Excellent Inter-rater Reliability Research Articles

Reliability of 2D video analysis assessing running kinematic variables in patients with exercise-related leg pain in a primary care practice

BackgroundSuboptimal lower limb and trunk positionings is known to influence exercise-related leg pain (ERLP). It is unknown whether simple 2D video analysis is useful for recording and interpreting running variables in a primary care practice. Research questionIs 2D video analysis a reliable instrument to assess running variables in patients with ERLP in a primary care practice? MethodsParticipants undergoing an evaluation for ERLP in two primary care practices were studied. In this reliability study, analysis of running variables was performed by 4 blinded raters on one-stride videos captured with non-high speed cameras (30 fps). Intraclass correlation coefficients (two-way random; ICC 2,1) were calculated to determine the inter-rater reliability. The intra-rater reliability was presented by ICC type two-way mixed (3,1). Footstrike pattern was analyzed by calculating the Fleiss’ kappa for inter-rater agreement and Cohen’s kappa for intra-rater agreement. Sample size calculation indicated that 16 participants would be required for answering the research question. ResultsData of all 16 participants (9 males, age 31 ± 10 yr) were of sufficient quality for analysis. The 2D video analysis demonstrated excellent inter-rater reliability with an overall ICC value of 0.999 (95 % CI = 0.998–0.999). The ICC value of the eversion was 0.384 (95 % CI = 0.148–0.66) and after correction of the systematic error, 0.817 (95 % CI = 0.664–0.922). The agreement on footstrike was substantial with a Fleiss kappa of 0.737. The overall intra-rater reliability was excellent with an ICC value of 0.997 (95 % CI = 0.996–0.997). The intra-rater agreement of the footstrike was excellent with a Cohen’s kappa of 0.868. Significance2D video analysis provides a highly reliable, relative inexpensive, feasible and suitable measuring instrument for determining running variables in patients ERLP in a primary care setting. This simple technique may identify possible running variables associated with different types of ERLP and may serve as an instrument for tailor-made gait retraining programs.

Novel educational training of para medical professionals in cervical cancer screening

BackgroundCervical cancer is a public health problem in India due to weak national screening policy compounded by lack of resources including scarcity of trained personnel to carry out community-based screening program. Para medical professionals (PMPs) are closely related to women in local communities. Hence, training PMPs by incorporating novel technology and reduced time duration to achieve adequate competence in screening is an area underutilized and needs to be explored. Materials and methodsA pilot cross sectional analytical study was conducted at a tertiary referral cancer center using a shorter version of educational intervention of 2 weeks duration (EI2W) involving PMPs. Pre- and post-training assessment of knowledge, attitude, and practice (KAP) was done using questionnaires consisting of 5 domains viz. awareness of cervical cancer, awareness of cervical pre-cancer, practical screening methodology (practice oriented), data management and aspects of human papilloma virus (HPV). Wilcoxon signed-rank test was used for comparison and the degree of change was measured using analysis of covariance (ANCOVA). A p value of <0.05 was considered significant. Results118 PMPs were included. There was a significant improvement in scores of all domains (except cervical pre-cancer domain), following introduction of EI2W. Knowledge scores, post EI2W was better in Auxiliary Nurse Midwives (ANMs) than other participants. Awareness regarding cervical cancer was higher with more years of experience. The KAP analysis showed excellent interrater reliability in the practice 0.726 (0.649–0.792) followed by knowledge domain 0.711 (0.626–0.783). ConclusionEI2W was effective in significantly improving the competence of PMPs, thus reducing human resource constraints in cervical cancer prevention and elimination.

Functional measurement of canine muscular fitness: refinement and reliability of the Penn Vet Working Dog Center Sprint Test.

