Intra-rater Reliability Research Articles

The Italian version of the Postural Assessment Scale for Stroke Patients (PASS): transcultural translation and validation.

The Postural Assessment Scale for Stroke Patients (PASS) is commonly used by health professionals in Italy in several different translations. This study aimed to provide a validated version in Italian. The main focus is on the evaluator, to guarantee a uniform application and interpretation of the statements and scoring for each item in the Italian context. A standardized protocol was used for the translation and cross-cultural adaptation. A pilot study conducted using the first draft of the scale led to a revised version, PASS-IT. A principal component analysis (PCA) was performed. The correlation with the Trunk Control Test (TCT) was examined for concurrent validity. In addition, the relationship with the Barthel Index (BI) and the Functional Ambulation Categories (FAC) was tested. Patients with recent stroke were tested for intra-rater (N = 49) and inter-rater agreement (N = 30). Cronbach's alpha, item-to-total correlation, corrected inter-item correlation, the intraclass correlation coefficient (ICC), and measurement error were used to evaluate internal consistency and intra-/inter-rater reliability. The PCA showed a two-dimensional structure, with high reliability in both subsections ("non-weight-bearing" α = 0.865; "weight-bearing" α = 0.949). A strong correlation (ρ > 0.80) was found with the TCT, the BI, and the FAC. The PASS-IT showed high internal consistency, intra-rater (ICC = 0.942) and inter-rater reliability (ICC = 0.940). The PASS-IT is a recommended scale, suitable for clinical practice and research in the acute and subacute stage. The introduction of operating instructions resulted in the uniform application. A different order of the items allows faster administration, reducing changes of posture.

Pediatric Medial Humeral Condyle Fractures: Classification, Treatment, and Outcomes.

The purpose of this study was to develop and validate a classification system that describes the injury pattern of pediatric medial humeral condyle fractures and provide treatment guidelines. Patients less than 18 years old with medial humeral condyle fractures from 2012 to 2022 were identified. A classification system was developed based on fracture pattern and putative mechanism of injury. Type 1 fractures were characterized by a valgus/avulsion type injury while type 2 fractures were characterized by a vertical shear pattern. Each type was subdivided by amount of fragment displacement: (A) nondisplaced or minimally displaced (<2mm) versus (B) displaced (>2mm). Three attending orthopaedic surgeons evaluated and classified each patient's fracture. Intrarater and inter-rater reliability was calculated with Kappa statistics. Twenty-seven patients (16 males) with an mean age of 10.5 years were included. There were 4 type 1A, 17 type 1B, and 6 type 2B fractures with substantial agreement in inter-rater (ĸ=0.62, CI=0.45-0.78), and intrarater (mean ĸ=0.79, range=0.70-0.93) reliability analysis. Surgical treatment was performed in 25/27 patients; 4 patients underwent closed reduction percutaneous pinning (CRPP) and 21 underwent open reduction and internal fixation (ORIF). Ten patients required advanced imaging to assist in surgical decision making. Both nonoperative patients had type 1A fractures. Nearly one-fourth of patients (6/27, 22%) had some functional loss of motion and poor outcomes based on Flynn's criteria, with a Fisher exact test revealing an increased risk of functional loss of motion in skeletally mature children (P=0.02). Two patients had complications including 1 nonunion after initial nonoperative management (type 1B) and 1 patient (type 2B) required manipulation under anesthesia for postoperative stiffness. Moderate to strong inter-rater and intrarater reliability was demonstrated with the proposed classification system. Type 1A fractures are amenable to nonoperative treatment while types 1B and 2B require surgical management. Skeletally mature patients may be at greater risk of motion loss following injury. Level IV-case series.

Impact of Patient-Specific Hip Joint Geometry on the Morphology of Acetabular Fractures

