Excellent Intrarater Reliability Research Articles

A Prospective Analysis of Skin and Fingertip Advanced Glycation End-Product Devices in Healthy Volunteers.

Background: Advanced glycation end products (AGEs) have been shown to accumulate in bone and are gaining interest in connective tissue research. Aims: To investigate the intrarater reliability, two-timepoint agreement and correlations within and between two commercially available skin autofluorescence (SAF) AGE devices. Methods: Healthy volunteers were enrolled in a prospective study at a single academic institution. Each participant underwent SAF analysis by two different, commercially available devices on two occasions, 14 days apart. Upon enrollment, a general survey about the participant’s lifestyle and health status was completed and followed up on for any changes at timepoint two. Results: In total, 40 participants (F:M ratio 5:3) with an average age of 39.0 ± 12.5 years were analyzed. For the AGE reader (skin) and AGE sensor (fingertip), both intrarater reliability and two-timepoint agreement were excellent with an interclass correlation coefficient (ICC) > 0.90 and a strong correlation within both machines. However, there was no correlation between both machines for either timepoint. In total, 4 participants were identified as outliers above the +2SD. Additionally, 5 participants with dark-colored skin could not be measured with the AGE reader at timepoint one and 4 at timepoint two. In contrast, all participants were able to undergo SAF analysis with the AGE sensor, irrespective of their skin type. Conclusions: Both machines showed excellent intrarater reliability and two-timepoint agreement, but the skin AGE reader might have limited applicability in individuals with dark-colored skin. Future research on AGEs might take our findings into consideration.

Modified Radiographic Classification System for Congenital Thumb Duplication: An Analysis of 2,300 Thumbs in 2,108 Children

The objectives of this study were to (1) evaluate the radiographic characteristics of children with congenital thumb duplication (CTD) seen in our institution between August 2015 and April 2021; (2) introduce a modified radiographic classification system (MCS) capable of including all cases of CTD based on their radiographic pathoanatomy; and (3) evaluate the inter- and intrarater reliability of the new classification system. We retrospectively reviewed 2,108 patients with 2,300 CTDs. The MCS is based on the Wassel-Flatt and Chung etal classification systems and includes specific subtypes from the Rotterdam and modified Wassel-Flatt classifications. The MCS is characterized by 4 groups according to the anatomical morphology of the duplication: A (joint), B (epiphysis), C (bone), and D (soft tissues). Each group includes 4 subtypes according to the location of the CTD, with subtypes 1-3 extending from the distal phalanx to the metacarpal or interphalangeal joints, then to the carpometacarpal joint, and with subtype 4 only including the triphalangia of the main thumb. Among the 2,300 fingers, 360 (15.7%), 2 (0.1%), and 3 (0.1%) CTDs could not be classified according to the Wassel-Flatt, Chung etal, and Rotterdam classifications, respectively. According to the MCS, the 2 most common forms of CTD were A2 (680/2,300; 29.6%) and D2 (308/2,300; 13.4%). All cases could be classified according to this classification system. The MCS showed excellent intrarater (0.875) and interrater (0.851) reliability relative to the Wassel-Flatt (0.863 and 0.820, respectively), Chung etal (0.793 and 0.822, respectively), and Rotterdam (0.873 and 0.836, respectively) systems. The MCS is a potential radiographic classification for CTD that enables the classification of all patients and has excellent inter- and intrarater reliability. Existing classification systems do not allow classification of the full spectrum of CTD and are not always related to surgery, and some existing systems are complex, with many categories that are rarely encountered, or are difficult to use widely in clinical practice.

Intra-rater Variability of the Brussels Infants and Toddlers Stool Scale (BITSS) Using Photographed Stools.

