High Intraobserver Reliability Research Articles

Measurement of isolated subtalar range of motion: a cadaver study.

Fifteen fresh-frozen cadaveric lower extremities were studied to evaluate the reliability of measuring subtalar motion using a bubble inclinometer. There was high intra-observer reliability for manual inversion and eversion of the subtalar joint with the tibiotalar joint locked and unlocked. Poor correlation of radiographic and clinical measurements questioned the validity of bubble inclinometer measurements. The contribution of the tibiotalar joint to apparent subtalar motion, as measured clinically and radiographically, was found to be one-third of the arc of motion, as compared to motion measured clinically and radiographically with the tibiotalar joint locked.

Epidermal nerve fiber density: normative reference range and diagnostic efficiency.

The sensitivity of neuron-specific antibodies permit the identification of the small unmyelinated nerve fibers within the skin. To develop a reference range of epidermal nerve fiber density in humans, and to evaluate their diagnostic efficiency for sensory neuropathies. Ninety-eight normal controls (age range, 13-82 years) were examined with both directed neurologic examinations and quantitative sensory testing. The diagnostic utility was examined in 20 patients with sensory neuropathies. Each subject had 2 punch biopsies performed at each site in the thigh and distal part of the leg (total of 392 biopsies). After formalin fixation, 50-microm-thick free-floating sections were stained with a polyclonal antibody to neuron-specific ubiquitin hydrolase, anti-protein gene product 9.5. We enumerated intraepidermal nerve fibers per millimeter to derive a "linear density." The linear density technique was validated against a stereological technique that used the fractionator to measure the total length of intraepidermal nerve fibers per 3-mm punch. The biopsy technique was well tolerated, with no notable complications. The linear density quantitation was rapid and had high intraobserver and interobserver reliability. We determined that the density of intraepidermal fibers in normal controls was 21.1+/-10.4 per millimeter (mean +/- SD) in the thigh (fifth percentile, 5.2 per millimeter), and was 13.8+/-6.7 per millimeter at the distal part of the leg (fifth percentile, 3.8 per millimeter). Significantly higher intraepidermal fiber densities were seen in the youngest group (P = .004), and we observed no significant effect of race, sex, height, or weight. The density at the thigh was significantly correlated with that at the distal part of the leg (P = .01) and was consistently higher by about 60%, a reflection of the normal proximal-distal gradient. The results obtained with stereology and the linear density correlated significantly (P=.001), providing internal validation for the technique. Epidermal nerve fiber density was significantly reduced (P = .001) in patients with sensory neuropathies. With a cutoff derived from the fifth percentile of the normative range for the distal part of the leg, the technique had a positive predictive value of 75%, a negative predictive value of 90%, and a diagnostic efficiency of 88%. We have established a reference range for intraepidermal nerve fiber density in normal humans by means of a simple quantitation method based on enumeration of individual intraepidermal nerve fibers on vertical sections of punch skin biopsy specimens stained with the sensitive panaxonal marker anti-protein gene product 9.5. The utility of the density measurement was confirmed for sensory neuropathy with a diagnostic efficiency of 88%. Skin biopsies may be useful to assess the spatial distribution of involvement in peripheral nerve disease and the response to neurotrophic and other restorative therapies.

Skeletal maturity in Belgian youths assessed by the Tanner-Whitehouse method (TW2)

Reference data for skeletal maturity (TW2 method) of the hand and wrist are provided for large representative samples of Belgian boys and girls. The sample of Belgian boys consisted of 21,174 boys aged 12 to 20 years studied in a nationwide cross-sectional and longitudinal study on the physical fitness of secondary schoolboys (1969-1974). The girls' sample consisted of 9698 6-19-year-old Flemish girls studied cross-sectionally (1979-1980). Both samples were multi-stage stratified cluster samples of entire school classes. All skeletal maturity assessments of the boys were made by the same observer (GB). His estimations agreed quite closely with those of the originators of the method. The skeletal age assessments of the girls were made by two observers trained by GB. Both observers showed high intraobserver reliability after training, and during the assessments. Moreover their ratings compared favourably with those of GB and the originators of the method. Smoothed percentile curves of the maturity scores (TW2-20 bone, RUS and CARP scores) were calculated by means of cubic splines using a stepwise regression procedure for the selection of suitable knots. In the boys, the TW2 scores (20 bone and RUS) increase linearly between 12 and 14.5 years of age, slow down for a while, and then increase again, while the CARP scores increase linearly between 12 and 15 years of age. In girls, the 20-bone maturity scores increase nearly linearly from 6 through 9.5 years of age, accelerate until 11.0 years followed by a smaller increase; RUS scores increase curvilinearly from 6 years of age onwards; and Carp scores increase almost linearly between 6.0 and 12.5 years of age. Belgian boys are advanced in RUS scores but are delayed for the carpal bones as compared with the British standards. The Belgian girls show advancement for both scales as compared with the British reference data. The skeletal maturation of youths from several other continental European countries corresponds more closely with the Belgian than with the British data. The reference data presented herein most probably provide suitable standards for youths of West-European countries.