Reporting Standards for a Bland–Altman Agreement Analysis: A Review of Methodological Reviews

Abstract

The Bland–Altman Limits of Agreement is a popular and widespread means of analyzing the agreement of two methods, instruments, or raters in quantitative outcomes. An agreement analysis could be reported as a stand-alone research article but it is more often conducted as a minor quality assurance project in a subgroup of patients, as a part of a larger diagnostic accuracy study, clinical trial, or epidemiological survey. Consequently, such an analysis is often limited to brief descriptions in the main report. Therefore, in several medical fields, it has been recommended to report specific items related to the Bland–Altman analysis. The present study aimed to identify the most comprehensive and appropriate list of items for such an analysis. Seven proposals were identified from a MEDLINE/PubMed search, three of which were derived by reviewing anesthesia journals. Broad consensus was seen for the a priori establishment of acceptability benchmarks, estimation of repeatability of measurements, description of the data structure, visual assessment of the normality and homogeneity assumption, and plotting and numerically reporting both bias and the Bland–Altman Limits of Agreement, including respective 95% confidence intervals. Abu-Arafeh et al. provided the most comprehensive and prudent list, identifying 13 key items for reporting (Br. J. Anaesth. 2016, 117, 569–575). An exemplification with interrater data from a local study accentuated the straightforwardness of transparent reporting of the Bland–Altman analysis. The 13 key items should be applied by researchers, journal editors, and reviewers in the future, to increase the quality of reporting Bland–Altman agreement analyses.

Influence of Artefact Correction and Recording Device Type on the Practical Application of a Non-Linear Heart Rate Variability Biomarker for Aerobic Threshold Determination

“…Estimate of the median difference between NA and artefact segments of the non-overlapping 2-min windows was calculated using the Hodges Lehmann shift method along with Wilcoxon testing of paired groups in view of potential outlier values [ 34 , 35 ]. Although agreement between groups was assessed by Bland Altman analysis, if proportional bias was detected, regression-based calculation of mean differences and limits of agreement were performed [ 36 , 37 ]. Bland Altman mean differences for 2-min segment comparisons was expressed as percentage bias (difference/mean × 100).…”

A Pilot Study of the Reliability and Agreement of Heart Rate, Respiratory Rate and Short-Term Heart Rate Variability in Elite Modern Pentathlon Athletes

“…Therefore, the criteria for defining strong agreement in these studies are not well defined. Recent reviews have highlighted that important data from the Bland–Altman method are often omitted [ 79 , 80 ]. Abu-Arafeh et al recently provided a comprehensive list of key items for reporting Bland–Altman analysis [ 79 ].…”

How Replicates Can Inform Potential Users of a Measurement Procedure about Measurement Error: Basic Concepts and Methods

“…However, even if the specification of such limits is widely recommended (cf. [ 10 ]), such relevance limits are rarely specified in scientific investigations of the measurement error. Typically, it is assumed that the users can judge the numerical information about the magnitude of the measurement error based on their familiarity with the quantity of interest in their use in routine practice.…”