Intra-rater Scores Research Articles

Intra-rater and inter-rater reliability of cranio cervical flexion test in symptomatic subjects of neck pain using pressure biofeedback

Objective: To investigate the intra – rater and inter – rater reliability of cranio cervical flexion test in symptomatic subjects. Background of study: Neck flexor muscles endurance was negatively correlated with cervical pain and dysfunction. Cranio cervical flexion test protocol has been advocated to train cranio cervical flexor muscle performance at present there is no consensus to the most effective method. The CCFT is a clinical test of neuromotor control of deep flexor of the cervical spine. Methodology: This was an observational study design with test-retest type and conducted in the ACS medical college and hospital. 50 samples were selected based on inclusion criteria. The CCFT was measured by one tester twice for intra rater reliability and two testers for inter-rater reliability were again tested after 24 Hours (Next day) by keeping time and environment optimal. In this CCFT, the activation pressure score and highest-pressure score was measured using Pressure Biofeedback unit. Result: The mean score for Activation Pressure by intra-rater tester one was found to be 2.24 (1.69) and 2.64 (1.48) in retest. The ICC intrarater score for Highest pressure value by tester one was 23.92 (2.17) and 24.32 (1.99) in retest. The mean score for activation pressure by Inter – rater examiners was found to be 2.92(1.15) by examiner - 1 and 2.72(1.19) by examiner - 2. The ICC Inter – rater score for highest pressure value by examiner - 1 was 24.32(1.95) and 24.4(2.33) by examiner - 2. The ICC value of the study indicated high reliability of the activation pressure and highest-pressure value among the intra and inter-raters. Conclusion: The CCFT has high inter-rater and intra-rater reliabilities in symptomatic subjects. Bangladesh Journal of Medical Science Vol. 22 No. 03 July’23 Page : 617-622

Revised Hammersmith Scale for spinal muscular atrophy: Inter and intra-rater reliability and agreement.

The Revised Hammersmith Scale (RHS) for Spinal Muscular Atrophy (SMA) was designed as a psychometrically robust clinical outcome assessment to assess physical abilities of patients with type 2 and 3 SMA. The reliability properties of the RHS have not yet been reported. A prospective RHS reliability study was undertaken in a UK cohort of experienced neuromuscular paediatric Physiotherapists. Reliability testing was conducted via a virtual survey platform two weeks apart. Through the virtual platform participants scored videos of two RHS assessments, one of a child with SMA 2 and one of a child with SMA 3. Inter and intra-rater reliability was analysed using a type 3 Intraclass Correlation Coefficient (ICC). Intra-rater agreement was further analysed using Bland Altman (BA) Limits of Agreement (LOA) and plots. The acceptable inter and intra-rater variability was set as a change of ± 2 by the international team of expert physiotherapists who developed the RHS. Inter-rater agreement, n = 22 raters, type 3 ICC was 0.989 (95% CI 0.944 to 1.00), 97.7% of scores were within the acceptable limits of ± 2 points. Intra-rater agreement, n = 21 raters, type 3 ICC ranged from 0.922 to 1.0, with 97.6% of scores within the acceptable limits of ± 2 points. The mean SMA 2 intra-rater difference was -0.10 (-0.6 to 0.4), with lower LOA -2.24 and upper LOA +2.04. Intra-rater difference between tests for SMA 3 intra-rater difference was -0.05 (-0.6 to 0.5), with lower LOA -2.48 and upper LOA +2.38. Intra-rater scoring precision fell within BA agreement limits of ±2 points. The results demonstrate that the RHS is highly reliable when used by experienced UK physiotherapists, and variability of test scores regarding inter and intra-rater reliability was confirmed to lie within ±2 points.

