Detectable Change Research Articles

The Discrepancy Between Visual Acuity Decline and Foveal Involvement in Geographic Atrophy

To investigate the discrepancy between visual acuity (VA) decline and foveal involvement in geographic atrophy (GA) secondary to non-exudative age-related macular degeneration (AMD), and to explore how early retinal changes impact the progression of visual impairment. Retrospective, longitudinal cohort study. This study evaluated 80 eyes from 60 patients (mean age 74.2±10 years) with progressing non-neovascular AMD using blue-light fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SD-OCT). The study monitored the onset of foveal involvement and analyzed VA changes over an average follow-up of 60±26.4 months, encompassing 785 observations. Mixed-effects models with natural splines assessed the effects of demographic and ocular characteristics on baseline VA and its rate of decline. Survival analyses compared the timing of anatomical changes with the most rapid functional declines, indicated by the highest first derivative of VA trajectories. Discrepancies between visual and anatomical changes were explored using generalized linear mixed-effects models. VA declined consistently by an average of 0.010 LogMAR per month (SE: 0.0003, p<0.001). The onset of foveal involvement significantly exacerbated this decline, adding an average loss of 0.15 LogMAR (SE: 0.02, p<0.001). Stabilization of VA typically occurred around 41 months post-foveal involvement. Significant factors associated with worse baseline VA were older age, female gender, unifocal GA morphology, and drusen-associated forms of GA (p<0.05). The most rapid declines in VA typically occurred about 9 months (IQR 0-27 months) prior to detectable subfoveal changes. The reticular FAF pattern (27/46 [59%] vs. 2/13 [15%], p=0.02) and smaller baseline GA lesions (p=0.01) were associated with faster deterioration preceding visible foveal damage. This study demonstrates that significant VA loss in GA can precede detectable foveal involvement, suggesting a window for early interventions to slow the progression of visual impairment. Identifying specific GA characteristics and FAF patterns as predictors of rapid VA decline supports the need for personalized treatment strategies to optimize outcomes for patients with non-exudative AMD.

Specific spectral sub-images for machine learning evaluation of optical differences between carbon ion and X ray radiation effects

Advances in radiotherapy, particularly the exploration of alternative radiation types such as carbon ions have updated our understanding of its effects and applicability on chondrosarcoma cells. Here we compare the optical effects produced by carbon ions (CI) and X-rays (XR) radiations on chondrosarcoma cells nuclei and set an automated method for evaluating the radiation-induced alterations without the need of chemical marking. Hyperspectral images (HSI) of SW1353 chondrosarcoma line carry detectable optical changes of the cells irradiated either with CI or XR compared to non-irradiated ones (REF). The differences between the spectral profiles of CI, XR and REF nuclei classes led to partitioning the HSIs into spectral sub-images. The changes are detected by support vector machine (SVM) classifiers whose performances are evaluated by the most used point metrics: sensitivity (SEN), accuracy (ACC), and precision (PREC), applied on spatial feature values. Specific interaction mechanisms by radiation type reveal distinct subintervals where HSIs changes are more prominent, and the classifiers perform at best. For CI the best classifiers are obtained for sub-images in the interval (424–436 nm), while for XR the best classifiers are obtained for sub-images in the interval (436–445 nm). The classifiers work better with texture features than roughness features in both cases. The classifier with the best SEN point metric in the testing phase is the most suitable to measure the irradiation efficiency irrespective of the radiation type. The altered nuclei are easier to discriminate when irradiated with CI than with XR. The study proves that SVM with optical data offers a rapid, automated, and label-free method for evaluating radiation-induced alterations in chondrosarcoma nuclei, thereby enabling effective analysis of extensive data.

