Fair Reliability Research Articles

Measuring residual limb health in persons with upper limb amputation: Modifications of the Prosthetic Evaluation Questionnaire residual limb health scale.

Assessing the user perspective on residual limb health problems is particularly important for amputation care, given the relationship between residual limb health and prosthetic satisfaction. Only 1 measure, the Residual Limb Health scale of the Prosthetic Evaluation Questionnaire (PEQ) has been validated for use in lower limb amputation, but not examined in persons with upper limb amputation (ULA). The objective of this study was to examine the psychometric properties of a modified PEQ Residual Limb Health scale in a sample of persons with ULA. The study involved a telephone survey of 392 prosthesis users with ULA, with a 40-person retest sample. The PEQ item response scale was modified to a Likert scale. The item set and instructions were refined in cognitive and pilot testing. Descriptive analyses characterized the prevalence of residual limb issues. Factor analyses and Rasch analyses evaluated unidimensionality, monotonicity, item fit, differential item functioning, and reliability. Test-retest reliability was assessed by an intraclass correlation coefficient. Sweating and prosthesis odor were prevalent at 90.7% and 72.5%, respectively; blisters/sores (12.1%) and ingrown hairs (7.7%) were the least prevalent problems. Response categories were dichotomized for 3 items and trichotomized for 3 items to improve monotonicity. After adjusting for residual correlations, confirmatory factor analyses showed acceptable fit (comparative fit index = 0.984, Tucker-Lewis index = 0.970, and root mean square error approximation = 0.032). Person reliability was 0.65. No items had moderate-to-severe differential item functioning by age or sex. Intraclass correlation coefficient for test-retest reliability was 0.87 (95% CI, 0.76-0.93). The modified scale had excellent structural validity, fair person reliability, very good test-retest reliability, and no floor or ceiling effects. The scale is recommended for use with persons with wrist disarticulation, transradial amputation, elbow disarticulation, and above-elbow amputation.

A COMPARATIVE ANALYSIS OF INTEROBSERVER RELIABILITY AND INTRAOBSERVER REPRODUCIBILITY OF OSWESTRY BRISTOL CLASSIFICATION AND THE DEJOUR CLASSIFICATION FOR TROCHLEAR DYSPLASIA OF THE KNEE

Classifying trochlear dysplasia (TD) is useful to determine the treatment options for patients suffering from patellofemoral instability (PFI). There is no consensus on which classification system is more reliable and reproducible for this purpose to guide clinicians in order to treat PFI. There are also concerns about validity of the Dejour classification (DJC), which is the most widely used classification for TD, having only a fair reliability score.The Oswestry-Bristol classification (OBC) is a recently proposed system of classification of TD and the authors report a fair-to-good interobserver agreement and good-to-excellent intra-observer agreement in the assessment of TD. The aim of this study was to compare the reliability and reproducibility of these two classifications.6 assessors (4 consultants and 2 registrars) independently evaluated 100 magnetic resonance axial images of the patella-femoral joint for TD and classified them according to OBC and DJC. These assessments were again repeated by all raters after 4 weeks. The inter and intra-observer reliability scores were calculated using Cohen's kappa and Cronbach's alpha.Both classifications showed good to excellent interobserver reliability with high alpha scores. The OBC classification showed a substantial intra-observer agreement (mean kappa 0.628)[p<0.005] whereas the DJC showed a moderate agreement (mean kappa 0.572) [p<0.005]. There was no significant difference in the kappa values when comparing the assessments by consultants to those by registrars, in either classification systems.This large study from a non-founding institute shows both classification systems to be reliable for classifying TD based on magnetic resonance axial images of the patella-femoral joint, with the simple to use OBC having a higher intra-observer reliability score compared to the DJC.

Reliability of Decision-Making and Reinforcement Learning Computational Parameters.

Computational models can offer mechanistic insight into cognition and therefore have the potential to transform our understanding of psychiatric disorders and their treatment. For translational efforts to be successful, it is imperative that computational measures capture individual characteristics reliably. Here we examine the reliability of reinforcement learning and economic models derived from two commonly used tasks. Healthy individuals (N = 50) completed a restless four-armed bandit and a calibrated gambling task twice, two weeks apart. Reward and punishment learning rates from the reinforcement learning model showed good reliability and reward and punishment sensitivity from the same model had fair reliability; while risk aversion and loss aversion parameters from a prospect theory model exhibited good and excellent reliability, respectively. Both models were further able to predict future behaviour above chance within individuals. This prediction was better when based on participants' own model parameters than other participants' parameter estimates. These results suggest that reinforcement learning, and particularly prospect theory parameters, as derived from a restless four-armed bandit and a calibrated gambling task, can be measured reliably to assess learning and decision-making mechanisms. Overall, these findings indicate the translational potential of clinically-relevant computational parameters for precision psychiatry.

