Assessment Of Intrarater Reliability Research Articles

Skeletal muscle architecture and aging: A comparison of ultrasound techniques and an assessment of intrarater reliability.

To assess intrarater reliability of ultrasound-determined measurements of skeletal muscle characteristics across different measurement outcomes, imaging techniques, and age groups. 2D ultrasound images (B-mode) of the quadriceps were obtained from young (26 ± 4 year, n = 8 M, 8 F) and older (70 ± 7 year, n = 7 M, 5 F) adults on two occasions, separated by 6 ± 3 days. With participants in both standing and supine postures, images were collected from five anatomical sites along the anterior (two sites) and lateral (three sites) compartments of the thigh corresponding to 56%, 39%, and 22% (lateral only) of femur length. Images were analysed for muscle thickness, pennation angle, and echogenicity. Intraclass correlation coefficients (ICC) were used to assess reliability. Muscle thickness values were higher (p < 0.05) on images collected in the stand versus supine posture only for muscles of the anterior compartment, independent of age. Echogenicity values were higher (p < 0.05) in the vastus intermedius on images collected in the supine versus stand posture only in older adults. Pennation angle values were not impacted by imaging posture (p > 0.05). ICC values for thickness, echogenicity, and pennation angle were generally higher for analyses conducted on images collected in the supine versus stand posture. Imaging posture generated a greater difference in ICC values in the lateral versus anterior muscles and in older versus younger participants. Our findings suggest that participant posture during imaging impacts the absolute values and intrarater reliability of ultrasound-determined muscle characteristics in a muscle-specific fashion, and this effect is greater in older compared to younger individuals.

Performance of dental students, orthodontic residents, and orthodontists for classification of midpalatal suture maturation stages on cone-beam computed tomography scans – a preliminary study

BackgroundAssessment of midpalatal suture maturation on cone-beam computed tomography (CBCT) scans is performed by visual inspection and is therefore subjective. The extent to which the assessment of midpalatal suture maturation is affected by rater experience has not been adequately explored in the existing literature, thus limiting the availability of evidence-based findings. This study compared the outcomes of classification by dental students, orthodontic residents, and orthodontists.MethodsThree different groups of students, orthodontic residents, and orthodontists evaluated 10 randomly chosen CBCT scans regarding midpalatal suture maturation from a pool of 179 patients (98 female and 81 male patients) aged 8 – 40 years which were previously classified by evaluating CBCT scans. The pool was set as benchmark utilizing midpalatal suture maturation classification by one examiner (OsiriX Lite version 11.0; Pixmeo SARL, Bernex, Switzerland). For assessment of intra-rater reliability of the examiners of each group the randomly chosen subjects were reclassified for midpalatal suture maturation after a wash-out period of two weeks by using the same software. Statistical analysis was performed to evaluate intra- and interrater reliability of the three groups with differing experience level.ResultsGroupwise intra-rater reliability assessment between the classification and reclassification was weak for examiners with a low level of experience (k = 0.59). Orthodontists had highest degree of agreement with regard to benchmark classification with an inter-rater reliability to be considered as moderate (k = 0.68).ConclusionsAssessment of midpalatal suture maturation on CBCT scans appears to be a subjective process and is considerably related to the experience level of the examiner. A high level of clinical experience seems to be favorable but does not necessarily ensure accurate results.

O21: ASSIST: Validation of a novel hybrid clinician-patient remote outcome measure for diagnosis of surgical site infection

Abstract Introduction Current remote methods of surgical site infection diagnosis have high specificity but lack sensitivity in diagnosis. This study evaluates the acceptability, reliability and validity of a novel hybrid clinician-patient remote outcome measure (ASSIST) for detecting SSI. Methods Patients completed the Bluebelle wound healing questionnaire (WHQ) at 30 days post-surgery and additionally submitted wound image(s). Images were reviewed two independent clinicians. Internal consistency of the unidimensional scale was assessed. Inter-rater and intra-rater reliability assessments were performed. Sensitivity and specificity for SSI discrimination against face-to-face CDC diagnosis were evaluated and receiver operator characteristic (ROC) curve plotted with calculation of the area under the curve. Results 69 participants were included and no questionnaires contained missing items. The single scale showed strong Internal consistency (α = 0.9). Intra-rater reliability was good with intraclass correlation (ICC) of 0.818 (95% CI, 0.672-0.903, p&amp;lt;0.001). Inter-rater agreement was excellent (ICC 0.915, 95% CI 0.733-0.903, p&amp;lt;0.001). Sensitivity and specificity for SSI diagnosis were excellent at 91.7% and 97.6% respectively. Discrimination for SSI was high with an area under the receiver operating characteristic curve of 0.966 (95%CI 0.913-1.000). Discussion The ASSIST measure is acceptable, reliable, and valid for diagnosis of SSI. Implementation can be safely utilised in both patient-initiated follow-up or at pre-determined time points for safe post discharge surveillance.