Field Hip Stability Isometric Test (F-HipSIT): Reliability of Assessing the Hip Posterolateral Muscle Strength in Sports Settings

Context: The Hip Stability Isometric Test (HipSIT) is commonly employed in clinical settings for evaluating the hip posterolateral muscle strength. In this study, we introduced the “Field Hip Stability Isometric Test” (F-HipSIT) and assessed the intrarater and interrater reliability of this strength assessment specifically designed for sports settings. Design: Reliability study. Methods: Two independent raters (A and B) went to athletes’ training facilities to conduct 2 sessions of F-HipSIT spaced at least 1 week apart. The average peak force value from 3 valid attempts of each leg was recorded and normalized by the participant’s body mass for statistical analysis. Results: Thirty male and 30 female amateur athletes took part in this study. Rater A obtained similar values in the first (0.39 [0.05] and 0.44 [0.07] kg·f/kg) and second (0.39 [0.06] and 0.45 [0.07] kg·f/kg) testing days for men and women, respectively. Rater B also found similar values in the first (0.35 [0.06] and 0.42 [0.08] kg·f/kg) and second (0.36 [0.06] and 0.45 [0.08] kg·f/kg) testing days for men and women, respectively. Excellent intrarater intraclass correlation coefficient (ICC) values were found for men (ICC = .922) and women (ICC = .930), with coefficient of variation of 6% to 8% and minimal detectable change of 0.06 to 0.10 kg·f/kg. The F-HipSIT presented good interrater reliability for men (ICC = .857) and women (ICC = .868), with coefficient of variation of 5% and minimal detectable change of 0.05 to 0.06 kg·f/kg. Conclusion: The F-HipSIT intrarater and interrater reliability among male and female recreational athletes supports this field test as a quick and convenient screening tool to monitor hip posterolateral muscle strength in sports settings.

Test-Retest Reliability and Visual Perturbation Performance Costs During 2 Reactive Agility Tasks.

High secondary injury rates after orthopedic surgeries have motivated concern toward the construct validity of return-to-sport test batteries, as it is evident that common strength and functional assessments fail to elicit pertinent behaviors like visual search and reactive decision making. This study aimed to establish the test-retest reliability of 2 reactive agility tasks and evaluate the impact of visual perturbation on physical performance. Fourteen physically active individuals completed 2 agility tasks with reaction time (ie,4 corner agility), working memory, and pathfinding (ie,color recall) components. Participants completed both tasks 4 times in 2 sessions scheduled 7days apart. Outcomes included performance metrics of reaction time, time to target, number of targets, and total time assessed with reactive training timing gates. To assess test-retest reliability, we used intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and minimal detectable change (MDC). Stroboscopic goggles induced visual perturbation during the fourth trial of each task. To assess the effect of visual perturbation, we used paired t tests and calculated performance costs. The 4-corner agility task demonstrated excellent reliability with respect to reaction time (ICC3,1 = .907, SEM = 0.13, MDC = 0.35s); time to light (ICC3,1 = .935, SEM = 0.07, MDC = 0.18s); and number of lights (ICC3,1 = .800, SEM = 0.24, MDC = 0.66 lights). The color recall task demonstrated good-to-excellent test-retest reliability for time to lights (ICC3,1 = .818-.953, SEM = 0.07-0.27, MDC = 0.19-0.74s); test time (ICC3,1 = .969, SEM = 5.43, MDC = 15.04s); and errors (ICC3,1 = .882, SEM = 0.19, MDC = 0.53 errors). Visual perturbation resulted in increased time to target (P = .022-.011), number of targets (P = .039), and total test time (P = .013) representing moderate magnitude degradation of performance (d = 0.55-0.87, performance costs = 5%-12%). Both tasks demonstrated acceptable test-retest reliability. Performance degraded on both tasks with the presence of visual perturbation. These results suggest standardized reactive agility tasks are reliable and could be developed as components of dynamic RTS testing.

Assessing Lower-Extremity Visuo-Motor Reaction Time in Young Male Soccer Players: Test-Retest Reliability and Minimum Detectable Change of the Brain Pro System.

