Intraclass Correlation Coefficients For Intraobserver Reliability Research Articles

BLU-DAT: a new reliable and accurate arthrometer for measuring anterior knee laxity

PurposeAlthough many arthrometers have been developed to assess anterior knee laxity, reliability and diagnostic accuracy of these devices are still debated. The aim of the present study was to evaluate the validity of a new arthrometer in the outpatient setting, with the hypothesis that it had good validity in terms of reliability and diagnostic accuracy.MethodsSeventy-eight subjects (39 with ACL injury and 39 with normal ACL) were tested. ATT was assessed by means of the Lachman test at 30° of flexion with a new testing device (BLU-DAT) under three different loading conditions: 7 kg (69 N), 9 kg (88 N) and maximum (MMT). The tests were performed on both knees to obtain SSD. In the ACL injury group, the tests were performed by two examiners and one of them repeated a second test series. Inter- and intra-observer reliability were assessed with the intraclass correlation coefficients (ICCs) for the average SSD measures. In the normal-ACL group, the analysis was performed with the same testing setup. Side-to-side difference measures of the two groups at every loading condition were compared by Student’s t test. Data of test series were dichotomized based on the threshold value of 3-mm SSD as pathological ATT and 2 × 2 contingency tables were used to assess diagnostic accuracy.ResultsThe ICCs for intra-observer reliability at 7-kg (69 N), 9-kg (88 N) and MMT measurements were 0.781, 0.855 and 0.913, respectively. The ICC for inter-observer reliability at 7-kg (69 N), 9-kg (88 N) and MMT measurements were 0.701, 0.845 and 0.834, respectively. Comparison between the two groups showed a significant mean difference ranging from 3.4 mm for 7-kg (69 N) load to 4.6 mm for MMT. Overall accuracy ranged from 84.6% for 7-kg load to 98.7% for MMT.ConclusionThe BLU-DAT has proven to be an instrument with good intra- and inter-observer reliability and very good accuracy in the diagnosis of ACL injuries in the outpatient setting. So, the BLU-DAT can be a new useful tool in everyday clinical practice to assist in the diagnosis of ACL injury.Level of evidenceII.

Reliability of acetabular index measurement in developmental dysplasia of the hip screening by orthopaedic trainees: a comparative study

Background: Radiographic measurements are used for screening of developmental dysplasia of the hip (DDH) in children. The ability to detect acetabular dysplasia requires validated radiographic outcome measures. The acetabular index (AI) measurement has been shown to be a reliable measure worldwide. This study aims to test the reliability of the AI measurement in a DDH screening population by orthopaedic junior and senior residents. Methods: The review examined 470 radiographs taken during 4 yr (2016-2019) in a university hospital. AI measurement was performed by two surgeons, four senior residents, and four junior residents at three different times. The intraobserver and interobserver reliability for each group was assessed. Results: The intraobserver reliability intraclass correlation coefficient (ICC) for the AI measurement performed by seniors was excellent at 0.98 (confidence interval [CI] 0.98 to 0.99) for the right side and 0.99 (CI 0.98 to 0.99) for left side. Indistinguishably, the ICC for AI measurement performed by orthopaedic juniors for right and left side was excellent at 0.96 (CI 0.95 to 0.97) and 0.95 (CI 0.95 to 0.96), respectively. The overall ICCs for interobserver reliability for the AI measurement between professors, seniors, and juniors for right and left side was between good and excellent at 0.89 (CI 0.87 to 0.90) and 0.89 (CI 0.87 to 0.91), respectively. Conclusions: Orthopaedic juniors are less reliable in terms of intraobserver and interobserver variability in detecting DDH in screening program in comparison with seniors using AI measurement in a pediatric orthopaedic clinic. Level of Evidence: Level III.

Correlation of tibiofemoral joint-space width with the clinico-radiological scoring of knee osteoarthritis – a comparison between anteroposterior and lyon-schuss radiographic views

Background The degree of joint space narrowing measured on radiographs provide a reliable estimate of the extent and severity of Osteoarthritis (OA) of the knee. While the standing antero-posterior (AP) view radiographs have been used traditionally, recent studies suggest that the Lyon-Schuss (LS) view is able to detect early OA changes better. The present study was, therefore, conducted to make an objective comparison between the two views with respect to their corelation with the patient's clinical and radiological scores. Methods Forty patients (80 knees) were included in this cross-sectional study. Medial as well as lateral tibiofemoral joint space widths (JSW) were measured using vernier callipers on printed, calibrated radiographic images. Knee Society Score (Function) (KSS-F) was used as the clinical outcome measure while Ahlbäck grade was used for determining radiological severity. JSW was correlated with KSS-F and the Ahlbäck grade using Spearman's rho correlation coefficient. Reproducibility of the method was assessed using the intra-class correlation coefficient (ICC). Results Average age of the participants was 60 ± 7.65 (range 50–78) years, with 18 males and 22 females. ICC for intraobserver reliability was 0.97 and for inter-observer reliability, was 0.91 (AP view) and 0.92 (LS view), respectively. Medial JSW measurements taken on the AP view were found to have a significantly higher degree of correlation with both KSS-F and Ahlbäck grade ( p < 0.05) than those obtained from the LS view. Conclusion Although the LS view may be more sensitive for detecting early OA changes in knee, particularly in the lateral tibiofemoral compartment, the present study shows that AP view correlates better with the patient's overall clinical and radiological profile.

