Interrater Reliability Intraclass Correlation Research Articles

Reliability of confocal corneal microscopy for measurement of dendritic cell density in suspected small fiber neuropathy.

Dendritic cells (DCs) and their contacts with corneal nerves are described in animal models of nerve damage. Dendritic cell density (DCD) is a potential marker of immune activity in suspected small-fiber neuropathy (SFN). Here, we aim to evaluate the intra- and inter-rater reliability of DCD measurements in suspected SFN. This retrospective study collected DCD from confocal microscopy images from the corneal sub-basal epithelium of the eye from 48 patients (mean age 49.6 ± 12.1 y, 61% female). Two examiners, each blinded to the other's examinations and measurements, assessed DCD to evaluate inter-rater reliability. For intra-rater reliability, the first examiner performed a second measurement after 14 days. DCs were classified into two cell morphological subtypes: mature and immature. Test-retest reliability for total DCD showed excellent agreement, with an intraclass correlation coefficient of 0.96 and inter-rater reliability intraclass correlation coefficient of 0.77. The immature cell subtype showed excellent intra-rater reliability but lower inter-rater reliability. We found that DCD measurements in the corneal sub-basal epithelium are sufficiently reliable for consideration in clinical studies of patients with suspected SFN.

Reliability of the 44-question Home Fall Hazard Assessment Tool and demographic characteristics associated with home hazards among the Thai elderly

Background: The 44-question Thai Home Fall Hazard Assessment Tool (Thai-HFHAT) was developed to assist healthcare professionals in identifying the risk of falls among community-dwelling older adults from their home environment. However, the reliability of this tool has not been studied. This study aimed to examine the reliability of the 44-question Thai-HFHAT and determine the demographic characteristics associated with home hazards. Methods: A descriptive cross-sectional study design was used to evaluate inter-rater reliability. The participants in this study were 51 older people from various types of Thai houses: a one-story elevated house, a one-story non-elevated house, and a house with two or more floors, 51 caregivers of older patients, and 5 village health volunteers (VHV). A prospective design was used to evaluate test-retest reliability with older people at different times in their homes. All participants answered 44 Thai-HFHAT questions to determine inter-rater and test-retest reliabilities. The reliabilities were analyzed using an intra-class correlation coefficient (ICC). Demographic characteristics including sex, occupation, and education were used to identify the factors affecting home hazards, and linear regression was used to analyze. Results: The ICC of inter-rater reliability of the 44-question Thai-HFHAT was 0.74 (95% CI: 0.57-0.84) and the test-retest reliability was 0.80 (95% CI: 0.64-0.88) for the older adults, 0.80 (95% CI: 0.65-0.89) for the caregivers and 0.70 (95% CI: 0.477-0.83) for the VHV. In demographic variables, personal business career and education level (grades 1-3) had significant relations with the total number of home hazards in the 44-questions Thai-HFHAT. Conclusions: The 44-question Thai-HFHAT is suitable for home hazard assessment among older adults in Thailand. Further studies are needed to investigate changes in the house environment after using the 44-question Thai-HFHAT to determine which changes can reduce fall risk.

Reliability of the 44-question Home Fall Hazard Assessment Tool and demographic characteristics associated with home hazards among the Thai elderly.

Background: The 44-question Thai Home Fall Hazard Assessment Tool (Thai-HFHAT) was developed to assist healthcare professionals in identifying the risk of falls among community-dwelling older adults from their home environment. However, the reliability of this tool has not been studied. This study aimed to examine the reliability of the 44-question Thai-HFHAT and determine the demographic characteristics associated with home hazards. Methods: A descriptive cross-sectional study design was used to evaluate inter-rater reliability. The participants in this study were 51 older people from various types of Thai houses: a one-story elevated house, a one-story non-elevated house, and a house with two or more floors, 51 caregivers of older patients, and 5 village health volunteers (VHV). A prospective design was used to evaluate test-retest reliability with older people at different times in their homes. All participants answered 44 Thai-HFHAT questions to determine inter-rater and test-retest reliabilities. The reliabilities were analyzed using an intra-class correlation coefficient (ICC). Demographic characteristics including sex, occupation, and education were used to identify the factors affecting home hazards, and linear regression was used to analyze. Results: The ICC of inter-rater reliability of the 44-question Thai-HFHAT was 0.74 (95% CI: 0.57-0.84) and the test-retest reliability was 0.80 (95% CI: 0.64-0.88) for the older adults, 0.80 (95% CI: 0.65-0.89) for the caregivers and 0.70 (95% CI: 0.477-0.83) for the VHV. In demographic variables, personal business career and education level (grades 1-3) had significant relations with the total number of home hazards in the 44-questions Thai-HFHAT. Conclusions: The 44-question Thai-HFHAT is suitable for home hazard assessment among older adults in Thailand. Further studies are needed to investigate changes in the house environment after using the 44-question Thai-HFHAT to determine which changes can reduce fall risk.

