Intraclass Correlation Coefficient Scores Research Articles

The reliability and validity of the Turkish version of the European Health Interview Survey - Physical Activity Questionnaire (EHIS-PAQ)

Purpose: To translate and cross-culturally adapt the Turkish version of the EHIS-PAQ and to evaluate its reliability and validity in young adults.
 Methods: A total of 431 young adults were assessed with the Turkish version of the EHIS-PAQ and International Physical Activity Questionnaire-Short Form (IPAQ-SF). One week later, 117 participants refilled the Turkish EHIS-PAQ for the test-retest reliability. Reproducibility and construct validity was analyzed with intraclass correlation coefficient (ICC) and Pearson correlation coefficient, respectively. In addition, standard error of measurement (SEM) and minimal detectable change (MDC) were calculated for the Turkish EHIS-PAQ.
 Results: The mean age of the participants were 21.29.8 years. The ICC score for the total Physical Activity (PA) of Turkish EHIS-PAQ was 0.873 (CI:0.81-0.91). Test-retest reliability for the total score was excellent (ICC>0.80). The highest correlation was observed between the walking minute value of Turkish EHIS-PAQ and the walking PA sub-score of IPAQ-SF, as expected (r=0.625, p

The patient-rated tennis elbow evaluation questionnaire was successfully translated to Korean

IntroductionLateral epicondylitis is a common tendinopathy of the elbow. An adequately validated questionnaire is essential to compare the various treatment options, because there is still controversy regarding the best treatment for lateral epicondylitis. Purpose of the studyThe patient-rated tennis elbow evaluation (PRTEE) was introduced to measure the degree of symptoms and the limitation of function in these patients. This English questionnaire was previously translated into several languages and validated; however, it has not been translated into Korean. The aim of this study was to translate and cross-culturally adapt the PRTEE questionnaire into Korean, and to assess the reliability and validity of the translated questionnaire. MethodsEighty-three patients were asked to complete the Korean version of the PRTEE and other questionnaires related to the upper extremity or to the general health condition (the Disabilities of Arm, Shoulder, and Hand questionnaire, Short Form-12, and EQ-5D). The PRTEE responses were recorded twice to evaluate test-retest reliability. Internal consistency, test-retest reliability, concurrent validity, and ceiling and flooring effects were evaluated. ResultsThe Korean version of the PRTEE showed high internal consistency (Cronbach's alpha = 0.968). The overall test-retest reliability was good (intra-class correlation score = 0.94). High correlation efficiencies between the PRTEE and other questionnaires were observed, supporting high concurrent validity (Spearman's correlation = 0.83 for the Disabilities of Arm, Shoulder, and Hand questionnaire; -0.73 for Short Form-12; and -0.57 for EQ-5D). Ceiling and floor effects were not observed on this test. ConclusionWe successfully translated the PRTEE into the Korean language; this version of the PRTEE showed good reliability and construct validity in Korean-speaking patients with lateral epicondylitis.

The test-retest reliability and concurrent validity of the 3-m backward walk test and 50-ft walk test in community-dwelling older adults.

Three-meter backward walk test (3MBWT) and 50-ft walk test (50FWT) are frequent physical performance tests in clinical practice. The aim of the study was to determine the test-retest reliability and concurrent validity of the 3MBWT and 50FWT in community-dwelling older adults. A cross-sectional study was carried out with 65 participants. 3MBWT, 50FWT, Timed Up and Go Test (TUG), and Five Times Sit to Stand Test (FTST) were evaluated in the first assessment. The test-retest reliability was evaluated by performing two repetitions of the 3MBWT and 50FWT with 1-h interval. The test-retest reliability and validity were assessed by the intraclass correlation coefficient (ICC) and the Spearman correlation coefficient, respectively. The mean age of the participants was 68.9±3.7 years. The ICC score of 3MBWT and 50FWT were 0.940 and 0.820, respectively. The test-retest reliability of both tests was excellent (> 0.80). Both the test and retest assessment of the 3MBWT were strongly correlated with TUG (rtest = 0.649, rretest = 0.645, p < 0.01). 50FWT (test) was not significantly correlated with FTST (r = 0.215, p > 0.05). 50FWT (retest) were weakly correlated with FTST (r = 0.260, p < 0.05). Both the test and retest assessments of the 50FWT was strongly correlated with TUG (rtest = 0.550, rretest = 0.596, p < 0.01). The 3MBWT and 50FWT are valid and reliable performance tests in community-dwelling older adults. MDC value of both tests provides an essential contribution to clinical practice.

