Excellent Intra-examiner Reliability Research Articles

Inter-Examiner and Intra-Examiner Reliability of Quantitative and Qualitative Ultrasonography Assessment of Peripheral and Respiratory Muscles in Critically Ill Patients

ICU patients are exposed to several factors that can lead to muscle structural and functional changes, and ultrasonography can identify them. Although several studies have analyzed the reliability of muscle ultrasonography assessment, a protocol with more muscle assessments becomes a challenge. The aim of this study was to analyze the inter and intra-examiner reliability of peripheral and respiratory muscle ultrasonography assessment in critically ill patients. The sample size was 10 individuals aged ≥ 18 years who were admitted to the ICU. Practical training of four health professionals from different backgrounds was performed. After training, each examiner acquired three images to assess the thickness and echogenicity of the muscle groups: biceps brachii, forearm flexor group, quadriceps femoris, tibialis anterior and diaphragm. For the reliability analysis, an intraclass correlation coefficient was performed. Six hundred US images were analyzed for muscle thickness and 150 for echogenicity. Excellent intra-examiner reliability for echogenicity (ICC: 0.867-0.973) and inter-examiner reliability for thickness were found in all muscle groups (ICC: 0.778-0.942). For muscle thickness intra-examiner reliability, excellent results were found (ICC: 0.798-0.988), with a "good" correlation in one diaphragm assessment (ICC: 0.718). Excellent inter- and intra-examiner reliability of the thickness assessment and intra-examiner echogenicity of all muscles analyzed were found.

Clinical Effectiveness of Vestibular Shields in Orthodontic Treatment: A Scoping Review.

This systematic literature search was performed to determine the clinical effectiveness of vestibular shields (VSs) in children undergoing orthodontic treatment. A comprehensive electronic search was performed in May 2022 using three databases (Medline via PubMed, the Cochrane Central Register of Controlled Trials, and Ovid). The initial screening of articles was based on titles and abstracts. Studies meeting the inclusion criteria were retrieved for the final quality assessment and the methodological qualities were assessed according to the Newcastle-Ottawa Scale and Cochrane risk of bias. The initial search identified 262 publications, of which 15 studies were potentially eligible, with excellent intra-examiner reliability (K = 0.88). A total of five studies were selected for the final analysis, including one randomized controlled trial, three clinical trials, and one cohort study. VS may have potential impacts on orthodontic treatment, lips and dental arches, but further high-quality studies are warranted.

The Application of Image Texture Analysis Techniques on the Effects of Dry Needling versus Placebo in Low-Back Pain Patients: A Pilot-Study

Low back pain is the leading cause of disability in the world, with a significant socio-economic impact. Deep dry needling is effective in the treatment of this pain, and it is one of the techniques preferred by physiotherapists. In this field, the use of ultrasound provides information of interest such as length, thickness, diameter, cross-sectional area, or muscle volume, among others. Objective: To find out whether the tissue changes (thickness, histogram, and contraction rate) that occur in the lumbar multifidus after application of the deep dry needle are related to changes in the pain and the disability of the patient. Design: Randomized, double-blind, parallel-group clinical trial. Setting: University of Alcalá, Department of Physiotherapy. Subjects: 21 voluntary patients (women and men) with non-specific low-back pain aged 18–65 years. Intervention: Patients were randomly divided into two groups. One group received dry needling and the other group a dry needling placebo. Initial post-needling and one week post-needling assessments were performed by a therapist blinded to the intervention. Variables: Lumbar multifidus thickness measured by RUSI, contraction time measured by M-mode, histograms measured by image analysis, muscle area, pain measured by VAS, pressure pain threshold measured by pressure algometer, and disability measured by Roland–Morris questionnaire. Conclusions: The contraction speed, resting thickness, and pain demonstrated significant differences within each group, but not between groups. There were significant differences in contraction ratio and in PPT between groups. There was excellent intra-examiner reliability in image collection for histogram analysis. Histogram analysis showed no significant differences between groups and measurements, neither for the parameters nor for the parameters combined with the outcome variables. A robust method for the image texture analyses in future histogram muscle analyses has been performed.

Athree-dimensional method to calculate mechanical advantage in mandibular function : Intra- and interexaminer reliability study.