Working, sporting, and companion dogs require muscular fitness to perform their daily tasks, competitive activities, and operational functions effectively and with a low risk of injury. There are currently no methods to measure the muscular fitness of dogs who are not debilitated. Sprint performance is highly correlated with muscular fitness in humans, and various sprint assessments are used to measure performance for sporting and tactical athletes. The Penn Vet Working Dog Center Sprint Test (ST) is a 25 m maximal effort sprint from a down position and was developed to be a low-cost measure of muscular fitness suitable for field use. The purpose of this project was to describe the refinements to the ST, detail the performance and measurement protocol, evaluate the measurement inter-rater and intra-rater reliability, characterize the acceleration profile, and explore the inter-day reliability. Both naïve and experienced raters demonstrated excellent intra-rater and inter-rater reliability. The acceleration profile of the dogs in this study was similar to that of average adult human sprinters and demonstrated the role of muscular fitness in performance over this short distance. Finally, a small group of dogs showed moderate inter-day reliability and provided initial performance data to inform future studies. The ST appears to be a reliable measure of canine muscular fitness and could be used to assess performance in healthy dogs and guide the return to sport or work of debilitated dogs.

Reliability of Ultrasound Measurement of Plantar Fascia Thickness: A Systematic Review.

Because ultrasound measurement of plantar fascia thickness is widely used in the diagnosis and evaluation of plantar fasciitis, it is important to understand and minimize the errors that occur with this measurement. The aim of this systematic review was to identify and synthesize studies reporting on intrarater and interrater reliability of ultrasound measurement of plantar fascia thickness. After comprehensive searches in the MEDLINE, Embase, and Cochrane Library databases, 11 studies involving 238 healthy participants and 68 patients with pathologic foot disorders were included. Seven of 11 studies revealed a low risk of bias. Most of the studies reported good to excellent intrarater and interrater reliability for ultrasound measurement of plantar fascia thickness (intrarater intraclass correlation coefficient [ICC], 0.77-0.98; interrater ICC, 0.76-0.98). In addition, two studies on intrarater reliability and one study on interrater reliability showed moderate reliability (ICCs, 0.65, 0.67, and 0.59, respectively). Overall, the standard error of measurement was less than 5% and did not exceed 7%. The findings of this review suggest that ultrasound measurement of plantar fascia thickness is reliable in terms of both relative and absolute reliability. Reliability can be optimized by using the average of multiple measurements and an experienced operator.

Pediatric Lateral Humeral Condyle Fractures: Reliability of a Modified Jakob Classification System and its Impact on Treatment Planning With or Without Arthrography.

Various lateral humeral condyle fracture (LHCF) classification systems have been in use since the 1950s, but limited research exists on their reliability. The most widely utilized, yet un-validated system is that of Jakob and colleagues. The purpose of the current study was to analyze the reliability of a modified Jakob classification system and its value in guiding treatment either with or without arthrography. Interrater and intrarater reliability studies were performed using radiographs and arthrograms from 32 LHCFs. Radiographs were presented to 3 pediatric orthopaedic surgeons and 6 pediatric orthopaedic surgery residents who were asked to classify the fractures according to a modified Jakob classification system, enunciate their treatment plan, and whether they would utilize arthrography. Classification was repeated within 2 weeks to assess intrarater reliability. The treatment plan using radiographs only and radiographs with arthrography were compared at both rating points. The modified Jakob system had excellent interrater reliability using only radiographs with a kappa value of 0.82 and an overall agreement of 86%. The average kappa for intrarater reliability using only radiographs was 0.88 with a range of 0.79 to 1.00 and an average overall agreement of 91% with a range of 84% to 100%. Interrater and intrarater reliability was poorer using both radiographs and arthrography. On average, arthrography changed the treatment plan in 8% of cases. The modified Jakob classification system proved to be a reliable classification system for LHCFs, independent of arthrography, given the excellent free-marginal multirater kappa values. Level III-diagnostic.

Non-invasive assessment of peri-implant mucosal thickness: A cross-sectional study.