Test-Retest Reliability of the Patient Activation Measure-13 in Adults with Substance Use Disorders and Schizophrenia Spectrum Disorders.

Patient Activation Measure-13 (PAM-13) is a valid and widely used questionnaire that assess an individual’s knowledge, confidence, and skills for self-management of their chronic illness. Although there is some evidence regarding its reliability, the test–retest reliability has not been investigated among patients with substance use disorders (SUDs) or schizophrenia spectrum disorders. We investigated the internal consistency and test–retest reliability of PAM-13 in these populations. Test–retest reliability was analysed using data from 29 patients with SUDs and 28 with schizophrenia spectrum disorders. Cronbach’s α and Intraclass Correlation Coefficient (ICC) scores were used to examine internal consistency and test–retest reliability, respectively. Of the 60 collected test–retest questionnaires, 57 were included in the analyses. No mean differences between time one (T1) and time two (T2) were observed in either patient group, except for item 12 in schizophrenia spectrum disorders patients (p < 0.05). Internal consistency for T1 and T2 was 0.75 and 0.84 in SUDs patients and 0.87 and 0.81 in schizophrenia spectrum disorders patients, respectively. The ICC was r = 0.86 in patients with SUDs and r = 0.93 in patients with schizophrenia spectrum disorders. To conclude, PAM-13 showed good internal consistency and test–retest reliability in SUDs and schizophrenia spectrum disorders patients.

Development of the Mandarin Nonsense Word Identification Test

Objective This study aimed to develop a digitised Mandarin Nonsense Word Speech Perception Test for use in Malaysia, a multilingual country in Southeast Asia. Design In Phase I, 400 vowel-consonant-vowel (VCV) nonsense word samples containing 20 Mandarin consonants in /a/, /i/, or /u/ contexts were recorded from two speakers of different genders. Acoustic analyses, sound quality ratings, and item validations were used to guide selection of items to form two gender-specific test lists. In Phase II, performance-intensity functions and test-retest reliability for the lists were established. Study sample Native Mandarin-speaking adults with normal hearing participated in Phase I (n = 10) and Phase II (n = 69). Results Eighty-four of the 400 VCV words were selected to form two gender-specific test lists. A two-way repeated measure ANOVA revealed a significant interaction effect between speaker-gender and presentation level [F (4.88, 283.20) = 22.79, p < 0.001, ηp 2= 0.28]. Intraclass correlation scores of 0.75 and 0.87 were obtained for the female-speaker and male-speaker lists respectively. Conclusions The preliminary normative data of the Mandarin nonsense word test have been developed. It is recommended to use separate gender-specific norms when conducting the test. The test has good validity and reliability for testing Mandarin-speaking adults in Malaysia.

Translation, Adaptation and Validation of a Chinese Medicine Questionnaire to Brazilian Portuguese

The Constitution in Chinese Medicine Questionnaire [CCMQ] organizes 9 body constitutions according to Traditional Chinese Medicine [TCM]. The translation was realized by a Medical Doctor [MD] specialized in TCM and the back translation by an english-speaking MD. Comprehensibility assessment was performed (N = 40, main scores ranged from 4.20 to 4.95). On the test-retest reliability Cronbach’s alpha was 0.920 in the first application and 0.943 in the second, the intraclass correlation scores ranged between good and excellent (0.6 - >0.80). The results show that the adaptation of the CCMQ is valid and ready to be used.