The Brussels Infants and Toddlers Stool Scale (BITSS) was developed for the assessment of stool consistency in non-toilet-trained children. This study aimed to (1) investigate the intra-rater reliability of the BITSS among health care professionals (HCPs) and caregivers (CGs); (2) study a potential learning curve; (3) explore the impact of photo quality on intra-rater reliability. Photos of diapers containing stool were assessed twice by 4 HCP (2432 photos) and 8 CGs (492 photos) using the BITTS. Intra-rater reliability was calculated by the percentage of exact agreement and a κ-value. A learning effect and the impact of photo quality was explored using mixed linear model and generalized estimating equations. HCPs generated 24,320 stool consistency ratings: 12.1% were scored as watery, 31.0% loose, 29.4% formed, and 27.6% hard. CGs performed 7872 ratings: 9.2% classified as watery, 34.6% loose, 28.9% formed, and 27.3% hard. Intra-rater reliability (κ) for HCPs ranged from 0.64 [95% confidence interval (CI) = 0.61-0.66] to 0.78 (95% CI = 0.76-0.80) and from 0.68 (95% CI = 0.63-0.73) to 0.94 (95% CI = 0.91-0.97) in the CG group. Both groups had <1% improvement in the odds of identical classification per 50 photos. The percentage of absolute agreement was higher in photos rated as good quality than those that were not (HCPs: 80.3% vs 69.5%, P < 0.001; CGs: 90.4% vs 86.3%, P < 0.001). The BITSS has an excellent intra-rater reliability for the stool consistency scoring of photographs of stools in diapers, but can be influenced by photo quality. A clinically meaningless learning effect was found.

Orthodontic clear aligners and TikTok videos: A content, reliability and quality analysis

The social media platform, TikTok, has the potential to disseminate orthodontic information to an enormous global audience. The aim of this investigation was to assess the content, reliability and quality of videos regarding orthodontic clear aligners (OCAs) on the TikTok platform. Three search terms were used to identify relevant videos. Characteristics such as video source and the number of views were documented. An 8-point information domain score was applied to categorise the videos as "not useful", "slightly useful", "moderately useful" and "very useful". The DISCERN tool and the Global Quality Score (GQS) were used to evaluate video reliability and quality. Intraclass coefficients (ICC) were computed for intrarater reliability. Statistical analyses were via IBM® SPSS®, version 27.0.0.0 (SPSS Inc. Chicago, IL, USA). Of the 117 videos that satisfied inclusion/exclusion criteria, most were uploaded by laypersons (44.4%) and orthodontists (35.9%). The assessed videos had over 300 million views. The overall mean (SD) number of information domains present in the videos was 1.85/8 (1.73). Most videos were deemed "slightly useful" (54.7%) or "not useful" (26.5%). The overall mean (SD) DISCERN score was 1.8/5 (1.28). The overall mean (SD) GQS was 2.48/5 (0.86). Higher DISCERN scores correlated with higher GQS (r=0.73; P<0.01). ICC scores (0.92-0.94) indicated excellent intrarater reliability. The content, reliability and quality of videos found on TikTok related to OCAs was poor. The orthodontic profession must direct patients to reliable and high-quality resources as well as uploading content onto TikTok to counteract the deficiencies highlighted in this study.

Poster 118: The Accuracy of a Smartphone App in Measuring Shoulder Range of Motion

Objectives:Measuring shoulder movements, specifically range of motion (ROM) of the shoulder joint is an important clinical parameter related to glenohumeral disorders and for functional evaluation of the shoulder before and after treatment, which may include surgery. Currently shoulder ROM measurements are performed in an office setting by the provider or alternatively may be performed by a physical therapist, traditionally with the use of a goniometer. The purpose of this study was to determine the accuracy of a smartphone-based digital ROM tool in assessing active shoulder ROM, compared to traditional goniometry measured by a physical therapist in an office setting.Methods:A prospective, non-blinded study was conducted at a single institution (University of St. Augustine, Austin< TX). Thirty (30) eligible and consenting participants with normal shoulder ROM were recruited. Each participant self-assessed their active shoulder ROM using the smartphone App. A physical therapist concurrently measured each participant’s active shoulder ROM using a hand-held goniometer. This concurrent data collection was designed for greater efficiency and minimal bias. Forward flexion (FF), abduction (AB) external rotation (ER), internal rotation (IR) and extension (EX) were measured. Agreement between the smartphone App and goniometric measurements, as well as intra-rater reliability (precision) was assessed using intraclass correlation coefficients (ICC) and Limits of Agreement analysis. Each measurement was performed in duplicate to assess precision. Statistical analysis was performed using R (https://www.r-project.org/)Results:Data were analyzed for 60 shoulders (30 right, 30 left) from 30 participants (mean age was 31.4, 92% female.) The inter-rater reliability between the two methods was excellent for all movements, with ICC ranging from 0.9 to 0.96. For all movements except AB, the mean difference in the measurements between PT and App was less than 1.3 degrees, and the difference was within 6 degrees of the mean differences for 80% of the participants. For AB, the mean difference was 2.08, and the difference was within 15 degrees of the mean difference for 80% of the participants. The intra-rater reliability or precision ranged from good to excellent. For all movements except IR, both PT and App showed excellent intra-rater reliability (ICCs > 0.90). For IR, good intra-rater reliability (ICCs >= 0.75) was observed.Conclusions:These data provide evidence that the smartphone App can be a reliable and valid tool for measuring shoulder ROM. Smartphone Apps enable self-assessment of ROM by patients at the convenience of their home and allow for remote monitoring at zero visit cost to the patient.

