Repeated teaching courses of the modified Rodnan skin score in systemic sclerosis

Objective. To evaluate the efficacy of a repeated teaching process of the modified Rodnan skin score (MRSS) in systemic sclerosis (SSc). The question is whether a repeated teaching course is required to maintain good results after a first, successful teaching process. Methods. Two consecutive teaching courses were organised by two Romanian EUSTAR centres for the same rheumatologists, to evaluate and compare the inter-observer variability. Coefficients of variation, the intra-class correlation coefficients (ICC) and the within patient standard deviations were calculated. Results. The ICC showed good agreement between 12 participants of both the first teaching course (0.639) and of the course seven months later (0.684). Conclusion. For rheumatologists, a good ICC that is close to 0.7 can be achieved, and these results remain stable without the need for another, repeated teaching cycle. The high inter-rater variations seen in some patients demand that, in clinical studies, the same investigator should assess the same patient at each visit.