Widening of sternoclavicular joint distances in blunt chest trauma

Purpose: Blunt chest trauma has high mortality and morbidity rates. The aim of this study was to evaluate the relationship between trauma findings and sternoclavicular joint (SCJ) distances in patients with blunt chest trauma. &#x0D; Materials and Methods: Between May 2019- September 2019, Thorax Computed Tomography (CT) images of 102 patients (78 males, 24 females, aged 19-88 years) with blunt chest trauma were evaluated retrospectively. Rib fractures, costal cartilage fractures and other signs of trauma were evaluated. SCJ distances were measured at the inferior, mid, and superior segments in the coronal reformatted CT images. Post-traumatic SCJ expansion was evaluated in patients with rib and costal cartilage fractures. Additionally, SCJ and the presence of other post-traumatic signs were compared. An inter-observer reliability analysis with Intraclass correlation coefficient (ICC) scores with 95% CIs were calculated. &#x0D; Results: In the presence of fractures of 1st to 4th ribs a statistically significant widening of superior and mid segments of the ipsilateral SCJs were detected. A 2-mm or greater difference of widening of the superior segment of the ipsilateral SCJ compared to the contralateral joint was found statistically significant for hemothorax, pneumothorax, and wall emphysema. The inter-observer agreement was excellent for the measurements of the SCJ on coronal plane, having an ICC score ranging from 0.921 to 0.961 (95% CI). &#x0D; Conclusion: The expansion of the ipsilateral SCJ distances in rib fractures in the upper part of the chest wall shows that SCJ performs an important role in the absorption of energy to the chest wall.

Assessing the test-retest reliability and smallest detectable change of the Haemophilia Activities List.

IntroductionThe Haemophilia Activities List (HAL) is a preferred instrument to measure self‐reported limitations in activities in persons with haemophilia (PWH). Information on reliability and interpretability of HAL scores is lacking.AimTo examine the test‐retest reliability and smallest detectable change (SDC) of the HAL in adult PWH.MethodsFifty adult (≥18 years) persons with mild to severe haemophilia completed the HAL (42 items, 7 domains, optimum 100) at baseline (T0) and 3‐4 weeks later (T1). The intraclass correlation coefficient (ICC) and SDC were calculated for sum and component scores.ResultsFifty persons with haemophilia were included (median age 49 years; 92% haemophilia A; 70% severe haemophilia). The median (interquartile ranges) HAL sum score was 77 (62 to 99) at T0 and 81 (64 to 98) at T1. Reliability was good with ICCs for sum and component scores >0.9. The SDC for the sum score was 10.2, for the upper extremity component score 9.2, for the basic lower extremity component score 16.7 and for the complex lower extremity component score 13.4.ConclusionThe HAL has a good reliability for the sum and component scores. Score changes of the normalized sum HAL score greater than the SDC 10.2 indicate that the change was not a result of measurement error.

Using the Active Movement Extent Discrimination Apparatus to Test Individual Proprioception Acuity: Implications for Test Design.

The Active Movement Extent Discrimination Apparatus (AMEDA) has been used for measuring proprioception at various joints in the body for more than two decades. The utility of this instrument for discriminating groups has been reported in terms of an area under the curve (AUC) derived from an absolute identification test. This metric has supported statistically significant group differences, but it is not clear whether the AMEDA's testing protocol is suitable for measuring individual proprioception acuity changes. This study aimed to test the reliability, variance and absolute AUC scores obtained with the AMEDA with reference to other studies that have tested absolute identification acuity in other domains and the theoretical underpinnings of the testing protocol. We re-analyzed raw data from a 2013 study involving 65 people, most of whom were tested three times over two separate sessions on the ankle AMEDA by now assessing the accuracy of individual responses and calculating the sensitivity index, d', in addition to the AUC. To assess reliability, we calculated the intraclass correlation coefficient (ICC) and standard error of measurement (SEM) for those who completed all three tests. Fewer than 50% of presented stimuli were accurately identified and relatively poor discrimination was achieved between adjacent stimuli (in only one case was the median d' value greater than 1). The ICC of AUC scores across the three tests was poor (0.47). The SEM was 0.04, while 90% of participants' AUC scores fell between 0.59 and 0.76. The variation in performance at the individual level was substantial, producing a large SEM relative to the population spread of scores. We considered potential theoretical factors that may be affecting these results and concluded that an alternative approach will be needed in order for the apparatus to be used to explore individual proprioceptive performance.

Reliability and Validity of the Functional Gait Assessment in Incomplete Spinal Cord Injury.