Background: Acetabular fractures continue to pose a major challenge in clinical practice, not least because of the growing geriatric population. While the influence of the force vectors on fracture formation is well established, the impact of anatomical factors on fracture morphology remains poorly understood. The aim of this study was to investigate patient-specific hip joint geometry, identify structural risk factors and correlate these with the resulting fracture patterns. Methods: This retrospective cohort analysis included 226 patients (Mdn age = 58 yrs.) with acetabular fracture categorized by Judet/Letournel and the AO/OTA classification. Computed tomography (CT) datasets of the injured and contralateral sides were analyzed using multiplanar reconstruction. Parameters included modified center-edge (CE) angle (Wiberg), rotation angles (Ullmann and Anda), acetabular sector angle (Anda), true caput-collum-diaphyseal (CCD) angle, femoral head diameter and volume, as well as femoral neck length, circumference, and diameter. In addition, intrarater reliability within a subcohort was assessed for the metric measurements and inter-rater analysis for the classification of the entire sample. Results: The primary analysis showed direct effects of femoral head diameter, femoral neck length and femoral head size on the fracture type according to AO/OTA (type A/B/C), whereby this effect was particularly seen between type A and type C fractures (p = 0.001). Ordinal regression identified femoral head diameter as the only significant predictor (p = 0.02), with a 25% increased likelihood of complex fractures per unit of change. Low-energy trauma doubled the risk of severe fractures. Specific findings include a higher acetabular anteversion in anterior column fractures. Age correlated positively with the cause of injury and fracture type. The inter-rater reliability for fracture classification was excellent, as was the intrarater reliability of the measurements. Conclusions: This study suggests that anatomical factors, particularly proximal femoral geometry, have an impact on acetabular fracture morphology—in addition to factors such as trauma type and patient demographics.

The Reliability and Validity of a Novel Clinical Test for Assessing Shoulder Rotation ROM in Collegiate Baseball Players: Functional Assessment of System Tension of the Shoulder (FAST-SHDR).

Traditional methods to measure rotational passive range of motion (PROM) in the throwing shoulder do not reflect the complexity of the throwing motion. Therefore, a sport specific shoulder rotation PROM test (FAST-SHDR) was developed and compared to traditional standard methods to measure shoulder internal and external rotational PROM in the throwing shoulder. The aim of this study was to determine the intra-rater reliability of the FAST-SHDR test in young, healthy, male Division 1 baseball players. Reliability and validity analysis. A study with 49 healthy participants (31 collegiate baseball players, 18 controls) examined a sport specific shoulder rotation PROM test (FAST-SHDR) and compared this to the standard supine 90/90 shoulder in a single session assessment. Intra-class correlation coefficient (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) were calculated. Within and between group differences were based on t-tests (p<0.001), absolute differences and effect sizes (95% CIs). The novel test (FAST-SHDR) had good to excellent reliability with ICCs ranging from 0.95 (0.89 to 0.98) to 0.96 (0.92-0.98). MDC ranged from 7°-11° which is equivalent to 11-14% of mean PROM scores. In the dominant shoulder of baseballers, when FAST-SHDR IR/ER was compared to standard IR/ER testing the FAST-SHDR scores were lower for both IR (MD 23.3°; 95% CI 19.7-26.8) and ER (MD 50.7°; 95% 44.7 to 56.7). Comparing the shoulder rotation PROM in baseballers, the FAST-SHDR ER and IR measurements were significantly lower (p<0.0001) when compared to traditional standard PROM testing for shoulder IR and ER rotation. FAST-SHDR testing shows good to excellent intra-rater reliability for measuring shoulder rotational PROM and demonstrates both face and discriminant validity. 3.

Intra-rater Reliability of B-mode Ultrasound in the Measurement of Soft Tissue Thickness and Composition over the Lateral Proximal Femur

ObjectivesComprehensive characterization of soft tissue composition and distribution over the lateral proximal femur is necessary to improve our understanding of fall-related hip fractures; however, a protocol that produces reliable data is needed. Accordingly, the aim of this study was to assess the intra-rater reliability of B-mode ultrasound measured muscle, adipose, and total soft tissue thicknesses over the lateral proximal femur in a simulated sideways fall configuration. MethodsTwenty-five young adults (12 males, 13 females, age (SD) = 20.8 (1.9) years) underwent B-mode ultrasound imaging of 12 locations over their lateral proximal femur while in a side-lying position. Side-lying was chosen to allow imaging of the tissues impacted during a lateral fall event. Muscle, adipose, and total soft tissue thicknesses were measured at each location (further grouped into posterolateral, lateral, and anterolateral locations for statistical analysis) and two-way mixed model absolute agreement intraclass correlation coefficients (ICCs) and standard error of measurement were used to assess reliability of tissue type, location, and sex. ResultsICCs were excellent (ICC > 0.9) for each tissue type, measurement location, and sex. There were interactions between tissue type, measurement location, and sex on reliability. While measures of adipose thickness were excellent across all conditions, reliability of muscle and total soft tissue thickness measurements were dependent on measurement location and sex. ConclusionsThis ultrasound imaging protocol demonstrated good-to-excellent reliability of soft tissue-specific thickness measurements over the lateral proximal femur. This protocol has implications for subject-specific hip fracture risk screening tools and biomechanical models of impact dynamics that incorporate biofidelic soft tissue morphology.

