Low inter-rater reliability in traditional Chinese medicine for female infertility

Background Treatment of patients according to individual pattern diagnoses is an important feature of acupuncture rooted in traditional Chinese medicine (TCM). Little is known about the reliability of TCM pattern diagnoses. Objective To examine in a cross-sectional study the inter-rater reliability of TCM diagnoses and acupuncture point selection. Methods 30 infertile and 24 previously pregnant women were examined for TCM patterns by two acupuncturists. An operational interview guide related to gynaecology was used. The acupuncturists independently decided on the TCM patterns (categorised as excess, deficiency and merged patterns) and the prescription of acupuncture points. Kappa Statistics were used in the analyses. Results 39 different TCM patterns and 36 different acupuncture points were used. For the choice of acupuncture points, poor to no agreement was found. Moderate to fair agreement was seen in excess/deficiency and merged patterns. Perfect match to moderate agreement on treatment was obtained when choosing meridians given certain TCM patterns. Conclusions The low agreement on diagnoses indicates that acupuncturists follow individual pattern differentiation processes. The selection of acupuncture points seem to be closely related to the choice of TCM pattern diagnoses. The results indicate that the poor reliability in the diagnoses and thus treatment received by a patient will vary individually, which in turn is a challenge for clinical trials of acupuncture.