients before and after training on a form, which included 17 domains with a total score-range between "0" and "51". Then using the SPSS15 software program, inter-rater reliability was assessed with intraclass correlation(<b>ICC</b>) analysis for both pre- and post-training mRSS.Fleiss' kappa was used to measure the degree of agreement according to 12 Rodnan score areas before and after the training. <h3>Results:</h3> The ICC value for pre-training and post-training total Rodnan scores was 0.867 (95% CI-0.625-1.00, P=0.05), and 0.905(95% CI 0.045-1.00, P=0.02), respectively. Individual analysis of score areas showed that after the training there was an increase in degree of agreement in some of these areas, while there was no difference in one area, and it decreased in others (Table 1). <h3>Conclusion:</h3> Several studies have demonstrated the applicability, reliability, and validity of mRSS, a measure of dermal involvement, and that evaluation of the score requires experience, and an attentive learning process.In the literature, the inter-rater ICC values during previous training courses are reported to range between 0.378 and 0.92(1). These studies show differences in terms of the number and experience of participants, number of patients, course-length, and repeated courses. Similar to the observation by Ionescu <i>et al</i>(2), the pre-training inter-observer ICC value was very high(0.867), and it increased to 0.905 after the training. Presence of an increase in some areas, and reduction in some others in individual analysis of areas after the training may suggests the need for repeated training. Our limitations were low number of participants and patients. We obtained very good inter-rater ICC values in the mRSS training course given to rheumatology fellows; however we may benefit from new studies for optimization of these conclusions by increasing the numbers of trainees, patients, and the lenght of courses. <h3>References</h3> [1] Czirjak, L., et al., the EUSTAR model for teaching and implementing the modified Rodnan skin score in systemic sclerosis. Ann Rheum Dis, 2007. [2] Ionescu, R., et al., Repeated teaching courses of the modified Rodnan skin score in systemic sclerosis. Clin Exp Rheumatol, 2010. <h3>Disclosure of interests:</h3> None declared