Reliability of the 44-question Home Fall Hazard Assessment Tool and personal characteristics associated with home hazards among the Thai elderly

Background: The 44-question Thai Home Fall Hazard Assessment Tool (Thai-HFHAT) was developed to assist healthcare professionals in identifying the risk of falls among community-dwelling elderly from their home environment. However, the reliability of this tool has not been studied. This study aimed to examine the reliability of the 44-question Thai-HFHAT and determine the personal characteristics associated with home hazards. Methods: A descriptive cross-sectional study design was used to evaluate interrater reliability. The participants in this study were 51 elderly people from various types of Thai houses: a one-story elevated house, a one-story non-elevated house, and a house with two or more floors, 51 caregivers of elderly patients, and 5 village health volunteers (VHV). A prospective design was used to evaluate test-retest reliability with older people at different times in their homes. All participants answered 44 Thai-HFHAT questions to determine inter-rater and test-retest reliabilities. The reliabilities were analyzed using an intra-class correlation coefficient (ICC). Personal characteristics including sex, occupation, and education were used to identify the factors affecting home hazards, and linear regression was used to analyze. Results: The ICC of inter-rater reliability of the 44-question Thai-HFHAT was 0.74 (95% CI: 0.57-0.84) and the test-retest reliability was 0.80 (95% CI: 0.64-0.88) for the elderly, 0.80 (95% CI: 0.65-0.89) for the caregivers and 0.70 (95% CI: 0.477-0.83) for the VHV. Personal business career and education level grades 1-3 are less than 0.05, which showed these factors had a significant relationship with the 44-question Thai-HFHAT score as the dependent variable. Conclusions: The 44-question Thai-HFHAT is suitable for home hazard assessment among the elderly in Thailand. Further studies are needed to investigate changes in the house environment after using the 44-question Thai-HFHAT to determine which changes can reduce fall risk.

Reliability of the 44-question Home Fall Hazard Assessment Tool and personal characteristics associated with home hazards among the Thai elderly

Background: The 44-question Thai Home Fall Hazard Assessment Tool (Thai-HFHAT) was developed to assist healthcare professionals in identifying the risk of falls among community-dwelling elderly from their home environment. However, the reliability of this tool has not been studied. This study aimed to examine reliability of the 44-question Thai-HFHAT and determine the person characteristics associated with home hazards. Methods: A descriptive cross-sectional study design was used for this research. The participants in this study were 51 elderly people from various types of Thai houses: a one-story elevated house, a one-story non-elevated house, and a house with two or more floors, 51 caregivers of elderly patients and 5 village health volunteers (VHV). All participants answered 44 Thai-HFHAT questions to determine inter-rater and test-retest reliabilities. The reliabilities were analyzed using an intra-class correlation coefficient (ICC). Personal characteristics including sex, occupation, and education were used to identify the factors affecting home hazard and linear regression was used to analyze. Results: The ICC of inter-rater reliability of the 44-question Thai-HFHAT was 0.74 (95% CI: 0.57-0.84) and the test-retest reliability was 0.80 (95% CI: 0.64-0.88) for the elderly, 0.80 (95% CI: 0.65-0.89) for the caregivers and 0.70 (95% CI: 0.477-0.83) for the VHV. Personal business career and education level grade 1-3 are less than 0.05, which showed these factors had a significant relationship with the 44-question Thai-HFHAT score as dependent variable. Conclusions: The 44-question Thai-HFHAT is suitable for the home hazards assessment among the elderly in Thailand. Further studies are needed to investigate changes in the house environment after using the 44-question Thai-HFHAT to determine which changes can reduce the risk of fall.

