Intrarater Intraclass Correlation Coefficients Research Articles

A Screening Tool for Patients With Lumbar Instability: A Content Validity and Rater Reliability of Thai Version

ObjectiveLumbar instability is a condition that has been extensively reported in its prevalence and its effect on patients. To date, however, a clinical screening tool for this condition has not been developed for use in Thailand. The objectives of this study were to translate and test the content validity and rater reliability of a screening tool for evaluating Thai patients with lumbar instability. MethodsThe investigators selected the lumbar instability questionnaire from an original English version. Elements of the tool comprised the dominant subjective findings reported by this clinical population. The screening tool was translated into the Thai language following a process of cross-cultural adaptation. The index of item-objective congruence (IOC) was checked for content validity by 5 independent experts. Seventy-five Thai patients with chronic nonspecific low back pain were asked to report their symptoms. The interview procedure using the tool was conducted by expert and novice physical therapists, which informed the intraclass correlation coefficient (ICC) for inter- and intrarater reliability. ResultsThe IOC was 0.95. The interrater ICC between expert and novice physical therapists was 0.92 (95% CI = 0.88-0.95). The intrarater ICC of novice physical therapist was 0.91 (95% CI = 0.86-0.94). ConclusionThe Thai version of the screening tool for patients with lumbar instability achieved excellent content validity and interrater and intrarater reliability. This screening tool is recommended for use with Thai patients with low back pain to identify the subpopulation with lumbar instability.

Reliability of Measuring Insertion Depth in Cochlear Implanted Infants and Children Using Cochlear View Radiography

Cochlear implant depth of insertion affects audiologic outcomes and can be measured in adults using plain films obtained in the "cochlear view." The objective of this study was to assess interrater and intrarater reliability of measuring depth of insertion using cochlear view radiography. Prospective, observational. Tertiary referral pediatric hospital. Patients aged 11 months to 20 years (median, 4 years; interquartile range [IQR], 1-8 years) undergoing cochlear implantation at our institution were studied over 1 year. Children underwent cochlear view imaging on postoperative day 1. Films were deidentified and 1 image per ear was selected. Two cochlear implant surgeons and 2 radiologists evaluated each image and determined angular depth of insertion. Images were re-reviewed 6 weeks later by all raters. Inter- and intrarater reliability were calculated with intraclass correlation coefficients (ICCs). Fifty-seven ears were imaged from 42 children. Forty-nine ears (86%) had successful cochlear view x-rays. Median angular depth of insertion was 381° (minimum, 272°; maximum, 450°; IQR, 360°-395°) during the first round of measurement. Measurements of the same images reviewed 6 weeks later showed median depth of insertion of 382° (minimum, 272°; maximum, 449°; IQR, 360°-397°). Interrater and intrarater reliability ICCs ranged between 0.81 and 0.96, indicating excellent reliability. Postoperative cochlear view radiography is a reliable tool for measurement of cochlear implant depth of insertion in infants and children. Further studies are needed to determine reliability of intraoperatively obtained cochlear view radiographs in this population.

Preliminary study: evaluating the reliability of CBCT images for tongue space measurements in the field of orthodontics.

Accurately measuring tongue space is challenging, but this information can be useful to many dental specialties. This study was intended to estimate the reliability of using cone-beam computed tomography (CBCT) to measure tongue space, which includes tongue volume and the oral cavity air capacity. For this preliminary study, CBCT images from ten participants (five females and five males, mean age of 29.8 ± 3.3years) were available for evaluation. Each participant was radiographed two times (T0 and T1). The average time between T0 and T1 was 15.8 ± 3.7days. CBCT scans were standardized to reduce variability. Three-dimensional landmarks were established to identify tongue space and 3D image analysis software (SimPlant® 17 Pro; Materialise Dental, Leuven, Belgium) was used to measure the volume circumscribed by the landmarks. Two investigators independently calculated airway, tongue dimensions, and total tongue space for CBCT image T0 twice (day 1 and day 14), and T1 once. Intraclass correlation coefficients (ICCs) wereused to estimate intra-rater and inter-rater reliability. Bland-Altman charts were constructed to demonstrate agreement within and between raters. The intra-rater and inter-rater ICCs of the CBCT measurements at T0 were excellent (> 0.90). Measurements for T0 vs. T1 show good (0.75-0.90) intra-rater and excellent (> 0.90) inter-rater reliability. Bland-Altman charts show that 90-95% of the total measurements fall within the 95% limits of agreement for both intra- and inter-rater pairs CONCLUSIONS: The results of this preliminary study suggest that the landmarks chosen to measure the overall tongue space are reproducible and can be measured clearly using CBCT.