Evaluate the efficacy and reliability of functional gradients in within-subject designs.

The cerebral cortex is characterized as the integration of distinct functional principles that correspond to basic primary functions, such as vision and movement, and domain-general functions, such as attention and cognition. Diffusion embedding approach is a novel tool to describe transitions between different functional principles, and has been successively applied to investigate pathological conditions in between-group designs. What still lacking and urgently needed is the efficacy of this method to differentiate within-subject circumstances. In this study, we applied the diffusion embedding to eyes closed (EC) and eyes on (EO) resting-state conditions from 145 participants. We found significantly lower within-network dispersion of visual network (VN) (p=7.3 × 10-4 ) as well as sensorimotor network (SMN) (p=1 × 10-5 ) and between-network dispersion of VN (p=2.3 × 10-4 ) under EC than EO, while frontoparietal network (p=9.2 × 10-4 ) showed significantly higher between-network dispersion during EC than EO. Test-retest reliability analysis further displayed fair reliability (intraclass correlation coefficient [ICC] < 0.4) of the network dispersions (mean ICC=0.116 ± 0.143 [standard deviation]) except for the within-network dispersion of SMN under EO (ICC=0.407). And the reliability under EO was higher but not significantly higher than reliability under EC. Our study demonstrated that the diffusion embedding approach that shows fair reliability is capable of distinguishing EC and EO resting-state conditions, such that this method could be generalized to other within-subject designs.

Automated measures of speech content and speech organization in schizophrenia: Test-retest reliability and generalizability across demographic variables

Technological advances in artificial intelligence and natural language processing have increased efficiency of assessing speech content and speech organization in schizophrenia. Despite these developments, there has been little focus on the psychometrics of these approaches. Using two common assessments, the current study addressed this gap by: 1) measuring test-retest reliability; and 2) assessing whether speech content and/or speech organization generalize across demographics. To test these aims, we examined psychometric properties of the Linguistic Inquiry Word Count (LIWC), a speech content measure, and the Coh-Metrix, a speech organization measure. Across baseline to six month (n = 101) and baseline to one year (n = 47) narrative speech samples, we generally observed fair reliability for speech content measures and fair to good reliability for speech organization measures. Regarding demographics, multiple speech indices varied by race, income, and education. The lack of excellent reliability scores for speech indices holds important implications for examining speech variables in clinical trials and highlights the dynamic nature of speech. This work illustrates the importance of designing speech content and speech organization measures with external validity across demographic factors. Future studies examining speech in schizophrenia should account for potential biases against demographic groups introduced by linguistic analysis tools.

Effect of surgical experience and spine subspecialty on the reliability of the AO Spine Upper Cervical Injury Classification System.

The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5-10 years, 10-20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson's chi-square or Fisher's exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5-10 years: 0.69 vs 10-20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5-10 years: 0.62 vs 10-20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5-10 years: 0.61 vs 10-20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system.

Test-retest reliability of human threat conditioning and generalization across a 1-to-2-week interval.

Given the increasing use of threat conditioning and generalizationfor clinical-translational research efforts, establishing test-retest reliability of these paradigms is necessary. Specifically, it is an empirical question whether the same participant evinces a similar generalization gradient of conditioned responses across two sessions with the identical contingencies and stimuli. Here, 46 human volunteers participated in an identical auditory threat acquisition and generalization protocol at two sessions separated by 1-to-2 weeks. Skin conductance responses (SCR) and trial-by-trial shock risk ratings served as primary measures. We used linear mixed effects modeling to test differential threat responses and generalization gradients, and Generalizability (G) theory coefficients as our primary formal assessment of test-retest reliability of intraindividual stability and change across time. Results showed largely invariant differential conditioning and generalization gradients across time. G coefficients indicated fair reliability for acquisition and generalization SCR. In contrast, risk rating reliabilities were mixed, and reliability was particularly low for acquisition risk ratings. Our findings generally support reliability of the threat conditioning and generalization paradigm for shorter test-retest intervals and highlight their utility for assessments of behavioral interventions in mental health research, but challenges remain and further work is needed. Threat conditioning and generalization tasks are increasingly used for translational efforts to improve behavioral interventions, and thus test-retest reliability for these tasks needs to be established. Our results support the test-retest reliability of threat conditioning and generalization over a relatively short (1-to-2week) interval, but this depends on the measure used (physiological vs. self-report). Overall, these tasks could be appropriate for repeated testing over the course of a short-duration intervention study, but more research is needed, particularly in regard to longer-duration studies.