Registration of Bony Landmarks and Soft Tissue Laxity during Robotic Total Knee Arthroplasty is Highly Reproducible.

There is growing interest and enthusiasm for robotic total knee arthroplasty (TKA). Many robotic systems require registration of bony landmarks as well as a dynamic soft tissue evaluation to plan femoral and tibial resections. Variability in this user-driven registration can introduce error and undermine the purported precision and accuracy offered by robotics. The purpose of this study was to evaluate inter- and intrarater reliability in robotic registration with a new robotic system (ROSA®; Zimmer-Biomet, Warsaw, IN). Two unpaired cadaveric knee specimens were exposed, and optical arrays were placed into the femur and tibia. Three separate evaluators conducted repeated trials of anatomic registration and assessment of soft tissue laxity, as well as coronal alignment, sagittal alignment, femoral size, and maximum opening in the medial and lateral compartments in both flexion and extension. Repeated trials were conducted using these specimens with and without preoperative imaging for landmarking (image-based and image-free workflows). An Intraclass Correlation Coefficient (ICC) was calculated for each observer and across observers to determine intra-and interrater reliability, respectively, in robotic registration. There was good to excellent reliability for all conditions, and all correlation coefficients were >0.767. On average, ICCs for intrarater reliability were excellent for Doctor 1 (0.952), Doctor 2 (0.975), and Doctor 3 (0.925). On average, the ICCs for interrater reliability were excellent for both the "Registration + Gap Assessment" condition (0.961) and the "Gap Assessment" condition (0.994). Our results show a high repeatability of registration of anatomic landmarks and gap assessment among observers using this robotic system for both image-based and image-free software.

Development of the Auburn Induction Scale for evaluating induction quality in dogs

ObjectiveTo develop and begin establishing evidence for validity of an instrument to assess the quality of induction in dogs. Study designCross-sectional survey and video scoring. Animals and populationA total of 51 veterinary anesthesia personnel, four board-certified anesthesiologists and videos of induction of anesthesia in 18 dogs. MethodsIn Part 1, an online survey was sent to veterinary anesthesia personnel to solicit expressions and words that they associate with induction of anesthesia. These expressions were evaluated by four anesthesiologists to create a composite scale (Auburn Induction Scale). In Part 2, 18 videos were reviewed by the same four anesthesiologists on two separate occasions. The videos were scored using the Auburn Induction Scale, a simple descriptive scale (SDS) and a visual analog scale (VAS). Intra-rater and inter-rater reliability was measured using an intraclass correlation coefficient (ICC). Significance was set at p < 0.05. ResultsThe survey yielded 51 responses that were condensed into 133 expressions. The four anesthesiologists created 18 items incorporating the 133 expressions. The mean ± standard deviation intra-rater reliability ICC was 0.81 ± 0.08 for the Auburn Induction Scale, 0.71 ± 0.02 for the SDS and 0.71 ± 0.08 for the VAS for all raters. The mean ± standard deviation inter-rater reliability ICC was 0.69 ± 0.04 for the Auburn Induction Scale, 0.61 ± 0.05 for the SDS and 0.60 ± 0.06 for the VAS. Conclusions and clinical relevanceIn a research setting, widespread use of this scale may be helpful in increasing the accuracy of data and improving agreement between studies assessing induction of anesthesia in dogs. The results of this study have yielded a composite scale that is more reliable between and among raters than a unidimensional scale.

The Polish Version of the Alberta Infant Motor Scale: Cultural Adaptation and Validation.

