Reliability testing of the Larsen and Sharp classifications for rheumatoid arthritis of the elbow

Nicholas B. Jew, Anthony M. Hollins, Benjamin M. Mauck, Richard Smith, Frederick M. Azar, Robert H. Miller, Thomas W. Throckmorton

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Abstract

Background Two popular systems for classifying rheumatoid arthritis affecting the elbow are the Larsen and Sharp schemes. To our knowledge, no study has investigated the reliability of these 2 systems. We compared the intraobserver and interobserver agreement of the 2 systems to determine whether one is more reliable than the other. Methods The radiographs of 45 patients diagnosed with rheumatoid arthritis affecting the elbow were evaluated. Anteroposterior and lateral radiographs were deidentified and distributed to 6 evaluators (4 fellowship-trained upper extremity surgeons and 2 orthopedic trainees). Each evaluator graded all 45 radiographs according to the Larsen and Sharp scoring methods on 2 occasions, at least 2 weeks apart. Results Overall intraobserver reliability was 0.93 (95% confidence interval [CI], 0.90-0.95) for the Larsen system and 0.92 (95% CI, 0.86-0.96) for the Sharp classification, both indicating substantial agreement. Overall interobserver reliability was 0.70 (95% CI, 0.60-0.80) for the Larsen classification and 0.68 (95% CI, 0.54-0.81) for the Sharp system, both indicating good agreement. There were no significant differences in the intraobserver or interobserver reliability of the systems overall and no significant differences in reliability between attending surgeons and trainees for either classification system. Conclusion The Larsen and Sharp systems both show substantial intraobserver reliability and good interobserver agreement for the radiographic classification of rheumatoid arthritis affecting the elbow. Differences in training level did not result in substantial variances in reliability for either system. We conclude that both systems can be reliably used to evaluate rheumatoid arthritis of the elbow by observers of varying training levels.

Original languageEnglish (US)
Pages (from-to)140-143
Number of pages4
JournalJournal of Shoulder and Elbow Surgery
Volume26
Issue number1
DOIs
StatePublished - Jan 1 2017

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Elbow
Rheumatoid Arthritis
Confidence Intervals
Upper Extremity
Research Design

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

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Reliability testing of the Larsen and Sharp classifications for rheumatoid arthritis of the elbow. / Jew, Nicholas B.; Hollins, Anthony M.; Mauck, Benjamin M.; Smith, Richard; Azar, Frederick M.; Miller, Robert H.; Throckmorton, Thomas W.

In: Journal of Shoulder and Elbow Surgery, Vol. 26, No. 1, 01.01.2017, p. 140-143.

Research output: Contribution to journalArticle

Jew, Nicholas B. ; Hollins, Anthony M. ; Mauck, Benjamin M. ; Smith, Richard ; Azar, Frederick M. ; Miller, Robert H. ; Throckmorton, Thomas W. / Reliability testing of the Larsen and Sharp classifications for rheumatoid arthritis of the elbow. In: Journal of Shoulder and Elbow Surgery. 2017 ; Vol. 26, No. 1. pp. 140-143.
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