Task and ecologically based assessment of upper-limb passive function before and after botulinum injections in adults with stroke using the Upper-Limb Performance Assessment: French cross-cultural adaptation and feasibility pilot study

Purpose To test feasibility of a French translation and cross-cultural adaptation of the Upper-Limb Performance Assessment (ULPA) for task and ecologically based assessment of individualized passive function of upper-limb (UL) performance in adults treated with botulinum toxin-A. Materials and methods A case series with seven adults with stroke (29–74 years) for spastic hypertonia management with passive use objectives (hygiene or positioning) established through Goal Attainment Scaling (GAS). Scores on ULPA Task Performance Mastery (TPM) were obtained through clinical and home-based performances before and after treatment. Results Time administration per task ranged from 5-10 min. Median (range) ULPA, Task Performance Mastery (ULPA-TPM) scores pre-intervention of 58 mastery (35–71) improved to 75 (58–88). Tau-U demonstrated significant large effect sizes (≥.65) for five participants. Complementary measures demonstrated improvement of passive performance for five participants and improvements in GAS for six participants. Testing indicates excellent intra-rater (ICC = 0.90) and moderate inter-rater (ICC = 0.64) reliability, with SDC of 10.16 and 18.23%, respectively. Conclusions French use of ULPA is a promising standardized, objective and ecologically based assessment of passive performance in adults with stroke. Preliminary findings after TCCA support feasibility for measurement of individualized goals for UL passive use. Future studies may explore other tasks and environments. Implications for rehabilitation ULPA is a performance-based, criterion-referenced and ecological measure of individualized goals based on task-analysis of upper-limb (UL) performance in real-life situations providing an interest for individualized assessment of activity and participation. The measure provides a standardized and quantitative approach, applicable to passive use of UL across environments, promoting ecological validity of assessment. Preliminary data will support clinical interpretation of change before and after botulinum injections of UL passive performance. Access to a transculturally validated French version of ULPA complements standardized assessment of UL impairment, perceived performance and goal attainment.

Reliability and Validity of Mini-Balance Evaluation System Test in Type 2 Diabetic Patients with Peripheral Neuropathy.

Type 2 diabetic peripheral neuropathy is known to cause balance limitations in static, dynamic, and functional activity. The Mini-BESTest, a shortened version of BESTest, was evolved to identify balance disorders within a short duration. No prior studies have yet been conducted to assess the usefulness of Mini-BESTest in the diagnosis of type 2 diabetic peripheral neuropathy. The current study aimed to examine the reliability and discriminant validity by comparing the Mini-BESTest scores between type 2 diabetic patients with peripheral neuropathy, divided into two 2 groups based on reporting scores of <4 and ≥4 in the MNSI questionnaire, respectively. Therefore, a cross-sectional study design was conducted including 44 type 2 diabetic patients (4 males and 40 females; aged 56.61 ± 7.7 years old). Diabetic peripheral neuropathy was diagnosed by physical assessment using the Michigan Neuropathy Screening Instrument (MNSI). Inter-rater (two physiotherapists) and Intra-rater (7–10 days) reliability of the Mini-BESTest were explored with intraclass correlation coefficients (ICC2,1) and (ICC3,1). The Mini-BESTest presented an excellent inter-rater reliability (ICC2,1= 0.95, 95% CI = 0.91–0.97, SEM = 0.61) and an excellent intra-rater reliability (ICC3,1 = 0.93, 95% CI = 0.87–0.96, SEM = 0.66), with confirmation by a good agreement presented by the Bland–Altman plots. The internal consistency measured with the overall Cronbach’s alpha showed an acceptable agreement (0.73). The MDC was 2.16. In addition, the Mini-BESTest scores in the type 2 diabetic neuropathy patients reporting MNSI questionnaire scores <4 was found to be significantly higher when compared with those reporting scores ≥4. The Mini-BESTest can be used as a highly reliable and valid clinical application in the population with type 2 diabetic peripheral neuropathy.