A reliable, versatile means of assessing visuo-motor reaction time (V-MRT) is important to football (soccer) players for many reasons, including the fact that faster V-MRT is a critical sport skill that may even play a role in reducing common sports injuries to the lower muscle extremities that can be associated with lost time on the field. We aimed to determine the test-retest reliability and minimum detectable change (MDC) of the Brain Pro System for assessing lower-extremity V-MRT in young male football players. We had 68 participants (M age = 16.35, SD = 1.71years) perform two assessment sessions one-week apart. For test-retest reliability, we calculated a one-way intra-class correlation coefficient (ICC) at the 95% confidence interval and provided the standard error of measurement (SEM) and minimum detectable change (MDC) (MDC = SEM × 1.96 × √2) for V-MRTs. We obtained excellent V-MRT test-retest reliability for dominant lower-extremity, non-dominant lower-extremity, and dominant and non-dominant lower-extremities (ICC2,1 = .93, 95%CI = .89-.96; ICC2,1 = .94, 95%CI = .91-.96; ICC2,1 = .96, 95%CI = .94-.97; respectively). The calculated MDC for the dominant lower-extremity V-MRT, the non-dominant lower-extremity V-MRT, and dominant and non-dominant lower-extremities (random) V-MRT were 1.21seconds, 1.13seconds, and 1.21seconds, respectively. Brain Pro System had excellent reliability for assessing lower-extremity V-MRT in young male football players. The MDC values at the 95% confidence level (MDC95) we obtained were reliable for assessing clinically meaningful V-MRT changes.

Validity and Reliability of 2 Cirrus Optical Coherence Tomography Procedures for Measuring Objective Ocular Torsion

Torsional eye position by the disc-fovea angle (DFA) is a relevant objective parameter in vertical strabismus. DFA measurement with optical coherence tomography (OCT) has proven to be a good alternative to the gold standard measurement in fundus photography. Our study aims to analyze the validity and reliability of 2 undescribed Cirrus high-definition OCT (HD-OCT; Carl Zeiss Meditec) methods that offer clinical advantages for measuring objective cycloposition in normal patients compared with Spectralis spectral-domain OCT (Heidelberg Engineering) and the reference method. Prospective validity and reliability analysis. Objective cycloposition by means of the DFA was measured in the right eyes of 59 binocularly normal individuals attending the ophthalmology service of a medical institution. DFA was obtained by fundus photography (gold standard), FoDi software of Spectralis spectral-domain OCT, HD 1 line scan of Cirrus HD-OCT, and macular cube of Cirrus HD-OCT (fundus, FoDi, line, and cube methods, respectively). Measurements were performed 3 times for each method and the patient was repositioned and realigned between captures. Posterior manual quantification was made by 2 observers with external protractor software for the fundus and cube methods. The 3 OCT methods showed and excellent agreement with fundus photography (ICC 0.83-0.84) with no significant differences comparing mean values (P = .36 for fundus-FoDi, P = .09 for fundus-line, and P = .09 for fundus-cube). Absolute differences between methods were 1.5°. All methods showed excellent reliability (ICC 0.92 for FoDi, 0.91 for line, 0.92 for cube, and 0.91 for fundus). The minimal detectable change was lower than 3° and the absolute difference between repeated measurements was 1° for all methods. Interrater reliability was excellent for methods requiring manual quantification (ICC 0.98 for cube, ICC 0.94 for fundus). Measurement of the DFA by Cirrus HD-OCT methods in normal patients was a valid and reliable alternative for the cycloposition assessment. Among the methods, the Cirrus OCT HD 1 line improved clinical performance due to the simplicity and speed of measurement, with no need to export the image for quantification.

Reliability and minimal detectable change of the Yoni task for the theory of mind assessment.

The Theory of Mind (ToM) assessment is becoming essential to evaluate the response to a social cognition intervention and to monitor the progression of social abilities impairment in atypical conditions. In the Italian setting, the Yoni task has been recently validated in its short version (the Yoni-48 task) to evaluate ToM in the clinical setting. The present study aimed to verify the test-retest reliability and the Minimal Detectable Change (MDC) of the Yoni-48 task. The Yoni-48 task was administered to 229 healthy adults at two evaluation sessions 3 weeks apart (mean days between sessions = 20.35 ± 1.75) by a psychologist. The test-retest reliability of the Yoni-48 task accuracy and response time was tested by the Intraclass Correlation Coefficient (ICC2,1, two-way random model, absolute agreement type). Then, the MDC95 and MDC90 were computed based on the standard error of measurement. Finally, the 95% limits of agreement were plotted (LOA plot) to visualize the difference and mean score of each pair of measurements. The total Yoni-48 task accuracy, but not the response time score, showed a high ICC (>0.80), with an MDC of 0.10. By plotting the LOA plot for the accuracy score no systematic trends were observed. This evidence will support the adoption of the Yoni task in longitudinal designs.