The Alberta Infant Motor Scale (AIMS) is a diagnostic tool for the assessment of the motor performance of infants from the time of birth, to the period of independent walking (0–18 months). This study aims to derive a Polish version of the AIMS through its cultural adaptation and validation. The study included 145 infants aged 0–18 months, who were divided into four further age groups: 0–3 months, 4–7 months, 8–11 months, and older than 12 months. The validation was based on an analysis of intrarater and interrater reliability values, as well as concurrent validity, using the gross motor scale of Peabody Developmental Motor Scales-2 (PDMS-2). The total Intraclass Correlation Coefficient (ICC) for intrarater reliability was 0.99 (ICC range in positions was 0.87–0.99, in subgroups was 0.91–0.99), while in particular positions, the ICC ranges were as follows: prone 0.97–0.99, supine 0.94–0.99, sitting 0.95–0.99, and standing: 0.63–0.99. The total ICC for interrater reliability was 0.99 (ICC range in positions was 0.98–0.99, in subgroups was 0.91–0.99), while in particular positions, the ICC ranges were as follows: prone 0.95–0.99, supine 0.93–0.96, sitting 0.93–0.98, standing 0.91–0.98. Only the standing position was analyzed for the subgroup of participants over 12 months old. The Spearman correlation between the Polish version of the AIMS and the gross motor scale of PDMS-2 was significant in the total population (r = 0.97, p < 0.0001) and in subgroups (r = 0.79–0.85, p < 0.0001). The results of our study confirm that the Polish version of the AIMS is reliable for infants aged 0–18 months and can be applied to this population for clinical and scientific purposes.Trial RegistryClinicalTrials.gov ID NCT05264064, URL https://clinicaltrials.gov/ ct2/show/NCT05264064.

Application of objective structured clinical examination (OSCE) for the evaluation of Kampo medicine training

BackgroundThe purpose of this study was to develop an objective, content-valid, and reliable assessment method for Kampo medicine using an objective structured clinical examination (OSCE) for the assessment of clinical competence in Kampo medicine.MethodsWe developed a blueprint followed by a list of 47 assessment items and three task scenarios related to clinical competence in Kampo medicine. An eight-member test committee checked the relevance of the assessment items on a Likert scale. We calculated a content validity index and content validity ratio, and used the Angoff method to set the passing threshold. We trained a total of nine simulated patients with three assigned to each scenario. We conducted an OSCE for 11 candidates with varying medical abilities, and conducted three stations per person, which were evaluated by one evaluator in one room by direct observation. We used video recordings to test the inter-rater reliability of the three raters. We used the test results to verify the reliability of the assessment chart.ResultsThe inter-rater reliability (intraclass correlation coefficient [2,1]) was 0.973. The reliability of the assessment chart for each scenario (Cronbach’s α) was 0.86, 0.89, and 0.85 for Scenarios 1, 2, and 3, respectively. The reliability of the assessment chart for the whole OSCE (Cronbach’s α) was 0.90.ConclusionsWe developed a content-valid new OSCE assessment method for Kampo medicine and obtained high inter-rater and test reliabilities. Our findings suggest that this is one of the most reliable evaluation methods for assessing clinical competence in Kampo medicine.

Validity and Reliability of Quick Motor Function Test in Ambulatory Duchenne Muscular Dystrophy Patients

AbstractThe quick motor function test (QMFT) is used to evaluate Pompe patients' motor function. This study aims to evaluate the convergent validity and reliability of the cross-culturally adapted Turkish version of QMFT in patients with Duchenne muscular dystrophy (DMD). Twenty-eight patients diagnosed with DMD were included in the study. The QMFT was translated and adapted to Turkish. The functionality of the patients was assessed with the north star ambulatory assessment (NSAA) and the 6-minute walk test (6MWT); muscle strength was evaluated with a hand-held dynamometer. There were two separate practitioners on the first day of the QMFT study; it was applied a second time by the first practitioner 14 days later. The mean age of DMD patients was 9.03 ± 3.39 (minimum 4–maximum 18 . Twenty-seven patients concluded all the necessary assessments. Intrarater reliability of QMFT in patients with DMD was intraclass correlation coefficient (ICC) = 0.98, and interrater reliability ICC = 0.98 was excellent. QMFT correlated very well with 6MWT (r s = 0.86; p &lt; 0.001) and NSAA (r s = 0.91; p &lt; 0.001). Both the QMFT and NSAA show stronger correlations with proximal muscle groups (convergent validity) than with distal muscle groups (divergent validity). QMFT is a reliable and valid test for evaluating motor function in patients with DMD.

Aliased Flow Signal Planimetry by Cardiovascular Magnetic Resonance Imaging for Grading Aortic Stenosis Severity: A Prospective Pilot Study.