Evaluation of radiological instability signs in the distal radioulnar joint in children and adolescents with arthroscopically-verified TFCC tears

IntroductionRecent reports in the adult literature reported the use of standardized radiographic measurement techniques to determine distal radioulnar joint (DRUJ) instability. The aim of this study was to evaluate the efficacy and accuracy of (1) the MRI-based modified radioulnar ratio technique and (2) the pisoscaphoid (PiSca) and radioulnar (RaUl) distances in true lateral radiographs in children and adolescents with arthroscopically-verified TFCC tears.Materials and methodsWe retrospectively assessed lateral wrist radiographs and axial MRI sequences of 18 adolescent patients (22 wrists) who had arthroscopically-confirmed TFCC tears and compared them to similar imaging of a control group of 28 healthy patients (28 wrists). Three raters assessed the images twice in a 2-week interval. Intraclass correlation coefficients (ICCs), unifactorial ANOVA, and ROC analysis were performed with regards to the different radiographic variables.ResultsThe interrater ICCs were almost perfect for all measurements except RaUl1, which showed a substantial agreement (0.751) among the three observers. The intrarater ICCs were almost perfect when measuring PiSca and MRI, and substantial to almost perfect for RaUl. Pearson‘s correlation showed a moderate, positive correlation between PiSca and RaUl distances (r = 0.608; p < 0.001), and a moderate, negative correlation between RaUl distance and MRI shift (r = − 0.486; p = 0.010). When the three core groups (peripheral, central tear, controls) were compared to each other regarding the radiographic instability parameters, only the MRI shift revealed a statistically significant difference (p = 0.003). Comparisons revealed significant differences between patients and controls (p = 0.004) and peripheral tears vs. controls (p = 0.001 and p = 0.010). The ROC analysis revealed a significant AUC only for the MRI (AuC 0.787 and p = 0.002).ConclusionsChildren and adolescents with peripheral TFCC tears showed significantly increased instability parameters in MRI compared to controls. These measurement techniques are no replacement for a thorough clinical examination but may be helpful for indicating diagnostic wrist arthroscopy in ambiguous cases.Level of evidenceLevel III; Diagnostic.

A novel method to quantify cutaneous vascular innervation.

To develop a new method to quantify the density of nerves, vessels, and the neurovascular contacts, we studied skin biopsies in diabetes and control subjects. Skin biopsies with dual immunofluorescent staining were used to visualize nerves and blood vessels. The density of nerves, vessels, and their neurovascular contacts were quantified with unbiased stereology. Results were compared with examination findings, validated questionnaires, and autonomic function. In tissue from 19 controls and 20 patients with diabetes, inter-rater and intra-rater intraclass correlation coefficients were high (>0.85; P < .001) for all quantitative methods. In diabetes, the nerve densities (P < .05), vessel densities (P < .01), and the neurovascular densities (P < .01) were lower compared with 20 controls. Results correlated with autonomic function, examination and symptom scores. We report an unbiased, stereological method to quantify the cutaneous nerve, vessel and neurovascular density and offer new avenues of investigation into cutaneous neurovascular innervation in health and disease.

Berg Balance Scale: inter-rater and intra-rater reliability of the Spanish version with incomplete spinal cord injured subjects.

Cross sectional. To determine the inter-rater and intra-rater reliability of the Spanish version of the Berg Balance Scale with incomplete spinal cord injured subjects. CINER Rehabilitation Center. We administered and video recorded the Spanish version of the Berg Balance Scale to 20 incomplete SCI patients. Two raters scored the videos on two different occasions at least three weeks apart. We used intraclass correlation coefficient (ICC) and a confidence interval (CI) of 95% to evaluate the inter-rater and intra-rater (test-retest) reliability of the BBS total scores. ICC values for inter-rater reliability at first and second observation were 0.99 (95% CI 0.97-1.00) and 0.99 (95% CI 0.99-1.00), respectively. Intra-rater ICC for rater 1 was 1.00 (95% CI 1.00-1.00) and for rater 2 was 1.00 (95% CI 0.99-1.00). All of them were excellent. The results indicate that the Spanish version of the Berg Balance Scale is a reliable tool to evaluate spinal cord injured patients' balance.

