臺灣及美國矯正醫師甄審評分制度之比較

A Comparison of Taiwan and American Board of Orthodontics Objective Grading System

莊子伶(Tzu-Ling Chuang)

指導教授 ： 賴向華

國立臺灣大學/醫學院/臨床牙醫學研究所/碩士(2018年)

https://doi.org/10.6342/NTU201803956

摘要

矯正醫師追尋的治療目標，除了改善齒列的美觀，還要為病人建立理想的咬 合。如何定義「好的治療結果」，需要有一套以合理數據為憑的客觀評分制度。 過去歐美國家的學者提出許多評分制度作為矯正醫師的參考標準，目前最廣泛被 使用的國際標準為美國齒顎矯正學會客觀評分系統(The American Board of Orthodontics Objective Grading System, ABO-OGS)，而台灣醫師目前遵循的標準為 中華民國齒顎矯正部定專科醫師口試病例審查評分標準(Taiwan Board of Orthodontics Objective Grading System, TBO-OGS)。一套評分制度的結果，理論上 不應受到評分考官個人因素之影響，若不同的考官利用相同的評分制度所評出的 分數，不存在顯著差異，即可認定評分制度的公平性良好。本實驗想了解 TBO- OGS、ABO-OGS 在信度上的表現，以及不同訓練背景的醫師，透過相同評分制 度所評出的結果，是否有所差異。
研究對象為 9 名牙醫師，分別為 3 名一般牙科醫師、3 名受訓第一年之矯正 科研究生醫師、3 名矯正專科醫師。從台大醫院齒顎矯正科治療完成的病人中挑 選 36 例，條件符合中華民國齒顎矯正學會專科醫師考試病例屬性且病歷資料完 整。請評分醫師依照 TBO-OGS 做 2 次評分，再依照 ABO-OGS 做 2 次評分，時間間隔約 2 週。根據評分結果，計算組內相關係數以了解施測者內及施測者間信 度，並比較 TBO-OGS 和 ABO-OGS 之間的差異。
實驗結果顯示利用 TBO-OGS 進行測量的平均得分為 30.29 ± 2.95，利用 ABO-OGS 進行測量的平均扣分為 22.40 ± 6.11。針對施測者內信度進行分析，利 用 TBO-OGS 進行測量時，組內相關係數大於 0.75 的評分醫師有 1 位一般牙科醫 師、2 位矯正專科醫師。利用 ABO-OGS 進行測量時，組內相關係數大於 0.75 的 評分醫師有 2 位研究生醫師、2 位矯正專科醫師。針對施測者間信度進行分析， TBO-OGS 及 ABO-OGS 的施測者間信度並無不同。
根據實驗結果，可推論平均分數不受到施測者個人訓練背景的影響。最大值 和最小值分數和評分醫師性格因素較為相關。但是一般牙科醫師、研究生醫師、 矯正專科醫師三個組別進行比較，可得知矯正專科醫師的施測者內信度較其他兩 組高。TBO-OGS 及 ABO-OGS 的施測者間信度，因為分數變異太大，並且受限 於醫師人數不夠的因素，無法計算統計結果。而 TBO-OGS 和 ABO-OGS 評分項 目的信度差異，來自於兩者定義不同的影響，當扣分標準較為嚴格時，信度會減低。

關鍵字

評分制度 ； 信度

並列摘要

Many scoring indexes had developed for evaluating the outcomes of orthodontic treatment. Such an ideal tool needs reliability and validity to make the judgement equal. An ideal index for assessing the treatment outcomes should not be impacted by examiner’s subjective opinion. If different examiners gave the same results by following the same rules, that meant the index was a reliable tool for assessment. In this study, we assessed the reliability of the Taiwan Board of Orthodontics Grading System(TBO-OGS) and American Board of Orthodontics Objective Grading System(ABO-OGS). And we want to analyze the results of the examiners with different training background.
Three general dentists, three first-year graduate students under orthodontics training, and three certificated orthodontists were recruited into the study, total 9 examiners. We randomly selected 36 patients who completed orthodontic treatment in National Taiwan University Hospital. The case should meet the case assessment form for the board exam of the Taiwan Board of Orthodontics. Each examiner used TBO-OGS and ABO-OGS to assess the end-of-treatment dental casts and panoramic film of each patient independently. Intraclass correlation coefficients (ICC) was conducted to evaluate the intra-rater and inter-rater reliability of three examiner groups.
The results show the average scores of TBO-OGS was 30.29 ± 2.95, the average scores of ABO-OGS was 22.40 ± 6.11. As for the intra-rater reliability, there were 1 general dentist, 2 orthodontists whose ICC > 0.75 while using TBO-OGS. There were 2 graduate students, 2 orthodontists whose ICC > 0.75 while using ABO-OGS. As for the inter-rater reliability, no significant difference was found between 9 examiners.
According to the results, the average scores were not impacted by different examiners. The minimum and maximum score may be related to examiner’s personal traits. To compare between general dentists, graduate students and orthodontists, the intra-rater reliability was better in orthodontists group. The inter-rater reliability could not be calculated due to the variation of 9 examiners and the small sample size. The precision of the index may affect the reliability. If the criteria were set in a very narrow interval, it would be difficult to meet the same level at the next assessment. Thus the reliability decreased.

並列關鍵字

Scoring indices ； Reliability

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