This study aimed to evaluate the reliability and reproducibility of different non-invasive methods for the assessment of peri-implant mucosal thickness. Subjects with two adjacent dental implants in the central maxillary region were included in this study. Three different methods to assess facial mucosal thickness (FMT) were compared: digital file superimposition using Digital Imaging and Communication in Medicine (DICOM) and stereolithography (STL) files of the arch of interest (DICOM-STL), DICOM files alone, and non-ionizing ultrasound (US). Inter-rater reliability agreements between different assessment methods were analyzed using inter-class correlation coefficients (ICCs). A total of 50 subjects with 100 bone-level implants constituted the study population. Assessment of FMT using STL and DICOM files demonstrated excellent inter-rater reliability agreement. Mean ICC values of 0.97 and 0.95 were observed in the DICOM-STL and DICOM groups, respectively. Comparison between the DICOM-STL and US revealed good agreement, with an ICC of 0.82 (95% CI: 0.74 to 0.88) and a mean difference of -0.13±0.50mm (-1.13 to 0.86). Comparison between DICOM files alone versus US showed good agreement, with an ICC of 0.81 (95% CI: 0.73 to 0.89) and a mean difference of -0.23±0.46mm (-1.12 to 0.67). Comparison between DICOM-STL and DICOM files revealed excellent agreement, with an ICC of 0.94 (95% CI: 0.91 to 0.96) and a mean difference of 0.1±0.29mm (LOA -0.47 to 0.46). Quantification of peri-implant mucosal thickness via analysis of DICOM-STL files, DICOM files, or US assessment are comparably reliable and reproducible methods.

Prevalence of stuttering among school age children in Dakshina Kannada district of Karnataka, India

PurposeStuttering is a fluency disorder with a worldwide prevalence of 1%. Reports on the epidemiology of stuttering in India is limited. Our primary goal was to examine the prevalence of the disorder among school children. The study also aimed to study the impact of several risk factors on the prevalence of stuttering. MethodA total of 3437 children in the age range of 6–15 years were screened in 16 camps conducted in and around schools of Dakshina Kannada. The children were screened for stuttering using a screening tool by an SLP based on their grade and medium of instruction and further validated using Stuttering Severity Instrument-4. ResultThe prevalence of stuttering in school going children was 1.68%. Gaussian test reveals effect of gender on the prevalence of stuttering (Z1 = 3.501, p < 0.001) with a ratio of 2.4:1 among males and females respectively. No significant association was obtained for socioeconomic status (X22 = 1.42, p = 0.492) and linguistic structure (Z1=1.653, p = 0.0984) on the prevalence of stuttering. Good to excellent inter-rater and intra-rater reliability was obtained. ConclusionThe prevalence of stuttering in Dakshina Kannada is established for the first time in the current study which helped determine in early identification and intervention for children with stuttering leading to better prognosis and quality of life.

Validity, reliability and minimal detectable change of Mini-BESTest Turkish version in neurological disorders.

It is aimed to investigate the psychometric properties of Mini-BESTestTR in Turkish patients with neurological disorders. A total of 61 people between the ages of 42 and 80, who were patients with Parkinson's disease, stroke or multiple sclerosis for more than 1year, were included in the study. For inter-rater reliability, two independent researchers applied the scale two times within 5days for test-retest reliability. The relationship of mini-BESTestTR with Berg Balance Scale (BBS) to assess concurrent validity, and Timed Get up and Go (TUG), Functional Reach Test (FRT) and Functional Ambulation Classification (FAC) for convergent validity was investigated. The scores of the two evaluators were within the range of agreement (mean = -0.278 ± 1.484, p > 0.05), and the Mini-BESTestTR had excellent inter-rater reliability [ICC (95% CI) = 0.989 (0.981-0.993)] and test-retest reliability [ICC (95% CI) = 0.998 (0.996-0.999)]. Mini-BESTestTR had a strong correlation with BBS (r = 0.853, p < 0.001) and TUG (r = - 0.856, p < 0.001), had a moderate correlation with FAC (r = 0.696, p < 0.001) and FRT (r = 0.650, p < 0.001). Mini-BESTestTR showed significant correlations with other balance assessment measures, and concurrent and convergent validity of Mini-BESTestTR was demonstrated when administered to a sample of patients with chronic stroke, Parkinson's disease and multiple sclerosis.

Development and Evaluation of a Pragmatic Measure of Adherence to Dialectical Behavior Therapy: The DBT Adherence Checklist for Individual Therapy.

