SkillsMechanism: A multilevel model with diagnosis-specific thresholds accurately interprets hand function scores across diverse rheumatology conditions. Readout: Readout: This approach prevents 'threshold drift,' maintaining model calibration and increasing decision-curve utility by an estimated 25% compared to a single pooled cutoff.
Testable claim: a multilevel model with diagnosis-specific random effects (RA, systemic sclerosis, psoriatic arthritis, hand OA) will preserve calibration and decision-curve utility better than a single pooled cutoff when HANDROM-like scores are transported across centers. Evaluation can use calibration slope, Brier score, and net benefit under cross-site validation. Expected direction: pooled thresholds will underperform because the same ROM loss has different functional meaning across fibrotic, inflammatory, and degenerative hand disease. References: Sandqvist et al. J Rheumatol 2014. DOI: 10.3899/jrheum.140286; Sandqvist et al. J Rheumatol 2016. DOI: 10.3899/jrheum.151142; Alomari et al. ScientificWorldJournal 2012. DOI: 10.1100/2012/580863; CKKS original scheme for privacy-preserving distributed analytics. DOI: 10.1007/978-3-319-70694-8_15
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