There are limited psychometrically sound measures to assess higher level balance in individuals with incomplete spinal cord injury (iSCI). To evaluate interrater and intrarater reliability and convergent validity of the Functional Gait Assessment (FGA) in individuals with iSCI. Twelve participants (11 male, 1 female) 32 to 73 years old with chronic motor iSCI, American Spinal Injury Association Impairment Scale C (n = 2) or D (n = 10), were included. Participants completed five outcome measures during a single test session including lower extremity motor scores from the International Standards for the Neurological Classification of Spinal Cord Injury, FGA, 10-Meter Walk Test (10MWT), Walking Index for Spinal Cord Injury (WISCI-II), and the Spinal Cord Injury Functional Ambulation Profile (SCI-FAP). Inter- and intrarater reliability for the FGA were excellent. Interrater reliability was excellent with intraclass correlation coefficient (ICC) scores greater than 0.92 (p < .001). Interrater reliability against an expert was also excellent for all raters, with an ICC greater than or equal to 0.92 (p < .01). Intrarater reliability was excellent with an ICC score of greater than 0.91 (p < .002) for all raters. Validity of the FGA with 10MWT was -0.90 (p = .000), FGA with WISCI-II was 0.74 (p = .006), and FGA with SCI-FAP was -0.83 (p = .001). The FGA is a reliable and valid outcome measure to use when assessing gait and balance in individuals with motor iSCI. The FGA provides clinicians with a single tool to utilize across a variety of neurologic diagnoses.

Is it time to switch your T1W sequence? Assessing the impact of prospective motion correction on the reliability and quality of structural imaging

New large neuroimaging studies, such as the Adolescent Brain Cognitive Development study (ABCD) and Human Connectome Project (HCP) Development studies are adopting a new T1-weighted imaging sequence with prospective motion correction (PMC) in favor of the more traditional 3-Dimensional Magnetization-Prepared Rapid Gradient-Echo Imaging (MPRAGE) sequence. Here, we used a developmental dataset (ages 5–21, N = 348) from the Healthy Brain Network (HBN) Initiative to directly compare two widely used MRI structural sequences: one based on the Human Connectome Project (MPRAGE) and another based on the ABCD study (MPRAGE+PMC). We aimed to determine if the morphometric measurements obtained from both protocols are equivalent or if one sequence has a clear advantage over the other. The sequences were also compared through quality control measurements. Inter- and intra-sequence reliability were assessed with another set of participants (N = 71) from HBN that performed two MPRAGE and two MPRAGE+PMC sequences within the same imaging session, with one MPRAGE (MPRAGE1) and MPRAGE+PMC (MPRAGE+PMC1) pair at the beginning of the session and another pair (MPRAGE2 and MPRAGE+PMC2) at the end of the session. Intraclass correlation coefficients (ICC) scores for morphometric measurements such as volume and cortical thickness showed that intra-sequence reliability is the highest with the two MPRAGE+PMC sequences and lowest with the two MPRAGE sequences. Regarding inter-sequence reliability, ICC scores were higher for the MPRAGE1 - MPRAGE+PMC1 pair at the beginning of the session than the MPRAGE1 - MPRAGE2 pair, possibly due to the higher motion artifacts in the MPRAGE2 run. Results also indicated that the MPRAGE+PMC sequence is robust, but not impervious, to high head motion. For quality control metrics, the traditional MPRAGE yielded better results than MPRAGE+PMC in 5 of the 8 measurements. In conclusion, morphometric measurements evaluated here showed high inter-sequence reliability between the MPRAGE and MPRAGE+PMC sequences, especially in images with low head motion. We suggest that studies targeting hyperkinetic populations use the MPRAGE+PMC sequence, given its robustness to head motion and higher reliability scores. However, neuroimaging researchers studying non-hyperkinetic participants can choose either MPRAGE or MPRAGE+PMC sequences, but should carefully consider the apparent tradeoff between relatively increased reliability, but reduced quality control metrics when using the MPRAGE+PMC sequence.