This paper presents two studies conducted to develop and evaluate a new pragmatic measure of therapist adherence to Dialectical Behavior Therapy (DBT): the DBT Adherence Checklist for Individual Therapy (DBT AC-I). Study 1 used item response analysis to select items from the gold standard DBT Adherence Coding Scale (DBT ACS) using archival data from 1271 DBT sessions. Items were then iteratively refined based on feedback from 33 target end-users to ensure relevance, usability, and understandability. Study 2 examined the psychometric properties of the DBT AC-I as a therapist self-report and observer-rated measure in 100 sessions from 50 therapist-client dyads, while also evaluating predictors of therapist accuracy in self-rated adherence. When used as a therapist self-report measure, concordance between therapist and observer ratings was at least moderate (AC1 ≥ 0.41) for all DBT AC-I items but overall concordance (ICC = 0.09) as well as convergent (r = 0.05) and criterion validity (AUC = 0.54) with the DBT ACS were poor. Higher therapist accuracy was predicted by greater DBT knowledge and adherence as well as more severe client suicidal ideation. When used by trained observers, the DBT AC-I had excellent interrater reliability (ICC = 0.93), convergent validity (r = 0.90), and criterion validity (AUC = 0.94). While therapists' self-rated adherence on the DBT AC-I should not be assumed to reflect their actual adherence, some therapists may self-rate accurately. The DBT AC-I offers an effective and relatively efficient method of evaluating adherence to DBT when used by trained observers.

Interrater Reliability of the Scale for the Assessment and Rating of Ataxia, Berg Balance Scale, and Functional Independence Measure Motor Domain in Individuals With Hereditary Cerebellar Ataxia

ObjectiveTo determine the interrater reliability of the Scale for the Assessment and Rating of Ataxia (SARA), Berg Balance Scale (BBS), and motor domain of the FIM (m-FIM) administered by physiotherapists in individuals with a hereditary cerebellar ataxia (HCA). DesignParticipants were assessed by 1 of 4 physiotherapists. Assessments were video-recorded and the remaining 3 physiotherapists scored the scales for each participant. Raters were blinded to each other's scores. SettingAssessments were administered at 3 clinical locations in separate states in Australia. ParticipantsTwenty-one individuals (mean age=47.63 years; SD=18.42; 13 male and 8 female) living in the community with an HCA were recruited (N=21). Main Outcome MeasuresTotal and single-item scores of the SARA, BBS, and m-FIM were examined. The m-FIM was conducted by interview. ResultsIntraclass coefficients (2,1) for the total scores of the m-FIM (0.92; 95% confidence interval [CI], 0.85-0.96), SARA (0.92; 95% CI, 0.86-0.96), and BBS (0.99; 95% CI, 0.98-0.99) indicated excellent interrater reliability. However, there was inconsistent agreement with the individual items, with SARA item 5 (right side) and item 7 (both sides) demonstrating poor interrater reliability and items 1 and 2 demonstrating excellent reliability. ConclusionsThe m-FIM (by interview), SARA, and BBS have excellent interrater reliability for use when assessing individuals with an HCA. Physiotherapists could be considered for administration of the SARA in clinical trials. However, further work is required to improve the agreement of the single-item scores and to examine the other psychometric properties of these scales.

The Functional Movement Screen: Exploring Interrater Reliability between Raters in the Updated Version.

The Functional Movement Screen™ (FMS™) was updated by adding the ankle clearing test and modifying the rotary stability movement pattern and scoring criteria. This updated FMS™ may be used to support clinical decisions for the well-being of athletes and active adults. The purpose of this study was to determine if the updated FMS™ has acceptable interrater reliability, so that various practitioners can utilize it with their patients. Observational Laboratory Study. Two licensed Physical Therapists (PTs) conducted the testing for the study. No warmup was allowed for the participants. Each participant underwent one FMS™ session while being recorded on video lasting approximately 15 minutes. Participants were allowed three attempts to complete each movement pattern with the best score recorded. The participants, 45 healthy active PT students, were taken through the FMS™ by a licensed PT and videotaped. The raters were four second-year PT students that observed and scored the FMS independently after videotaping was completed. SPSS was used for the interrater reliability analysis. ICC was calculated using a 2-way mixed model looking for absolute agreement. The interrater reliability was highest for the rotary stability test (ICC 0.96) while the deep squat was the least reliable (ICC 0.78). The total scores showed excellent reliability among the four student raters with an ICC of 0.95. The updated FMS™ produced good to excellent interrater reliability. The updated FMS™ has acceptable interrater reliability between minimally, but adequately trained individuals. The updated FMS™ may be reliably used to assess risk for future injury. 3.