Intra-rater reliability, inter-rater reliability and minimal detectable change of the posterior shoulder endurance test in elite athletes

ObjectiveInvestigate intra-rater and inter-rater reliability of the posterior shoulder endurance test (PSET) and calculate minimal detectable change (MDC) to establish measurement properties and inform use of the PSET in practice. Study designTest-retest reliability. Setting: British Canoe Slalom National Training Centre. ParticipantsTwelve participants (7 male, 5 female; 22.5 ± 4.48 years; 73.4 ± 6.36 kg) were investigated by two physiotherapists with >10 years’ experience. Main outcome measureIntraclass correlation coefficients (ICC) were calculated for intra-rater reliability (ICC 3,1) and inter-rater reliability (ICC 2,1) and used to calculate MDC. ResultsIntra-rater reliability scores were 0.84 and 0.85 for rater A and B, respectively, with 95% confidence interval (CI) crossing moderate to excellent reliability for both raters (0.5–0.75 and > 0.9). Inter-rater reliability scores were 0.74 and 0.63 at baseline and follow-up, respectively, with 95% CI crossing poor to good reliability in both time points (<0.5 and >0.75). MDC95% for intra-rater scores was 6 repetitions, MDC95% for inter-rater scores was 8 repetitions at baseline and 9 repetitions at follow-up. ConclusionThe PSET has acceptable intra-rater reliability but further work is needed to narrow the CI to an appropriate level for inter-rater reliability. The MDC calculated helps clinicians interpret changes in tests scores.

What's in a hashtag: A content evaluation of Instagram posts related to orthodontic retention and retainers

To evaluate and compare the content of posts placed on Instagram by orthodontic treatment providers (OTP) and patients regarding orthodontic retention and retainers. Six "hashtag" terms related to orthodontic retention were searched on the social media Web site, Instagram. Relevant uploaded posts were evaluated for the presence of nine retainer and retention-related domains. Patient posts were also qualitatively evaluated for themes via discourse analysis. Descriptive and univariate statistical analyses were carried out. Cohen's kappa intrarater reliability testing was performed. Most of the 144 posts that satisfied inclusion criteria were uploaded by OTPs (81.9%). Text and image(s) comprised 86.8% of posts. The most frequently included domain posted by OTPs related to "what is a retainer" and "the importance of wearing a retainer" (49.2%). Posts by OTPs referred to a greater number of domains (P= 0.028), whereas posts by patients recorded comparatively more "quality-of-life"-related content (P= 0.027). Most patient posts were positive (53.8%). The main negative theme within patient posts related to retainer discomfort and the unhappiness associated with the requirement for indefinite retainer wear. The intrarater score was 0.89 for the presence of domains. OTPs appear to use Instagram for posting orthodontic retention-related information more often than patients. The content of Instagram posts differed between OTPs and patients. OTPs must ensure that the content of their Instagram posts is relevant to the concerns articulated in posts uploaded by patients.

Short communication: Evaluation of a foot dirtiness scoring system for dairy cows

Lameness in dairy cattle is an important health and welfare concern directly affecting the economic benefits of farmers. Although foot dirtiness is a recognized risk factor for diseases inducing lameness, there is a lack of scoring systems that focus specifically on the foot. Therefore, the aim of this study was to evaluate the reliability of a 3-point dirtiness scoring system recently conceived for the assessment of the dirtiness present at the lower legs and claws of dairy cows. The scores of both the lateral and back views from 4 unfamiliar raters at 4 different times were used to evaluate interrater reliability (3 times) and intrarater scoring consistency (1 time). The findings of this investigation revealed that coefficients for interrater agreement (0.38, 0.62 and 0.63) and rating concordance (0.55, 0.75 and 0.74) of back-view scorings improved over time and were superior or similar to those obtained from lateral-view evaluations (coefficients for interrater agreement = 0.20, 0.35, and 0.69; coefficients for rating concordance = 0.48, 0.59, and 0.78). Additionally, the scoring consistency of the raters using the back-view grid was excellent (Cronbach's α = 0.93). The results suggest that the 3-point back-view dirtiness scoring grid may provide dairy consultants and farmers a reliable and easy tool for assessing cow foot dirtiness.