The association between patellar tendon stiffness measured with shear-wave elastography and patellar tendinopathy\u2014a case-control study

Objectives(1) To determine the association between patellar tendon stiffness and the presence of patellar tendinopathy (PT). (2) To evaluate the reliability of shear-wave elastography (SWE).MethodsParticipants were consecutively enrolled between January 2017 and June 2019. PT was diagnosed clinically and confirmed by either grayscale US or power Doppler US, or both. Controls had no history of anterior knee pain and no clinical signs of PT. Patellar tendon stiffness (kilopascal, kPa) was assessed using SWE. Logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Reliability analyses included coefficients-of-variation (CV), coefficients-of-repeatability (CR), intraclass correlation coefficient (ICC) for intraobserver and interobserver reliability, and Bland-Altman analysis.ResultsIn total, 76 participants with PT (58 men, mean age 24.4 ± 3.8 years) and 35 asymptomatic controls (16 men, mean age 21.5 ± 3.8 years) were included. Univariate analyses (OR 1.094, 95% CI 1.061–1.128, p < .001) and adjusted multivariate analyses (OR 1.294, 95% CI 1.044–1.605, p = .018) showed that athletes with PT had significantly increased patellar tendon stiffness. ICC for intraobserver reliability was 0.95 (95% CI 0.92–0.97), CR (CV) 12 kPa (10%) and 0.79 (95% CI 0.65–0.88), CR (CV) 18 kPa (21%) for interobserver reliability. Mean differences from Bland-Altman analysis were 5.6 kPa (95% CI 3.1–8.1, p < .001) for intraobserver reliability and 4.6 kPa (95% CI 1.9–7.2, p < .001) for interobserver reliability.ConclusionsPT is associated with significantly higher patellar tendon stiffness. SWE measurements demonstrate excellent intraobserver reliability and good interobserver reliability. Therefore, SWE is a promising tool to implement in longitudinal studies and future studies should evaluate its prognostic value and utility as a monitoring tool in athletes with PT.Key Points• Patellar tendon stiffness measured with shear-wave elastography (SWE) is higher in athletes with patellar tendinopathy than in healthy controls, also after adjusting for potential confounders.• Excellent intraobserver reliability and good interobserver reliability were found for the quantitative assessment of patellar tendon stiffness using SWE.

Reliability and validity of the instrument for scoring clinical outcomes of research for epidermolysis bullosa (iscorEB).

Epidermolysis bullosa (EB) is a group of rare and currently incurable genetic blistering disorders. As more pathogenic-driven therapies are being developed, there is an important need for EB-specific validated outcomes measures designed for use in clinical trials. To test the reliability and construct validity of an instrument for scoring clinical outcomes of research for EB (iscorEB), a new combined clinician- and patient-reported outcomes tool. We conducted an observational study consisting of independent 1-day assessments (six assessors) at two academic hospitals. The assessments consisted of iscorEB clinician (iscorEB-c), Birmingham Epidermolysis Bullosa Severity (BEBS) and global severity assessment for physicians; and iscorEB patient (iscorEB-p), Quality of Life evaluation in Epidermolysis Bullosa and Children's Dermatology Life Quality Index for patients. Construct validity and intraclass correlation coefficients (ICCs) for interobserver, intraobserver and test-retest reliability were calculated. Overall, 31 patients with a mean age of 19·5 years (1·8-45·2) were included. Disease severity was mild in 42% of cases, moderate in 29% and severe in 29%. The interobserver ICC was 0·96 for both the clinician-reported section of iscorEB-c and BEBS. The ICC for intraobserver reliability was 0·91 and 0·70 for the skin and mucosal domains of iscorEB-c, respectively. Cronbach's alpha for iscorEB-c was 0·89. The test-retest reliability of iscorEB-p was 0·97 and Cronbach's alpha was 0·84. The clinical score differentiated between subjects with mild, moderate and severe disease, and both clinical and patient subscores discriminated between recessive dystrophic EB and other EB subtypes. iscorEB has robust reliability and construct validity, including strong ability to distinguish EB types and severities. Further studies are planned to test its responsiveness to change.

RELIABILITY OF A BRAZILIAN PORTUGUESE TRANSLATED AND CROSS-CULTURALLY ADAPTED VERSION OF THE MJOA SCALE.

ABSTRACTObjectiveTo assess the intra- and inter-observer reliability of a Brazilian Portuguese translated and cross-culturally adapted version of the mJOA questionnaire.MethodsThe reliability of the Brazilian Portuguese version of the mJOA scale was assessed through the evaluation of a sample of patients with cervical myelopathy by two independent experienced spine surgeon examiners. Inter-observer reliability was defined by the Intraclass Correlation Coefficient (ICC) between the evaluations of the two examiners, and intra-observer reliability was assessed by the ICC between the two evaluations of one examiner.ResultsFifty-five patients were included in the study (mean age 58.7 years). The ICC for inter-observer reliability of the Brazilian Portuguese version of the mJOA was 0.967, and the ICC for intra-observer reliability was 0.869, both classified as “almost perfect” (> 0.81).ConclusionThe Brazilian Portuguese translated and cross-culturally adapted version of the mJOA questionnaire appears to be valid and reliable. Level of evidence I, Diagnostic Studies, Investigating a Diagnostic Test.

