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J. Clin. Med. 2017, 6(11), 105;

Inter-Rater Reliability of Provider Interpretations of Irritable Bowel Syndrome Food and Symptom Journals

Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
Department of Human Centered Design and Engineering, University of Washington, Seattle, WA 98195, USA
Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
Department of Biostatistics and Office of Nursing Research, University of Washington, Seattle, WA 98195, USA
Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA 98195, USA
Author to whom correspondence should be addressed.
Received: 29 September 2017 / Revised: 27 October 2017 / Accepted: 1 November 2017 / Published: 4 November 2017
(This article belongs to the Special Issue Irritable Bowel Syndrome)
PDF [917 KB, uploaded 4 November 2017]


There are currently no standardized methods for identifying trigger food(s) from irritable bowel syndrome (IBS) food and symptom journals. The primary aim of this study was to assess the inter-rater reliability of providers’ interpretations of IBS journals. A second aim was to describe whether these interpretations varied for each patient. Eight providers reviewed 17 IBS journals and rated how likely key food groups (fermentable oligo-di-monosaccharides and polyols, high-calorie, gluten, caffeine, high-fiber) were to trigger IBS symptoms for each patient. Agreement of trigger food ratings was calculated using Krippendorff’s α-reliability estimate. Providers were also asked to write down recommendations they would give to each patient. Estimates of agreement of trigger food likelihood ratings were poor (average α = 0.07). Most providers gave similar trigger food likelihood ratings for over half the food groups. Four providers gave the exact same written recommendation(s) (range 3–7) to over half the patients. Inter-rater reliability of provider interpretations of IBS food and symptom journals was poor. Providers favored certain trigger food likelihood ratings and written recommendations. This supports the need for a more standardized method for interpreting these journals and/or more rigorous techniques to accurately identify personalized IBS food triggers. View Full-Text
Keywords: irritable bowel syndrome; diet; self-management; journaling irritable bowel syndrome; diet; self-management; journaling

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Zia, J.; Chung, C.-F.; Xu, K.; Dong, Y.; Schenk, J.M.; Cain, K.; Munson, S.; Heitkemper, M.M. Inter-Rater Reliability of Provider Interpretations of Irritable Bowel Syndrome Food and Symptom Journals. J. Clin. Med. 2017, 6, 105.

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