Modified Clavien-Dindo-Sink system is reliable for classifying complications following surgical treatment of early-onset scoliosis.

Appropriately measuring and classifying surgical complications is a critical component of research in vulnerable populations, including children with early-onset scoliosis (EOS). The purpose of this study was to assess the inter- and intra-rater reliability of a modified Clavien-Dindo-Sink system (CDS) classification system for EOS patients among a group of pediatric spinal deformity surgeons. Thirty case scenarios were developed and presented to experienced surgeons in an international spine study group. For each case, surgeons were asked to select a level of severity based on the modified CDS system to assess inter-rater reliability. The survey was administered on two occasions to allow for assessment of intra-rater reliability. Weighted Kappa values were calculated, with 0.61 to 0.80 considered substantial agreement and 0.81 to 1.00 considered nearly perfect agreement. 11/12 (91.7%) surgeons completed the first-round survey and 8/12 (66.7%) completed the second. Inter-observer weighted kappa values for the first and second survey were 0.75 [95% CI 0.56-0.94], indicating substantial agreement, and 0.84 [95% CI 0.70-0.98], indicating nearly perfect agreement, respectively. Intra-observer reliability was 0.86 (range 0.74-0.95) between the first and second surveys, indicating nearly perfect agreement . The modified CDS classification system demonstrated substantial to nearly perfect agreement between and within observers for the evaluation of complications following the surgical treatment of EOS patients. Adoption of this reliable classification system as a standard for reporting complications in EOS patients can be a valuable tool for future research endeavors, as we seek to ultimately improve surgical practices and patient outcomes. Level V.

Inappropriate Prescriptions in Older People-Translation and Adaptation to Portuguese of the STOPP/START Screening Tool.

Inappropriate prescribing, which encompasses the prescription of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), is a common problem for older people. The STOPP/START tool enables general practitioners, who are the main prescribers, to identify and reduce the incidence of PIMs and PPOs and appraise an older patient’s prescribed drugs during the diagnosis process to improve the clinical care quality. This study aimed to translate and validate the STOPP/START screening tool to enable its use by Portuguese physicians. A translation-back translation method including the validation of the obtained Portuguese version was used. Intra- and inter-rater reliability and agreement analyses were used in the validation process. A dataset containing the information of 334 patients was analyzed by one GP twice within a 2-week interval, while a dataset containing the information of 205 patients was independently analyzed by three GPs. Intra-rater reliability assessment led to a Kappa coefficient (κ) of 0.70 (0.65–0.74) for the STOPP criteria and 0.60 (0.52–0.68) for the START criteria, considered to be substantial and moderate values, respectively. The results of the inter-rater reliability rating were almost perfect for all combinations of raters (κ > 0.93). The version of the STOPP/START criteria translated into Portuguese represents an improvement in managing the medications prescribed to the elderly. It provides clinicians with a screening tool for detecting potentially inappropriate prescribing in patients older than 65 years old that is reliable and easy to use.

To tether or fuse? Significant equipoise remains in treatment recommendations for idiopathic scoliosis.