Reliability of a Novel Ultrasound Transducer Holder for Flow‐Mediated Dilation

BackgroundFlow‐mediated dilation (FMD) is the most common test to evaluate endothelial function. Although efforts have been made to incorporate FMD in clinical settings, guidelines still do not advocate for its use because the wide variability on results among testers. Strategies to overcome this problematic scenario include the use of transducer holders to increase the reproducibility on image acquisition. Therefore, the purpose of this study was to test the reliability of a novel ultrasound (US) transducer holder for brachial FMD.MethodsUsing 3D printing technology, an arm US transducer holder was created to assist the assessment of the vasculature via US imaging during FMD. A total of 15 young healthy subjects were evaluated for Intrarater and Interrater FMD reliability. Statistical analysis included Coefficient of Variation (CV) and Intraclass Correlation Coefficient (ICC). Based on the CV, reproducibility was categorized as excellent (0–10%), good (10–20%), moderate (20–30%), or poor (&gt;30%). Regarding ICC, reproducibility was catalogued as poor (&gt;0.5), moderate (0.5–0.75), good (0.75–0.9), and excellent (&gt;0.90).ResultsThe baseline and peak after deflation artery diameter images were analyzed using an automatic edge detection software. The following data was collected:The results in table 1 show that the degree of reliability for an arm US transducer holder during FMD, between and within raters using artery diameter, %FMD, and delta‐FMD as markers, is excellent. The CV for all categories within the inter‐ and intrarater were under 7%, which supports achieving inter‐ and intrarater reliability. The ICC for all categories, with the exception of one, was 90% or better, this shows that the reproducibility of the holder was catalogued as excellent. The Interrater ICC for one category, delta‐FMD, was rated good at 0.89.ConclusionExcellent reliability was achieved with interrater and intrarater FMD using the arm US transducer holder device. This holder has the ability to improve the results of this type of noninvasive endothelial function testing. Analyzed data collected during FMD Reliability Test Baseline Artery Diameter Peak Artery Diameter %FMD Delta‐FMD Intrarater CV (%) 0.26 (0.39) 0.40 (0.42) 6.44 (6.1) 6.27 (6.09) Interrater CV (%) 0.23 (0.16) 0.52 (0.38) 5.75 (5.29) 5.82 (5.39) Intrarater ICC 0.99 0.99 0.97 0.95 Interrater ICC 0.97 0.96 0.97 0.89

The Influence of the Early Childhood Education and Care Environment on Young Children's Physical Activity: Development and Reliability of the PLAYCE Study Environmental Audit and Educator Survey.

(1) Background: Participation in physical activity is crucial for the healthy growth and development of young children. More robust measurement of environmental influences on children’s physical activity in early childhood education and care (ECEC) settings may help resolve inconsistencies in the literature. This study evaluated the reliability of an environmental audit and educator practice survey for assessing ECEC physical, policy, and social environments related to young children’s physical activity. (2) Methods: A convenience sample of 20 ECEC centres participated in this PLAYCE (Play Spaces and Environments for Children’s Physical Activity) sub-study. Trained auditors conducted audits and educators completed surveys, two weeks apart. Test-retest reliability of the survey (n = 32), inter-rater (n = 20 pairs) and intra-rater reliability (n = 38) of the audit was assessed using intra-class correlation coefficients (ICCs), Kappa statistics and percent agreement. (3) Results: Intra-rater and inter-rater reliability ICCs for outdoor equipment, spaces and features were good to excellent (ICC = 0.70–0.94), while ratings for indoor equipment, media and spaces varied from fair to excellent (ICC = 0.46–0.78). The majority of items were rated by Kappa as moderate or above for intra-rater, inter-rater and survey test-retest reliability. (4) Conclusions: The PLAYCE Study instruments provide reliable measures of ECEC physical activity environments which can help to better understand influences on young children’s physical activity.

Reliability and validity of the Vitiligo Signs of Activity Score (VSAS).