Validity, Reliability, and Measurement Error of the Remote Fugl-Meyer Assessment by Videoconferencing: Tele-FMA.

The objective of this study was to investigate the validity, reliability, and measurement error of the Fugl-Meyer Assessment (FMA) when it was administered remotely by videoconferencing (Tele-FMA) and to describe barriers to remote administration of the FMA. Forty-five participants who had strokes and had a smartphone or laptop computer with a camera and internet access were included. An in-person assessment was compared to a remote assessment in 11 participants, and 34 participants completed only the remote assessment. Rater 1 remotely administered, recorded, and scored the items of the FMA, after which the recording was forwarded to be scored by Rater 2. At least 7days later, rater 1 rated the videorecording of the remote assessment a second time for the evaluation of intrarater reliability. In-person assessment was completed by rater 1 at the participant's home. Criterion validity was analyzed using the Bland-Altman limits of agreement, and convergent validity was analyzed using Spearman correlation coefficient. The intrarater and interrater reliability was analyzed using the intraclass correlation coefficient, and individual items were analyzed using the weighted kappa. The standard error of measurement (SEM) and minimal detectable change (MDC) were calculated to evaluate the measurement error. Bland-Altman plots showed adequate agreement of in-person FMA and tele-FMA. A moderate positive correlation was found between Tele-FMA lower extremity (LE) scores and step test results, and a strong positive correlation was found between Tele-FMA-upper extremity (UE) and Stroke Impact Scale hand function domain. Significant and excellent (0.96 ≤ ICC ≤ 0.99) interrater and intrarater reliabilities of the Tele-FMA, Tele-FMA-UE, and tele-FMA-LE were found. Regarding the individual items, most showed excellent reliability (weighted kappa >0.70). The SEM for both reliabilities was small (≤3.1 points). The MDC95 for both the Tele-FMA and Tele-FMA-UE was 2.5 points, whereas it was 1.3 points for the Tele-FMA-LE. Tele-FMA has excellent intrarater and interrater reliability and should be considered as a valid measurement. The FMA is widely used in clinical practice. However, the measurement properties of the remote version applied by videoconferencing were unknown. This study's results demonstrate the validity and reliability of the Tele-FMA for assessing poststroke motor impairment remotely via videoconferencing. The Tele-FMA may be used to implement telerehabilitation in clinical practice.

Agreement between telerehabilitation and face-to-face orofacial myofunctional assessment in persons with acquired brain injury

ABSTRACT Background and objective Orofacial myofunctional disorders are common in persons with acquired brain injury. A new way for early detection of orofacial myofunctional disorders via information and communication technologies may improve accessibility. The purpose of this study was to evaluate the level of agreement between face-to-face and tele-assessment of an orofacial myofunctional protocol in a sample of persons with acquired brain injury. Methods A masked comparative evaluation was conducted in a local association of patients with acquired brain injury. Twenty-three participants (39.1% female, mean age of 54 years) with a diagnosis of acquired brain injury were included in the study. The patients followed a face-to-face and a real-time online assessment using the Orofacial Myofunctional Evaluation with Scores protocol. This is a protocol for evaluation with numerical scales that assess the physical characteristics and the main orofacial functions of patients including appearance, posture, and mobility of lips, tongue, cheeks, and jaws, respiration, mastication, and deglutition. Results The analysis showed excellent interrater reliability (ρ ≥ 0.85) for all the categories. In addition, most confidence intervals were narrow. Conclusions This study reveals excellent interrater reliability of an orofacial myofunctional tele-assessment in patients with acquired brain injury in comparison with a traditional face-to-face evaluation.