Reliability of Repeated Nordic Hamstring Strength in Rugby Players Using a Load Cell Device.

Hamstring strain injuries are one of the most common injuries in Rugby Union players, representing up to 15% of all sustained injuries. The Nordic eccentric hamstring test assesses the maximal hamstring eccentric strength and imbalances between limbs. Asymmetries and deficits in hamstring strength between legs are commonly assessed and used as screening methods to prevent injuries which can only be proven effective if hamstring strength measures are reliable over time. We conducted a repeated-measures reliability study with 25 male Rugby Union players. Nordic eccentric strength and bilateral strength balance was assessed. Three testing sessions were undertaken over three consecutive weeks. Intrasession and intersession reliabilities were assessed using typical errors (TE), coefficient of variations (CV), and intraclass correlation coefficients (ICC). Our results showed good intrasession reliability (ICC = 0.79-0.90, TE = 26.8 N to 28.9 N, CV = 5.5% to 6.7%), whilst intersession reliability was fair for mean and the max (ICC = 0.52-0.64, TE = 44.1 N to 55.9 N, CV from 7.4% to 12.5%). Regarding the bilateral strength balance ratios, our results showed good intrasession reliability (ICC = 0.62-0.89, TE = 0.5, CV = 4.4% to 7.2%), whilst the intersession reliability for mean and max values was fair (ICC = 0.52-0.54) with a good absolute intersession reliability CV ranging from 8.2% to 9.6%. Assessing the Nordic eccentric hamstring strength and the bilateral strength balance in Rugby players using a load cell device is a feasible method to test, and demonstrated good intrasession and fair intersession reliability. Nordic eccentric strength assessment is a more practical and functional test than isokinetic; we provide data from Rugby Union players to inform clinicians, and to establish normative values in this cohort.

Test-retest reliability of a finger-tapping fMRI task in a healthy population.

Measuring brain activity during functional MRI (fMRI) tasks is one of the main tools to identify brain biomarkers of disease or neural substrates associated with specific symptoms. However, identifying correct biomarkers relies on reliable measures. Recently, poor reliability was reported for task-based fMRI measures. The present study aimed to demonstrate the reliability of a finger-tapping fMRI task across two sessions in healthy participants. Thirty-one right-handed healthy participants aged 18-60 years took part in two MRI sessions 3 weeks apart during which we acquired finger-tapping task-fMRI. We examined the overlap of activations between sessions using Dice similarity coefficients, assessing their location and extent. Then, we compared amplitudes calculating intraclass correlation coefficients (ICCs) in three sets of regions of interest (ROIs) in the motor network: literature-based ROIs (10-mm-radius spheres centred on peaks of an activation likelihood estimation), anatomical ROIs (regions as defined in an atlas) and ROIs based on conjunction analyses (superthreshold voxels in both sessions). Finger tapping consistently activated expected regions, for example, left primary sensorimotor cortices, premotor area and right cerebellum. We found good-to-excellent overlap of activations for most contrasts (Dice coefficients: .54-.82). Across time, ICCs showed large variability in all ROI sets (.04-.91). However, ICCs in most ROIs indicated fair-to-good reliability (mean = .52). The least specific contrast consistently yielded the best reliability. Overall, the finger-tapping task showed good spatial overlap and fair reliability of amplitudes on group level. Although caution is warranted in interpreting correlations of activations with other variables, identification of activated regions in response to a task and their between-group comparisons are still valid and important modes of analysis in neuroimaging to find population tendencies and differences.