Masticatory muscles are physically affected by several skeletal features. The muscle performance depends on muscle size, intrinsic strength, fiber direction, moment arm, and neuromuscular control. To date, for the masticatory apparatus, only atwo-dimensional cephalometric method for assessing the mechanical advantage, which is ameasure for the ratio of the output force to the input force in asystem, is available. This study determined the reliability and errors of athree-dimensional (3D) mechanical advantage calculation for the masticatory system. Using cone-beam computed tomography images from teenage patients undergoing orthodontic treatments, 36craniofacial landmarks were identified, and the moment arms for seven muscles and their load moment arms (biomechanical variables) were determined. The 3D mechanical advantage for each muscle was calculated. This procedure was repeated by three examiners. Reliability was verified using the intraclass correlation coefficient (ICC) and the errors by calculating the absolute differences, variance estimator and coefficient of variation (CV). Landmark coordinates demonstrated excellent intra- and interexaminer reliability (ICC 0.998-1.000; p < 0.0001). Intraexaminer data showed errors < 1.5 mm. Unsatisfactory interexaminer errors ranged from 1.51-5.83 mm. All biomechanical variables presented excellent intraexaminer reliability (ICC 0.919-1.000, p < 0.0001; CV < 7%). Interexaminer results were almost excellent, but with lower values (ICC 0.750-1.000, p < 0.0001; CV < 10%). However, the muscle moment arm and 3D mechanical advantage of the lateral pterygoid muscles had ICCs < 0.500 (p < 0.05) and CV < 30%. Intra- and interexaminer errors were ≤ 0.01 and ≤ 0.05, respectively. Both landmarks and biomechanical variables showed high reliability and acceptable errors. The proposed method is viable for the 3D mechanical advantage measure.

Intraoral scanner featuring transillumination for proximal caries detection. An in vitro validation study on permanent posterior teeth

ObjectivesTo assess the validity of an intraoral scanner system featuring near-infrared (NIR) transillumination to aid the detection of proximal caries lesions, and to compare the diagnostic performance of this system with that of conventional caries detection methods and with that of an intraoral camera featuring NIR transillumination (DIAGNOcam). MethodsNinety-five permanent posterior teeth were examined using a prototype tip functioning with TRIOS 4 intraoral scanner system (3Shape TRIOS A/S, Denmark) and emitting NIR light, DIAGNOcam, and visual and radiographic examination employing ICDAS criteria. One or two approximal surfaces per tooth, sound or with caries lesions at different stages, were examined (N1=158). Histological assessment was used as the reference standard. ResultsAll methods showed excellent intra-examiner reliability (κintra ≥0.80). Two independent examiners assessed the NIR images obtained with both devices. The first examiner, who obtained and assessed the images, showed improved diagnostic performance than the second examiner, who only had access to the images. The inter-examiner agreement between the two examiners assessing the NIR images was substantial (κinter 0.57-0.72). The intraoral scanner and DIAGNOcam showed similar diagnostic performance. Regarding initial caries lesions, the NIR image assessment resulted in equal or improved sensitivity (SE 0.50-0.89) compared to radiographic assessment (SE 0.49-0.51) and higher than visual examination (SE 0.28-0.39). Radiographic and NIR image assessment resulted in similar SE in detecting moderate-extensive dentin caries lesions (SE 0.59-0.70), while visual examination showed an inferior value (SE 0.30). ConclusionsThe intraoral scanner system featuring NIR transillumination and DIAGNOcam showed an overall good diagnostic performance. The conventional caries detection methods showed inferior sensitivity at initial caries lesion stages. Clinical significanceConsidering the promising diagnostic performance of the intraoral scanner featuring transillumination and the advantages offered by combining the NIR images with the 3D models of the teeth, this system has the potential to contribute towards more reliable caries detection and monitoring in clinical practice without the use of ionizing radiation.

Potential impact of pediatric obstructive sleep apnea on mandibular cortical width dimensions.

To analyze differences in mandibular cortical width (MCW) among children diagnosed with obstructive sleep apnea (OSA) or at high- or low-risk for OSA. A total of 161 children were assessed: 60 children with polysomnographically diagnosed OSA, 56 children presenting symptoms suggestive of high-risk for OSA, and 45 children at low risk for OSA. Children at high- and low-risk for OSA were evaluated through the Pediatric Sleep Questionnaire. MCW was calculated using ImageJ software from panoramic radiograph images available from all participants. Differences between MCW measurements in the 3 groups were evaluated using analysis of covariance and Bonferroni post-hoc tests, with age as a covariate. The association between MCW and specific cephalometric variables was assessed through regression analysis. The participants' mean age was 9.6 ± 3.1 years (59% male and 41% female). The mean body mass index z-score was 0.62 ± 1.3. The polysomnographically diagnosed OSA group presented smaller MCW than the group at low-risk for OSA (mean difference = -0.385 mm, P = .001), but no difference with the group at high-risk for OSA (polysomnographically diagnosed OSA vs high-risk OSA: P = .085). In addition, the MCW in the group at high-risk for the OSA was significantly smaller than the group at low-risk for the OSA (mean difference = -0.301 mm, P = .014). The cephalometric variables (Sella-Nasion-A point angle (SNA) and Frankfort - Mandibular Plane angle (FMA)) explained only 8% of the variance in MCW. Reductions in MCW appear to be present among children with OSA or those at high-risk for OSA, suggesting potential interactions between mandibular bone development and/or homeostasis and pediatric OSA. Fernandes Fagundes NC, d'Apuzzo F, Perillo L, et al. Potential impact of pediatric obstructive sleep apnea on mandibular cortical width dimensions. J Clin Sleep Med. 2021;17(8):1627-1634.