Reliability and Validity of Shoulder and Handgrip Strength Testing.

Purpose: This study aimed to estimate the intra- and inter-rater reliability of the JTECH computerized, wireless apparatus and its validity (compared to established devices) for measurements of maximal shoulder isometric strength and handgrip strength among healthy adults with no shoulder pathology. Methods: Twenty healthy young adults had shoulder strength tested with JTECH and Micro-FET2 hand-held dynamometers, and the handgrip strength was tested using JTECH and Jamar handgrip dynamometers. Assessments were performed by the same rater to determine intra-rater reliability and convergent validity, at least two days apart, while on a third visit, the other rater performed measures to determine inter-rater reliability. Results: The JTECH computerized, wireless devices demonstrated good to excellent intra-rater reliability (ICCs (2,1)=0.78-0.97) and inter-rater reliability for strength measures (ICCs (2,1)=0.76-0.95). The JTECH computerized device compared to the Micro-FET2 hand-held dynamometer showed substantial concurrent validity for shoulder flexion (R2=0.87), extension (R2=0.87), abduction (R2=0.88), and adduction (R2=0.85). Substantial concurrent validity was shown for the JTECH computerized device and Jamar handgrip dynamometers (R2=0.92). Conclusions: The JTECH computerized, wireless devices demonstrated high intra- and inter-rater reliability and substantial concurrent validity for shoulder isometric strength and handgrip strength in healthy adults.

A preliminary study of the reliability and validity of the Posterior Standing Overhead Arm Reach (SOAR) test as a measure of functional hip extension motion

BackgroundCurrent clinical tests do not provide a method to reliably measure closed chain hip extension. We developed the Posterior Standing Overhead Arm Reach (SOAR) test for this purpose. ObjectivesThis was a preliminary intrarater and interrater reliability and validity study of the Posterior SOAR test as a measure of functional hip extension. DesignCross-sectional. MethodHip extension on the Posterior SOAR test was measured with a standard goniometer independently by two examiners. The test was then repeated using three-dimensional (3D) motion capture. Intraclass correlation coefficients (ICC) were used to determine the intrarater and interrater reliability of the goniometric measure and Pearson correlations were used to assess the relationship between measures obtained via goniometry and 3D motion capture. ResultsFifty hips were assessed in 25 (14 female, 11 male) asymptomatic participants (mean age = 24.0 years, SD = 1.1). Intrarater reliability (ICC2,3) was 0.80 (95% CI = 0.68–0.88) for Examiner 1 and 0.77 (95% CI = 0.64–0.86) for Examiner 2, indicating excellent reliability. The standard error of the measure (SEM90) ranged from 2.5° to 3.0° with a minimal detectable change (MDC90) of 3.5° to 4.2°. Interrater reliability was good with ICC = 0.65 (95% CI = 0.36–0.80). Pearson correlations were significant with low to moderate associations (r = 0.36, P = 0.009; r = 0.51, P < 0.001). ConclusionsThe Posterior SOAR test demonstrated excellent intrarater reliability, good interrater reliability, and low to moderate associations with 3D motion capture. The Posterior SOAR test has the potential to provide a reliable and accurate assessment of closed chain hip extension.