SummaryBackgroundThe associations between disease activity and several clinical signs in vitiligo have been described, but a widely accepted and validated scoring system is lacking.ObjectivesTo validate the Vitiligo Signs of Activity Score (VSAS) for physicians.MethodsThree visible clinical signs were scored on 15 body locations: confetti‐like depigmentation (c), Koebner phenomenon (k) and hypochromic areas/borders (h). The inter‐ and intrarater reliability of the global VSAS and VSAS subscores (c‐VSAS, k‐VSAS and h‐VSAS) were tested by four and three raters (physicians), respectively. Construct validity and feasibility were evaluated.ResultsThe VSAS demonstrated good inter‐rater reliability, with an intraclass correlation coefficient (ICC) of 0·87 in the first round and 0·90 in the second round. The intrarater reliability ICCs were all ≥ 0·86. The inter‐rater reliabilities of the subscores were excellent for c‐VSAS and fair for k‐VSAS and h‐VSAS (ICC 0·83, 0·51 and 0·53, respectively, in the first round). Evidence for construct validity was provided. The completion time by the raters (median 2·18 min per patient) improved during the second round (median 1·33 min per patient). A limitation of the study is the low number of patients, mainly of skin phototypes II–III, from a single tertiary centre.ConclusionsThe VSAS appears to be a valid and reliable instrument to score visible clinical signs linked to disease activity in a standardized way. What is already known about this topic? Evidence exists for a possible link between several visible clinical signs in vitiligo and disease activity.A widely accepted and validated scoring system to quantify these clinical signs is lacking. What does this study add? The Vitiligo Signs of Activity Score (VSAS) underwent preliminary validation and may assist quantification of visible clinical signs linked to disease activity in a standardized way in clinical practice and trials. What are the clinical implications of this work? VSAS may be used for future trials that aim to establish the clinical significance of the specific visible clinical signs in vitiligo in a more controlled setting. Linked Comment: Eleftheriadou. Br J Dermatol 2020; 183:801–802.

Validity and reliability of a smartphone motion analysis app for lower limb kinematics during treadmill running

ObjectiveTo investigate the validity and reliability of a smartphone application for selected lower-limb kinematics during treadmill running. DesignValidity and reliability study. SettingBiomechanics laboratory. ParticipantsTwenty healthy female runners. Main outcome measure(s)Sagittal-plane hip, knee, and ankle angle and rearfoot eversion were assessed using the Coach’s Eye Smartphone application and a 3D motion capture system. Paired t-test and intraclass correlation coefficients (ICC) established criterion validity of Coach’s Eye; ICC determined test-retest and intrarater/interrater reliability. Standard error of measurement (SEM) and minimal detectable change (MDC) were also reported. ResultsSignificant differences were found between Coach’s Eye and 3D measurements for ankle angle at touchdown and knee angle at toe-off (p < 0.05). ICCs for validity of Coach’s Eye were excellent for rearfoot eversion at touchdown (ICC = 0.79) and fair-to-good for the other kinematics (range 0.51–0.74), except for hip at touchdown, which was poor (ICC = 0.36). Test-retest (range 0.80–0.92), intrarater (range 0.95–0.99) and interrater (range 0.87–0.94) ICC results were excellent for all selected kinematics. ConclusionCoach’s Eye can be used as a surrogate for 3D measures of knee and rearfoot in/eversion at touchdown, and hip, ankle, and rearfoot in/eversion at toe-off, but not for hip and ankle at touchdown or knee at toe-off. Reliable running kinematics were obtained using Coach’s Eye, making it suitable for repeated measures.

Method of limits: Female genital stretch perception thresholds.

Women with pelvic organ prolapse describe vaginal laxity and poor sensation of vaginal tone that does not correlate with anatomical findings. This discrepancy could be explained by altered vaginal sensation and a test that could measure sensation of vaginal tone, transmitted via Aα and Aβ nerve fibers, would further our understanding of the pathophysiology of vaginal laxity. To develop quantitative sensory testing (QST) for vaginal tone using genital stretch perception thresholds (PT), assess reproducibility, and the association with age and parity. Prospective observational cohort study of healthy women (Canadian task force classification II-2) who underwent QST method of limits at the vagina and introitus for sensation of first awareness and stretch using a modified anorectal physiology protocol. Forty women underwent repeatability testing. Intra- and inter-rater repeatability using intraclass correlation coefficients (ICC) was good to excellent for both first awareness and stretch at the vagina and introitus (intra-rater ICC = 0.93, 0.95, 0.81, and 0.88, respectively; inter-rater ICC = 0.83, 0.93, 0.71, and 0.86 respectively). Normative data were collected from 100 women. Log-linear regression found a significant association between age and PT for first awareness and stretch at the vagina and introitus (P = .020, .008, .002, and <.001, respectively). There was no association with parity and PT. Nomograms were calculated using the 95% confidence limits around the regression line. Stretch QST is clinically feasible, valid, and reproducible. The test can be used as a tool to measure sensation in women presenting with symptoms of vaginal laxity.

