Abstract
Background: Ayurveda is a traditional Indian system of medicine. The customized Ayurvedic approach consists of a combination of several diagnostic procedures and subsequent individualized therapeutic interventions. Evaluation of inter-rater reliability (IRR) of Ayurvedic diagnoses has rarely been performed. The aim of this study was to evaluate IRR of Ayurvedic diagnosis for patients with knee osteoarthritis.Methods: A diagnostic reliability study of 30 patients and 4 Ayurvedic experts was nested in a randomized controlled trial. Patients were diagnosed in a sequential order by all experts utilizing a semistructured patient history form. A nominal group technique as consensus procedure was performed to reach agreement on the items to be diagnosed. An IRR analysis using Fleiss' and Cohen's kappa statistics was performed to determine a chance-corrected measure of agreement among raters.Results: One hundred and twenty different ratings and 30 consensus ratings were performed and analyzed. While high percentages of agreement for main diagnostic entities and the final Ayurveda diagnosis (95% consensus agreement on main diagnosis) could be observed, this was not reflected in the corresponding kappa values, which largely yielded fair-to-poor inter-rater agreement kappas for central diagnostic aspects such as prakriti and agni (κ values between 0 and 0.4). Notably, agreement on disease-related entities was better than that on constitutional entities.Conclusions: This is the first diagnostic study embedded in a clinical trial on patients with knee osteoarthritis utilizing a multimodality whole systems approach. Results showed a contrast between the high agreement of the consented final diagnosis and disagreement on certain diagnostic details. Future diagnostic studies should have larger sample sizes and a methodology more tailored to the specificities of traditional whole systems of medicine. Equal emphasis will need to be placed on all core diagnostic components of Ayurveda, both constitutional and disease specific, using detailed structured history taking forms.
Highlights
Ayurveda is a traditional Indian system of medicine
Future diagnostic studies should have larger sample sizes and a methodology more tailored to the specificities of traditional whole systems of medicine
Equal emphasis will need to be placed on all core diagnostic components of Ayurveda, both constitutional and disease specific, using detailed structured history taking forms
Summary
Ayurveda is a traditional Indian system of medicine. The customized Ayurvedic approach consists of a combination of several diagnostic procedures and subsequent individualized therapeutic interventions. Ayurveda is the most common traditional system of medicine of India and has a significant impact on the health economy.[1,2,3] Its popularity is recently increasing in the West due to its person-centered approaches.[4,5,6,7] Its main concern is the maintenance of an abiding health, preventing as well as treating diseases. The factors determining resilience in an individual are conceived in Ayurveda as relative balance/imbalance between the functional principles called dosha, which are as follows: vata, pitta, and kapha. Vata dosha is related to the concept of movement/kinetics, pitta dosha to the concept of transformation/metabolism, and kapha dosha to the concept of cohesion/anabolism[16] (Supplementary Data S1). Additional essential paradigmatic elements are agni, the digestive and metabolic principle, mala, the physiologic waste products, ama, the result of dysmetabolism and digestive errors along with defective transformation of the body tissues termed dhatu.[17]
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