Measurement Techniques for Leg Length Discrepancy in Total Hip Arthroplasty: A Systematic Review of Reliability and Validity

BackgroundTotal hip arthroplasty (THA) carries a substantial litigative burden. THA may introduce leg length discrepancy (LLD), necessitating a valid and reliable technique for LLD measurement. This study investigates the reliability and validity of techniques quantitively measuring LLD in both pre- and post-THA. MethodsEmbase and MEDLINE databases were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for articles assessing either the validity or reliability of LLD measurement techniques. Data was pooled using random effects meta-analysis to derive reliability estimates. Study quality was assessed using the Brink and Louw checklist. ResultsForty-two articles with 2059 participants were included. Thirty-three investigated reliability and 25 validity. Reliability displayed high heterogeneity. Poor to excellent intra-rater reliability was reported for antero-posterior pelvis radiographs, moderate to excellent for computed tomography scanograms, and good to excellent for clinical methods and teleradiography, and excellent for bi-planar radiography (BPR). Poor to excellent inter-rater reliability was reported for antero-posterior pelvis radiographs and clinical methods, moderate to excellent for teleradiography, good to excellent for computed tomography scanogram and excellent for BPR. The tape measure method is a valid clinical measure of LLD whilst markerless motion analysis and the block method are not. Imaging techniques are appropriately cross-validated with the exception of BPR. ConclusionThe reported intra- and inter-rater reliability for most measurement techniques vary widely. The tape measure method is a valid clinical measurement of LLD. Imaging techniques have been appropriately cross-validated, with the exception of BPR, although they lack validation against a common reference technique.

Assessment of Flatfoot Deformity Using Digitally Reconstructed Radiographs: Reliability and Comparison to Conventional Radiographs.

Digitally reconstructed radiographs (DRRs) generated from weightbearing computed tomography (WBCT) may potentially substitute for weightbearing plain radiographs (XRs) but have not been clinically validated. This study aims to test the reliability of 6 radiographic parameters of progressive collapsing foot deformity (PCFD) as measured on DRR, to investigate whether DRR represents comparably to XR through the same measurements, and to compare agreement of DRR and XR measurements of a standardized arch height parameter with reference measurements made on WBCT. DRR generated from preoperative WBCT of 71 patients (72 feet) treated surgically for PCFD were retrospectively compared with preoperative weight-bearing XR after exclusion criteria were applied. Six radiographic measurements were performed, including Meary angle, calcaneal pitch (CPA), medial cuneiform height (MCH), AP talar-first metatarsal angle (T-1MT), talonavicular coverage (TNCA), and talar incongruency (TIA). Arch height was measured on XR, DRR, and WBCT using a validated, standardized, navicular-based index. Intraclass correlation coefficients assessed DRR intraobserver and interobserver reliability. Paired samples t tests tested differences between XR and DRR. Bland-Altman limits of agreement analysis compared DRR and XR agreement with WBCT measurements. Measurements were within standard PCFD ranges on XR and DRR. All measurements demonstrated excellent intrarater reliability and good to excellent interrater agreement, consistent with previous literature on XR. No differences were found for Meary, CPA, or TNCA. Minor differences were observed for MCH, T-1MT, and TIA. DRR measurements demonstrated greater agreement with WBCT than XR measurements. DRR from WBCT may be a promising substitute for XR in the clinical evaluation of PCFD. Radiographic measurements made on DRR demonstrated good to excellent reliability. Although small differences were found between XR and DRR for certain measurements, DRR more accurately represented medial arch anatomy compared to gold standard WBCT data than XR. If validated as a clinical substitute, DRR could eventually obviate XR where WBCT is available. Level III, retrospective cohort study.

Reliability, minimum detectable change and sociodemographic biases of selected neuropsychological tests among people living with HIV in south-eastern Nigeria

