Sunday, 5 August 2018

Using a new interrater reliability method to test the modified Oulu Patient Classification instrument in home health care: Common mistakes and methodological issue

Mohammad Aghajani 1, 2, Fatemeh Sadat Asgarian 3*

1.      Lecturer, Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
2.      Phd Candidate, Student Research Committee, Kashan University of Medical Sciences, Kashan, IR Iran.
3.      Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran

Keywords: home health care, Reliability, nursing intensity

I read the study conducted by Jill Flo and colleagues published in the January 2018issue of nursing open (Flo J, 2018). The authors tried to evaluate to test the interrater reliability of the modified Oulu Patient Classification instrument, using a multiple parallel classification method based on oral case presentations in home health care in Norway (Flo J, 2018). They used Kappa coefficient in their analysis (Flo J, 2018), which is one of the common mistakes in reliability or reproducibility analysis repeatability, or precision is being assessed by different statistical tests such as Kappa coefficients, which is one of the common mistakes in reliability analysis. Two major weaknesses of the kappa value to assess agreement of a qualitative variable are as follows: It depending on the prevalence in each stratum, which means, it can be possible to have a different kappa value having the same percentage for both concordant and discordant cells. The kappa value also depends on the number of stratums, which means the higher the number of stratums; the more kappa value is less (Rothman KJ, 2010, Lawrence I, 1998). Generally, for quantitative variable, Intra Class Correlation Coefficient (ICC), and for qualitative variables, weighted kappa should be used with caution because simple kappa has its own limitation (Lawrence I, 1998; M.SzKlo, 2007).In conclusion, for reproducibility or precision analysis; appropriate tests should be applied by researchers.

Conflict of interest:
The author reports no conflicts of interest.

Corresponding Author:
*Corresponding Author: Fatemeh Sadat Asgarian Address: IRAN/Kashan, Ghotb Ravandi Highway, Kashan University of Medical Sciences, Faculty of Nursing and midwifery, Iran.
Tel: +983155540021
Fax: +983155546633
E mail:


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