A novel classification of screw placement accuracy in the cervical spine.

Goal of this study is to present an easily reproducible and reliable measurement to evaluate accuracy of screw placement in cervical spine. Accuracy of cervical screw position was assessed in 52 patients treated with 163 screws. Each patient receiving pedicle, transarticular C1/2, lateral mass, or laminar screws and postoperative CT scan was included. Placement position was categorized in 5 grades: Grade 1 is ideal with pedicle wall perforation < 1 mm, grade 2 < 2 mm, grade 3 < 3 mm, and grade 4 < 4 mm. Grade 5 > 4 mm and/or obstruction of transverse foramen by more than half a screw diameter. Intraclass correlation coefficient (ICC) values were assessed for inter- and intraobserver reliability. The mode of individual evaluations was calculated to assign a single value to each screw. This yielded 89 grade 1 (54.6%), 48 grade 2 (29.4%), 14 grade 3 (8.6%), 3 grade 4 (1.8%), and 9 grade 5 (5.5%) screws. Intraobserver reliability ICC was 0.966 and 0.959 for measurements. Interobserver reliability ICC was 0.938. This study introduces a reliable classification of cervical spine instrumentation with various screw types. This should enable the use of a uniform and reproducible, and thus comparable classification for screw position in cervical spine.

Development and assessment of a digital X-ray software tool to determine vertebral rotation in adolescent idiopathic scoliosis

Background ContextThe amount of vertebral rotation in the axial plane is of key importance in the prognosis and treatment of adolescent idiopathic scoliosis (AIS). Current methods to determine vertebral rotation are either designed for use in analogue plain radiographs and not useful in digital images, or lack measurement precision and are therefore less suitable for the follow-up of rotation in AIS patients. PurposeThis study aimed to develop a digital X-ray software tool with high measurement precision to determine vertebral rotation in AIS, and to assess its (concurrent) validity and reliability. Study Design/settingIn this study a combination of basic science and reliability methodology applied in both laboratory and clinical settings was used. MethodsSoftware was developed using the algorithm of the Perdriolle torsion meter for analogue AP plain radiographs of the spine. Software was then assessed for (1) concurrent validity and (2) intra- and interobserver reliability. Plain radiographs of both human cadaver vertebrae and outpatient AIS patients were used. Concurrent validity was measured by two independent observers, both experienced in the assessment of plain radiographs. Reliability-measurements were performed by three independent spine surgeons. ResultsPearson correlation of the software compared with the analogue Perdriolle torsion meter for mid-thoracic vertebrae was 0.98, for low-thoracic vertebrae 0.97 and for lumbar vertebrae 0.97. Measurement exactness of the software was within 5° in 62% of cases and within 10° in 97% of cases. Intraclass correlation coefficient (ICC) for inter-observer reliability was 0.92 (0.91–0.95), ICC for intra-observer reliability was 0.96 (0.94–0.97). ConclusionsWe developed a digital X-ray software tool to determine vertebral rotation in AIS with a substantial concurrent validity and reliability, which may be useful for the follow-up of vertebral rotation in AIS patients.

THU0428 Validity and reliability of 3D us for detection of erosions in patients with rheumatoid arthritis using MRI as gold standard

BackgroundUse of ultrasound (US) in rheumatology has increased over the last decade. Until recently, the only US modality used was 2D, which has been shown to be more sensitive for...

The Accuracy of Digital Radiography in Orthopaedic Applications

Recent advances in technology and the use of image archiving and communication systems (PACS) has led some institutions to abandon conventional plain film radiography and rely solely on digital computed radiography. The level of accuracy of digital radiography in measuring distances for orthopaedic applications is unclear. Is it possible to accurately measure small distances using digital radiographs and PACS software? A model for measuring articular step-off was created using a commercially produced radiographic phantom with predetermined markings at known distances. Radiographs were taken using both indirect and direct computed radiography systems, then uploaded to a PACS system. Eighteen observers measured the distance between standardized, preselected points on the radiographic phantom. The measured values were compared with the known values for each measurement. The mean measured values differed by 0 and 0.1 mm (SD, 0.5 mm) for indirect and direct radiographs, respectively, when measuring short distances and 1.4 mm and 2.6 mm (SD, 1.0 mm) for indirect and direct radiographs, respectively, when measuring longer distances. The intraclass correlation coefficient (ICC) for interobserver reliability was 0.82 for indirect and 0.75 for direct digital radiography. The ICC for intraobserver reliability was 0.94 for indirect and 0.90 for direct digital radiography. Although the mean measured values were very accurate (within 0.1 mm for a known distance of 3.2 mm), the SD of measurements (0.5 mm) could affect the interpretation of data, especially in clinical situations such as evaluating the quality of fracture reduction.