補綴歯科治療の難易度を測定するプロトコルの信頼性の検討 : (社)日本補綴歯科学会による多施設臨床研究  [in Japanese] A Multi-Centered Epidemiological Study Evaluating the Reliability of the Treatment Difficulty Indices Developed by the Japan Prosthodontic Society  [in Japanese]

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Abstract

<b>目的:</b>(社)日本補綴歯科学会は,補綴治療を行う患者の複雑な多様性を評価し,それをもとに難易度分類を行うことを目的に「補綴治療の難易度を測定するプロトコル」を新たに作成した.本研究では本プロトコルの内容を紹介するとともに,多施設臨床研究により本プロトコルの信頼性を検討した.<br><b>方法:</b>新たに作成した多軸診断プロトコルは,口腔内の形態学的状態,身体社会的状態,口腔関連QOL(OHIP-J54),精神心理学的状態の4つの診断軸からなる.それぞれグレード0(易しい)から3(難しい)の4段階評価を行う.日本補綴歯科学会の認定研修施設である大学病院補綴科5施設で,歯質もしくは歯列欠損に対し補綴治療が必要と判断された初診患者を連続サンプリングした.本プロトコルの妥当性を大規模なコホート研究により検討する前に信頼性の検討をテスト・リテスト法により行った.具体的には,同じ評価を約2週間の間隔をおいて2度行い,その結果の一致度を重み付けカッパ(<i>Kw</i>)値を算出することにより評価した.<br><b>結果と考察:</b>4つの診断軸のうち,口腔内の形態学的状態のテスト・リテスト一致度は,Landis and Koch<sup>1)</sup>の基準に照らすと「十分な一致」となった(全部歯列欠損群/部分歯列欠損群/歯質欠損群の平均<i>Kw</i>値:0.82/0.73/0.78).さらに,身体社会的状態(0.88),OHIP-J54総得点(0.74),精神心理学的状態(0.61)でも「十分な一致」もしくは「優秀な一致」となった.<br><b>結論:</b>補綴歯科治療の難易度を初めて多軸診断することに成功した本プロトコルは,臨床使用上十分な信頼性を示した.

<b> Purpose:</b> The diagnostic assessment of the level of difficulty in treating patients who need prosthodontic care is useful to establish a medicoeconomically efficient system with primary care dentists and prosthodontic specialists.<br><b>Methods:</b> A multi-axis assessment protocol was established using the newly established treatment difficultyindices. The protocol contains Axis I: oral physiological conditions (e.g., teeth damage and/or missingteeth); Axis II: general health and sociological conditions (e.g., medical disorders); Axis III: oral health-related quality of life (OHRQOL; e.g., oral health impact profile: OHIP); and Axis IV: psychological health (e.g., mood, anxiety, somatoform disorders). A preliminary study on the test-retest consistency of the protocol was conducted to check the levels of reliability of the indices prior to a large-scale, multi-center cohort study on the validity of the protocol.<br><b>Results:</b> The test-retest consistency in terms of the oral physiological condition (Axis I) after data reduction was 0.82 for patients with teeth problems, 0.73 for partially edentulous patients, and 0.78 for edentulous patients. The reliability for general health and sociological conditions (Axis II), OHRQOL (Axis III), and psychological health (Axis IV) were 0.88, 0.74, and 0.61, respectively. These values reflect either "sufficient agreement" or "excellent agreement" in accordance with the criteria established by Landis and Koch<sup>1)</sup>.<br><b>Conclusions:</b> This protocol is the first multi-axis assessment scheme introduced for prosthodontic treatment with sufficient reliability. This new system is therefore expected to have a significant impact on future dental diagnostic nomenclature systems.

Journal

  • Annals of Japan Prosthodontic Society

    Annals of Japan Prosthodontic Society 5(2), 224-239, 2013-04-10

    Japan Prosthodontic Society

References:  18

Codes

  • NII Article ID (NAID)
    10031171025
  • NII NACSIS-CAT ID (NCID)
    AA12374568
  • Text Lang
    JPN
  • Article Type
    ART
  • ISSN
    18834426
  • Data Source
    CJP  J-STAGE 
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