On the reliability of tonometry: A pilot study of inter-rater consistency and related psychosocial factors underlying the formulation of tonometric judgments

Introduction. Tonometric judgments are critical in the diagnosis and treatment of lymphedema. Yet, while some studies (e.g. Lye et al., 2006) claimed the reliability of particular mechanical tonometric instruments, in summarizing the main findings of their systematic review Oremus et al. (2010) recently concluded that “there is too little evidence to draw conclusions about the reliability of [diagnostic] tests such as tonometry.” (p. 4, emphasis added). Materials and Methods. To fill this gap—a tangible lack of knowledge of great import both for the literature and even more for good clinical practice—we instructed a team of trained raters to independently supply distinct sets of tonometric judgments with respect to (a) patients with diagnosis of lymphedema (the clinical sample), and (b) their healthy counterparts (the comparison sample). Each judgment was supplemented by the assessment of two additional distinctive features lying at the core of any judgmental process—the degree of difficulty and the degree of certainty reported by the judge in formulating tonometric judgments. Results and Conclusions. We will illustrate and report on the stage of this developing research endeavor, and also suggest some initial conclusions on the basis of our earliest results.