A hybrid GNA instability

A semi-analytic admixed model formalism to study the stability effects of the inner crust regions against the local collective perturbations in non-rotating neutron stars is proposed. It consists of the viscoelastic heavy neutron-rich nuclei, superfluid neutrons, and degenerate quantum electrons. A normal spherical mode analysis yields a generalized linear dispersion relation multiparametrically mimicking the inner crust features of neutron stars. A hybrid gravito-nucleo-acoustic (GNA) instability mode is found to be excited. It is demonstrated that the electron density and the inner crust curvature act as its accelerating and antidispersive agents. In contrast, the heavy neutron-rich nucleus and neutron densities act as decelerating factors. The heavy nucleus density, electron density, and geometric curvature act as its destabilizers. It is only the neutron density that acts as the GNA stabilizing agent. The heavy neutron-rich nucleus and neutron densities are found to act as dispersive broadening factors to it. The high-K regions are the more unstable spectral windows indicating that the GNA mode plays a dominant role in the inner crust zone towards the local stability. Its fair reliability is indicated in light of the recent astronomic observed scenarios. It could be useful to explore acoustic mode signatures in non-rotating neutron stars and similar other compact astroobjects.

Development and validation of a fidelity instrument for Cognitive Adaptation Training

PurposeCognitive Adaptation Training (CAT) is a psychosocial intervention with demonstrated effectiveness. However, no validated fidelity instrument is available. In this study, a CAT Fidelity Scale was developed and its psychometric properties, including interrater reliability and internal consistency, were evaluated. MethodsThe fidelity scale was developed in a multidisciplinary collaboration between international research groups using the Delphi method. Four Delphi rounds were organized to reach consensus for the items included in the scale. To examine the psychometric properties of the scale, data from a large cluster randomized controlled trial evaluating the implementation of CAT in clinical practice was used. Fidelity assessors conducted 73 fidelity reviews at four mental health institutions in the Netherlands. ResultsAfter three Delphi rounds, consensus was reached on a 44-item CAT Fidelity Scale. After administration of the scale, 24 items were removed in round four resulting in a 20-item fidelity scale. Psychometric properties of the 20-item CAT Fidelity Scale shows a fair interrater reliability and an excellent internal consistency. ConclusionsThe CAT fidelity scale in its current form is useful for both research purposes as well as for individual health professionals to monitor their own adherence to the protocol. Future research needs to focus on improvement of items and formulating qualitative anchor point to the items to increase generalizability and psychometric properties of the scale. The described suggestions for improvement provide a good starting point for further development.

Assessing mother-infant bonding: reliability of the recorded interaction task

ABSTRACT Objective This study examined the intra- and inter-rater reliability of the Recorded Interaction Task (RIT); a novel tool to assess mother-infant bonding via observational methods. Background Mother-infant bonding describes the reciprocal early emotional connection between mother and infant. Whilst various tools exist to assess mother-infant bonding, many incorrectly confuse this construct with mother-infant attachment. Further, available tools are limited to those that employ self-report methods, thus may reflect perceived behaviour, rather than actual behaviour. The RIT is a novel tool for observational assessment of mother-infant bonding. A standard interaction between mother and infant is recorded, and later assessed against specified bonding-related behaviours. Before its use in research, reliability testing must be undertaken to ensure the RIT may be used consistently. Methods The RIT was administered to 15 mother-infant dyads. Participant recordings were assessed by three trained raters at two time points, using the RIT observation scoring sheet. Intra-rater reliability was determined by comparing scores at each time point for each rater. Inter-rater reliability was determined by assessing reliability of scores at the first time point. Results Strong intra-rater reliability (ICC >0.86) and fair inter-rater reliability (ICC = 0.55) were observed. Conclusion The current findings support the RIT’s potential to reliably assess mother-infant bonding.

Reliability and Validity Analysis of Pelvic Sagittal Inclination Calculated by Inverse Cosine Function Method on Pelvic Anteroposterior Radiographs.