Translation, psychometric testing and implementation of the perineal assessment tool for assessing incontinence-associated dermatitis risk in semi-intensive care patients

Skin injury is a growing issue among older adults, especially when admitted to an intensive care unit or long-term care facility. Skin prevention is a key point in dealing with this issue, and prompt and effective screening instruments should be used to identify risks and start preventive interventions and care. This descriptive study aimed to translate and examine the psychometric property and implement the Perineal Assessment Tool for incontinence associated dermatitis risk assessment. The English version was translated into Thai following the international guidelines from the World Health Organization by the bilinguals. From May to June 2023, 119 patients from the semi-intensive care unit were included using a consecutive sampling method. The research instruments included the demographic questionnaires, the original English version, and the translated Thai version. The Thai Version had a content validity index, an index of item-objective congruence, a Pearson correlation coefficient of percent agreement, the Pearson correlation coefficient of the interrater reliability, the Kappa coefficient of interrater reliability, the Pearson correlation coefficient of the intra-rater reliability, and the Kappa coefficient of intra-rater reliability ranked from 0.75 to 1.00. The 21.95% had a high risk of developing incontinence-associated dermatitis, which was associated with females, the length of stay in hospital and semi-intensive care unit longer than or equal to four days, receiving antibiotics, disease severity greater than or equal to 20 points, the albumin level less than 3.8 g/dl, and neuropathy and brain disorders. In conclusion, this instrument has high validity and reliability and can assess patients at risk of incontinence-associated dermatitis. This tool will help with early risk detection and guide for planning to manage various risk conditions to prevent dermatitis instead of taking care of them after the skin has already been damaged.

Cross-cultural adaptation, content validity, and reliability of the Amharic version of the modified John-Hopkins fall risk assessment scale among older adults who attend home health care services

BackgroundThe modified John-Hopkins fall risk assessment tool (mJH-FRAT) is a comprehensive and multi-factor fall risk assessment tool used to screen and grade older adult’s fall risk levels in home health care services. This can help to identify risky individuals early, establish prevention protocols, and reduce the occurrence of injury. Nevertheless, there is a dearth of contextually valid and reliable fall risk assessment tools among this population in the study area. The aim of this study is therefore to cross-culturally adapt and assess the content validity and reliability of the modified John-Hopkins fall risk assessment tool among older adults following home health care in Ethiopia.MethodThe English version of the mJH-FRAT underwent cross-cultural adaptation into Amharic. The final Amharic version was subjected to face validity and then content validity was computed. This community-based study was conducted from November 2023 to May 2024 with a total of 150 participants selected through convenience sampling. Data collection occurred through face-to-face interviews. Epi-Info 7 and Statistical Package for the Social Sciences software version 25 facilitated data entry and analysis, respectively. Reliability was assessed by employing intra-rater and inter-rater reliability using Cohen’s kappa.ResultThe CVI based on the item level of all the items was between 0.8 and 1. The S-CVI based on average for domains such as general condition and clinical condition was 0.925 and 1, respectively, and the S-CVI (average) of the scale was 0.96. The S-CVI based on the universal agreement value for the overall 8 items was 0.75. The kappa statistic coefficient value was between 0.79 and 1. The intra-rater reliability and inter-rater reliability were 0.94 and 0.93, respectively.ConclusionThe rigorous adaptation process, face and content validity, and reliability analyses demonstrated that the Amharic mJH-FRAT is a content valid and reliable tool for assessing the fall risk level in this population. Clinicians and researchers can utilize this tool for the advancement of both clinical practice and research work on this group of people in Ethiopia.