The test-retest reliability, concurrent validity and minimal detectable change of the 3-m backward walking test in patients with total hip arthroplasty

PurposeTo determine the test–retest reliability, concurrent validity and minimal detectable change of the 3-m backward walking test (3MBWT) in patients with Total Hip Arthroplasty (THA). MethodsA total of 29 patients after unilateral primary THA were enrolled in the study. All evaluations were carried out by the same physiotherapist. The test-retest reliability of the 3MBWT was assessed at an hour interval and analyzed by the Intraclass correlation coefficient (ICC). In the concurrent validity analysis, the Spearman correlation coefficient between 3MBWT and Harris Hip Score (HHS) was calculated. In addition, the standard error of measurement (SEM95) and Minimal Detectable Change (MDC95) values were also calculated. ResultsThe mean age of the patients was 75.6 ± 10.0 years. The mean time of the second test was 2.41 s better than the first assessment. The ICC score of 3MBWT was 0.983. Test-retest reliability was excellent. SEM95 and MDC95 values were 1.56 and 4.33, respectively. Both test and retest evaluations of the 3MBWT were correlated with the HHS (p < 0.01). The degree of correlations was moderate. ConclusionThe 3MBWT is a valid and reliable test in patients with primary unilateral THA. The MDC value of 3MBWT provides essential information to clinicians about patients’ clinical progression.

Evaluation of motor cortical excitability using evoked torque responses: A new tool with high reliability

BackgroundMotor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) are typically recorded via surface electromyography (EMG). However, another suitable alternative may be recording torque output associated with MEPs, especially when studying multiheaded muscles (e.g. quadriceps) for which EMG may not be ideal. MethodsWe recorded the motor evoked torque elicited by TMS along with conventional EMG-based MEPs (MEPEMG) over a range of TMS intensities (100–140 % of active motor threshold [AMT]) from twenty healthy young adults on two different days. MEPs were normalized using different normalization procedures (raw, normalized to maximum voluntary isometric contraction [MVIC], and peak MEP). Additionally, motor evoked torque was normalized to TMS-evoked peripheral resting twitch torque. Intraclass correlation coefficients (ICCs) were determined for each of these variables to compute reliability. ResultsMotor evoked torque showed good to excellent reliability (ICC: 0.65-0.90) at TMS intensities ≥ 110 % AMT, except when normalized by peak MEP. The reliability of raw MEPEMG and MVIC normalized MEPEMG was fair to excellent only at ≥ 130 % AMT (ICC: 0.42-0.82) and at ≥ 120 % AMT (ICC: 0.41-0.83), respectively. The reliability of both MEPEMG and motor evoked torque generally increased with increasing TMS intensities, with motor evoked torque normalized to the resting twitch torque yielding the best ICC scores. Comparison with existing methodsWhen compared with conventional MEPEMG, motor evoked torque offers superior and reliable estimates of corticospinal excitability, particularly when normalized to resting twitch torque. ConclusionsTMS-induced motor evoked torque can reliably be used to measure corticospinal excitability in the quadriceps muscles.

The test-retest reliability and concurrent validity of the five times sit to stand test and step test in older adults with total hip arthroplasty.

The aim of the study was to determine the test-retest reliability and concurrent validity of the five times sit to stand test (FTST) and step test (ST) in older adults with total hip arthroplasty (THA). A cross-sectional and prospective study was carried out with 32 unilateral total hip arthroplasty patients. FTST, ST, and Timed Up & Go Test were evaluated at the first evaluation session. The test-retest reliability was evaluated by performing two repetitions of the FTST and ST. Besides, the functional status of the patients was evaluated with the Harris Hip Score (HHS). The test-retest reliability of the FTST and ST were assessed by the intraclass correlation coefficient (ICC). In the concurrent validity analysis, the Pearson correlation coefficient was analyzed. In addition, the standard error of measurement (SEM95) and minimal detectable change (MDC95) values of the FTST and ST were also calculated. The mean age of the participants was 75.4 ± 10.3 years. The ICC score of FTST, ST (right) and ST (left) were 0.987, 0.908 and 0.846, respectively. SEM95 and MDC95 values of the FTST were 1.05 and 2.91, respectively. FTST was correlated with both the HHS and TUG (r1 = -0.522, r2 = 0.730, p < 0.01). SEM95 and MDC95 values of the ST (right) were 0.37 and 1.02, respectively. SEM95 and MDC95 values of the ST (left) were 0.55 and 1.52, respectively. Also, ST (right) was only correlated with TUG (r = -0.654, p < 0.01). ST (right) were correlated with both the HHS and TUG (r1 = 0.503, r2 = -0.806, p < 0.01). The degree of correlations was strong. The FTST and ST are valid and reliable performance tests in older adults with primary unilateral THA.