Development of the comprehensive inpatient transfer tool: initial reliability and validity.

A new patient transfer assessment scale for use in inpatient rehabilitation facilities (IRFs) is warranted to assess level of assistance, adaptations needed for success, and movement strategies. This study presents initial psychometric analyses for the Comprehensive Inpatient Transfer Tool (CITT). CITT items were developed through interdisciplinary team discussions. Interrater reliability was assessed between blinded pairs of raters administering the CITT for each subject on the same day. Intrarater reliability was assessed with one rater administering the CITT for each subject twice within the same day. Thirty-six subjects in an IRF completed the CITT four times during their rehabilitation stay; three times at admission and once at discharge. Intraclass correlations (mixed models) were used in reliability and minimal detectable change (MDC) analyses. Spearman correlations of CITT and CITT change scores with their respective Functional Independence Measure (FIM) and Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) transfer scores were performed for concurrent validity. Responsiveness was assessed using paired t-tests on change scores. Interrater and intrarater reliability ranged from 0.90 to 0.98. Correlations between the CITT and FIM/IRF-PAI ranged from 0.6 to 0.8. The MDC for CITT was 7.11 pts. Differences between admission and discharge CITT were significant (P < 0.001). The CITT, developed by an interdisciplinary team, addresses limitations of existing transfer measures utilized in IRFs. The CITT demonstrated excellent inter and intrarater reliability. Concurrent validity demonstrated modest agreement between existing transfer measures and the CITT. The CITT is a reliable, useful scale for evaluating transfer skills in patients admitted to an IRF.

Translation, cross-cultural adaptation and validation of the brazilian version of physical activity scale for individuals with physical disabilities (PASIPD) in people with lower limb amputation

ObjectiveTo perform the translation, cross-cultural adaptation and validation the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) for the Brazilian Portuguese in a sample of people with lower limb amputation. MethodsThis is a methodological study with cross-sectional design. Translation and cross-cultural adaptation of the scale were initially carried out in accordance with international guidelines. After its psychometric properties were evaluated, in addition to the presence of floor and ceiling effect, the standard error of measurement and the minimal detectable change. ResultsThe Brazilian version of PASIPD presented face and content validity and correlated significantly with International Physical Activity Questionnaire (rs: 0.71/p = 0.001). The degree of inter-examiner agreement ranged from 0.29 to 0.75, and the intra-examiner from 0.13 to 0.72. The inter-examiner was 0.71, and the intra-examiner was 0.78. The internal consistency measure (Cronbach's α) was 0.75. No floor or ceiling effect were observed. The standard error of measurement was 0.36 and the minimal detectable change was 1.66. ConclusionsThe Brazilian version of PASIPD is valid, reliable and has internal consistency among its items, and can be used by researchers and health professionals to evaluate the physical activity of Brazilians with lower limb amputation.

Pain Sensitivity Questionnaire: Cross-cultural adaptation and validation of the Greek version.