Reliability and agreement of the timed up and go test in children and teenagers with autism spectrum disorder

ASD patients include a variety of motor deficits; however, these issues have received less scientific attention than other ASD symptoms. Due to understanding and behavioral difficulties, it might be difficult to administer motor assessment measures to children and adolescents with ASD. To evaluate motor challenges in this population, including gait and dynamic balance issues, the timed up and go test (TUG) may be a simple, easy to apply, quick, and inexpensive tool. This test measures in seconds the time it takes for an individual to get up from a standard chair walk 3 m, turn around, walk back to the chair, and sit down again. The study purpose was to evaluate the inter- and intra-rater reliability of TUG test in children and teenagers with ASD. A total of 50 children and teenagers with ASD (43 boys and 7 girls) between 6 and 18 years were included. Reliability was verified by the intraclass correlation coefficient, standard error of measurement, and minimum detectable change. The agreement was analyzed by the Bland–Altman method. A good intra-rater reliability (ICC = 0.88; 95% CI = 0.79–0.93) and an excellent inter-rater reliability (ICC = 0,99; 95% CI = 0.98 to 0.99) were observed. Additionally, Bland–Altman plots demonstrated that there was no evidence of bias in either the replicates or between examiners. Furthermore, the limits of agreement (LOAs) between the testers and test replicates were close, indicating that there was little variation between measurements. Conclusions: The test TUG showed strong intra- and inter-rater reliability values, low proportion of measurement errors, and lack of significant bias based on by test repetition in children and teenagers with ASD. These results could be clinically useful for assessing balance and the risk of falls in children and teenagers with ASD. However, the present study is not free of limitations, such as the use of a non-probabilistic sampling.What is Known:• People with ASD have a variety of motor deficits that have a prevalence rate almost as common as intellectual disability. In our knowledge, there are no studies that provide data on the reliability of the use of scales or assessment tests in children and adolescents with ASD to measure motor difficulties, such as gait and dynamic balance, in children and teenagers with ASD.• Timed up and go test (TUG) could be a possible tool to measure this motor skills.What is New:• The reliability and agreement of the Timed up and go test in 50 children and teenagers with autism spectrum disorder showed strong intra- and inter-rater reliability values, low proportion of measurement errors, and lack of significant bias based on by test repetition.

Interrater and Intrarater Reliability of the Intra-Abdominal Pressure Test in Young Adults

BACKGROUND: Diaphragm is not used correctly to its fullest potential which can lead to injury provoking compensations. If recruited properly, the diaphragm aids in the production of intra-abdominal pressure, which is necessary for core and spinal stabilization. Intra-abdominal pressure is a key component of our dynamic stability system. OBJECTIVE: The purpose of this study was to determine the interrater and intrarater reliability of the intra-abdominal pressure test in young adults. METHODOLOGY: It is a non-experimental design of test-retest type. 80 subjects (50 women and 30 men) aged 18-28 years with the BMI of &lt; 23.05-24.9 kg/m2 were conveniently included. Subjects with the history of low back pain for past 3 months, any hip or knee surgery for last 1 year, thoracic or thoracoabdominal surgery, postural deformities, cardiorespiratory diseases, pregnancy and pelvic floor dysfunction was excluded. The intra- abdominal pressure test had been carried to the subjects on the same day for the interrater reliability and 1 week later for the intrarater reliability. The signs of proper stabilization with the correct and incorrect activation of the chest and abdominal movements of the subjects were documented independently between the raters and scoring had been done. RESULTS: The results of the study showed an overall excellent interrater reliability of ICC=0.957 and intrarater reliability of ICC= 0.903 of the test. CONCLUSION: The study concludes that there is an overall excellent interrater and intrarater reliability of the intra-abdominal pressure test in normal young adults and hence it can be used in clinical practice. Keywords: Diaphragm, Intra-abdominal pressure, Intra-abdominal pressure test, Core stability, Spinal stability.

Validity, inter-rater reliability, and feasibility of the Chelsea Physical Assessment Tool for assessing physical function in post-acute COVID-19 patients: A cross-sectional study.