Critical appraisal of the quality of clinical practice guidelines for idiopathic pulmonary fibrosis.

BackgroundClinical practice guidelines (CPGs) have long served as an essential tool for clinicians to rationalize their treatment in practice. However, the quality of guidelines varies greatly. The present study aimed to analyze high-quality CPGs of idiopathic pulmonary fibrosis (IPF) and highlight the potential for further improvement.MethodsThree guideline developers’ websites, PubMed, Embase, and Web of Science, as well as a public search engine, Google Scholar, were searched to retrieve CPGs regarding the management of IPF. The methodology and reporting quality of retrieved CPGs were assessed using the validated Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE II) and Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist.ResultsTwelve IPF CPGs were reviewed, among which 7 (58.3%) were considered as “recommended” and 1 (8.3%) as “recommended with modifications”. Among the 6 domains of AGREE II, scope and purpose (70.99%) and clarity of presentation (68.06%) were considered to be the fields in which CPGs performed best, evidenced by the highest mean AGREE II scores. The domains in which the reviewed CPGs received the lowest mean scores were rigor of development (50.87%) and applicability (34.14%). The intraclass correlation coefficient scores were excellent in each domain. The basic information domain received the highest overall reporting rate in the 7 domains of the RIGHT checklist; the other 6 domains had a full reporting rate of <50%. Eight items had a satisfactory level of reporting, whereas 14 items had poor reporting according to the RIGHT checklist. Correlation analysis revealed a highly positive correlation between the methodology and reporting quality of CPGs for IPF (r=0.872).ConclusionsThe methodological quality of selected IPF CPGs fluctuated greatly, and the full reporting rate was found to be quite low in some domains. In the future, we should focus not only on improving the methodological quality in the development of guidelines, but also on the reporting quality of guidelines.

Retrospective comparison of approaches to evaluating inter-observer variability in CT tumour measurements in an academic health centre

BackgroundA growing number of research studies have reported inter-observer variability in sizes of tumours measured from CT scans. It remains unclear whether the conventional statistical measures correctly evaluate the CT...

Application of non-contact scanning to forensic podiatry: A feasibility study

Foot impression evidence recovered from crime scenes can be available in the form of barefoot prints, sock-clad footprints, or as impressions within footwear. In some cases, suspects leave their footwear at the scene of the crime, and the insoles from the footwear can be important in linking a person to the footwear. The application of 3D data-collecting technology is becoming more and more popular within forensic science and has been used to recover footwear impression evidence. The present study is a feasibility study to discover if 3D data capturing devices can be applied to insoles; to capture the footprint impression for measurement using the Gunn method (a method used in forensic podiatry casework). Three different methods of data capture were conducted; Adobe Photoshop, MeshLab, and calipers used directly on the insole. Paired t-tests and Intraclass Correlation Coefficient (ICC) were conducted for all three data capture methods. Seven measurements used in this study were significantly different across all three methods. ICC scores were moderate to excellent for the Photoshop method, poor to good for the 3D method, and moderate to excellent for the Direct method.

Association between MRI histogram features and treatment response in locally advanced cervical cancer treated by chemoradiotherapy.

To examine the associations of histogram features of T2-weighted (T2W) images and apparent diffusion coefficient (ADC) with treatment response in locally advanced cervical cancer (LACC) following concurrent chemoradiotherapy (CCRT). Fifty-eight patients who underwent a 4-week CCRT regimen with MRI prior to treatment (pre-CCRT) and after treatment (post-CCRT) were retrospectively analysed. Histogram features were calculated from volumes of interest (VOIs) from one radiologist on T2W images and ADC maps. VOIs from two radiologists were used to assess observer repeatability in delineation and feature values at both time-points with the Dice similarity coefficient (DSC) and intraclass correlation coefficient (ICC). Treatment response was defined as a 90% reduction in tumour volume. Paired Mann-Whitney U tests were used to determine if features changed significantly between examinations. Two-sample Mann-Whitney U tests were used to identify features that were significantly different between response groups. Receiver operating characteristic (ROC) analysis was done on significantly different MRI features between treatment response groups. Pre-CCRT delineation and feature repeatability were generally good (DSC > 0.700; ICC > 0.750). Post-CCRT repeatability was low (DSC < 0.700; ICC < 0.750), but ADC mean and percentiles retained good ICC scores. All features, except for T2WKurtosis, significantly changed between examinations. Post-CCRT ADC50 was the only feature that demonstrated both good observer variability and significant differences between treatment response groups (p = 0.036) and had an AUC of 0.701 with a cut-off of 1.357 × 10-6 mm2/s. ADC and T2W histogram features could be used to track changes in LACC tumours undergoing CCRT. Post-CCRT ADC50 was associated with treatment response with good observer repeatability. • Pre-treatment tumour delineation and histogram feature values had good observer repeatability, while these were less repeatable at post-treatment. • MRI histogram analysis could be used to track changes in the tumour as it undergoes concurrent chemoradiotherapy. • Post-treatment median ADC was associated with treatment response and had good repeatability.