Intra- and Inter-Examiner Reliability of the Viladot Method in Children

ObjectiveThe aim of this study was to evaluate the interexaminer and intraexaminer reliability of classification with the Viladot method of plantar impression obtained by means of a footprinting mat. MethodsFootprints were taken from 40 participants using a footprinting mat. The images were subjected to analysis by 3 independent examiners. To investigate intraexaminer reliability, the analysis was repeated by 1 of the examiners 1 week later. ResultsExcellent intraexaminer reliability was found (κ = 1.0; 95% confidence interval [CI], 0.77-1.0; P < .00). For interexaminer reliability, in the right foot high concordance was found for typical feet (κp = 0.76; 95% CI, 0.58-0.93; P < .00) and excellent concordance for cavus feet and flat feet (respectively: κp = 0.86; 95% CI, 0.68-1.0; P < .00; and κp = 0.81; 95% CI, = 0.63-0.99; P < .00). In the left foot high concordance was observed between the 3 evaluators for typical feet and cavus feet (respectively: κp = 0.75; 95% CI, 0.57-0.93; P < .00; and κp = 0.69; 95% CI, 0.51-0.87; P < .00) and excellent concordance for flat feet (κp = 1.0; 95% CI, 0.82-1.0; P < .00). ConclusionThe Viladot method is reliable for analyses involving 1 or more examiners, presenting excellent intraexaminer reliability and high to excellent interexaminer reliability. The Viladot method is a reliable (replicable and consistent) instrument, that is, its repeated application to the same subject produces similar results.

Measurement error and reliability of three available 3D superimposition methods in growing patients

IntroductionCone-Beam Computed Tomography (CBCT) images can be superimposed, allowing three-dimensional (3D) evaluation of craniofacial growth/treatment effects. Limitations of 3D superimposition techniques are related to imaging quality, software/hardware performance, reference areas chosen, and landmark points/volumes identification errors. The aims of this research are to determine/compare the intra-rater reliability generated by three 3D superimposition methods using CBCT images, and compare the changes observed in treated cases by these methods.MethodsThirty-six growing individuals (11–14 years old) were selected from patients that received orthodontic treatment. Before and after treatment (average 24 months apart) CBCTs were analyzed using three superimposition methods. The superimposed scans with the two voxel-based methods were used to construct surface models and quantify differences using SlicerCMF software, while distances in the landmark-derived method were calculated using Excel. 3D linear measurements of the models superimposed with each method were then compared.ResultsRepeated measurements with each method separately presented good to excellent intraclass correlation coefficient (ICC ≥ 0.825). ICC values were the lowest when comparing the landmark-based method and both voxel-based methods. Moderate to excellent agreement was observed when comparing the voxel-based methods against each other. The landmark-based method generated the highest measurement error.ConclusionsFindings indicate good to excellent intra-examiner reliability of the three 3D superimposition methods when assessed individually. However, when assessing reliability among the three methods, ICC demonstrated less powerful agreement. The measurements with two of the three methods (CMFreg/Slicer and Dolphin) showed similar mean differences; however, the accuracy of the results could not be determined.

Prevalence and Characteristics of Three-rooted Mandibular Molars in Saudi Population: A Retrospective Radiographic Analysis