Validity and reliability of the Australian Therapy Outcome Measures \u2013 Physiotherapy, for podiatry (AusTOMs-PT for use in podiatry)

BackgroundValid and reliable outcome measure enable measurement of health care service impact. There are limited valid and reliable outcome measures for use in podiatry practice to measure the impact of treatment. This research aimed to test the face validity of the AusTOMs for Physiotherapy (AusTOMs-PT), it’s adaptability to podiatry clinical practice and the reliability of its use with podiatrists.MethodsStage 1 used a nominal group technique with podiatrists who worked in public and/or private settings. All podiatrists underwent self-directed training in the AusTOMs framework and measures prior to interviews or focus group discussion. Discussion was centred about transferability of the core scales of the AusTOMs-PT and an adjunct measure, AusTOMs for Occupational Therapy (AusTOMs-OT) to podiatry practice.Stage 2 used 10 case studies representative of people who had foot or ankle concerns. Podiatrists were recruited and trained in the use of the relevant AusTOMs-PT scales. Podiatrists individually scored the cases at two timepoints (1 month apart) using the six scales from the AusTOMs-PT deemed by stage 1 as relevant to podiatry. Intra and inter-rater reliability of scales were determined using intraclass correlation coefficients (ICCs).ResultsThirteen podiatrists participated in individual or focus group interviews in Stage 1. Consensus was gained on six of the nine core scales adopted from the AusTOMs-PT. These were 1. Balance and Postural Control, 3. Musculoskeletal Movement Related Functions, 4. Neurological Movement Related Functions, 5. Pain, 7. Sensory Functions, 8. Skin Functions. Each core scale rated the functional domains of Impairment, Activity Limitation, Participation Restriction and Wellbeing/Distress relating to that presentation of goals of the person in the case study.There were 22 podiatrists complete training and scored two rounds of case studies using the six scales in Stage 2. There were 91%(n = 20) participants with an intra-rater ICC > 0.5 (moderate or greater). Each domain had an inter-rater reliability of > 0.9 (excellent) during the first round.ConclusionsThe AusTOMs-PT for use in podiatry may be implemented to record change in impairment, function, participation and wellbeing of people receiving podiatry treatment. Podiatry specific training and mentoring, together with repeated use could be expected to improve intra-reliability.

Development and applicability of a smartphone torch based emergency light source for microscopy.

Modern microscopes are equipped with built-in illuminator. However, during a power outage, microscopy is not possible with extra mirror system if an alternative light source is not available. Smartphone torch can serve as a light source. Holding it under the microscope is difficult when both hands are engaged in microscopy. The aim of the study was to develop a stand for smartphone torch and to check the applicability of smartphone torch-based light source in microscopy. A stand was made with cardboard for keeping the smartphone on it. An optical diffuser was made with white polyethylene plastic. Smartphone with the stand and optical diffuser can serve as a soft light source. A convenient sample of 16 faculty member rated 11 slides first under the microscope with its built-in light source and then twice with the new device as a light source on 10-point Likert type scale. Applicability of the device was checked by validity and reliability by Intraclass Correlation Coefficients (ICC) with α = 0.05. The raters were able to examine the slides under the microscope with the new devices as a light source. An overall score (11 slides, 16 observers) for the image quality was 9.36 ± 0.86 (range 6-10). Interrater, intrarater, and test-retest ICC were 0.939 (P < 0.001), 0.853 (P = 0.003), and 0.889 (P < 0.001) respectively which indicate "good" to "excellent" level of reliability. Developed smartphone torch stand with an optical diffuser can serve as an emergency light source in microscopy. This may be a useful tool for settings with a frequent power outage.

P326 Changes in left atrial dimensions during stress echocardiography: linear vs planimetric methods