Verification of the psychometric properties of neuropsychological (NP) tests in each society of people living with HIV (PLWHIV) will facilitate accurate classification of HIV-associated neurocognitive disorder. This study aimed to determine the reliability, minimum detectable change (MDC) and sociodemographic biases of selected NP tests among PLWHIV. The study took place at the HIV clinic of the University of Nigeria Teaching Hospital, Enugu. A total of 60 PLWHIV were randomly recruited into two groups of 30 each. The first group was evaluated by two independent examiners (inter-rater) and the other by a single rater (intra-rater). The NP tests utilised included the Hopkins Verbal Learning Test-Revised (HVLT-R), controlled oral word association test (COWAT), Trail Making Test-A (TMT-A) and -B (TMT-B), Digit Span Test-forward (DST-f) and -backward (DST-b). We examined agreement using intra-class correlation (ICC), standard error of measurement and MDC. We verified the influence of sociodemographic variables on test performance using Man–Whitney U-test and Kruskal–Wallis test. The HVLT-R- delay recall (DR), TMT-A, TMT-B and COWAT showed excellent inter-rater reliability with ICC values of 0.83, 0.86, 0.78 and 0.89, respectively. The HVLT-R- verbal learning (VL), DST-f and DST-b showed moderate inter-rater reliability with ICCs of 0.4.99, 0.52 and 0.60, respectively. The HVLT-R-DR, TMT-A, DST-b and COWAT showed excellent intra-rater reliability, with ICCs values of 0.76, 0.80, 0.84 and 0.97, respectively. The TMT-A, DST-f and DST-b were free from sociodemographic bias. The HVLT-R-DR, TMT-A, TMT-B, DST-f, DST-b and COWAT are reliable candidate NP tests for PLWHIV in our setting.

Reliability and concurrent validity of the Spinal Cord Independence Measure III among rehabilitation professionals.

Study designA cross-sectional design.ObjectivesTo investigate rater reliability of the Spinal Cord Independence Measure or SCIM III among rehabilitation professionals, along with the concurrent validity of the tool as compared to standard measures covering wheelchair users (WU) and ambulatory (AM) individuals with spinal cord injury (SCI).SettingA tertiary rehabilitation center and communities.MethodsEighty-two participants with SCI (39 WU and 43 AM individuals) were assessed using SCIM III items. The data of first 30 participants were video recorded for rater reliability assessments by seven rehabilitation professionals, including nurses, occupational therapists, and physical therapists (one novice and one experienced rater for each professional). All participants were also assessed using standard measures to verify concurrent validity of SCIM III by an experienced rater.ResultsThe SCIM III showed excellent intra-rater and inter-rater reliability among rehabilitation professionals when analyzed for overall items (intraclass correlation coefficient (ICC) >0.90) and separately for each subscale (kappa values >0.80). The total SCIM III of WU and the mobility scores of AM participants showed significant correlation with standard measures for muscle strength, limit of stability, balance control, functional endurance, and walking ability (rs = 0.343–0.779; p < 0.05).ConclusionsThe present findings extend clinical benefit and confirm the use of SCIM III interchangeably among rehabilitation professionals after they have been adequately trained. The findings are important for community-based rehabilitation and home healthcare services, especially during the coronavirus (COVID-19) pandemic, when hospital beds and in-patient services are limited for individuals with SCI.

MRI Allows Accurate Measurement of Glenoid Bone Loss.

MRI Allows Accurate Measurement of Glenoid Bone Loss.

Reliability and Differences Between Sexes in Landing Mechanics when Performing the Lateral Bound Test.

Background and PurposeAnterior cruciate ligament injuries are prevalent among the athletic population, imposing a heavy economic burden, and the risk of re-injury. Most current biomechanical screening tasks are performed in the sagittal plane, and there is a need for more screening tools that assess sports specific movements in the frontal plane. The purpose of this study was to determine the reliability of and examine differences between sexes in the performance of the Lateral Bound Test (LBT).Materials/MethodsEach subject performed three trials of a LBT which included jumping laterally from one leg over a hurdle and landing on the opposite leg. Two cameras were placed six feet from the landing marker. Maximum dynamic knee valgus using the frontal plane projection angle and knee flexion angle at initial contact and maximal knee flexion were measured upon landing leg using 2D video analysis software. Additionally, video of 10 individuals’ trials were analyzed twice with one week between the analyses to obtain intra-rater reliability while 12 participants were retested one week later to determine test-retest reliability.ResultsThirty healthy subjects, 16 males, 14 females participated. Intra-rater reliability was determined to be excellent for all variables (ICC>0.96). In contrast, the test-retest reliability had greater disparity. Test-retest reliability ranged from poor (ICC = 0.47) to excellent (ICC > 0.90). Significant differences existed between the sexes, including males being significantly taller, weighing more, and demonstrating greater bilateral dynamic knee valgus (p < 0.05). No significant differences existed between sexes for knee flexion angles.ConclusionThe new LBT had excellent intra-rater reliability for assessing dynamic knee valgus and initial and maximum knee flexion angle when performing a functional movement in the frontal plane. Furthermore, males landed with more dynamic knee valgus than females which is contradictory to what has been observed with functional screening tools performed in the sagittal plane.Level of Evidence3b (reliability study)

