Rating (clinical trials)

Within the field of clinical trials, rating is the process by which a human evaluator subjectively judges the response of a patient to a medical treatment.[1][2] The rating can include more than one treatment response. The accessor is normally an independent observer other than the patient, but the accessor can also be the patient (a patient-reported outcome). Furthermore, some clinical outcomes can only be assessed by the patient (a "private phenomena").[3]

Because the evaluation is subjective, this can result in both inter-rater or intra-rater reliability.[4] When conducting clinical trials, ensuring rating consistency is important, but can prove to be quite difficult to obtain. Studies dealing with such indications as pain, mental disease or mood are not able to easily track progress with physical or physiological testing, rather, verbal subjective human testing is used. This can allow for an array of differences in rating.

Blinded assessors who are not told which treatment group a patient belongs to have a significantly lower observer bias compared to non-blinded assessors.[5][6]

Rater training is sometimes used in an attempt to lower rater variability.[7][8]


  1. Targum SD (June 2006). "Evaluating rater competency for CNS clinical trials". primary. Journal of Clinical Psychopharmacology. 26 (3): 308–10. doi:10.1097/01.jcp.0000219049.33008.b7. PMID 16702896.
  2. Khan A, Yavorsky WC, Liechti S, DiClemente G, Rothman B, Opler M, DeFries A, Jovic S (February 2013). "Assessing the sources of unreliability (rater, subject, time-point) in a failed clinical trial using items of the Positive and Negative Syndrome Scale (PANSS)". primary. Journal of Clinical Psychopharmacology. 33 (1): 109–17. doi:10.1097/JCP.0b013e3182776ebe. PMID 23277234.
  3. Moustgaard H, Bello S, Miller FG, Hróbjartsson A (December 2014). "Subjective and objective outcomes in randomized clinical trials: definitions differed in methods publications and were often absent from trial reports". review. Journal of Clinical Epidemiology. 67 (12): 1327–34. doi:10.1016/j.jclinepi.2014.06.020. PMID 25263546.
  4. Chin R, Lee BY. "Chapter 4.5.3: Observer Variability". Principles and Practice of Clinical Trial Medicine. pp. 72–74. ISBN 978-0-08-055793-9.
  5. Hróbjartsson A, Thomsen AS, Emanuelsson F, Tendal B, Hilden J, Boutron I, Ravaud P, Brorson S (March 2013). "Observer bias in randomized clinical trials with measurement scale outcomes: a systematic review of trials with both blinded and nonblinded assessors". review. Canadian Medical Association Journal. 185 (4): E201–11. doi:10.1503/cmaj.120744. PMC 3589328. PMID 23359047.
  6. Hróbjartsson A, Thomsen AS, Emanuelsson F, Tendal B, Rasmussen JV, Hilden J, Boutron I, Ravaud P, Brorson S (June 2014). "Observer bias in randomized clinical trials with time-to-event outcomes: systematic review of trials with both blinded and non-blinded outcome assessors". review. International Journal of Epidemiology. 43 (3): 937–48. doi:10.1093/ije/dyt270. PMID 24448109.
  7. Opler MG, Yavorsky C, Daniel DG (December 2017). "Positive and Negative Syndrome Scale (PANSS) Training: Challenges, Solutions, and Future Directions". review. Innovations in Clinical Neuroscience. 14 (11–12): 77–81. PMC 5788255. PMID 29410941.
  8. Hall C, Dallabrida SM (16 March 2015). "Why Rater Training Matters in Clinical Trials: A Science Overview". Clinical Leader. Archived from the original on 24 April 2016.
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