Vertebral body tethering (VBT) continues to grow in interest from both a patient and surgeon perspective for the treatment of scoliosis. However, the data are limited when it comes to surgeon selection of both procedure type and instrumented levels. This study sought to assess surgeon variability in treatment recommendation and level selection for VBT versus posterior spinal fusion (PSF) for the management of scoliosis. Surgeon members of the Pediatric Spine Study Group and Harms Study Group were queried for treatment recommendations and proposed upper instrumented vertebra (UIV) and lower instrumented vertebra (LIV) selection for PSF and VBT based on 17 detailed clinical vignettes. Responses were subdivided in each clinical vignette according to surgeon experience and treatment recommendations with assessment of intra-rater reliability. Binomial distribution tests were used to establish equipoise, selecting p < 0.10 to indicate the presence of a treatment choice with consensus set > 70% agreement. For treatment choice, responses were assessed first for consensus on the decision to proceed with PSF or VBT. Thirty-five surgeons with varied experience completed the survey with 26 surgeons (74%) completing the second follow-up survey. Overall, VBT was the recommended treatment by 47% of surgeons, ranging by clinical vignette. Consensus in treatment recommendation was present for 6 clinical vignettes including 3 for VBT and 3 for PSF, with equipoise present for the remaining 11. Of the 17 vignettes, 12 demonstrated moderate intra-observer reliability including the 3 consensus vignettes for VBT. Sanders stage ≤ 3 and smaller curve magnitude were related with VBT recommendation but neither age nor curve flexibility significantly influenced the decision to recommend VBT. Surgeons with high VBT volume, ≥ 11 VBT cases/year, were more likely to recommend VBT than those with low volumes (0-10 cases per year (p < 0.0001)). High VBT volume surgeons demonstrated consensus in VBT recommendation for Lenke 5/6 curves (75% mean recommendation). High VBT volume surgeons had a significantly higher VBT recommendation rate for Lenke 1A, 2A curves (71.8% vs 48.0%, p = 0.012), and Lenke 3 curves (62% vs 26.9%, p = 0.023). Equipoise was present for all vignettes in low volume surgeons. In addition, high VBT volume surgeons trended toward including more instrumented levels than low VBT volume surgeons (7.17 vs 6.69 levels). Significant equipoise is present among pediatric spine surgeons for treatment recommendations regarding VBT and PSF. Surgeon-, patient-, and curve-specific variables were identified to influence treatment recommendations, including surgeon experience, curve subtype, deformity magnitude, and skeletal maturity. This study highlights the need for continued research in identifying the optimal indications for VBT and PSF in the treatment of pediatric spinal deformity.

P38. A novel fusion classification system for the advent of bioactive interbody implants

BACKGROUND CONTEXT Historically, intervertebral fusion and biologically-mediated stability required bone bridging exclusively. The advent of bioactive interbody devices, which allow for appositional integration of bone at the endplate-implant interface, demands an evolution in our radiographic assessment of such fusion processes. Specifically, acknowledgement that endplate bone adhesion to the surface of these implant confers stability, and potentially an effective ‘fusion’, warrants strong consideration within a new classification scheme. PURPOSE We present a novel interbody fusion classification system that addresses inadequacies if traditional grading schemes in order to accommodate the integration capability of bioactive intervertebral cages. STUDY DESIGN/SETTING Classification System Reliability Survey. PATIENT SAMPLE A total of 37 surgeon respondents. OUTCOME MEASURES Intraclass correlation coefficients for inter- and intra-rater reliability assessments. METHODS A novel grading system for intervertebral fusion was developed by the authors (Figure) and included fusion consolidation through and/or around the intervertebral device, as well as the apposition of bone to the surface of the implants (ingrowth/ongrowth). Ten patient cases with 1year CT scans were selected for the survey, including coronal and sagittal reconstruction views which were provided to the respondents. Surveys were administered twice >2weeks apart and with cases in differential order. Intraclass Correlation Coefficient (ICC) was used to calculate inter and intrarater reliability. RESULTS A total of 51 spine surgeons participated, with 37 of them completing surveys on two separate occasions. For the entire cohort, ICC inter-rater reliability (95% CI) average was 0.618 (0.435-0.834; p<0.001), while the intra-rater reliability average was 0.778 (SD=0.211). Four respondents had outlier intra-rater reliability scores averaged 0.259. When removing those 4 respondents (10.8% of the respondents), and analyzing the more consistent 90% of the respondents, ICC inter-rater reliability average was 0.628 (0.445-0.841; p=<0.001), and intra-rater reliability average was 0.831 (SD=0.125). CONCLUSIONS Our novel CT-based interbody fusion classification system demonstrated substantial inter-rater reliability, and excellent intra-rater reliability when applied to a spectrum of real cases. Future assessment of interbody fusions should consider utilization of this new system in order to address the important contribution of appositional ongrowth/ingrowth, along with traditional bone healing through and around devices. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Historically, intervertebral fusion and biologically-mediated stability required bone bridging exclusively. The advent of bioactive interbody devices, which allow for appositional integration of bone at the endplate-implant interface, demands an evolution in our radiographic assessment of such fusion processes. Specifically, acknowledgement that endplate bone adhesion to the surface of these implant confers stability, and potentially an effective ‘fusion’, warrants strong consideration within a new classification scheme. We present a novel interbody fusion classification system that addresses inadequacies if traditional grading schemes in order to accommodate the integration capability of bioactive intervertebral cages. Classification System Reliability Survey. A total of 37 surgeon respondents. Intraclass correlation coefficients for inter- and intra-rater reliability assessments. A novel grading system for intervertebral fusion was developed by the authors (Figure) and included fusion consolidation through and/or around the intervertebral device, as well as the apposition of bone to the surface of the implants (ingrowth/ongrowth). Ten patient cases with 1year CT scans were selected for the survey, including coronal and sagittal reconstruction views which were provided to the respondents. Surveys were administered twice >2weeks apart and with cases in differential order. Intraclass Correlation Coefficient (ICC) was used to calculate inter and intrarater reliability. A total of 51 spine surgeons participated, with 37 of them completing surveys on two separate occasions. For the entire cohort, ICC inter-rater reliability (95% CI) average was 0.618 (0.435-0.834; p<0.001), while the intra-rater reliability average was 0.778 (SD=0.211). Four respondents had outlier intra-rater reliability scores averaged 0.259. When removing those 4 respondents (10.8% of the respondents), and analyzing the more consistent 90% of the respondents, ICC inter-rater reliability average was 0.628 (0.445-0.841; p=<0.001), and intra-rater reliability average was 0.831 (SD=0.125). Our novel CT-based interbody fusion classification system demonstrated substantial inter-rater reliability, and excellent intra-rater reliability when applied to a spectrum of real cases. Future assessment of interbody fusions should consider utilization of this new system in order to address the important contribution of appositional ongrowth/ingrowth, along with traditional bone healing through and around devices.