Reliability and validity of the Slovenian Translation of the Functional Oral Intake Scale (FOIS-SI)

Background: It is crucial that each and every stroke patient gets a systematic assessment of swallowing disorders, performed by a dysphagia specialist. Therefore, there is a need to use a standardized scale among professionals. The aim of this study was to translate, adapt, and obtain the statistical characteristics of the Functional Oral Intake Scale (FOIS), which is an observer-rated dysphagia severity scale primarily developed for stroke patients, into the Slovenian language.&#x0D; Methods: We performed a 5-step translation and adaptation process. Six speech and language pathologists had evaluated 30 clinical records of patients with an acute ischemic stroke in the carotid artery territory with the Slovenian translation of the Functional Oral Intake Scale (FOIS-SI). Every clinical record included a speech and language clinical bedside assessment of dysphagia, the sex, age, National Institutes of Health Stroke Scale (NIHSS), comorbidities of patients and lesion location. We examined interrater and intrarater reliability and additionally convergent validity of FOIS-SI with the theoretically related IDDSI-Functional Diet Scale (IDDSI-FDS).&#x0D; Results: The average measure Intraclass Correlation Coefficient (ICC) for the interrater reliability (ICC=0.959) and the intrarater reliability (ICC=0.979 and ICC=0.991) for both raters was excellent. The FOIS-SI scores correlated very high with the IDDSI-FDS (rs=0.927).&#x0D; Conclusion: The results of this study show that the Slovenian translation of the FOIS has an excellent interrater and intrarater reliability and very high validity, which implies the FOIS-SI can be used as a tool to quantitatively assess the severity of dysphagia in clinical practice and research in patients with stroke in carotid artery territory across the country in all medical and care settings.

Using Blumensaat's line to determine the sagittal alignment of the distal femur.

A coherent measurement approach for sagittal alignment of the distal femur after fracture reduction or distal femur osteotomies is not available. The present study aims to introduce a new method using Blumensaat'sline and tangent lines to the femoral cortexes to determine the sagittal alignment of the distal femur. 113 patients who had true lateral knee radiographs were included. All of the radiographs were evaluated by one fellowship-trained knee surgeon and one radiologist using the PACS system. The Blumensaat'sline was determined on the true lateral knee radiographs. Then, three long lines were drawn on the distal third of the femoral shaft. The first line is tangent to the anterior cortex of the femur, the second line is along with the anatomical axis of the femur, and the third line is tangent to the posterior cortex of the femur. The angles between Blumensaat'sline and these lines were measured. Intraclass Correlation Coefficient (ICC) was used to measure the strength of inter-and intra-rater agreement. The mean angle between the Blumensaat'sline and the anatomical axis of the femur was 35.4 ± 3°. The mean angle between the Blumensaat'sline and the line tangent to the anterior femoral cortex and the line tangent to the posterior femoral cortex were 34.5 ± 3° and 35.2 ± 3°, respectively. Excellent inter-and intra-rater reliabilities were observed between the measurements (ICC = 0.96 and ICC = 0.98, respectively). The angle between the Blumensaat'sline and the line tangent to the posterior femoral cortex was significantly higher in participants aged < 38years (p = 0.049). No other significant association was found between the angles and demographic characteristics of the patients. The expected mean angles between the Blumensaat'sline and the distal femur were 34.3 to 35.4 degrees. This finding could be useful to determine the normal sagittal alignment of the distal femur. II.

Muscle Quality Assessment by Ultrasound Imaging of the Intrinsic Foot Muscles in Individuals with and without Plantar Fasciitis: A Case-Control Study.

