Abstract
The study illustrates the application of generalizability theory (G-theory) to identify measurement protocols that optimize reliability of two clinical methods for assessing spine curvatures in women with osteoporosis. Triplicate measures of spine curvatures were acquired for 9 postmenopausal women with spine osteoporosis by two raters during a single visit using a digital inclinometer and a flexicurve ruler. G-coefficients were estimated using a G-study, and a measurement protocol that optimized inter-rater and inter-trial reliability was identified using follow-up decision studies. The G-theory provides reliability estimates for measurement devices which can be generalized to different clinical contexts and/or measurement designs.
Highlights
Measuring devices are used routinely in rheumatology clinical examinations and research
The study illustrates the application of generalizability theory (G-theory) to identify measurement protocols that optimize reliability of two clinical methods for assessing spine curvatures in women with osteoporosis
When differences arise among repeated measurements performed on a truly stable examinee, it is attributed to measurement error
Summary
Measuring devices are used routinely in rheumatology clinical examinations and research. When differences arise among repeated measurements performed on a truly stable examinee, it is attributed to measurement error. The clinical literature has devoted considerable attention to reliability studies to ensure that the measurements obtained are reliable [3,4,5]. Applied in the context of reliability analysis, measurement error is an all-encompassing term that includes inherent variation in the examinee, inconsistencies within and between raters, and many other sources of potential variation excluding true differences among examinees under investigation. Two coefficients—the reliability coefficient and the standard error of measurement (SEM)—are used to characterize the reliability of a measure [1]. The reliability coefficient is a unitless quantity As such, it comments on the relative, reliability of a measure. For a measure to be clinically useful it must possess a sufficiently high reliability coefficient and a sufficiently low SEM. Despite the availability of reliability studies, it is challenging to select information applicable to a particular clinical context
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