Radiographic assessment of the response of teeth following trauma during screw placement for maxillo-mandibular fixation.

Maxillo-mandibular fixation (MMF) screws have gained popularity in recent years for inter-maxillary fixation. MMF screw application involves the risk of dental injury. However, knowledge about the healing responses after root damage in humans is limited, thereby warranting the need to classify the radiographic assessment of healing to enable better prediction of the healing response and effective management of the potential complications. The aim of this study was to assess and classify the radiographic assessment of the responses after root damage to evaluate the long-term outcomes. The dental records of patients who underwent orthognathic surgery or trauma management during 2014-2016 at an Oral and Maxillofacial Surgery Department were retrospectively analyzed. The data regarding dental injuries resulting from MMF screw application were evaluated. In total, 16 patients with 34 roots damaged from MMF screw application were enrolled. Post-operative orthopantomographs were analyzed by visual inspection of the affected areas to clarify the extent of root healing. The inter- and intra-rater reliability assessments were subsequently performed. The results indicated substantial inter- and intra-rater reliability of the responses. Most cases of root damage that were not radiographically related to the pulp (Schulte-Geers Class III defects) had complete or partial healing responses. In addition, 20% of the defects related to the pulp had additional resorption of the bone/dental tissues during the follow-up period. Three different radiographic responses of root damage following MMF screw trauma were identified. Understanding these different responses is important to guide the management of the potential complications. This proposed radiographic assessment can be used to present root healing data in a more standardized and reliable manner.

The Prognostic Value of Radiologic Extranodal Extension Determined by MR Imaging in Nasopharyngeal Carcinoma: Implications for Future Editions of N-staging Systems

Extranodal extension (ENE) has been included as a new criterion for the 8th edition of the American Joint Committee on Cancer (AJCC) N category in non-viral-related head and neck cancers. However, the prognostic value of radiologic ENE (rENE) and its influences on the current 8th edition of AJCC N category in nasopharyngeal carcinoma (NPC) are still unclear. We aimed to in depth evaluate the prognostic value of rENE and influences on the 8th edition of the AJCC N category in NPC. In this retrospective study, a total of 1887 patients with newly diagnosed, non-distant metastatic NPC treated at the Sun Yat-sen University Cancer Center from 2009 to 2013 were enrolled and randomly divided into a training group (n = 955) and a validation group (n = 932). rENE was categorized as follows: Grade 0, nodes without rENEs; Grade 1, nodes with rENEs infiltrating the surrounding fat only; Grade 2, matted nodes (three or more nodes adjacent to one another with loss of the intervening fat planes); Grade 3, nodes with rENEs infiltrating adjacent structures (i.e., muscles, salivary glands, skin, etc.). The frequency of patients with MRI-positive cervical nodes was 66.5% (1254/1887), of whom Grade 0, Grade 1, Grade 2 and Grade 3 rENE cases accounted for 33.2% (416/1254), 14.9% (187/1254), 36.5% (458/1254) and 15.4% (193/1254), respectively. The kappa coefficients were 0.63, 0.51, 0.65, and 0.93 for the inter-rater and 0.76, 0.69, 0.72, and 1.0 for the intra-rater reliability assessment of Grades 0, 1, 2, and 3 rENE, respectively. Grade 3 was a significant negative factor for overall survival (OS), distant metastasis-free survival, regional relapse-free survival and disease failure-free survival in univariable (all P<.001) and multivariable analyses (all P<.05). The 5-year OS rates were 69% and 72% for patients in N1 and N2 with Grade 3 rENE, respectively, which were much worse than those of patients in N1 and N2 with Grades 0-2 rENE (88% and 79%), but were similar to those of patients in N3 with Grades 0-2 and N3 with Grade 3 rENE (69% and 63%). Thus, the recursive partitioning analysis of the training group generated the following proposed N category: eN0 (N0), eN1 (N1 without Grade 3), eN2 (N2 without Grade 3), and eN3 (N1/N2 with Grade 3, N3). Compared to the current system, the proposed N category also had advantages in terms of hazard consistency (0.558 vs 2.595), hazard discrimination (0.285 vs 0.327), sample size balance (0.604 vs 0.663) and outcome prediction (27.4 vs 26.5) in the validation group after 1000 bootstrap replicates of internal validation. Grade 3 rENE was an independent negative factor for NPC. Upstaging N1 and N2 patients with Grade 3 rENE to N3 led to better prognostic performance than the 8th edition N category.