The Pain Sensitivity Questionnaire (PSQ) was developed to assess general pain sensitivity. This study aimed to validate the Greek version of PSQ. The questionnaire was translated into Greek (PSQ-GR) and piloted in a small sample of patients with chronic pain (n=35). A total of 146 chronic pain patients and healthy volunteers completed the PSQ-GR, the Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS) and Central Sensitization Inventory (CSI). To evaluate the test-retest reliability, 36 volunteers completed the PSQ-GR twice over 7±2days. Internal consistency was excellent (Cronbach's alpha 0.90-0.96) for PSQ-total, PSQ-minor, and PSQ-moderate. The Intraclass Correlation Coefficient was estimated at 0.90-0.96 for PSQ-total, PSQ-minor and PSQ-moderate and the SEM was 0.59-0.90 for PSQ-total, PSQ-minor and PSQ-moderate approximately. The smallest detectable change was 0.48 for PSQ-total, 0.47 for PSQ-minor and 0.44 for PSQ-moderate. Positive and significant correlations were observed between PSQ-GR and HADS (r=0.38, p<0.01), PCS (r=0.41, p<0.01) and CSI (r=0.30, p<0.01). Statistically significant differences in PSQ-GR scores were identified between the healthy volunteers and the chronic pain patients. The PSQ-GR is a reliable and valid tool that can assess pain sensitivity in healthy individuals and chronic musculoskeletal pain patients.

Adaptation, development, validity, and reliability of the Escala Multidimensional de Fragilidad (EMFRA), and the 5-item FRAIL scale: a study design of the EMFRA project.

Introduction: The concept of frailty has been investigated in recent years. Currently, frailty in the elderly is understood as the presence of vulnerability to the occurrence of health-related adverse events. It was originally conceived as a construct dependent on the patient’s physical parameters. However, it is currently conceived on the basis of several physical, cognitive, emotional and social influences. Justification: Currently we do not count with enough tools in Spanish to assess frailty in the elderly, especially integrating multimodal assessments. Objectives: To develop the Multidimensional Frailty Scale (EMFRA), to cross-culturally adapt the 5-item FRAIL scale, and to explore the validity and reliability of both scales. Methods: The construction of the EMFRA will begin with a review and synthesis of the literature. Relevant factors will be identified for inclusion in the scale. A translation of the 5-item FRAIL scale will be performed. Content validation of both scales will begin with an expert panel, followed by cognitive interviews with healthcare workers and older adults. Convergent validity with physical performance will be analysed in the Short Physical Performance Battery, global cognitive function, with anxiety and depression levels, level of dependence. The criterion validity of the scales will be explored cross-sectionally with the level of dependence. The time to complete both scales, the floor effect and the ceiling effect will be analysed. The internal consistency, test-retest reliability, standard error of measurement and minimum detectable change of both scales will be studied. Keywords: Frailty; Instrument development; Validity; Content validity; Convergent validity; Criterion validity; Floor effect; Ceiling effect; Reliability; Internal consistency; Test-retest; Standard error of measurement; Minimum detectable change; Diagnosis; Older adults; Aging.

Further clarifications needed: Why Jetschke et al. (2023) underestimated the efficacy of bias-adjusted, standardized growth changes for pointer-year detection

In a recent communication, Jetschke et al. (2023) compared various pointer-year detection methods against the recently published (bias-adjusted) standardized growth change method (SGC and BSGC, Buras et al., 2020, 2022). Based on their comparative evaluation, Jetschke et al. (2023) pointed out specific weaknesses of the (B)SGC methods. In this short communication, I reveal their analyses to be erroneous and consequently their conclusions to be based on false grounds.

A Comparison of Test-Retest Reliability and Practice Effects of Short Portable Mental State Questionnaire and Montreal Cognitive Assessment in Patients with Stroke.

To compare the test-retest reliabilities and minimal detectable change (MDC) of the Short Portable Mental State Questionnaire (SPMSQ) and the Montreal Cognitive Assessment (MoCA) in patients with stroke. 63 patients were recruited from 1 medical center. The SPMSQ and MoCA were administered twice, 2 weeks apart. Both measures showed high intraclass correlation coefficients (SPMSQ: 0.87; MoCA: 0.89) and acceptable MDC%s (SPMSQ: 14.8%; MoCA: 19.6%). A small correlation (r = 0.30) was found between the absolute difference and average in each pair of assessments in the SPMSQ, which was close to the criterion of heteroscedasticity. A small practice effect was observed in the MoCA (Cohen's d = 0.30). The SPMSQ demonstrated smaller random measurement error and an absence of practice effect. When comparing the psychometric properties of the SPMSQ and MoCA as outcome measures for assessing cognitive function in patients with stroke, the SPMSQ appears to be a more suitable choice than the MoCA.