Abstract OnBehalf On behalf of the Stress Echo 2020 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) Background The measurement of left atrium (LA) can be obtained with simple linear or more complex biplane disk summation Simpson (S) method at rest and during stress echocardiography (SE). Although planimetric methods are mandatory to accurately assess resting LA volume, we sought to study if linear (L) methods can be equally valuable in assessing dynamic changes during SE. Purpose To assess accuracy of LA- SE with S compared to L method. Methods SE was performed in 34 patients (age 59 ± 16 years, 18 females) with known or suspected coronary artery disease. All had acceptable acoustic window at rest and were referred for clinically-driven SE (dobutamine in 21, dipyridamole in 13). LA was measured at rest and peak stress with both methods: 1- S biplane method from 4- and 2-chamber views; 2- L method with measurement of anteroposterior diameter from 2-D targeted M-mode in parasternal long-axis view. Two independent observers measured a set of 20 clips and repeated the measurements after 1 month on the same images. Stress-rest differences of L and S were compared with Spearman non-parametric correlation. Results LA measurement was obtained in all patients with L, 34/42 with S (feasibility 100%, and 80%, respectively). The off-line analysis time at each step (rest and stress) measured by stop-clock was 22.3 sec for L and 93 sec for S method (p &amp;lt; 0.001). The intra-rater intra-class correlation coefficient for L was 0.965 for single measures and 0.982 for average measures. For S, it was 0.830 in single measures and 0.907 for average measures. The inter-rater correlation coefficient for L was 0.920 for single measures and 0.958 for average measures. For S, it was 0.901 for single measures and 0.948 for average measures. Absolute LA dimensions were moderately correlated between S and L at rest (r = 0.61, p &amp;lt; 0.01), and during stress (r = 0.476, p &amp;lt; 0.01). Rest-stress variations were not correlated (r = 0.004, p = NS). Conclusion LA measurement is highly feasible during SE with L and S methods. Absolute values with both are only moderately correlated at rest, less at peak stress, and not correlated when only rest-to-stress variations are considered. Although L is more feasible, less time-consuming, and more reproducible, S should be the first choice for more accurate assessment of rest-stress LA dimensions in pharmacologic SE. Abstract P326 Figure. Correlation of LA rest-stress

Intra and inter-rater agreement of inflammatory choroidal neovascular membrane measurements using optical coherence tomography angiography.

Automated measurement algorithm software is not routinely available in optical coherence tomography angiography (OCTA) devices and manual measurement of choroidal neovascular membrane (CNVM) size is necessary. Our aim was to determine intra- and inter-rater agreement of inflammatory CNVM manual measurements obtained with OCTA. OCTA (Triton® Topcon Corporation) images in patients with inflammatory CNVM were imported into ImageJ software v1.50 (NIH image). Two experienced observers performed manual area and perimeter measurements independently, and one of the observers performed the same measurements twice. Agreement was evaluated with intraclass correlation coefficients (ICC) and concordance correlation coefficients (CCC). Bland-Altman plots were plotted to graphically assess concordance. Statistical analysis was performed using STATA v13.0. Sixteen eyes of 16 subjects, with a mean age of 39.0 ± 16.6 years (range 13-71), were included. Mean CNVM area and perimeter was 124.83 ± 117.80 and 4.20 ± 2.00 mm, respectively. Intra-rater ICC for both area and perimeter measured was 0.99 (95% confidence interval (CI) 0.99-0.99). Inter-rater ICC for area and perimeter measured was 0.95 (95%CI 0.87-0.98) and 0.81 (95%CI 0.17-0.94), respectively. Intra-rater CCC for both area and perimeter measured was 0.99 (95%CI 0.99-0.99). Inter-rater CCC for both area and perimeter measured was 0.91 (95%CI 0.81-0.99) and 0.66 (95%CI 0.44-0.88), respectively. Inflammatory CNVM manual measurement showed high intra-rater agreement and moderate inter-rater agreement. Repeatability and reproducibility studies are essential in manual analysis to establish thresholds that can distinguish measurements variation from true clinical change. An automatic algorithm may be helpful to accurately grade lesions and monitor disease activity and response to treatment.

Ultrasound assessment of pelvic floor muscle contraction: reliability and development of an ultrasound-based contraction scale.