Objective Acoustic Quantification of Perceived Voice Tremor Severity

Purpose This study compared auditory-perceptual measures of presence/absence and severity of vocal tremor to acoustic markers of vocal tremor. The validity (both concurrent and diagnostic) of various acoustic markers of vocal tremor was also assessed. Method Fifty-six midvowel sustained [a:] recordings were selected to yield a representative convenience sample of vocal tremor. After training with 10 synthesized samples, 4 female audiologists rated these samples on "voice tremor severity" on a continuous 10-cm scale. Afterward, 15 randomly selected recordings were presented a 2nd time for intrarater reliability assessment. Customized audio signal processing in Praat yielded 12 acoustic measures of rate, extent and perturbation of fundamental frequency (f 0), and intensity level (IL) modulation. Enter-type multiple linear regression analysis was applied to weight and combine these acoustic variables into an acoustic model of vocal tremor severity. Results After removing the vocal tremor severity ratings of 1 of the audiologists because of insufficient intra- and interrater reliability, mean single-measures consistency-type intraclass correlation coefficients equaled .83 within raters and .72 between raters. Correlation between mean ratings and the 12 acoustic markers ranged from .76 for median extent of f 0 modulation to .11 for rate of IL modulation. Correlation between mean ratings and the acoustic model was .89. Analysis of this model's receiver operating characteristics yielded an area under receiver operating characteristic curve of .93, denoting sensitivity of .87 and specificity of .91. Conclusions This study demonstrated that auditory-perceptual ratings of vocal tremor severity are guided primarily by f 0 and IL modulation extent, less by modulation perturbation, and least by modulation rate. The acoustic model covering all these modulation properties yielded acceptable results in terms of both concurrent and diagnostic validity. However, external cross-validation of this model is warranted before applying it in clinical voice/speech assessment.

Could Residents Adequately Assess the Severity of Hidradenitis Suppurativa? Interrater and Intrarater Reliability Assessment of Major Scoring Systems

A wide variety of assessment tools have been proposed for hidradenitis suppurativa (HS) until now, but none of them meets the criteria for an ideal score. Because there is no gold standard scoring system, the choice of the measure instrument depends on the purpose of use and even on the physician’s experience in the subject of HS. The aim of this study was to assess the intrarater and interrater reliability of 6 scoring systems commonly used for grading severity of HS: the Hurley Staging System, the Refined Hurley Staging, the Hidradenitis Suppurativa Severity Score System (IHS4), the Hidradenitis Suppurativa Severity Index (HSSI), the Sartorius Hidradenitis Suppurativa Score and the Hidradenitis Suppurativa Physician’s Global Assessment Scale (HS-PGA). On the scoring day, 9 HS patients underwent a physical examination and disease severity assessment by a group of 16 dermatology residents using all evaluated instruments. Then, intrarater reliability was calculated using intraclass correlation coefficient (ICC), and interrater variability was evaluated using the coefficient of variation (CV). In all 6 scorings the ICCs were >0.75, indicating high intrarater reliability of all presented scales. The study has also demonstrated moderate agreement between raters in most of the evaluated measure instruments. The most reproducible methods, according to CVs, seem to be the Hurley staging, IHS4, and HSSI. None of the 6 evaluated scoring systems showed a significant advantage over the other when comparing ICCs, and all the instruments seem to be very reliable methods. The interrater reliability was usually good, but the most repeatable results between researchers were obtained for the easiest scales, including Hurley scoring, IHS4 and HSSI.