ObjectiveEvaluation of sagittal pelvic tilt is significant for hip surgeons. However, the accurate measurement of pelvic sagittal inclination (PSI) is still a challenge. The objective of this study is to propose a new method for measurement of PSI from pelvic anteroposterior radiograph based on the inverse cosine function obtained from individualized pelvic model.MethodsCollecting the imaging data of 30 patients with both pelvic CT and full‐length spine radiographs. Establishing pelvic model by customized 3D reconstruction software. The length of three groups of longitudinal and transverse line segments (A′p and B′) were measured from full‐length spine anteroposterior radiographs. The corresponding anatomical parameters, including A, B, b, ∠α, ∠γ, were measured and calculated on the same patient's pelvic model. The estimated PSI (ePSI) based on three groups of anatomical landmarks, including ePSI‐1, ePSI‐2, and ePSI‐3, were calculated by equation, ePSI=arccosA′pb*B′−∠α, and compared with the actual PSI (aPSI) measured by Surgamap software. For the reliability and validation evaluation, three observers measured these parameters in two rounds. Intra‐class correlation and inter‐class correlation were both calculated. Bland–Altman method was used to evaluate the consistency between the estimated PSI (ePSI) and the actual PSI (aPSI).ResultsePSI‐1 and ePSI‐2 showed excellent intra‐observer reliability (0.921–0.997, p < 0.001) and inter‐observer reliability (0.801–0.977, p < 0.001). ePSI‐3 had a fair inter‐observer reliability (0.239–0.823, p < 0.001). ePSI‐1 showed the strongest correlation with aPSI (r = 0.917, p < 0.001). Mean (maximum) absolute difference of ePSI‐1, ePSI‐2, and ePSI‐3 is 2.62° (7.42°), 4.23° (13.78°), and 7.74° (31.47°), respectively. The proportion of cases with absolute difference less than 5° in three groups were 86.7% (ePSI‐1), 66.7% (ePSI‐2), 56.7% (ePSI‐3).ConclusionThis new method based on inverse cosine function has good reliability and validity when used in the evaluation of PSI on pelvic anteroposterior radiographs.

Radiomics based on diffusion-weighted imaging for differentiation between focal-type autoimmune pancreatitis and pancreatic carcinoma.

To evaluate the parameters of support vector machine (SVM) using imaging data generated from the apparent diffusion coefficient (ADC) to differentiate between focal-type autoimmune pancreatitis (f-AIP) and pancreatic ductal adenocarcinoma (PDAC) when using SVM based on diffusion-weighted imaging. The 2D-ADCmean and texture parameters (16 texture features × [non-filter+17 filters]) were retrospectively segmented by 2 readers in 28 patients with f-AIP and 77 patients with pathologically proven PDAC. The diagnostic accuracy of the SVM model was evaluated by receiver operating characteristic curve analysis and calculation of the area under the curve (AUC). Interreader reliability was assessed by intraclass correlation coefficient (ICC). The 2D-ADCmean and 3D-ADCmean were significantly lower in cases of f-AIP (1.10-1.15 × 10-3 mm2/s and 1.21-1.23× 10-3 mm2/s, respectively) vs PDAC (1.29-1.33 × 10-3 mm2/s and 1.41-1.43 × 10-3 mm2/s, respectively), with excellent and good interreader reliability, respectively (ICC = 0.909 and 0.891, respectively). Among the texture parameters, energy with exponential filtering yielded the highest AUC (Reader 1: 74.7%, Reader 2: 81.5%), with fair interreader reliability (ICC = 0.707). The non-linear SVM, a combination of 2D-ADCmean, object volume and exponential-energy showed an AUC value of 96.2% in the testing cohorts. Our results suggest that non-linear SVM using a combination of 2D-ADCmean, object volume, and exponential-energy may assist in differentiating f-AIP from PDAC. The radiomics based on an apparent diffusion coefficient value may assist in differentiating f-AIP from PDAC.

Reliability of a three-dimensional spinal proprioception assessment for patients with adolescent idiopathic scoliosis

PurposeAlthough it is evident that some patients with adolescent idiopathic scoliosis (AIS) have proprioceptive deficit in peripheral joints, knowledge on the proprioceptive function of the deformed spine is limited. Nonetheless, spinal proprioception in AIS may be affected three-dimensionally, prior studies only focussed on evaluating peripheral proprioception in single plane. Therefore, this study aimed to develop a novel spinal proprioception assessment using three-dimensional motion analysis in patients with AIS.MethodsParticipants were included if they had a primary diagnosis of AIS who did not receive or failed conservative treatments. Three trunk repositioning tests involving flexion-extension, lateral-flexion, and axial-rotation were conducted. A three-dimensional kinematics of the trunk was used as the outcome measures. The proprioceptive acuity was quantified by the repositioning error. The intra-examiner and test-retest reliability were analysed by the intraclass correlation coefficient (ICC).ResultsFifty-nine patients with AIS were recruited. Regarding the trunk flexion–extension test, the single measure ICC showed moderate reliability (0.46) and the average measures ICC demonstrated good reliability (0.72). As for the trunk lateral-flexion test, the reliability of single measure and average measures ICC was moderate (0.44) and good (0.70) reliability, respectively. For the trunk axial-rotation test, the single measure ICC indicated fair reliability (0.32), while the average measures ICC showed moderate reliability (0.59).ConclusionThis is the first study to evaluate the reliability of novel three-dimensional spinal proprioception assessments in patients with AIS. The trunk flexion-extension repositioning test may be preferable clinical test given its highest reliability.