Reliability of dynamic and isometric upper muscle strength testing in breast cancer survivors.

Breast cancer is the most common cancer in women worldwide, and its treatment usually involves a combination of many medical procedures, including surgery, chemotherapy, radiotherapy, and hormonal therapy. One of the detrimental effects on physical function is reduced upper limb muscle strength. This study aimed to evaluate upper body strength intra-day and inter-day (test-retest) reliability using the handgrip strength test (HGS) and the bilateral isometric bench press (BIBP) and the test-retest reliability of the one repetition maximum on the bench press (BP-1RM) in breast cancer survivors (BCS). Thirty-two (52.94 ± 8.99 yrs) BCS participated in this study. The muscle strength tests were performed in two different moments, three to seven days apart. Intraclass coefficient correlation (ICC) and coefficient of variation (CV) were used to assess the reliability. Standard error of measurement (SEM), typical error of measurement (TEM), and minimally detectable change (MDC) analyses were performed. The Bland-Altman analysis was used to assess the agreement between test-retest. We found a reliability that can be described as "high" to "very high" (ICC ≥ 0.88; CV ≤ 10%) for intra-day and test-retest. SEM% and MDC% were lower than 5% and 11%, respectively, for all intra-day testing. SEM% and TEM% ranged from 3% to 11%, and MDC% ranged from 9% to 23% in the test-retest reliability. The agreement demonstrated a systematic bias ranging from 2.3% to 6.0% for all testing, and a lower systematic bias may be presented in the non-treated side assessed by HGS and BIBP. HGS, BIBP, and BP-1RM assessments are reliable for measuring upper-body muscle strength in BCS.

A Comprehensive Analysis of 10-Yard Sprint Reliability in Male and Female Youth Athletes.

Wannouch, YJ, Leahey, SR, Whitworth-Turner, CM, Oliver, JL, YH, KC, Laffer, JC, and Leicht, AS. A comprehensive analysis of 10-yard sprint reliability in male and female youth athletes. J Strength Cond Res 38(9): e477-e488, 2024-This study investigates the inter-week test-retest reliability of 9.14 meter (10 yard) sprint times in youth athletes. Although essential for assessing athletic ability and training efficacy, the critical and comprehensive examination of both relative and absolute reliability indices for short-distance sprints has been insufficient in youth contexts. One hundred ninety-eight youth athletes (128 males and 70 females) underwent 2 sprint attempts across 2 separate trials 24 hours apart and within 7 days of each other. The sprints were measured using dual-beam timing gates to capture split times for 0-4.57 meter (0-5 yards), 4.57-9.14 meter (5-10 yards), and 0-9.14 meter (0-10 yards). The minimal mean difference between the best sprint times across trials was 0.02 ± 0.13 seconds for males and 0.003 ± 0.14 seconds for females. No significant mean differences were found between trials for either gender (males: p = 0.0875; females: p = 0.8752), suggesting no systematic bias in sprint times. The SEM was 0.092 seconds for males and 0.099 seconds for females, with a corresponding SEMCV% of 4.6 and 4.8%. The overall coefficient of variation was 9.8% for males and 8.9% for females. Intraclass correlation coefficient values suggested that the sprint times across trials were reliable (males: 0.80; females: 0.76). The minimal detectable change was 0.25 seconds for males, 0.27 seconds for females. Cohen's d indicated trivial effects (<0.2) for males (0.154) and females (0.021). Minimal mean differences, a low SEM , and consistent ICC values demonstrate that the 0-9.14 meter sprint is a reliable assessment in youth athletes.

Defining a clinically meaningful within-patient change threshold for the Cohen-Mansfield Agitation Inventory in Alzheimer's dementia.