Investigation of Study Procedures to Estimate Sensitivity and Reliability of a Virtual Physical Assessment Developed for Workplace Concussions: Method-Comparison Feasibility Study

Abstract Background Remote approaches to workplace concussion assessment have demonstrated value to end users. The feasibility of administering physical concussion assessment measures in a remote context has been minimally explored, and there is limited information on important psychometric properties of physical assessment measures used in remote contexts. Objective The objectives of this feasibility study were to determine recruitment capability for a future larger-scale study aimed at determining sensitivity and reliability of the remote assessment, time required to complete study assessments, and acceptability of remote assessment to people with brain injuries and clinicians; document preliminary results of the sensitivity of the remote assessment when compared to the in-person assessment; and estimate the preliminary interrater and intrarater reliability of the remote assessments to inform procedures of a future larger-scale study that is adequately powered to reliably estimate these parameters of interest. Methods People living with acquired brain injury attended 2 assessments (1 in-person and 1 remote) in a randomized order. The measures administered in these assessments included the finger-to-nose test; balance testing; and the Vestibular/Ocular Motor Screening (VOMS) tool, including documentation of change in symptoms and distance for near point convergence, saccades, cervical spine range of motion, and evaluation of effort. Both assessments occurred at the Ottawa Hospital Rehabilitation Center. After the assessments, a clinician different from the person who completed the original assessments then viewed and documented findings independently on the recordings of the remote assessment. The same second clinician viewed the recording again approximately 1 month following the initial observation. Results The rate of recruitment was 61% (20/33) of people approached, with a total of 20 patient-participants included in the feasibility study. A total of 3 clinicians participated as assessors. The length of time required to complete the in-person and remote assessment procedures averaged 9 and 13 minutes, respectively. The majority of clinicians and patient-participants agreed or strongly agreed that they were confident in the findings on both in-person and remote assessments. Feedback obtained revolved around technology (eg, screen size), lighting, and fatigue of participants in the second assessment. Preliminary estimates of sensitivity of the remote assessment ranged from poor (finger-to-nose testing: 0.0) to excellent (near point convergence: 1.0). Preliminary estimates of reliability of the remote assessment ranged from poor (balance testing, saccades, and range of motion: κ=0.38‐0.49) to excellent (VOMS change in symptoms: κ=1.0). Conclusions The results of this feasibility study indicate that our study procedures are feasible and acceptable to participants. Certain measures show promising psychometric properties (reliability and sensitivity); however, wide CIs due to the small sample size limit the ability to draw definitive conclusions. A planned follow-up study will expand on this work and include a sufficiently large sample to estimate these important properties with acceptable precision.

Assessing the Reliability of the Bleeding Assessment Scale in Critically Ill Children (BASIC) Definition: A Prospective Cohort Study.

To determine the reliability of the Bleeding Assessment Scale in critically Ill Children (BASIC) definition of bleeding severity in a diverse cohort of critically ill children. Prospective cohort study. Eight mixed PICUs in the Netherlands, Israel, and the United States. Children ages 0-18 years admitted to participating PICUs from January 1, 2020, to December 31, 2022, with bleeding noted by bedside nurse. None. The bleeding events were classified as minimal, moderate, or severe, according to the BASIC definition, by two independent physicians at two different time points. Patient demographic data, laboratory values, and clinical outcomes were collected. Three hundred twenty-eight patients were enrolled. The overall inter-rater reliability was substantial (weighted kappa coefficient, 0.736; 95% CI, 0.683-0.789), and the intra-rater reliability was "almost-perfect" (weighted kappa coefficient, 0.816; 95% CI, 0.769-0.863). The platelet count (p = 0.008), prothrombin time (p = 0.004), activated partial thromboplastin time (p = 0.025), and fibrinogen levels (p = 0.035) were associated with the bleeding severity, but the international normalized ratio was not (p = 0.195). Patients were transfused blood components in response to any bleeding in 31% of cases and received hemostatic medications in 9% of cases. More severe bleeding was associated with increased 28-day mortality, longer hospital length of stay, and more days receiving inotropic support. The BASIC definition is a reliable tool for identifying and classifying bleeding in critically ill children. Implementing this definition into clinical and research practice may provide a consistent and reliable evaluation of bleeding.

Intra-rater and inter-rater reliability of a handheld myotonometer measuring myofascial stiffness of lower lumbar myofascial tissue in healthy adults.