To determine intra- and interrater reliability and agreement for ultrasound measurements of pelvic floor muscle contraction and to assess the correlation between ultrasound and vaginal palpation. We also aimed to develop an ultrasound scale for assessment of pelvic floor muscle contraction. This was a cross-sectional study of 195 women scheduled for stress urinary incontinence (n = 65) or prolapse (n = 65) surgery or who were primigravid (n = 65). Pelvic floor muscle contraction was assessed by vaginal palpation using the Modified Oxford Scale (MOS) and by two- and three-dimensional (2D/3D) transperineal ultrasound. Proportional change in 2D and 3D levator hiatal anteroposterior (AP) diameter and 3D levator hiatal area between rest and contraction were used as measures of pelvic floor muscle contraction. One rater repeated all ultrasound measurements on stored volumes, which were used for intrarater reliability and agreement analysis, and three independent raters analyzed 60 ultrasound volumes for interrater reliability and agreement analysis. Reliability was assessed using the intraclass correlation coefficient (ICC) and agreement using Bland-Altman analysis. Tomographic ultrasound was used to identify women with major levator injury. Spearman's rank correlation coefficient (rS ) was used to assess the correlation between ultrasound measurements of pelvic floor muscle contraction and MOS score. The proportion of women allocated to each category of muscle contraction (absent, weak, moderate or strong) by palpation was used to determine the cut-offs for the ultrasound scale. Intrarater ICC was 0.81 (95% CI, 0.74-0.85) for proportional change in 2D levator hiatal AP diameter. Interrater ICC was 0.82 (95% CI, 0.72-0.89) for proportional change in 2D AP diameter, 0.80 (95% CI, 0.69-0.88) for proportional change in 3D AP diameter and 0.72 (95% CI, 0.56-0.83) for proportional change in hiatal area. The prevalence of major levator injury was 22.6%. The strength of correlation (rS ) between ultrasound measurements and MOS score was 0.52 for 2D AP diameter, 0.62 for 3D AP diameter and 0.47 for hiatal area (P < 0.001 for all). On the ultrasound contraction scale, proportional change in 2D levator hiatal AP diameter of < 1% corresponds to absent, 2-14% to weak, 15-29% to normal and > 30% to strong contraction. Ultrasound seems to be an objective and reliable method for evaluation of pelvic floor muscle contraction. Proportional change in 2D levator hiatal AP diameter had the highest ICC and moderate correlation with MOS score assessed by vaginal palpation, and we constructed an ultrasound scale for assessment of pelvic floor muscle contraction based on this measure. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

A New In-Skates Balance Error Scoring System for Ice Hockey Players.

Evaluate a new in-skates balance error scoring system (SBESS) for ice hockey players wearing their equipment. Prospective, randomized, single blinded study. Sport Medicine Clinic. Eighty university hockey players. A control group performed the SBESS assessment at rest on 2 separate occasions and an experimental group performed the assessment at rest and after exertion. The SBESS consists of maintaining different stances on ice skates for 20 seconds each, while wearing full equipment (no stick, gloves and helmet) and standing on a hard rubber surface. Three independent reviewers scored the video recorded assessments. Primary outcome was the number of balance errors and the secondary outcome was the number of falls. The control group's median SBESS scores were 2 and 3 on the first and second attempts at rest, respectively. The experimental group's median SBESS scores were 2 at rest and 2 after exertion. There was no fatigue effect and no athletes fell while performing the test. Of the 4 stances tested, the tandem stance had the highest variability in error scores between athletes and when repeated by the same athlete. The intraclass correlation coefficient (ICC) for interrater reliability was above 0.82, and the intrarater reliability ICC was above 0.86 for all SBESS scores. There was no concordance between the SBESS and the modified BESS. The SBESS, omitting the tandem stance, is a safe and reproducible sideline balance assessment of ice hockey players wearing full equipment.

Pressure Pain Threshold in Subjects With Piriformis Syndrome: Test-Retest, Intrarater, and Interrater Reliability, and Minimal Detectible Changes

ObjectiveThis study aimed to assess the test-retest, intrarater, and interrater reliability of using the pressure pain threshold (PPT) in healthy and affected piriformis muscles and to estimate its absolute reliability. As a secondary objective, the degree of tenderness of the affected piriformis muscles was compared with healthy piriformis muscles. Study DesignThis study used a comparative and reliability-based design. SettingRehabilitation clinic. ParticipantsPatients (N=30) with unilateral piriformis muscle syndrome (30 affected and 30 healthy piriformis muscles) were recruited, and the PPT of both the healthy and affected piriformis muscles was recorded using digital algometry. Measurements of PPT were done by 2 raters (rater 1 and 2), which were selected at random order. Rater 1 repeated the PPT measurements 24-72 hours after initial assessment. InterventionsNot applicable. Main Outcome MeasurePPT. ResultsExcellent intrarater intraclass correlation coefficient (ICC) values were observed for the PPT of the affected piriformis (ICC: 0.86-0.96) and the healthy piriformis (ICC: 0.88-0.96) in the same session. The PPT measurements using digital algometry showed good-to-excellent interrater reliability (ICC: 0.64-0.92) and test-retest reliability (ICC: 0.72-0.95) in both the healthy and affected piriformis muscles. The findings revealed a significant decrease in the PPT of the affected piriformis muscle in comparison to the healthy piriformis muscle (mean difference 12.76; 95% confidence interval, 15.69-9.82; P<.001). ConclusionsDigital algometry is a reliable tool for measuring piriformis PPT, regardless of the testing session and the rater. Patients with unilateral piriformis muscle syndrome have increased tenderness and decreased PPT in the affected piriformis muscle in comparison to the healthy piriformis muscle.