The Cohen-Mansfield Agitation Inventory (CMAI) quantifies the frequency of agitation behaviors in elderly persons. This post hoc analysis of data from the brexpiprazole clinical program aimed to determine a meaningful within-patient change (MWPC) threshold for CMAI Total score among patients with agitation associated with dementia due to Alzheimer's disease. Data were included from three 12-week, multicenter, randomized, double-blind, placebo-controlled, parallel-arm trials of brexpiprazole for the treatment of agitation associated with dementia due to Alzheimer's disease (ClinicalTrials.gov identifiers: NCT01862640, NCT01922258, NCT03548584). Change in CMAI Total score (range 29-203; higher scores indicate higher frequency of agitation behaviors) from baseline to Week 12 was the primary endpoint in each trial. MWPC thresholds were estimated from anchor-based mean change analyses and receiver operating characteristic (ROC) curves. The Clinical Global Impression-Severity of illness (CGI-S) and Clinical Global Impression-Improvement (CGI-I) scales, both as related to agitation, were used as anchors. Empirical cumulative distribution functions (eCDFs) and probability density functions (PDFs) were plotted as supportive evidence. Distribution-based methods were also employed. Data from 898 patients were analyzed (mean age, 73.7 years; mean baseline CMAI Total score, 73.8). The mean CMAI Total score change corresponding to a difference of small improvement vs. stable (CGI-S one-point decrease vs. no change), or minimally improved vs. no change (CGI-I rating of 3 vs. 4), ranged from -10.6 to -13.5 points. The mean CMAI Total score change corresponding to a difference of moderate improvement vs. stable (CGI-S two-point decrease vs. no change), or much improved vs. no change (CGI-I rating of 2 vs. 4), ranged from -20.2 to -25.7 points. ROC curve analyses generally produced smaller estimates of meaningful change. eCDFs and PDFs showed good distribution and separation of CMAI Total score change between CGI-S/CGI-I categories. In distribution-based analyses, the minimal detectable change for CMAI Total score (10.5-11.8 points) was generally lower than anchor-suggested thresholds. Triangulation of evidence from anchor- and distribution-based analyses supports an MWPC threshold for CMAI Total score of -20 points, with a threshold range of -15 to -25 points, in patients with agitation associated with dementia due to Alzheimer's disease.

Minimal Detectable Change of Cough and Lingual Strength Outcomes in Neurodegenerative Disease.

Minimal detectable change (MDC) represents the smallest amount of change required for an outcome to be considered real and not merely due to measurement error or task variability. This study aimed to examine MDC for cough and lingual strength outcomes among individuals with neurodegenerative disease. In a single session, individuals diagnosed with Parkinson's disease (PD), progressive supranuclear palsy (PSP), and cerebellar ataxia completed repeated measurements of voluntary sequential cough via spirometry (n = 143) and lingual isometric and swallowing pressure with the Iowa Oral Performance Instrument (n = 231). The MDC at the 95% confidence level was calculated with the following formula: MDC = 1.96 × √2 × SEM. MDC for cough strength was 0.52 L/s (PD), 0.57 L/s (PSP), and 0.20 L/s (ataxia). On trials with the same number of coughs, MDC for cough strength was 0.18 L/s in PD and 0.24 L/s in ataxia. MDC for lingual isometric pressure was 5.44 kPa (PD), 2.35 kPa (PSP), and 3.41 kPa (ataxia), whereas swallowing pressure was 5.60 kPa (PD), 2.97 kPa (PSP), and 7.34 kPa (ataxia). These findings elucidate MDC for cough and lingual strength outcomes and expand our understanding of change that can be considered "real" and not merely due to task variability. MDC facilitates valid interpretations of changes following treatment, as well as power analyses to determine the smallest effect size of interest before data collection. To illustrate the application of MDC, we situate these findings in the context of hypothetical case studies and research studies. 3 Laryngoscope, 2024.

