PulSe DIAgnOSIS AnD ClInICAl PRACTICe

There have been few studies that evaluate the reliability of the clinical use of pulse diagnosis despite it being a fundamental part of Oriental medicine diagnostics. The objective of this study was to determine the levels of intra-rater and inter-rater reliability of practitioners using an operationally defined method, Contemporary Chinese Pulse Diagnosis (CCPD), to evaluate the radial pulse of volunteer subjects. The study utilised a real-life design to investigate CCPD in a clinical setting. Fifteen volunteer subjects and six testers skilled in the CCPD method were recruited. Two episodes of data collection were conducted 28 days apart as a practical test and retest. For each subject, 30 pulse categories defined by the CCPD system were assessed and reassessed by the same four testers during both phases of testing. All assessments were conducted according to the CCPD method. Intra-rater reliability was measured by comparing individual tester results on day one with day two, while inter-rater agreement and reliability were determined by comparing all testers across both days. The data were analysed using Cohen’s kappa coefficient. Kappa values were interpreted according to recommendations from previous clinical studies and parameters considered acceptable when using a tool such as CCPD to assist in clinical diagnosis. Results for intra-rater reliability showed excellent agreement in 43.2%, moderate to good agreement in 42.5% and poor agreement in 14.3% of the raw kappa calculations. Inter-rater agreement demonstrated excellent agreement in 23.5%, moderate to good agreement in 46% and poor agreement in 30.5% of the raw kappa calculations. In conclusion, when the system of pulse diagnosis is operationally defined, acceptable levels of reliability can be achieved. Disagreement was either intrinsic to the subject or indicative of ambiguity within the CCPD system. Accordingly, review of the terminology of the appropriate pulse categories and their clinical reliability is recommended. K E y W O R D S pulse diagnosis, intra-rater reliability, inter-rater reliability, Chinese medicine, acupuncture, Cohen’s kappa coefficient, Contemporary Chinese Pulse Diagnosis.