To study the prevalence of three-rooted mandibular permanent first molars (PFM) among Saudi population in Al Zulfi. Subjects were selected from the patients' records, College of Dentistry, Majmaah University, Al Zulfi, Kingdom of Saudi Arabia. Healthy patients with the presence of both mandibular PFM, orthopantomogram (OPG) and/or intraoral periapical (IOPA) radiographs were included in the study. All patients included were evaluated by a single examiner using OPG and IOPA radiographs. The occurrence of three roots, status of the tooth and associated anomalies were considered for analysis. Descriptive statistics performed using IBM SPSS (Version 21.0) at a 95% confidence interval (p < 0.05) while the Chi-square test and Fisher test were used for the incidence, and comparison of occurrence of the third root in PFM in the mandibular arch. A sample of 433 subjects was selected randomly based on our inclusion criteria. Only 24 (5.5%) subjects had evidence of three-rooted mandibular PFM with the mean age of 27.67 years. The frequency of bilateral and unilateral three-rooted mandibular PFM was 2.3% (10) and 3.2% (14), respectively. Overall 41.6% of subjects were witnessed with the bilateral occurrence and unilateral occurrence was 58.4% [(57% (8) were on the right and 42% (6) were left side] (p < 0.05). However, no significant relationship was observed between the left and right occurrence of three-rooted mandibular PFM (p < 0.05). Thirty-four (7.8%) PFM were presented with three roots and among them, 70% (24) received treatment. Dilacerations (12.5%), taurodontism (37%) and hypodontia (4%) were associated with three-rooted PFM in the mandibular arch. Kappa statistics showed excellent intra-examiner reliability (κ = 0.9). The prevalence of three-rooted PFM was 5.5% in the present study and unilateral occurrence is very common. Over 70% of these PFM received dental treatment in Saudi Arabia population. Always, IOPA radiographs are required to confirm the evidence of three-rooted mandibular PFM where three-dimensional imaging is not available. An Eagle's eye of an endodontist on three-rooted PFM is of utmost importance in the treatment protocol when the tooth is planned for root canal therapy.

An Agreement of Two Tonometers: Goldmann Applanation and Non-Contact Scheimflug Technology in Healthy, Ocular Hypertension and Open-angle Glaucoma Patients

Objective: The primary objective was to find an agreement of intraocular pressure (IOP) assessed by Goldmann applanation tonometry (GAT) and Corvis in healthy, ocular hypertension (OHT) and primary open-angle glaucoma (POAG). The secondary objective was to find a reliability of intra-examiner and inter-examiner IOP measurement by GAT and Corvis. Methods: Fifty three eyes from 53 participants were included and were divided into healthy (N=20), OHT (N=13) and POAG group (N=20). Only right eyes were selected for further statistical analysis except one patient with only left eye eligible. The eyes with corneal pathologies, greater than 2.5 diopters astigmatism, or recent ocular surgery were excluded. Randomized examining sequence between GAT and Corvis was applied. To minimize an after measurement IOP fluctuation, five minutes and two minutes gap between measurements were strictly applied for Corvis and GAT respectively. The first ten patients had 3 measurements per measurer and two measurers were assigned per machine to evaluate intra-examiner and inter-examiner reliability. Intraclass correlation coefficient was used to analyze the reliability of the IOP measuring machine. Bland & Altman plot was used to analyze an agreement between the machines. Results: High ICCs were found in both measurers using GAT (ICC of measurer 1 = 0.954, measurer 2 = 0.977) and Corvis (ICC of measurer 1 = 0.920, measurer 2 = 0.927) which indicated excellent intra-examiner reliability. High ICCs were found when comparing IOP between 2 measurers who used the same machine (GAT ICC = 0.928, Corvis ICC = 0.915) which indicated excellent inter-examiner reliability. GAT tends to yield higher IOP reading. The mean IOP were 13.93±3.849 by GAT and 12.15±4.030 by Corvis. The mean IOP differences were 1.8, 1.7, 1.4 and 2.2 mmHg in total, healthy, OHT and POAG group respectively. POAG had highest mean difference and widest standard deviation which might result from poor agreement between 2 machines. According to Bland & Altman plot the values were scattered and no trend was found indicating higher or lower average IOP would result in higher or lower difference between the two machines. From the clinical point of view, 71.7% and 47.2% fall into IOP difference range of ±3 and ±2 mmHg respectively. Conclusion: Corvis-IOP is a good parameter with excellent intra-examiner and inter-examiner reliability. In clinical practice, the usefulness of Corvis-IOP is limited especially in POAG patients according to the poor agreement with gold standard GAT-IOP.

Establishing the reliability of a novel battery of range of motion tests to enable evidence-based classification in Para Swimming

ObjectivesTo evaluate the reliability of swimming-specific range of movement tests developed in order to permit evidenced-based classification in the sport of para swimming. DesignTest-retest intra- and inter-examiner reliability. SettingInternational Swimming training camps and university exercise science departments. Participants42 non-disabled participants (mean age 23.2 years) and 24 Para swimmers (mean age 28.5 years). Main outcome measuresIntra- and inter-examiner reliability of a battery of novel active range of motion tests. ResultsGood to excellent intra-examiner reliability was found for the majority (32/34) of tests in non-disabled participants (ICC = 0.85–0.98). SEM values ranged from 1.18° to 6.11°. Similarly, good to excellent inter-examiner reliability was found for the majority (35/42) of tests in non-disabled participants (ICC = 0.85–0.98). SEM values range from 0.73° to 6.52°. Para swimmers exhibited significantly reduced range of motion compared to non-disabled participants. ConclusionsThe large majority of ROM tests included in this novel battery were reliable both within and between examiners in non-disabled participants. The tests were found to differentiate between non-disabled participants and Para swimmers with hypertonia or impaired muscle power.