Parkinson’s disease – palliative care needs assessment tool: adaptation and psychometric testing

ObjectiveParkinson’s disease is a progressive, life-limiting disease, which benefits from structured palliative care. Systematic recognition and triage of needs helps facilitate care, allows focused referral to specialist palliative care and...

A Study on Nurse Manager Competency Model of Tertiary General Hospitals in China.

(1) Background: The nurse manager competency model is widely used in hospitals in the management of nursing human resources. This study aimed to construct a scientific and practical model of nurse manager competency, which can be used as a tool by hospitals to select nurse managers. (2) Methods: The nurses’ competency indicators were first collected through a literature review and behavioral event interview, and the preliminary screening of competency elements was based on the Delphi method. Then, questionnaires and statistical analyses were used to determine the elements of the model. The reliability was determined using Cronbach’s alpha. Factor analysis was used to delineate the dimensions of the model. (3) Results: The results of the factor analysis show that the 22 competency elements were grouped into the four dimensions of leadership and management ability, personal traits, professional quality, and professional ability. The Cronbach’s alpha coefficients of the four dimensions ranged from 0.745 to 0.885, which indicated a high level of reliability. The result of the factor analysis indicated a high structural validity and fitting effect. (4) Conclusions: Our study indicates that the nurse manager competency model of tertiary general hospitals is an instrument with fair reliability and validity that fully reflects the characteristics of nurses in Chinese public hospitals.

Normative Data of Mini-Mental State Examination, Montreal Cognitive Assessment, and Alzheimer’s Disease Assessment Scale-Cognitive Subscale of Community-Dwelling Older Adults in Taiwan

Introduction: Appropriate tools and references are essential for evaluating individuals’ cognitive levels. This study validated the Taiwan version of the Alzheimer’s Disease Assessment Scale-Cognitive subscale (ADAS-cog) and provided normative data for the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and ADAS-cog in community-dwelling older adults. Methods: MMSE, MoCA, and ADAS-cog were administered to 150 nondemented healthy adults aged 55–85 years during 2018–2020 as part of the Northeastern Taiwan Community Medicine Research Cohort. ADAS-cog was translated from the original English version to traditional Chinese with cultural and language considerations in Taiwan. Cronbach’s alpha (α) tested the reliability of ADAS-cog, and Pearson correlations examined its external validity using MMSE and MoCA as comparisons. Normative data were generated and stratified by age and education, and the one-way analysis of variance compared scores between age and education groups. Another 20 hospital-acquired participants with cognitive impairment joined the 150 healthy participants. Comparisons in the Clinical Dementia Rating (CDR) tiers tested the discriminability of the tests for different cognitive levels. The area under the receiver operating characteristic curve (AUROC) analyzed the power of ADAS-cog in predicting CDR 0.5 from CDR 0. Results: The Taiwan version of ADAS-cog had fair reliability between items (α = 0.727) and good correlations to MMSE (r = −0.673, p < 0.001) and MoCA (r = −0.746, p < 0.001). The normative data of MMSE, MoCA, and ADAS-cog showed ladder changes with age (p = 0.006, 0.001, and 0.437) and education (p < 0.001, <0.001, and <0.001) in the 150 nondemented older adults. Next, in the 170 mixed participants from the communities and the hospital, MMSE, MoCA, and ADAS-cog scores were well differentiable between CDR 0, 0.5, and 1. In addition, ADAS-cog discriminated CDR 0.5 from 0 by an AUROC of 0.827 (p < 0.001). Discussion/Conclusion: The three structured cognitive tests consistently reflect cognitive levels of healthy older adults. The Taiwan version of ADAS-cog is compatible with MMSE and MoCA to distinguish people with mildly impaired from normal cognition. In addition, this study derived MMSE, MoCA, and ADAS-cog norms tailored to demographic factors. The findings highlight the need for stratification of age and education rather than applying a fixed cutoff for defining normal and abnormal cognition.