Coronal Flexion Versus Coronal Neutral Sonographic Views in Infantile DDH: An Important Source of Variability.

Ultrasound (US) is the preferred imaging modality for the diagnosis and treatment of infantile developmental dysplasia of the hip (DDH). Currently accepted indices that distinguish normal from dysplastic hips in the coronal plane include percent femoral head coverage (FHC), α angle, and β angle. Recent data suggests that significant user and interscan variability may exist for these metrics. Less studied, however, is potential variability because of patient positioning, specifically coronal flexion versus coronal neutral views. The purpose of this study was to compare standard DDH indices between coronal US views with hips in flexion versus neutral positions, for hips of varying DDH severity. This retrospective study included normal infants and those treated for different severities of DDH. Coronal flexion and coronal neutral US images from the same study were evaluated at diagnosis, early treatment, start of weaning, and treatment resolution. FHC, α, and β angles were measured on both views at each time point and compared. Inter-rater and intra-rater reliability assessments were performed for all metrics. Among the 168 hips in this study (45 normals, 45 Ortolani positive, 17 Barlow positive, and 61 stable dysplasia), median FHC was significantly lower in coronal flexion compared with coronal neutral for normals and all 3 severities of DDH at each time point (mean decrease 8.4%; range 5.5% to 10.9%; P<0.01). Alpha angle also decreased on coronal flexion views, observed for all hip types, but only at certain time points (mean decrease 3.3 degrees; range 0 to 7.5 degrees; P<0.01 to 0.35). β angles demonstrated less variability between views, but also had poor reliability. Coronal flexion and coronal neutral views demonstrated significant differences in FHC and α angle across a spectrum of DDH severities and treatment time points. Flexion views may represent a "baby Barlow" test, revealing subtle instability as evidenced by the significant and consistent decrease in FHC across all hips. Indices measured in flexion, therefore, may represent more stringent criteria for defining normal hips. Level III-diagnostic study.

Goniometric evaluation of the spinal sagittal curves in children and adolescents: A reliability study.

Gold standard for spine deformities assessment is X rays, but the procedure bears a risk of exposure. To investigate intra-rater and inter-rater reliability of a pocket compass needle goniometer (IncliMed®, University of Padua) to non-invasively evaluate spine curves in children and adolescents. Prospective reliability study in a paediatric population (mean age 12.5 years ± 2.5). Children with spine deformities (Scheuermann's or postural kyphosis, idiopathic scoliosis) and healthy controls were included. Two physician measured spinal curves with the surface goniometer IncliMed® within a temporal range of 10 minutes. Participants were re-tested after a mean of 28 days for the intra-rater study. Agreement limit and coefficient of repeatability were calculated according to the linear regression analysis; the Bland and Altman method was applied to obtain average of differences and standard error of the mean of the differences. One hundred and thirty-nine subjects participated to the inter-rater reliability assessment; 30 to the intra-rater reliability assessment. Inter-observer variability for IncliMed® measurements was ± 11° both for kyphosis and for lordosis. The intra-observer variability for kyphosis and lordosis measurements was ± 11° and ± 12°. IncliMed® is a reliable, non-invasive tool to screen and monitor spinal curves in paediatric populations.

Assessing the outcome of hand and forearm allotransplantation using the Action Research Arm Test.

The aims of this study were to apply for the first time the Action Research Arm Test for functional assessment of an allotransplanted upper extremity (hand or forearm), to describe any adaptations required to this test system for the abovementioned purpose, and to use this test to record any changes in outcome over time. A structured approach to the Action Research Arm Test was adopted including interrater and intrarater reliability assessment at the very beginning of its use and ongoing comprehensive monitoring of patients through regular checkups. Four male patients who had undergone hand or forearm allotransplantations, in the authors' center, were examined. All 19 items in the Action Research Arm Test were reviewed, and the total score was calculated, taking into account the given time limits for each item. All patients showed a marked clinical improvement in their test results over time. They continued to have difficulties with performing items in the pinch subtest. The intrarater and interrater assessment achieved consistent results. The data of this study indicate that the Action Research Arm Test is suitable for assessing the level of upper extremity function. The test can be used to compare functional outcomes after hand and forearm allotransplantation between different centers, providing objective information concerning the quality of reconstruction.