The reliability of shoulder range of motion measures in competitive swimmers

ObjectivesInvestigate reliability of shoulder internal and external rotation (IR, ER), abduction in internal rotation (ABIR) and combined elevation (CE) range of motion tests in competitive swimmers. DesignWithin participants, inter- and intra-examiner reliability. SettingPhysiotherapy Department, University of Melbourne, Australia. Participants17 competitive swimmers (aged 12–24 years) who participate in at least 5 weekly swimming sessions and two physiotherapy examiners. Main outcome measuresInter- and intra-examiner reliability of IR, ER, ABIR and CE. ResultsGood to excellent intra-examiner reliability across tests (ICCs: 0.85–0.96) with standard error of measurement (SEM)and minimal detectable change at 90% confidence interval (MDC90) ranging from 2 to 5, and 5–12°, respectively. Good to excellent inter-examiner reliability for all tests (ICCs: 0.77–0.94) except left IR (ICC: 0.65). Inter-examiner SEM and MDC90 ranged from 2 to 5° and 5–12°, respectively. ConclusionShoulder range of motion tests were reliable when applied by the same examiner. Inter-examiner reliability was acceptable for all tests except IR, which was affected by inconsistent manual scapula stabilisation between examiners.

Validation of quantitative light-induced fluorescence-digital (QLF-D) for the detection of approximal caries in vitro

ObjectivesDetection of approximal caries lesions can be difficult due to their anatomical position. This study aimed to assess the ability of the quantitative light-induced fluorescence-digital (QLF-D) in detecting approximal caries, and to compare the performance with those of the International Caries Detection and Assessment System II (ICDAS II) and digital radiography (DR). MethodsExtracted permanent teeth (n=100) were selected and mounted in pairs. The simulation pairs were assessed by one calibrated dentist using each detection method. After all the examinations, the teeth (n=95) were sectioned and examined histologically as gold standard. The modalities were compared in terms of sensitivity, specificity, areas under receiver operating characteristic curves (AUROC) for enamel (D1) and dentine (D3) levels. The intra-examiner reliability was assessed for all modalities. ResultsAt D1 threshold, the ICDAS II presented the highest sensitivity (0.80) while the DR showed the highest specificity (0.89); however, the methods with the greatest AUC values at D1 threshold were DR and QLF-D (0.80 and 0.80 respectively). At D3 threshold, the methods with the highest sensitivity were ICDAS II and QLF-D (0.64 and 0.64 respectively) while the method with the lowest sensitivity was DR (0.50). However, with regard to the AUC values at D3 threshold, the QLF-D presented the highest value (0.76). All modalities showed to have excellent intra-examiner reliability. ConclusionsThe newly developed QLF-D was not only able to detect proximal caries, but also showed to have comparable performance to the visual inspection and radiography in detecting proximal caries. Clinical significanceQLF-D has the potential to be a useful detection method for proximal caries.

Cervical dystonia severity scale reliability study.

Cervical dystonia (CD) is characterized by sustained contractions of the neck musculature, resulting in abnormal head postures. The Cervical Dystonia Severity Scale (CDSS) was developed to provide a reliable measure of treatment response in patients with CD. The CDSS uses a protractor and wall chart to rate the severity of the head's deviation from neutral in each of three planes of motion (rotation, laterocollis, anterocollis/retrocollis), which is then scored in 5 degree intervals (1 degree to 5 degrees deviation = 1; 86 degree to 90 degrees deviation = 18). To test the reliability of the CDSS, four centers, each with two independent examiners, evaluated 42 patients with CD. At each site, each of the two examiners used the CDSS to evaluate the head position of each patient twice, on the same day, for a total of four evaluations. The kappa value for intra-examiner agreement was 0.94 (95% confidence limit of 0.900-0.972), indicating excellent intra-examiner reliability. The kappa value for interexaminer reliability was 0.79 for the first evaluation and 0.86 for the second evaluation (95% confidence limits of 0.668-0.920 and 0.790-0.920) indicating excellent interexaminer reliability. Thus, the CDSS was highly reliable in both intra-examiner and interexaminer scoring comparisons.