Objectives: Transthoracic echocardiography (TTE) is the standard technique for assessing aortic stenosis (AS), with effective orifice area (EOA) recommended for grading severity. EOA is operator-dependent, influenced by a number of pitfalls and requires multiple measurements introducing independent and random sources of error. We tested the diagnostic accuracy and precision of aliased orifice area planimetry (AOAcmr), a new, simple, non-invasive technique for grading of AS severity by low-VENC phase-contrast cardiovascular magnetic resonance (CMR) imaging.Methods: Twenty-two consecutive patients with mild, moderate, or severe AS and six age- and sex-matched healthy controls had TTE and CMR examinations on the same day. We performed analysis of agreement and correlation among (i) AOAcmr; (ii) geometric orifice area (GOAcmr) by direct CMR planimetry; (iii) EOAecho by TTE-continuity equation; and (iv) the “gold standard” multimodality EOA (EOAhybrid) obtained by substituting CMR LVOT area into Doppler continuity equation.Results: There was excellent pairwise positive linear correlation among AOAcmr, EOAhybrid, GOAcmr, and EOAecho (p < 0.001); AOAcmr had the highest correlation with EOAhybrid (R2 = 0.985, p < 0.001). There was good agreement between methods, with the lowest bias (0.019) for the comparison between AOAcmr and EOAhybrid. AOAcmr yielded excellent intra- and inter-rater reliability (intraclass correlation coefficient: 0.997 and 0.998, respectively).Conclusions: Aliased orifice area planimetry by 2D phase contrast imaging is a simple, reproducible, accurate “one-stop shop” CMR method for grading AS, potentially useful when echocardiographic severity assessment is inconclusive or discordant. Larger studies are warranted to confirm and validate these promising preliminary results.

Inter-rater and test-retest reliability of computerized clinical vestibular tools.

Clinical vestibular technology is rapidly evolving to improve objective assessments of vestibular function. Understanding the reliability and expected score ranges of emerging clinical vestibular tools is important to gauge how these tools should be used as clinical endpoints. The objective of this study was to evaluate inter-rater and test-retest reliability intraclass correlation coefficients (ICCs) of four vestibular tools and to determine expected ranges of scores through smallest real difference (SRD) measures. Sixty healthy graduate students completed two 1-hour sessions, at most a week apart, consisting of two video head-impulse tests (vHIT), computerized dynamic visual acuity (cDVA) tests, and a smartphone-assisted bucket test (SA-SVV). Thirty students were tested by different testers at each session (inter-rater) and 30 by the same tester (test-retest). ICCs and SRDs were calculated for both conditions. Most measures fell within the moderate ICC range (0.50-0.75). ICCs were higher for cDVA in the inter-rater subgroup and higher for vHITs in the test-retest subgroup. Measures from the four tools evaluated were moderately reliable. There may be a tester effect on reliabilities, specifically vHITs. Further research should repeat these analyses in a patient population and explore methodological differences between vHIT systems.

Reliability and validity of the Japanese version of the overall dry skin score in older patients.

Dry skin is the most common skin problem, especially in the elderly. However, there is no effective instrument to assess dry skin in Japan. This study aimed to evaluate the reliability and validity of the Japanese version of the overall dry skin score (ODS-J), the gold standard for dry skin assessment. A cross-sectional study was conducted on 47 patients aged>65 years. Images of skin on their limbs were captured using a digital camera; both upper and lower limbs were assessed (n=4/patient). One dermatologist; two wound, ostomy, and continence nurses; and three nursing researchers independently evaluated the images using the ODS-J to assess the intraclass correlation coefficient (ICC) for inter-rater reliability. Stratum corneum hydration (SCH) and transepidermal water loss (TEWL) were the external criteria used to verify concurrent and known-groups validity. In total, 182 sites at which the SCH and TEWL could be measured were evaluated for the ODS-J. The ICC for inter-rater reliability of the six raters was 0.939 (p<0.001). A higher ODS-J was associated with lower SCH (ρ=-0.374; p<0.001) and lower TEWL (ρ=-0.287; p<0.001) values. The ODS-J for the lower legs was significantly higher than that of the forearms (p<0.001). The ODS-J showed good inter-rater reliability, concurrent validity, and known-groups validity. It can be used by clinical nurses in Japan to observe patients' skin and is an effective indicator for the evaluation of skin care.