Measurement Reliability for Keratitis Morphology.

To evaluate the reliability of manual annotation when quantifying cornea anatomical and microbial keratitis (MK) morphological features on slit-lamp photography (SLP) images. Prospectively enrolled patients with MK underwent SLP at initial encounter at 2 academic eye hospitals. Patients who presented with an epithelial defect (ED) were eligible for analysis. Features, which included ED, corneal limbus (L), pupil (P), stromal infiltrate (SI), white blood cell (WBC) infiltration at the SI edge, and hypopyon (H), were annotated independently by 2 physicians on SLP images. Intraclass correlation coefficients (ICCs) were applied for reliability assessment; dice similarity coefficients (DSCs) were used to investigate the area overlap between readers. Seventy-five MK patients with an ED received SLP. DSCs indicate good to fair annotation overlap between graders (L = 0.97, P = 0.80, ED = 0.94, SI = 0.82, H = 0.82, WBC = 0.83) and between repeat annotations by the same grader (L = 0.97, P = 0.81, ED = 0.94, SI = 0.85, H = 0.84, WBC = 0.82). ICC scores showed good intergrader (L = 0.98, P = 0.78, ED = 1.00, SI = 0.67, H = 0.97, WBC = 0.86) and intragrader (L = 0.99, P = 0.92, ED = 0.99, SI = 0.94, H = 0.99, WBC = 0.92) reliabilities. When reliability statistics were recalculated for annotated SI area in the subset of cases where both graders agreed WBC infiltration was present/absent, intergrader ICC improved to 0.91 and DSC improved to 0.86 and intragrader ICC remained the same, whereas DSC improved to 0.87. Manual annotation indicates usefulness of area quantification in the evaluation of MK. However, variability is intrinsic to the task. Thus, there is a need for optimization of annotation protocols. Future directions may include using multiple annotators per image or automated annotation software.

Psychometric evaluation of a Patient Satisfaction Survey Questionnaire to assess advanced practice nurse ambulatory services in primary care.

AimTo determine the construct validity and test–retest reliability of the Patient Satisfaction Survey Questionnaire (PSSQ).BackgroundAdvanced practice nurses (APNs) co‐manage patients with non‐communicable diseases (NCDs) with public primary care physicians in Singapore. The original Nurse Practitioner Satisfaction Survey (NPSS) instrument was adapted (renamed as PSSQ) to assess satisfaction with APN service.MethodA total of 209 patients self‐administered the PSSQ at first visit and repeated it in a retest through phone within the next 2 weeks in 2018. Cronbach's alpha and intra‐class correlation (ICC) coefficients were performed to evaluate the internal consistency and test–retest reliability. Construct validity was determined by confirmatory factor analysis (CFA).ResultsThe overall Cronbach's alpha (>0.7) and ICC scores (0.697–0.729) indicated excellent test–retest reliability and good internal consistency, respectively. The CFA results of three‐factor model showed poor fit. Additional exploratory factor analysis (EFA) and principal component analysis (PCA) with varimax rotation revealed that adding another factor (communication with physician) resulted in a better model (eigenvalue > 1). The ICC for the four‐factor model ranged from 0.664 to 0.825, indicating fair to excellent reliability.ConclusionThe PSSQ shows good internal consistency and test–retest reliability. The four‐factor model is a better instrument to assess APN service in local populations.Implications for Nursing ManagementThe validated PSSQ can be used as instrument to assess the quality of services provided by various categories of nurses, including registered nurses, nurse clinicians and APNs.