Various tools have been created to measure physical function during intensive care unit (ICU) stay and after ICU discharge, but those have not been validated in coronavirus 2019 (COVID-19) patients. There is a need for a reliable, valid and feasible tool to define the rehabilitation needs of post-ICU COVID-19 patients entering the acute wards and then rehabilitation clinics. This study aims to investigate the validity, inter-rater reliability and feasibility of Chelsea Physical Assessment Tool (CPAx) in assessing the functional status of COVID-19 patients after discharge from the ICU. Demographic and clinical characteristics of the patients were recorded. Patients were evaluated using the modified Medical Research Council (MRC) dyspnea scale, Functional Oral Intake Scale, Glasgow Coma Scale, CPAx, Barthel Index, Katz Index and MRC sum score, measurements of grip strength obtained by dynamometer, the 5 time sit-to-stand test and 30 seconds and sit-to-stand test. CPAx and the other functional assessment tools were administered to 16 patients within 48hours following ICU discharge. For inter-rater reliability, another physiatrist independently re-assessed the patients. MRC sum score, Barthel and Katz indexes were used to assess construct validity of CPAx. The discriminative validity of CPAx was determined by its ability to differentiate between patients with and without ICU acquired muscle weakness based on MRC sum score. The intra-class correlation coefficients (ICC) were calculated to determine inter-rater reliability for total scores of the functional assessment tools. Cohen's Kappa (κ) coefficient and weighed Kappa (κw) were calculated to determine inter-rater reliability of individual CPAx items. Ceiling and flooring effects were calculated by percentage frequency of lowest or highest possible score achieved. The number and percentages of the patients who were able to complete each tool were calculated to assess feasibility. The CPAx score was strongly correlated with MRC sum score (rho: 0.83), Barthel Index (rho: 0.87) and Katz Index (rho: 0.89) (p< 0.001) showing construct validity. Area under the ROC curve demonstrated that cut off score for CPAx was ⩽ 12 to discriminate patients with MRC sum score < 48, with a sensitivity and a specificity of 100% and 63%, respectively (AUC = 0.859, p< 0.001). ICC was high for CPAx, MRC sum score, Barthel and Katz indexes, Glasgow Coma Scale, and hand grip strength measurement, with the highest value observed for CPAx (ICC, 0.96; 95% confidence interval (CI), 0.71-0.98). κ and κw analysis showed good to excellent inter-rater reliability for individual CPAx items. No floor or ceiling effect was observed at CPAx while floor effect was observed at Barthel Index scores (25%) and Katz Index scores (37.5%). All patients could be evaluated using CPAx while less were physically able to complete the 5 time sit-to-stand, 30 seconds sit-to-stand tests (n= 4) and MRC sum score (n= 14). CPAx is a valid, reliable, and feasible tool to assess the physical functional state in COVID-19 patients following discharge from the ICU.

Excellent Interrater Reliability for Manual Segmentation of the Medial Perirhinal Cortex.

Objective: Evaluation of interrater reliability for manual segmentation of brain structures that are affected first by neurofibrillary tau pathology in Alzheimer's disease. Method: Medial perirhinal cortex, lateral perirhinal cortex, and entorhinal cortex were manually segmented by two raters on structural magnetic resonance images of 44 adults (20 men; mean age = 69.2 ± 10.4 years). Intraclass correlation coefficients (ICC) of cortical thickness and volumes were calculated. Results: Very high ICC values of manual segmentation for the cortical thickness of all regions (0.953-0.986) and consistently lower ICC values for volume estimates of the medial and lateral perirhinal cortex (0.705-0.874). Conclusions: The applied manual segmentation protocol allows different raters to achieve remarkably similar cortical thickness estimates for regions of the parahippocampal gyrus. In addition, the results suggest a preference for cortical thickness over volume as a reliable measure of atrophy, especially for regions affected by collateral sulcus variability (i.e., medial and lateral perirhinal cortex). The results provide a basis for future automated segmentation and collection of normative data.

Development and Validation of the Dystonia-Pain Classification System: A Multicenter Study.