Objective: The primary aim of the present study was to compare the echo intensity (EI) and echovariation (EV) of the intrinsic foot muscles (IFMs) between individuals with and without plantar fasciitis (PF), using ultrasound imaging. The secondary objective was to study the intra-rater reliability of the echotexture variables. Methods: A case–control study was conducted with 64 participants, who were divided into the following two groups: A, the PF group (n = 32); B, the healthy group (n = 32). Results: The comparison between the two groups did not identify significant differences (p > 0.05) between the flexor hallucis brevis (FHB), flexor digitorum brevis (FDB), quadratus plantae (QP) and abductor hallucis brevis (AHB) variables for the EI and EV. Moreover, excellent intra-rater reliability was reported for the following ultrasound imaging EI variables: ABH (ICC = 0.951), FHB (ICC = 0.949), FDB (ICC = 0.981) and QP (ICC = 0.984). Conclusions: The muscle quality assessment using the EI and EV variables did not identify differences in the FHB, FDB, AHB and QP muscles between individuals with and without PF through USI evaluation. The reliability of all the IFM measurements was reported to be excellent.

Reliability and agreement of the Nine Hole Peg Test in patients with unilateral spastic cerebral palsy.

Upper extremity involvement is one of the most common motor impairments in children with unilateral spastic cerebral palsy (CP). One tool for the assessment of manual function in CP is the Nine Hole Peg Test (NHPT). However, the reliability of the NHPT in patients with unilateral CP is unknown. This study aimed to analyze the intra-rater inter-session reliability of the NHPT in unilateral spastic CP, for its use in clinical practice and research. A total of 27 participants with spastic unilateral CP were included. Reliability was verified by the intraclass correlation coefficient (ICC), standard error of measurement, and minimum detectable change. The agreement was analyzed by the Bland–Altman method. An excellent intra-rater reliability was observed for the non-affected side (ICC = 0.94) and the affected side (ICC = 0.96). The minimal detectable change was 4 and 12 s for the non-affected and affected side, respectively. There were no significant biases between repetitions. Conclusions: The NHPT showed excellent intra-rater inter-session reliability in patients with spastic unilateral CP. In addition, the test shows adequate agreement and proportionally small errors to assess manual dexterity.What is Known:• The Nine Hole Peg Test (NHPT) is widely used to assess dexterity in patients with neurological conditions.• The NHPT has demonstrated appropriate measurement properties in healthy children and adults with neurological conditions.What is New:• The NHPT presents excellent reliability, small measurement errors, and adequate agreement for the assessment of patients with cerebral palsy.• The measurement error of the NHPT in unilateral cerebral palsy may be up to 13% of the total time to perform it.Supplementary informationThe online version contains supplementary material available at 10.1007/s00431-022-04423-w.

The feasibility and reliability of measuring forearm muscle thickness by ultrasound in a geriatric inpatient setting: a cross-sectional pilot study

BackgroundGiven the potential benefits of introducing ultrasound in the clinical assessment of muscle disorders, this study aimed to assess the feasibility and reliability of measuring forearm muscle thickness by ultrasound in a geriatric clinical setting.MethodsCross-sectional pilot study in 25 participants (12 patients aged ≥ 70 years in an acute geriatric ward and 13 healthy volunteers aged 25–50 years), assessed by three raters. Muscle thickness measurement was estimated as the distance between the subcutaneous adipose tissue-muscle interface and muscle-bone interface of the radius at 30% proximal of the distance between the styloid process and distal insertion of the biceps brachii muscle of the dominant forearm. Examinations were repeated three times by each rater and intra- and inter-rater reliability was calculated. Feasibility analysis included consideration of technological, economic, legal, operational, and scheduling (TELOS) components.ResultsMean muscle-thickness measurement difference between groups was 4.4 mm (95% confidence interval [CI] 2.4 mm to 6.3 mm], p < 0.001). Intra-rater reliability of muscle-thickness assessment was excellent, with intraclass correlation coefficient (ICC) of 0.947 (95%CI 0.902 to 0.974), 0.969 (95%CI 0.942 to 0.985), and 0.950 (95%CI 0.907 to 0.975) for observer A, B, and C, respectively. Inter-rater comparison showed good agreement (ICC of 0.873 [95%CI 0.73 to 0.94]). Four of the 17 TELOS components considered led to specific recommendations to improve the procedure’s feasibility in clinical practice.ConclusionOur findings suggest that US is a feasible tool to assess the thickness of the forearm muscles with good inter-rater and excellent intra-rater reliability in a sample of hospitalized geriatric patients, making it a promising option for use in clinical practice.