Multicriteria decision analysis methods with 1000Minds for developing systemic sclerosis classification criteria

Sindhu R. Johnson*, Raymond P. Naden, Jaap Fransen, Frank Van Den Hoogen, Janet E. Pope, Murray Baron, Alan Tyndall, Marco Matucci-Cerinic, Christopher P. Denton, Oliver Distler, Armando Gabrielli, Jacob M. Van Laar, Maureen Mayes, Virginia Steen, James R. Seibold, Phillip Clements, Thomas A. Medsger, Patricia E. Carreira, Gabriela Riemekasten, Lorinda ChungBarri J. Fessler, Peter A. Merkel, Richard Silver, John Varga, Yannick Allanore, Ulf Mueller-Ladner, Madelon C. Vonk, Ulrich A. Walker, Susanna Cappelli, Dinesh Khanna

*Corresponding author for this work
35 Citations (Scopus)


Objectives Classification criteria for systemic sclerosis (SSc) are being developed. The objectives were to develop an instrument for collating case data and evaluate its sensibility; use forced-choice methods to reduce and weight criteria; and explore agreement among experts on the probability that cases were classified as SSc. Study Design and Setting A standardized instrument was tested for sensibility. The instrument was applied to 20 cases covering a range of probabilities that each had SSc. Experts rank ordered cases from highest to lowest probability; reduced and weighted the criteria using forced-choice methods; and reranked the cases. Consistency in rankings was evaluated using intraclass correlation coefficients (ICCs). Results Experts endorsed clarity (83%), comprehensibility (100%), face and content validity (100%). Criteria were weighted (points): finger skin thickening (14-22), fingertip lesions (9-21), friction rubs (21), finger flexion contractures (16), pulmonary fibrosis (14), SSc-related antibodies (15), Raynaud phenomenon (13), calcinosis (12), pulmonary hypertension (11), renal crisis (11), telangiectasia (10), abnormal nailfold capillaries (10), esophageal dilation (7), and puffy fingers (5). The ICC across experts was 0.73 [95% confidence interval (CI): 0.58, 0.86] and improved to 0.80 (95% CI: 0.68, 0.90). Conclusions Using a sensible instrument and forced-choice methods, the number of criteria were reduced by 39% (range, 23-14) and weighted. Our methods reflect the rigors of measurement science and serve as a template for developing classification criteria.

Original languageEnglish
JournalJournal of clinical epidemiology
Issue number6
Pages (from-to)706-714
Number of pages9
Publication statusPublished - 06.2014

Research Areas and Centers

  • Academic Focus: Center for Infection and Inflammation Research (ZIEL)


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