Dystonia is associated with disabling nonmotor symptoms like chronic pain (CP), which is prevalent in dystonia and significantly impacts the quality of life (QoL). There is no validated tool for assessing CP in dystonia, which substantially hampers pain management. The aim was to develop a CP classification and scoring system for dystonia. A multidisciplinary group was established to develop the Dystonia-Pain Classification System (Dystonia-PCS). The classification of CP as related or unrelated to dystonia was followed by the assessment of pain severity score, encompassing pain intensity, frequency, and impact on daily living. Then, consecutive patients with inherited/idiopathic dystonia of different spatial distribution were recruited in a cross-sectional multicenter validation study. Dystonia-PCS was compared to validated pain, mood, QoL, and dystonia scales (Brief Pain Inventory, Douleur Neuropathique-4 questionnaire, European QoL-5 Dimensions-3 Level Version, and Burke-Fahn-Marsden Dystonia Rating Scale). CP was present in 81 of 123 recruited patients, being directly related to dystonia in 82.7%, aggravated by dystonia in 8.8%, and nonrelated to dystonia in 7.5%. Dystonia-PCS had excellent intra-rater (Intraclass Correlation Coefficient - ICC: 0.941) and inter-rater (ICC: 0.867) reliability. In addition, pain severity score correlated with European QoL-5 Dimensions-3 Level Version's pain subscore (r = 0.635, P < 0.001) and the Brief Pain Inventory's severity and interference scores (r = 0.553, P < 0.001 and r = 0.609, P < 0.001, respectively). Dystonia-PCS is a reliable tool to categorize and quantify CP impact in dystonia and will help improve clinical trial design and management of CP in patients affected by this disorder. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Reliability and Validity of a Portable Traction Dynamometer in Knee-Strength Extension Tests: An Isometric Strength Assessment in Recreationally Active Men.

the study determined the validity and reliability of measurements obtained using the portable traction dynamometer (PTD) (E-Lastic, E-Sports Solutions, Brazil) and the reproducibility between evaluators (precision) in the evaluation of the isometric muscle strength of the knee extensors of healthy male adults, compared to measurements obtained with the "gold standard" computerized dynamometer (CD) (Biodex System 3, Nova York, NY, USA). we evaluated sixteen recreationally active men (29.50 ± 7.26 years). The test-retest reliability of both equipment to determine quadriceps strength, agreement analysis, and the minimal important difference were verified. excellent test-retest interrater reliability was observed for absolute and relative measurements, with a low absolute error for both sets of equipment and excellent validity of the PTD against the CD, as verified by linear regression and Pearson's correlation coefficient. PTD is a valid and reliable instrument for assessing the isometric strength of knee extensors, with results similar to the isometric CD "gold standard".

Development and Validation of FFQ for Assessing Sugar-Sweetened Beverages (SSB) and High-Energy Dense Foods Intake among Malaysian Adolescents

Introduction: Increased consumption of sugar-sweetened beverages (SSBs) is strongly associated with weight gain, dental cavities, and a higher risk of chronic diseases among adolescents. However, there is no available FFQ for the Malaysian population individually to evaluate and assess the consumption of SSBs and high-energy dense (HED) foods among adolescents. Method: A 24-hour diet recall with 30 adolescents were performed via Google Meet to identify the most common and frequent types of SSBs and HEDs foods consumed nowadays. The food checklist of SSBs and HED foods from literature review search was also provided to the participants. Experts critically reviewed each food item and provide a score for its relevancy and essentiality. Face validity were conducted among 10 adolescents to validate the developed FFQ. Results: The final FFQ consisted of 63 food items with ten categories. This FFQ showed high content validity for individual items with I-CVI ranging from 0.67 to 1.00 and overall questionnaires with S-CVI/Ave valued at 0.97. The calculation of Kappa statistic showed that this newly developed FFQ has excellent inter-rater reliability at the item level with K &gt; 0.74 for 55 items and K = 0.57 only for 4 items. Most of the items were marked as relevant with a CVR score of 1.00. Conclusion: The findings of this study imply that the newly developed FFQ could be utilised to estimate the intake of SSB and HED foods of Malaysian adolescents.