Passive Range of Movement of the Shoulder: A Standardized Method for Measurement and Assessment of Intrarater Reliability

ObjectiveThe purpose of this study was to determine the intrarater reliability and reproducibility of a standardized procedure for measuring passive shoulder movement in asymptomatic individuals. MethodsA single assessor used a digital inclinometer and standardized protocol to measure the passive range of motion of 7 shoulder movements in 168 asymptomatic shoulders. Following a warm-up maneuver, 3 measurements were taken for each movement on 2 occasions. Both shoulders were measured using a standardized order of movement. Selection of measurement beginning with left or right shoulder was randomly determined. The entire process was repeated 7 days later to assess reproducibility. Intraclass correlation coefficients (ICCs) with 95% confidence intervals and standard errors of measurement (SEMs) were calculated to assess the intrarater reliability of the methods. ResultsThe intrarater reliability of our methods was substantial for total shoulder flexion (ICC = 0.82, SEM = 12.3°), whereas all other movements demonstrated moderate reliability (ICC range = 0.64-0.75) except external rotation in neutral abduction, for which reliability was classed as slight (ICC = 0.28, SEM = 31°). Moderate reliability was evident for all movements on follow-up at 7 days (ICC range = 0.60-0.77). ConclusionsThese methods of measurement have moderate to substantial reliability for the majority of tested passive shoulder movements, with moderate reliability sustained after 1 week, in a large sample of asymptomatic individuals.

Sitting bodily configuration: A study investigating the intra-tester reliability of positioning subjects into a predetermined sitting posture

Sitting posture predominates in lifestyle and workplace, but quantitative postural designation is limited due to divergence of methodology used in the studies.To date, no study has investigated the upper body’s habitual or a predetermined sitting posture in healthy individuals assessing together pelvis, spine and head. The objectives were (i) assessment of intra-rater reliability of positioning subjects to a lordotic sitting posture and (ii) comparison of habitual sitting posture (HSP) with the lordotic posture. Another objective was to synthesize and propose an improved 3D model for pelvis, trunk and head to assess quantitatively the postural sagittal configuration.A single session test-retest design was employed. After power calculations 25 subjects were recruited. A repeated measure ANOVA revealed significant differences between HSP and the predetermined posture used in the study. Intra-rater reliability was analysed used the intra-class correlation coefficient (ICC) and also standard error of measurement (SEM) and smallest real difference (SRD) were calculated. The ICC values for all angles ranged from 0.85 to 0.98 indicating almost perfect agreement. The SEMs for all angles ranged in degrees from 0.65 to 1.50 and the SRDs from 1.80 to 4.16.This study provides the most specific sagittal measurement of surface spinal curves, head and pelvis position, in reference to a lordotic seated posture. The clinical significance of this study is reinforced by the fact that postural assessment is conducted by body surface evaluation. The results regarding reliability and SEMs established that healthy individuals can be reliably positioned in an upright lordotic sitting posture.

The intra- and inter-rater reliability of X-ray radiological measurements for patellar instability

AimPatellar instability is a complex, multi-factorial disorder. Radiological assessment is regarded as an important part of the management of this population. The purpose of this study was to determine the intra- and inter-rater reliability of common radiological measurements used to evaluate patellar instability. Methods and materialsOne hundred and fifty X-rays from 51 individuals were reviewed by five reviewers, two orthopaedic trainees, a radiological trainee, a consultant radiologist and an orthopaedic physiotherapist. Radiological measurements assessed included patellar shape, sulcus angle, congruence angle, lateral patellofemoral angle, lateral patellar displacement (LPD), lateral displacement measurement (LDM), boss height, and patellar height ratios. All assessors were provided with a summary document outlining the method of assessing each measurement. No further formal teaching was provided. Bland–Altman analyses were adopted to assess intra- and inter-rater reliability. ResultsThe results indicated generally low measurement error on intra-rater reliability assessment, particularly for LPD, LDM and boss height measurements. Whilst the inter-rater reliability between assessors indicated a low mean difference for assessments of patellar height measurements, patellar angle, lateral patellar dislocation and lateral displacement, wide 95% limits of agreement for all measurements indicated poor precision. ConclusionMany of the standard measurements used to assess the patellofemoral joint on plain radiographs have poor precision. Intra-rater reliability may be related to experience but it seems likely that to achieve good inter-rater reliability, specific training may be required to calibrate observers. More formal training in the technique of radiological measurement for those who were inexperienced might have improved the inter-rater reliability.

