TY - JOUR T1 - Autofeedback from Ultrasound Images Provides Rapid Improvement in Palpation Skills for Identifying Joint Swelling in Rheumatoid Arthritis JF - The Journal of Rheumatology JO - J Rheumatol SP - 1207 LP - 1214 DO - 10.3899/jrheum.111433 VL - 39 IS - 6 AU - MICHIHIRO OGASAWARA AU - GO MURAYAMA AU - YUSUKE YAMADA AU - TAKUYA NEMOTO AU - MICHIAKI KAGEYAMA AU - SHOKO TOYAMA AU - MAKIO KUSAOI AU - SHIN ONUMA AU - TAKAYUKI KON AU - FUMIO SEKIYA AU - KAORU SUGIMOTO AU - RAN MATSUDAIRA AU - MASAKAZU MATSUSHITA AU - KURISU TADA AU - KAZUO KEMPE AU - KEN YAMAJI AU - NAOTO TAMURA AU - YOSHINARI TAKASAKI Y1 - 2012/06/01 UR - http://www.jrheum.org/content/39/6/1207.abstract N2 - Objective. Joint swelling, an important factor in the classification criteria and disease activity assessment in rheumatoid arthritis (RA), renders joint palpation a necessary skill for physicians. Ultrasound (US) examination that visualizes soft tissue abnormalities is now used to assess musculoskeletal disease. We assessed the usefulness of US assessments in enhancing physical joint examination skills. Methods. We examined 1944 joints (bilateral shoulder, elbow, wrist, metacarpophalangeal joints 1–5, and knee joints) in 108 patients with RA during April–July 2011. We first physically examined and confirmed joint swelling; subsequently, the same rheumatologist conducted US examinations and multiple assessors graded the joint swelling. When the 2 results differed, we received autofeedback from the US results to improve the physical examination skills. Results. The sensitivities and specificities of physical examination for US-detected swollen joint, the correlation coefficient (CC) of the swollen joint counts, and the concordance rate in each patient for joint swelling sites and power Doppler (PD)-positive sites with the κ coefficients between the physical and US examinations were compared over time. We found that the sensitivity of physical examination increased by 42 percentage points (pp), while the specificity decreased by 18 pp. The average CC in June–July was greater than that in April–May. The percentage of κ coefficients > 0.8 increased from 8.8% to 17% for joint swelling and from 8.3% to 14% for PD-positive sites. Conclusion. Our results suggest that autofeedback from US assessment provides quick improvement in palpation skills for identifying joint swelling in patients with RA. ER -