Unilateral Heel-Raise Test: Estimating Normative Value and Reliability in Healthy Teenagers

Abstract Background: The unilateral heel-raise test (UHRT) is a manual muscle testing procedure used to evaluate the power and endurance of the plantar flexors, which are important muscles for human locomotion. UHRT is commonly used in clinical practice, and normative reference values for UHRT in both adults and the pediatric population can be found in the literature. However, there is a lack of normative values for UHRT specifically for teenagers. The objective of this research study was to determine the normative value of UHRT and establish intra-and inter-tester reliability in teenagers in age group 13–17 years old. Materials and Methods: A total of 315 healthy adolescents were recruited as a part of this research. The participants were instructed to stand on the dominant foot by keeping the opposite foot off the ground (by flexing the knee to 90°). UHRT was performed actively up to maximum repetitions until the development of fatigue. Observations were recorded and further analyzed. Results: The inter- and intra-reliability of UHRT were ICC(2,k) = 0.83 (0.77–0.88) and ICC(3,1) = 0.83 (0.76–0.88), respectively. The median value (25th and 75th interquartile range) obtained for UHRT was 21 (18, 24). The Bland-Altman limits of agreement were also satisfied. The standard error of measurement (SEM) was 0.41, and the minimal detectable change (MDC) for the test was estimated to be 2. Conclusions: This study determined the normative values for UHRT in healthy teenagers of the age group 13–17 years old. It provides a valuable benchmark for interpreting the results of UHRT in teenagers. The analyses revealed good inter- and intra-reliability and minimal error, suggesting that it can be used objectively in research and clinical evaluations.

Psychometric properties of the arabic version of occupational value with pre-defined ítems

Background Perceived occupational value is closely linked with well-being and there is need worldwide for assessment tools that target this phenomenon. The Occupational Value with pre-defined items (OVal-pd), measuring three dimensions of occupational value; concrete, socio-symbolic and self-rewarding, was designed for that purpose. Aim To pilot an Arabic version of OVal-pd and evaluate its psychometric properties in terms of content validity, factor structure, homogeneity, construct validity, test-retest stability, floor and ceiling effects, and measurement error. Methods Snowball sampling was used to recruit Arabic-speaking persons living in Sweden (n = 55). They completed the OVal-pd and questionnaires addressing background factors, content validity and feasibility. Confirmatory factor analysis, Spearman’s rank correlation, Cronbach’s α, intraclass correlation coefficients, and minimum detectable change were calculated. Results A 22-item version of the Arabic OVal-pd was found to have acceptable content validity and feasibility and the proposed three occupational value dimensions were confirmed. Good properties in terms of construct validity, internal consistency and test-retest stability were also established. No floor or ceiling effects were observed. Conclusion The Arabic OVal-pd showed good validity and reliability on various psychometric aspects. Significance In today’s multicultural societies, the Arabic OVal-pd can be an important tool for occupational therapists working with Arabic-speaking clients.

Repeatability and intra and interrater reproducibility of the DIPA-S eHealth© capture and analysis system for clinical assessment of scoliosis.

To assess the repeatability, intra and interrater reproducibility of the DIPA-S eHealth© system for capturing and measuring clinical variables of scoliosis, including frontal trunk imbalance (FTI), sagittal trunk imbalance (STI), and angle of trunk rotation (ATR). Patients were photographed using the DIPA-S eHealth Capture© mobile application by family members, physiotherapists, or surgeons. Three photos were taken in each position: standing in the frontal and sagittal planes and in the axial plane in forward bending position of the trunk. The photos were analyzed by three independent evaluators using the DIPA-S eHealth Analysis© software. For repeatability, each photo was analyzed twice consecutively by the three evaluators. For intrarater reproducibility, only one evaluator reanalyzed the first photo from each plane with a 5-day interval. For interrater reproducibility, the three evaluators analyzed the first photo from each plane. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were used (p < 0.05). The sample comprised 262 images (n = 30). Repeatability was excellent for all three evaluators in all three planes (ICC 0.94 to 1.00). Intrarater reproducibility was excellent in all three planes (ICC 0.88 to 0.99). Interrater analysis was excellent for the frontal and axial planes (ICC 0.98 and 0.93), respectively. However, it was weak in the sagittal plane ICC 0.32. The SEM ranged from 0.02 to 17.6 and MDC from 0.03 to 34.6. The DIPA-S eHealth© Capture and Analysis system demonstrates reproducibility for use in the clinical assessment of scoliosis through teleconsultations.