A generic outcome assessment of mobility capacity in neurorehabilitation: measurement properties of the de Morton Mobility Index

BackgroundMobility capacity is a key outcome domain in neurorehabilitation. The de Morton Mobility Index (DEMMI), an established and generic outcome assessment of mobility capacity in older patients, is promising for use in neurorehabilitation. The aim of this study was to examine the measurement properties of the DEMMI in rehabilitation inpatients with neurological conditions.MethodsCross-sectional study including a mixed sample of adult inpatients in a neurorehabilitation hospital. Structural validity, unidimensionality and measurement invariance (Rasch analysis), construct validity, internal consistency reliability, and inter-rater reliability of the DEMMI (scale range: 0–100 points) were established. The minimal detectable change, the 95% limits of agreement, and possible floor and ceiling effects were calculated to indicate interpretability.ResultsWe analyzed validity (n = 348) and reliability (n = 133) in two samples. In both samples, the majority of participants had a sub-acute stroke or Parkinson’s disease.Rasch analysis indicated unidimensionality with an overall fit to the model (chi-square = 59.4, P = 0.074). There was no relevant measurement invariance by disease group. Hypotheses-based correlation analyses (DEMMI and other functional outcome assessments) showed sufficient construct validity. Internal consistency reliability (Cronbach’s alpha = 0.94) and inter-rater reliability (intraclass correlation coefficient = 0.94; 95% confidence interval: 0.91–0.95) were sufficient. The minimal detectable change with 90% confidence was 15.0 points and the limits of agreement were 39%. No floor or ceiling effects were observed.ConclusionsResults indicate sufficient measurement properties of the DEMMI in rehabilitation inpatients with neurological conditions. The DEMMI can be used as a generic outcome assessment of mobility capacity in neurorehabilitation.Trial registrationGerman Clinical Trials Register (DRKS00004681). Registered May 6, 2013.

Ultrasound Imaging Analysis of the Lumbar Multifidus Muscle Echo Intensity: Intra-Rater and Inter-Rater Reliability of a Novice and an Experienced Rater

Background and Objectives: Ultrasound echo intensity (EI) of the lumbar multifidus muscle (LMM) could offer valuable insights regarding muscle quality in people with low back pain (LBP). However, whether the rater’s experience noticeably influences the reliability and precision of LMM EI measurements has not been established. The aims of this study were to investigate the intra-rater and inter-rater reliability of LMM EI measurements, and to compare the reliability and SEM between a novice and an experienced rater. Materials and Methods: Twenty athletes (10 females, 10 males) with a history of LBP were included in this study. Transverse ultrasound images of LMM were taken at L5 in prone. LMM EI measurements were obtained bilaterally by tracing the maximum ROI representing the LMM cross-sectional area (CSA), avoiding the inclusion of bone or surrounding fascia. All measurements were performed by two novice raters and an experienced researcher. Each measurement was acquired by each rater three times for each side on three different images, and the average was used in the analyses. Raters were blinded to each other’s measurements and the participant’s clinical information. Intra-class correlation coefficients (ICCs) were obtained to assess the intra-rater and inter-rater reliability. Results: The intra-rater ICC values for the LMM measurements for the experienced rater were excellent (ICC all > 0.997). The inter-rater reliability ICC values showed moderate to excellent reliability (0.614 to 0.994) and agreement between the novice raters and the experienced rater, except for Novice 1 for the right LMM, which revealed lower ICCs and a wider 95% CI. Intra-rater and inter-rater reliability results were similar when separately looking at the right and left side of the muscle and participant gender. Conclusions: Our findings support the clinical use of ultrasound imaging for the assessment of LMM EI in individuals with LBP.

Inter and Intra-Rater Reliability of Measuring Photometric Craniovertebral Angle Using a Cloud-Based Video Communication Platform.