Biomechanical muscle properties, such as stiffness, can be valuable indicators of tissue health and show promise as a diagnostic and treatment measure for chronic low back pain (CLBP). The development of accessible assessment technologies, such as the MyotonPRO portable device, allows for the convenient quantification of muscle tone and stiffness changes. The aim of this study is to assess the reliability of lumbar erector spinae muscle stiffness with the MyotonPRO in healthy adults and to compare stiffness changes between prone and sitting position. Thirty asymptomatic participants (N = 15 women and N = 15 men) aged between 18 and 65 years were recruited to participate in this study. Two examiners tested muscle stiffness at the palpable muscle belly, one finger away from the spinous process at the level of the L4 vertebra, first from the left and then from the right side, both in prone position and after in sitting position. For inter-rater reliability, all participants were tested by two examiners on the same day, and intra-rater reliability was calculated using the same examiner's assessment results with an exact 24-h interval. Intraclass correlation coefficients (ICC), standard error measures (SEM) and minimum detectable change (MDC) with a 95% confidence interval were calculated to assess intra-rater and inter-rater reliability. Statistical analysis revealed good intra-rater reliability with an ICC of 0.88 (95% CI [0.76-0.94]) for the stiffness of the left erector spinae and excellent intra-rater reliability with an ICC of 0.91 (95% CI [0.82-0.95]) for the right erector spinae, both in the prone position. Intra-rater reliability in the sitting position was excellent to very good with an ICC of 0.91 (95% CI [0.82-0.96]) for the left side and an ICC of 0.89 (95% CI [0.78-0.95]) for the right side. The results for the left-sided prone position showed good inter-rater reliability with an ICC of 0.87 (95% CI [0.73-0.94]). The prone position on the right side also showed good inter-rater reliability with an ICC of 0.84 (95% CI [0.68-0.92]). The inter-rater reliability for the left and right side in the sitting position was excellent with an ICC of 0.96 (95% CI [0.92-0.98]) for the left side and an ICC of 0.95 (95% CI [0.90-0.97]) for the right side. This study demonstrated high reliability in measuring lumbar erector spinae muscle stiffness with the MyotonPRO in healthy adults and the ability of the device to detect even small changes in erector spinae muscle stiffness, testing both the right and left sides and measuring in both prone and sitting positions. The use of the sitting position to assess lumbar tissue tension in individuals may serve as a valuable substitute for the prone position, particularly for patients who experience discomfort in the prone position, and could have additional practical significance in clinical settings.

Internal Consistency and Reliability of the Filipino Gross Motor Functional Classification System – Expanded and Revised

Background and Objective. The Gross Motor Function Classification System – Expanded and Revised (GMFCS-E&amp;R) is a valid tool commonly used by physicians, therapists, and potentially also by other healthcare workers even at the primary care and grassroots levels to facilitate immediate screening, appropriate referral, and management of children with disability needing mobility devices. As Filipinos comprise one of the largest diaspora populations, this study aimed to provide a Filipino version of the GMFCS-E&amp;R and determine its internal consistency and inter- and intra-rater reliability. Methods. A multidisciplinary group of rehabilitation professionals at Philippine General Hospital worked with linguists to translate the original English GMFCS-E&amp;R to Filipino/Tagalog, the Philippines’ official language. Several steps were done: authorization from the original tool developers (CanChild™); forward and backward translations; semantic analysis; content analysis; pilot testing; and submission of final version to CanChild™. Internal consistency and inter- and intra-rater reliability were determined. Results. The Filipino GMFCS-E&amp;R translation was formulated and underwent several modifications. The final version yielded high internal consistency (Cronbach’s alpha: 0.96) and inter- and intra-rater reliability (interclass correlation coefficients: 0.895 and 0.928, respectively). Conclusion. The Filipino GMFCS-E&amp;R is a reliable tool for use among pediatric Filipino patients for communication, clinical decision-making, registries, and research.

A novel method of acetabular component anteversion measurement on plain radiographs

BackgroundAcetabular component anteversion (ACA) markedly impacts the outcome of total hip arthroplasty (THA) and thus is routinely measured on radiographs postoperatively. However, clinical ACA measurement methods are either too complicated or subjective due to three drawbacks: complex calculations, measurement of obscured points, and complex geometric drawings. This study aimed to develop a precise and convenient novel method of measuring ACA on routine radiographs without the three drawbacks and to verify its accuracy and reliability by comparing it against existing methods.MethodsA novel geometric principle to measure ACA was developed. Accordingly, a protractor was designed to measure radiographic anteversion (RA) on anteroposterior (AP) hip radiographs. Three researchers measured RA twice, using the protractor, McLaren’s, and Pradhan’s method on 26 computer-simulated radiographs with pre-set RAs and 20 actual radiographs. Accuracy was assessed by errors on simulated radiographs, and reliability was assessed by results of measurements on simulated and actual radiographs.ResultsThe absolute error of the novel method (1.01° ± 1.06°) was lower than McLaren’s method (1.34° ± 1.16°) (p < 0.05) and not significantly different from Pradhan’s method (1.10° ± 1.02°) (p = 0.392). The protractor’s intra-rater and inter-rater reliability were good-to-excellent or excellent and higher or equivalent to the two other methods.ConclusionsThe novel method avoids the three major drawbacks of conventional methods. Its accuracy is significantly higher than McLaren’s method and comparable to Pradhan’s. The novel method has higher or non-inferior accuracy and reliability than McLaren’s and Pradhan’s methods.

