Diagnostic Accuracy and Concordance of Standardized vs. Non-Standardized Joint Physical Examination for Assessing Disease Activity in Rheumatoid Arthritis: A Paired Comparison Using Ultrasound as Reference Standard.

Conversely, when false negatives were regarded as more critical, the standardized examination again yielded a substantially higher average kappa (0.59, SE = 0.023) relative to the non-standardized method (0.45, SE = 0.027), with this difference being highly significant ( p < 0.0001) and a 95% confidence interval ranging from 0.07 to 0.21.

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Regarding joint swelling, in scenarios where false positives were prioritized, the average kappa for the standardized examination was 0.457 (SE = 0.023) compared with 0.40 (SE = 0.028) for the non-standardized examination; however, this difference did not reach statistical significance ( p = 0.08), as the 95% confidence interval (−0.007 to 0.112) included zero.

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