Objective:Due to social distancing guidelines during the Coronavirus (COVID-19) pandemic, most providers and patients have wanted to avoid close contact. This makes physical therapy (PT) assessments difficult because of the lack of empirical evidence about the reliability of various clinical measurements performed in a virtual environment. One such procedure is the photometric measurement of craniovertebral (CV) angle. Craniovertebral angle measurement is usually performed in an outpatient setting and is defined as the acute angle formed between a straight line connecting the spinous process of C7 to the tragus of the ear, and the horizontal line passing through the spinous process of the C7. Although the photometric measurement of CV angles is considered both valid and reliable in the clinics, no empirical evidence exists about the CV angle measurement reliability when performed in a virtual environment. Thus, the purpose of this study was to assess the inter- and intra-rater reliability of photometric CV angle measurement using a cloud-based video communication platform. Number of Subjects: 66 subjects (57 females).Methods:All measurements were performed by two final year PT students who had completed the musculoskeletal part of the curriculum and were blinded to each other's measurements. Each subject was photographed in two postures over a HIPAA-compliant video-based telehealth platform: (1) normal/relaxed posture and (2) ideal posture (posture the subject considered good). Student researcher 1 measured the CV angle in both the relaxed posture and ideal posture, while student researcher 2 measured the CV angle only in the relaxed posture. Each subject's CV angle measurement was performed three times on three separate days and the means were used for further analysis. The shape of the CV angle frequency distribution was assessed using kurtosis and skewness values. Rater reliability was assessed using intraclass correlation coefficients (ICC), and interpreted based on the guidelines provided by Portney and Watkins (2009).Results:The CV angles were normally distributed in both relaxed and ideal postures. The mean and standard deviation (SD) of relaxed posture was 50.7o ± 6.3o with kurtosis and skewness of 0.67 and −0.74 respectively. The mean and SD of ideal posture was 55.5o ± 5.4o, with kurtosis and skewness of 0.1 and −0.54 respectively. The ICC for inter-rater reliability in the relaxed posture was 0.88 and the ICC for intra-rater reliability for relaxed posture was 0.91.Conclusions:Craniovertebral angles were normally distributed in the sample. An acceptable level of inter- and intra-rater reliability can be attained when measuring CV angle using a cloud-based video communication platform.

Brazilian version of the Functional Gait Assessment: translation, reliability, and validity for use on stroke patients

Objective. Translate and adapt the Functional Gait Assessment (FGA) to Brazilian Portuguese as a measure of balance during gait in stroke patients and determine its validity and reliability based on evidence of its measurement properties. Method. A convenience sample of 45 stroke survivors (average of seven months since diagnosis) was included (mean age: 55 years; 51% women). The instrument under consideration was translated and back-translated. The performance of the FGA was assessed by two raters to determine intrarater and interrater reliability. Concurrent and discriminant validity were investigated using the Berg Balance Scale (BBS) as well as normal and fast walking speed. Results. No difficulties with the translation were found during the application of the tests. Therefore, no structural or conceptual changes to the translated version were needed to achieve cultural equivalence. Intrarater (intraclass correlation coefficient=0.93) and interrater reliability (intraclass correlation coefficient=0.90) were almost perfect for the total scores. The reliability of single items was also strong, ranging from 0.74 to 0.95. Concurrent validity with other measures of gait and balance was moderate to substantial. The FGA was correlated (p&lt;0.001) with the BBS (0.71), normal walking speed (0.66), and fast walking speed (0.70). Conclusion. The Brazilian version of the FGA is a reliable, valid instrument for assessing functional gait performance in stroke survivors.

Development of the Teaching Interpersonal Skills for Telehealth Checklist.

While interpersonal skills in telehealth may positively impact clinical practice, patient engagement and outcomes, assessment strategies are lacking. We conducted a multi-stage iterative approach to develop and test validity and reliability of the Teaching Interpersonal Skills in Telehealth checklist (TIPS-TC). First, we identified observable communication behaviors from the literature. Second, we surveyed telehealth managers and researchers (N = 11) to rate appropriateness of potential checklist items. Level of agreement (35%-91%) and Kappa statistic (0.18-0.89) confirmed items to be retained and identified items to modify. Based on response patterns and comments, we reduced 44 items to 12 critical checklist behaviors. Third, student clinicians used the checklist with video telehealth consultations and provided feedback. Fourth, we conducted reliability testing with practitioners and administrators (N = 68) who completed the TIPS-TC for two versions of a telehealth scenario. Strong interrater reliability intraclass correlation coefficient (ICC) and test-retest reliability ICC (both p < .001), along with non-significant findings of order effects supported the checklist as an acceptable instrument to differentiate high skill from low skill telehealth sessions. The TIPS-TC offers an evidence-based approach to assessing interpersonal skills in telehealth to help evaluate clinician competence and tailor learning activities across disciplinary roles.