Application of DSP2 for biological sex estimation in a Spanish sample: analysis based on sex and side.

Applying existing sexing methodologies to different populations, and reporting these findings is important to enhance their applicability and accuracy in real cases across the world. DSP was published in 2005 (Murail et al., 2005) and updated as a DSP2 in 2017 (Brůžek et al., 2017) based on a database of 10 pelvic measurements from 2040 individuals worldwide. These tools have been applied subsequently to various populations, however, its applicability to a dry Spanish population is lacking. 303 hipbones belonging to 157 individuals from the School of Legal Medicine from the University Complutense of Madrid (Spain), of which 140 individuals were documented, were analyzed to investigate the reliability, applicability and accuracy of the DSP2 sex estimation methodology, examining side and sex-based potential differences for the first time. In most of the DSP variables, intra-rater reliability showed excellent results and % applicability was higher than 85.0%. Overall % accuracy was higher than 94.0% regardless of the number or discriminant power of the utilized DSP variables. However, % sexing decreased when less variables or less discriminant ones were used for estimations, reaching 45.51% (left) and 43.31% (right). Regarding sexual dimorphism, females' results of % applicability, % sexing and % accuracy were higher compared to males. In addition, left os coxae achieved better outcomes (aforementioned percentages) in most of the cases in the sex-pooled sample. Decreasing the mandatory posterior probability by 10% yielded an increase in the % sexing but reduced % accuracy, and thus, does not seem to enhance the approach's performance. The present study validates the applicability and reliability of DSP for sexing a Spanish population. Future investigations will attempt to assess its applicability within virtual anthropology.

Peak hip external rotation torque and single-rater reliability is influenced by measurement position in the ISOMED2000

Measurement of hip external rotation strength (ERS) is important for preventive and rehabilitative purposes. ERS can be measured in 3 different positions in the isokinetic dynamometer ISOMED2000. However, it is not clear whether these measurement positions effect ERS nor if these positions are reliable in the ISOMED2000. Hence, the purpose of this study was to compare ERS in these positions, the reliability and the agreement. A cross-sectional design was conducted to compare measurement positions and a test–retest design to assess intra-rater reliability and agreement. Twenty-four healthy, physically active athletes participated in the study. Peak isometric torque was measured in the ISOMED in prone, supine, and side-lying position across two sessions on one day. Differences between positions were evaluated with the Wilcoxon-signed-rank test and cliff’s delta. Reliability was assessed via intraclass correlation. Agreement was determined using the standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman analysis (BAA). Results indicated a significant influence of measurement position on ERS (p < 0.001) with high effect sizes (>0.74). Reliability and agreement were high in all positions, but highest for the side-lying position (ICC = 0.90 [0.78, 0.96]; SEM = 0.08; MDC = 0.23; BAA_bias = 3.4 %, BAA_loA = 37 %). There were only poor to moderate correlations between measurement positions. These findings suggest that measurement position significantly affects ERS. Furthermore, the effect varies across individuals indicating that normative values cannot be used interchangeably or be adapted across positions. In diagnostic testing ERS should be measured in the same position, but preferably in the side-lying position.

Multi-institutional Validation of the Interarytenoid Assessment Protocol for Pediatric Laryngeal Cleft.