It\u2019s a thin line: development and validation of Dixon MRI-based semi-quantitative assessment of stress-related bone marrow edema in the wrists of young gymnasts and non-gymnasts

PurposeTo assess reliability and clinical utility of evaluating stress-related metaphyseal water distribution using a semi-quantitative Dixon MRI-based method for early diagnosis of physeal stress injuries in adolescent gymnasts.MethodsTwenty-four gymnasts with clinically suspected overuse injury of the distal radial physis, 18 asymptomatic gymnasts, and 24 non-gymnast controls aged 12 ± 1.5 years prospectively underwent hand radiographs and 3T MRI of the wrist including coronal T1-weighted and T2-weighted Dixon sequences. Two raters measured metaphyseal water signal fraction in 13 radial and ulnar regions of interest (ROI). Inter- and intrarater reliability, interslice (between 3 middle radial slices), and inter-ROI (between 3 ROIs on same level) reliability were assessed using intraclass correlation coefficients (ICC). Water signal fractions and their within-person ratios in distal versus most proximal ROIs were compared between groups using one-way analysis of variance.ResultsInter- and intrarater ICCs were 0.79–0.99 and 0.94–1.0 for T1-weighted, and 0.88–1.0 and 0.88–1.0 for T2-weighted Dixon. Interslice and inter-ROI ICCs were 0.55–0.94 and 0.95–0.97 for T1-weighted, and 0.70–0.96 and 0.96–0.97 for T2-weighted Dixon. Metaphyseal water signal fraction in symptomatic gymnasts was higher in six distal ROIs compared with asymptomatic gymnasts and in nine ROIs compared with non-gymnasts (p < 0.05). Metaphyseal water score (ratio of distal versus most proximal ROIs) was 1.61 in symptomatic gymnasts and 1.35 in asymptomatic gymnasts on T2-weighted Dixon (p < 0.05).ConclusionSemi-quantitative Dixon MRI-based water signal fraction assessment has good to excellent reproducibility and shows increased metaphyseal water scores in symptomatic gymnasts compared with asymptomatic gymnastic peers.Key Points• The proposed Dixon MRI-based semi-quantitative method for assessment of metaphyseal bone marrow water content is reliable, with off-the-shelf availability and short scan times.• The metaphyseal water score allows comparisons between gymnasts using a within-person reference area for unaffected metaphyseal bone.• As metaphyseal water score was increased in symptomatic gymnasts compared with asymptomatic gymnasts, this semi-quantitative method can potentially be used as an indicator of bone marrow edema in the early diagnosis of gymnastic physeal stress injury.

T2* mapping and subregion analysis of the tibialis posterior tendon using 3 Tesla magnetic resonance imaging.

Early detection of tibialis posterior tendon changes and appropriate intervention is necessary to prevent disease progression to flat-foot deformity and foot/ankle dysfunction, and the need for operative treatment. Currently, differentiating between early-stage tibialis posterior tendon deficiency patients who will benefit from conservative vs more aggressive treatment is challenging. The objective of this work was to establish a quantitative MRI T2* mapping method and subregion baseline values in the tibialis posterior tendon in asymptomatic ankles for future clinical application in detecting tendon degeneration. 26 asymptomatic volunteers underwent T2* mapping. The tendon was divided axially into seven subregions. Summary statistics for T2* within each subregion were calculated and compared using Tukey post-hoc pairwise comparisons. Results are reported for 24 subjects. The mean tibialis posterior tendon T2* was 7 ± 1 ms. Subregion values ranged from 6 ± 1 to 9 ± 2 ms with significant between-region differences in T2*. Inter- and intrarater absolute agreement intraclass correlation coefficient (ICC) values were all "excellent" (0.75 < ICC=1.00) except for regions 5 through 7, which had "fair to good" interrater and/or and intrarater ICC values (0.4 < ICC=0.75). A tibialis posterior tendon T2* mapping protocol, subregion division method, and baseline T2* values for clinically relevant regions were established. Significant differences in T2* were observed along the tendon length. This work demonstrates that regional variation exists and should be considered for future T2*-based research on posterior tibias tendon degeneration and when using T2* mapping to evaluate for potential tibialis posterior tendon degeneration.