Assessment of mirror movements in children and adolescents with unilateral cerebral palsy: reliability of the Woods and Teuber scale.

To investigate the inter- and intrarater reliability of the Woods and Teuber scale to detect mirror movements in children and adolescents with unilateral cerebral palsy (CP). A convenience sample of children and adolescents with unilateral CP (n=68; 31 males, 37 females; mean age 12y 2mo, SD 3y 6mo) in Manual Ability Classification levels I to III was recruited from Norway, Australia, and Belgium. Three therapists scored mirror movements according to the Woods and Teuber scale from three video-recorded tasks at two separate time points. A two-way, mixed model regression was used to calculate intraclass correlation coefficients (ICCs) reflecting overall inter- and intrarater reliability. In addition, ICCs for each hand and task were calculated separately. The overall interrater reliability ICC was 0.90 and the corresponding intrarater reliability ICC was 0.92. The ICCs for each hand ranged from 0.86 to 0.92 and for each task from 0.63 to 0.89. The Woods and Teuber scale shows excellent reliability for scoring mirror movements in children and adolescents with unilateral CP. The assessment is easy to administer with no need for specific equipment and scoring can be determined from short video recordings, making it a feasible instrument in research and clinical practice.

Validity and reliability of inertial sensors for elbow and wrist range of motion assessment.

BackgroundElbow and wrist chronic conditions are very common among musculoskeletal problems. These painful conditions affect muscle function, which ultimately leads to a decrease in the joint’s Range Of Motion (ROM). Due to their portability and ease of use, goniometers are still the most widespread tool for measuring ROM. Inertial sensors are emerging as a digital, low-cost and accurate alternative. However, whereas inertial sensors are commonly used in research studies, due to the lack of information about their validity and reliability, they are not widely used in the clinical practice. The goal of this study is to assess the validity and intra-inter-rater reliability of inertial sensors for measuring active ROM of the elbow and wrist.Materials and MethodsMeasures were taken simultaneously with inertial sensors (Werium™ system) and a universal goniometer. The process involved two physiotherapists (“rater A” and “rater B”) and an engineer responsible for the technical issues. Twenty-nine asymptomatic subjects were assessed individually in two sessions separated by 48 h. The procedure was repeated by rater A followed by rater B with random order. Three repetitions of each active movement (elbow flexion, pronation, and supination; and wrist flexion, extension, radial deviation and ulnar deviation) were executed starting from the neutral position until the ROM end-feel; that is, until ROM reached its maximum due to be stopped by the anatomy. The coefficient of determination (r2) and the Intraclass Correlation Coefficient (ICC) were calculated to assess the intra-rater and inter-rater reliability. The Standard Error of the Measurement and the Minimum Detectable Change and a Bland–Altman plots were also calculated.ResultsSimilar ROM values when measured with both instruments were obtained for the elbow (maximum difference of 3° for all the movements) and wrist (maximum difference of 1° for all the movements). These values were within the normal range when compared to literature studies. The concurrent validity analysis for all the movements yielded ICC values ≥0.78 for the elbow and ≥0.95 for the wrist. Concerning reliability, the ICC values denoted a high reliability of inertial sensors for all the different movements. In the case of the elbow, intra-rater and inter-rater reliability ICC values range from 0.83 to 0.96 and from 0.94 to 0.97, respectively. Intra-rater analysis of the wrist yielded ICC values between 0.81 and 0.93, while the ICC values for the inter-rater analysis range from 0.93 to 0.99.ConclusionsInertial sensors are a valid and reliable tool for measuring elbow and wrist active ROM. Particularly noteworthy is their high inter-rater reliability, often questioned in measurement tools. The lowest reliability is observed in elbow prono-supination, probably due to skin artifacts. Based on these results and their advantages, inertial sensors can be considered a valid assessment tool for wrist and elbow ROM.