Assessing the Reliability of Shoulder Strength Measurement: Hand-Held versus Fixed Dynamometry

Background Reliable measurements of shoulder strength are important in assessing rotator cuff integrity. Aim To determine whether a fixed strength assessment device is more reliable than a handheld dynamometer (HHD) when measuring the strength of five shoulder movements (internal rotation, external rotation, abduction, lift-off and adduction). Methods We tested 12 asymptomatic and 11 symptomatic shoulders in the intra-rater reliability assessment. For each shoulder tested, the strength of five shoulder movements were recorded three times using HHD and three times using the fixed device by the same examiner. We tested 11 asymptomatic shoulders and 10 symptomatic shoulders in the inter-rater reliability assessment. Each of three examiners tested the shoulder strength of each subjectl once using HHD and once using the fixed device. Intra-class correlation coefficients (ICCs) were calculated to assess reliability of measurements. Results Both HHD and the fixed device showed excellent (ICC &gt; 0.80) intra-rater and inter-rater reliability for all movements. The inter-rater reliability of HHD began to decrease as the subject strength increased when testing abduction in the plane of the scapula. Discussion HHD is a reliable method of measuring shoulder strength in the clinical setting. However, when several examiners are testing strength of stronger subjects in abduction of the scapular plane, stabilizing the dynamometer provides more reliable results.

The reliability and validity of the Chinese version of dynamic occupational therapy cognitive assessment for children

Objective To study the reliability and validity of the Chinese version of the dynamic occupational therapy cognitive assessment for children (DOTCA-Ch).Methods The English version of the DOTCA-Ch was translated into Chinese. One hundred and nine students from the city of Jiamusi were assessed with the Chinese Binet intelligence test and the DOTCA-Ch. Intra-class correlation coefficients (ICCs) were used in inter-rater and intra-rater reliability assessments. Cronbach's alpha coefficient was used to assess internal consistency. Factor analysis was used to assess construct validity. Pearson correlation coefficients were used in assessing criterion-related validity. Results The total ICC of the DOTCA-Ch was 0. 892. Cronbach's alpha coefficients for the subtests were orientation 0. 713 ; spatial perception 0. 793 ; praxis 0. 850 ; visuomotor construction 0. 844 and thinking operations 0. 630. The ICC for intra-rater reliability was 0. 991 and for inter-rater reliability it was 0. 989. Using the Binet intelligence test as a benchmark, the Pearson correlation coefficient between the IQ values and the total DOTCA-Ch scores was 0. 872 for 6 year-olds, but 0. 870 for 11 and 12 yearolds. Factor analysis revealed an acceptable set of 5 common factors. Their cumulative contribution was 67％.Conclusions The Chinese version of the DOTCA-Ch is reliable and valid. It can be used as an effective measuring tool to evaluate children's cognitive functioning. Key words: Dynamic occupational therapy cognitive assessment for children ; Binet test of intelligence; Validity; Reliability; China

Thickness and Biomechanical Properties of Capsule in Adhesive Capsulitis

Fibrous thickening of the capsule is believed to be the main pathology of adhesive capsulitis based on surgical findings or sophisticated imaging data. The thickened capsule might have different biomechanical properties than thinner. As previously reported, the authors were able to identify the unique biomechanical properties of joint capsules using pressure-monitored intra-articular fluid infusion. PURPOSE: To identify the biomechanical significance of thickened joint capsule in adhesive capsulitis METHODS: Clinically diagnosed 52 shoulders with adhesive capsulitis were enrolled. A needle was inserted into the posterior shoulder joint under ultrasonographic guidance. Fluid was infused in a constant-volume rate with real-time pressure monitoring. The pumping of the fluid was continued with a close pressure monitoring before rupture. The pressure, volume and compliance at the point of maximal pressure was determined as the peak pressure (P_peak), the volume at the peak pressure (V_peak), and compliance (C_peak). The ultrasound images of the posterior capsule were stored just after the termination of fluid instillation. The thickness was measured at 5 points with 2mm intervals along the highly echogenic line representing the posterior capsule, 10 mm lateral to the lateral edge of the labrum. One investigator repeated the thickness measurement of posterior capsules in one week interval for assessment of intrarater reliability. For interrater reliability, two investigators measured the thickness independently. RESULTS: Inter-rater and intra-rater reliability for measuring the thickness of posterior shoulder (T_cap) were.805(.650-.891) and.915(.848-.953), respectively. Mean thickness of capsule was 1.6±0.3mm. The Pearson correlation coefficients between T_cap and P_peak was significant (0.32, p-value=0.02), but not between T_cap and V_peak (0.19, p=0.17), and T_cap and C_peak (-0.15, p-value=0.30). CONCLUSIONS: The P_peak showed positive linear correlation with posterior capsular thickness. The thickened posterior capsule might be a characteristic ultrasonographic finding in adhesive capsulitis