A comprehensive guideline for Bland–Altman and intra class correlation calculations to properly compare two methods of measurement and interpret findings

Abstract

The rapid emergence of new measurement instruments and methods requires personnel and researchers of different disciplines to know the correct statistical methods to utilize to compare their performance with reference ones and properly interpret findings. We discuss the often-made mistake of applying the inappropriate correlation and regression statistical approaches to compare methods and then explain the concepts of agreement and reliability. Then, we introduce the intraclass correlation as a measure of inter-rater reliability, and the Bland–Altman plot as a measure of agreement, and we provide formulae to calculate them along with illustrative examples for different types of study designs, specifically single measurement per subject, repeated measurement while the true value is constant, and repeated measurement when the true value is not constant. We emphasize the requirement to validate the assumptions of these statistical approaches, and also how to deal with violations and provide formulae on how to calculate the confidence interval for estimated values of agreement and intraclass correlation. Finally, we explain how to interpret and report the findings of these statistical analyses.