Agreement Between Clinical Judgment and Standardized Questionnaires in Temperament (Mizaj) Assessment in Persian Medicine

Abstract

Background: Mizaj assessment is fundamental to diagnosis and therapeutic decision-making in Persian medicine (PM). Despite the development of standardized self-report questionnaires, inconsistencies between clinical judgment and questionnaire-based classifications remain a methodological concern. Objectives: This study evaluated the level of agreement between clinical Mizaj assessment (CMA) and two commonly used Mizaj questionnaires. Methods: In this descriptive-analytical cross-sectional study, 350 healthy healthcare workers aged 20 to 60 years were enrolled. A PM specialist determined Mizaj using the Ajnas-e-Ashara framework through CMA. Participants then completed the 10-item Mojahedi Mizaj Questionnaire (MMQ) and the 20-item Salmannezhad Mizaj Questionnaire (SMQ). Pairwise agreement between methods was assessed using the kappa coefficient. Results: The distribution of Mizaj categories varied across methods. The highest agreement was observed between the CMA and the SMQ for Hotness (kappa = 0.512; 95% CI, 0.422 - 0.602) and between the CMA and the MMQ for Coldness (kappa = 0.512; 95% CI, 0.368 - 0.656). The lowest agreement was observed between the CMA and the SMQ for Balance in Dryness and Wetness (kappa = 0.081; 95% CI, -0.023 to 0.185). Agreement between the two questionnaires (SMQ and MMQ) ranged from kappa = 0.132 to 0.366. Overall, inter-method agreement ranged from slight to moderate across temperament dimensions. Conclusions: The observed agreement between the clinical and questionnaire-based methods ranged from slight to moderate, suggesting that each approach captures different aspects of Mizaj. Integrating clinical evaluation with standardized instruments may provide a more comprehensive and reliable framework for assessing temperament.