Current assessment techniques for determining whether a patient has normal interarytenoid anatomy, a deep interarytenoid notch, or a minor laryngeal cleft are highly variable. However, differentiating between these three entities is important, given it may distinguish whether a patient should be considered for surgical intervention. The Interarytenoid Assessment Protocol (IAAP) was developed to provide standardization of interarytenoid anatomy evaluations. We aimed to assess the reliability of the IAAP for assessment of interaytenoid mucosal height (IAMH) through a multi-institutional validation study. Reliability of the IAAP was assessed by 10 pediatric otolaryngologists all from different academic centers. 30 de-identified endoscopic videos of interarytenoid assessments were rated at two separate time points, 2 months apart. Intra-class correlation (ICC) coefficients with two-way models were used to evaluate inter- and intra-rater reliability. Thirty endoscopic videos were collected for patients with a median (IQR) age of 4.9 years (59 months; range: 1 month to 20 years). On the first video assessment, inter-rater reliability was 0.74 (95% CI 0.63-0.84), and on the second video assessment, inter-rater reliability was 0.75 (95% CI 0.63-0.85) indicating strong inter-rater reliability. Overall intra-rater test-retest reliability was 0.75 (95% CI 0.69-0.79) indicating strong agreement. In almost half, 14 (46.6%) raters chose IAAP classification levels within 1 level of each other. Multi-institutional validation of the IAAP demonstrates strong inter- and intra-rater reliability for assessment of IAMH when evaluated through pictorial analysis. Standardization of anatomical evaluations may improve our ability to perform more reliable outcomes studies of pediatric pharyngeal dysphagia in the future. NA Laryngoscope, 2024.

Intra-rater and inter-rater reliability of the fixed plumb line for postural and scoliosis assessment in the sagittal plane: a pilot study.

The plumb line (PL) is a common tool for assessing the sagittal curvatures of the spine, but its accuracy depends on the ability of the physician to use it correctly. This study aimed to present a fixed plumb line (FPL) no longer held by a physician but fixed to a support, evaluating the reliability in posture assessment, comparing it with PL in both adolescent with and without scoliosis. The study evaluated the sagittal distances of the spine using a PL and a FPL in 80 young adults aged between 28.7±7.2 and 55 adolescents aged between 12.4±2.3, with and without scoliosis. Two expert and two novice clinicians tested the patients to evaluate the intra-rater and inter-rater reliability of FPL. Each clinician assessed participants twice on the same day, with a predetermined time interval (>1 h) to reduce recall bias. Multi-factor multivariate analysis of variance and two-way analysis of variance assessed the statistical significance, while intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) validated FPL consistency. FPL provided an ICC coefficient >0.90 for all the measures, while PL an average of 0.70. On AIS patients, PL and FPL showed a significant difference for C7 p<0.001 and T12 p<0.001. The measured parameters were sensitive to gender and age for the FPL, furthermore, the C7 and L3 measurements were statistically different between PL and FPL (p<0.001). Intra-rater reliability results for FPL ranged from 0.94 to 0.98 across various parameters, while the SEM and MDC values underscore the valuable precision of the FPL with changes exceeding 1 cm being meaningful. These findings suggest that FPL could be a reliable and accurate tool for measuring sagittal distances of the spine in both scoliotic and non-scoliotic patients.

Translation and Adaptation of the STOPP/START Criteria Version 3 for Potentially Inappropriate Prescribing in Older People to European Portuguese: A Study Protocol.

As the global population ages, managing medication use in older adults becomes increasingly complex due to polypharmacy and the associated risks of adverse drug events. To improve the safety and appropriateness of medication use in the older population, tools like the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) criteria have been developed. The availability of updated criteria is crucial to better support healthcare professionals in Portuguese-speaking regions. The aim of this study is to translate and validate the STOPP/START version 3 criteria for Portuguese, providing an updated and useful tool for healthcare professionals. This study will be conducted through four phases: I) translation of the STOPP/START version 3 criteria to European Portuguese; II) collection of sociodemographic, clinical, and medication data; III) intrarater reliability study; and IV) interrater agreement study. This study obtained ethics approval by the Ethics Committee of the Administração Regional de Saúde do Centro, Portugal. The availability of the translated criteria will enable the integration of STOPP/START version 3 into clinical practice in Portugal, facilitating improved medication safety and appropriateness. This integration is expected to lead to better management of polypharmacy and a reduction in adverse drug events, ultimately enhancing patient outcomes and supporting evidence-based prescribing practices.

Reliability, validity and usability of the K-force® grip dynamometer to evaluate handgrip-strength in patients with intensive care unit-acquired weakness.