Testing dynamic balance in youth female volleyball players: development, reliability and usefulness

Purpose.The aim of this research was to develop a dynamic balance test and examine its reliability by comparing first trial results with the average and best ones from multiple attempts.Methods.Overall, 32 volleyball players (aged 11.3 ± 0.67 years) were investigated in 2 sessions (with a 14-day interval), each consisting of 3 trials of the modified bench walk with 3 turns (MBW3T) test. Three test methods were compared: first trial (MBW3T&lt;sub&gt;trial1&lt;/sub&gt;), average result (MBW3T&lt;sub&gt;mean&lt;/sub&gt;), and best result (MBW3T&lt;sub&gt;best&lt;/sub&gt;). A paired-sample &lt;i&gt;t&lt;/i&gt;-test determined differences with an effect size. Test-retest reliability was assessed with an intraclass correlation coefficient.Results.The paired-sample &lt;i&gt;t&lt;/i&gt;-test revealed no significant difference in performance between test and retest for MBW3T&lt;sub&gt;trial1&lt;/sub&gt; (&lt;i&gt;t&lt;/i&gt; = 0.01, &lt;i&gt;p&lt;/i&gt; = 0.99), MBW3T&lt;sub&gt;mean&lt;/sub&gt; (&lt;i&gt;t&lt;/i&gt; = –0.46, &lt;i&gt;p&lt;/i&gt; = 0.65), and MBW3T&lt;sub&gt;best&lt;/sub&gt; (&lt;i&gt;t&lt;/i&gt; = –1.05, &lt;i&gt;p&lt;/i&gt; = 0.30). Standard error of measurement (SEM) as the absolute reliability within-individual variation parameter showed that MBW3T&lt;sub&gt;trial1&lt;/sub&gt; had higher variation than MBW3T&lt;sub&gt;mean&lt;/sub&gt; and MBW3T&lt;sub&gt;best&lt;/sub&gt;, in which the measurement error was minimal. To identify usefulness, we calculated the smallest worthwhile change and compared it with SEM for different effect sizes; the test was rated marginal to satisfactory. The study results indicated fair reliability when the first trial was observed and good reliability for the mean and best of 3 trials.Conclusions.MBW3T&lt;sub&gt;mean&lt;/sub&gt; and MBW3T&lt;sub&gt;best&lt;/sub&gt; are cheap, simple, reliable, and marginal to satisfactory useful measures for assessing dynamic balance in youth female volleyball players and can be used in scientific and practical settings.

A New Classification System for Acetabular Bone Defect Evaluation in Posttraumatic Acetabular Nonunion and Malunion.

There is no distinct classification system to evaluate the bone defect in previously managed acetabular fractures. We propose a new classification system for bone defect evaluation in a previously managed acetabular fracture that will be helpful for total hip arthroplasty (THA). The preoperative pelvis radiographs of 99 THA patients with previous acetabular fractures with at least 2 years of follow-up were evaluated by 10 experienced surgeons (Paprosky and new classification systems). As per the new classification system, the five types of bone defects are circumferential, posterior wall, posterior column, both column defect, and anterior column. The interobserver and intraobserver reliability was calculated, and a consensus management plan based on the recommendation of the observers was formulated. There was fair interobserver reliability for Paprosky classification (alpha coefficient 0.39) and substantial interobserver reliability for the new classification (alpha co-efficient 0.71). There was a substantial intraobserver agreement for the new classification (kappa value 0.80) and moderate intraobserver agreement for Paprosky classification (kappa value 0.55). Sixty-nine patients who were treated as per the management plan of the observers reported significant improvement in modified Harris hip score (improved from 25 to 85.88, p < 0.001). 89.7% of patients reported good to excellent outcomes. Overall best health as per EQ-5D VAS was obtained in THA following anterior column fracture (EQ-5D VAS 97.5), and relatively poor health was obtained after THA of posterior column nonunion (EQ-FD VAS 80). The new classification system for bone defect evaluation in previously treated acetabular fractures is valid and reliable. The proposed surgical plan for the management of bone defects in THA provided good to excellent outcomes.