Handgrip dynamometry is recognised as a method for evaluating volitional muscle strength in the intensive care, but conventional handgrip dynamometers cannot accurately measure grip strength in very weak patients. The aim of this study was to determine the reliability, validity and usability of the K-force® grip in patients with intensive care unit-acquired weakness. Evaluation of measurement properties of the K-force® grip. Two Intensive Care Units in The Netherlands. Patients diagnosed with intensive care unit-acquired weakness according to a Medical Research Council sum score <48. Intra- and inter-rater reliability of the K-force® grip were assessed using the intraclass correlation coefficient. Concurrent validity was examined using calibration weights. The usability was evaluated with the System Usability Scale. Intra-rater reliability showed an intraclass correlation coefficient of 0.987 for the dominant hand and 0.972 for the non-dominant hand. Inter-rater reliability showed coefficients of 0.944 for the dominant hand and 0.942 for the non-dominant hand. There was a perfect correlation (r = 1) between the K-force® grip and the calibration weights. The usability of the K-force® grip was rated excellent by 11 healthcare professionals with a System Usability Scale score of 86. The K-force® grip is a promising new tool for the evaluation of muscle strength in intensive care unit-acquired weakness patients who are too weak to use conventional hand dynamometers.

Reliability of Ultrasonographically Acquired Muscle Morphology Based on a Cohort of Men and Women

Objective: The objective was to evaluate intrarater and inter-rater reliability of ultrasonography muscle morphology measurements in men and women, considering morphological differences between the genders. Materials and Methods: Thirty-two healthy subjects (16 male; 16 female; 26.6 ± 4.9 years) participated in two evaluation days. On day 1, subjects were evaluated by a single experienced rater, who repeated the evaluation on the next testing day along with two other raters. Muscle morphology of quadriceps femoris (QMT), rectus femoris (RFMT), vastus intermedius (VIMT), vastus medialis (VMMT), and vastus lateralis (VLMT) muscle thickness, rectus femoris muscle cross-sectional area (RFCSA), vastus lateralis muscle fascicle length (VLFL), and pennation angle (VLPA) were obtained. Reliability was evaluated by intraclass correlation coefficients (ICCs). Results: All intrarater comparisons demonstrated good reliability (ICC &gt;0.90), even after participants’ gender stratification (ICC &gt;0.81). Inter-rater comparisons for RFCSA, and muscle thickness showed good reliability (ICC &gt;0.76). Male’s VLFL and VLPA reliability was considered insufficient (ICC = 0.58 and 0.60, respectively), while female’s was slightly higher (ICC = 0.79 and 0.75, respectively). Conclusion: Ultrasonography has potential to be used to observe changes in muscle size, but pennation angle and fascicle length should be evaluated by the same rater.

Hindi version of the lower extremity functional scale: a study of translation, validation and cross-cultural adaptation

BACKGROUND: Lower Extremity Function Scale (LEFS) serves as a patient-reported outcome measure, used to evaluate the functional status of lower extremity in different musculoskeletal conditions. It was originally developed in English language (E-LEFS) and numerous translations in different languages are available to measure its usability among different cultures. OBJECTIVES: To translate the English version of the Lower Extremity Function Scale (E-LEFS) into Hindi language and to evaluate its content validity, cross-cultural adaptation along with the concurrent validity and reliability. METHOD: Process of forward and backward translation was carried out by two bilingual translators and a physiotherapist after obtaining developer’s approval, for which the Beaton guidelines were used. For the content validation, Delphi method of was employed in which 12 field experts of more than 5 years of experience participated. Cultural adaptation procedures were then carried out with 12 patients, who reported in out-patient department of the hospital through convenience sampling who were asked about whether the H-LEFS was well understood by the patients. Their responses were recorded as positive and negative responses. This process was followed by concurrent validation which was conducted by comparing the scores with the SF-36 scale, involving 30 patients with activity limitation in their daily life. Lastly, 50 patients were recruited for intra-rater reliability testing. RESULT: The scale was successfully translated and verified by the bi-lingual language experts. Content validity came out to be significant with each item scoring more than 0.92. Nearly all items, excluding item no. 8, 16, 17, 18, and 19 received universal agreement with a content validity ratio of 1. The average scale-level validity stood at 0.98, indicating excellent level of validity and the scale was found to be well adapted by the native people as out of 12 patients, 10 patients provided 100% positive response. Concurrent validation using Pearson’s correlation coefficient came out excellent with the values of 0.993 for E-LEFS and 0.890 for SF-36. Cronbach's alpha and ICC values were calculated as 1.00 for Intra-rater reliability. CONCLUSION: LEFS was well translated into Hindi language with an excellent content and concurrent validity and is found to be highly reliable. Hence, it is recommended for the usage of native Hindi speaking population.