Facebook legal and regulatory advertising compliance by specialist orthodontic practices: a cross-sectional survey

Abstract Background Healthcare providers are increasingly using social media websites such as Facebook to advertise their services. The Australian Health Practitioner Regulation Agency guidance on the advertising of healthcare is based on the National Law in Australia and prohibits advertising that is contrary to the patient’s best interests. Aim To determine the legal and regulatory advertising compliance of the Facebook pages of specialist orthodontic practices in Australia. Methods The Facebook pages of specialist orthodontic practices were identified following a systematic search strategy. The content uploaded to each ‘eligible’ page between March 2019 and February 2020 was reviewed with regard to five specific domains of prohibited advertising. Cronbach’s Alpha Test was used to determine intra-rater agreement. Results The Facebook pages of 147 specialist orthodontist practices in Australia, representing 288 specialist orthodontists, satisfied inclusion criteria. Most Facebook pages (82.3%) breached the Law in one or more domains. The mean number (standard deviation) of domains breached was 1.65 (1.3), range 0–5. Non-compliance regarding ‘the use of testimonials’ (76.9%) and ‘information that was likely to create unrealistic expectations of orthodontic treatment’ (40.8%) were the domains most commonly contravened. All five domains were breached in 5.4% of practice Facebook pages. Intra-rater scores were strong, ranging from 0.84 to 0.94. Conclusions Compliance of the Facebook pages of specialist orthodontic practices in Australia with legal and regulatory advertisement requirements is poor. Greater awareness of the relevant obligations by specialist orthodontists responsible for their practice Facebook content is necessary to ensure that their advertising is not liable to charges of legal and/or professional misconduct.

Evaluation of balance recovery stability from unpredictable perturbations through the compensatory arm and leg movements (CALM) scale

Following unpredictable large-magnitude stance perturbations diverse patterns of arm and leg movements are performed to recover balance stability. Stability of these compensatory movements could be properly estimated through qualitative evaluation. In the present study, we present a scale for evaluation of compensatory arm and leg movements (CALM) in response to unpredictable displacements of the support base in the mediolateral direction. We tested the CALM scale for intra- and inter-rater reliability, correlation with kinematics of arm and leg movement amplitudes, and sensitivity to mode (rotation, translation and combined) and magnitude (velocity) of support base displacements, and also to perturbation-based balance training. Results showed significant intra- and inter-rater coefficients of agreement, ranging from moderate (0.46–0.53) for inter-rater reliability in the arm and global scores, to very high (0.87–0.99) for inter-rater leg scores and all intra-rater scores. Analysis showed significant correlation values between scale scores and the respective movement amplitudes both for arm and leg movements. Assessment of sensitivity revealed that the scale discriminated the responses between perturbation modes, platform velocities, in addition to higher balance recovery stability as a result of perturbation-based balance training. As a conclusion, the CALM scale was shown to provide adequate integrative evaluation of compensatory arm and leg movements for balance recovery stability after challenging stance perturbations, with potential application in fall risk prediction.

Reliability of observational- and machine-based teat hygiene scoring methodologies

Removal of teat-end debris is one of the most critical steps in the premilking process. We aimed to estimate inter- and intra-rater reliability of an observation-based rating scale of dairy parlor worker teat-cleaning performance. A nonrandom sample of 8 experienced raters provided teat swab debris ratings scored on a 4-point ordinal visual scale for 175 teat swab images taken immediately after teat cleaning and before milking unit attachment. To overcome the uncertainty associated with visual inspection and observation-based rating scales, we assessed the reliability of an automated observer-independent method to assess teat-end debris using digital image processing and machine learning techniques to quantify the type and amount of debris material present on each teat swab image. Cohen's kappa coefficient (κ) was used to assess inter-rater score agreement on 175 teat swab images, and the intraclass correlation coefficient was used to assess both intra-rater score agreement and machine reliability. The reliability of debris scoring of teat swabs by raters was low (overall κ = 0.43), whereas the machine-based rating system demonstrated near-perfect reliability (Pearson r > 0.99). Our findings suggest that machine-based rating systems of worker performance are much more reliable than observational-based methods when evaluating premilking teat cleanliness. Teat swab image analysis technology can be further developed for training and quality control purposes to enable more efficient, reliable, and independent feedback on worker milking performance. As automated technologies are becoming more popular on dairy farms, machine-based teat cleanliness scoring could also be incorporated into automated milking systems.

Expert-Rater Agreement and Inter-/Intrarater Reliability for the Furtado-Gallagher Computerized Observational Movement Pattern Assessment System.

Fundamental movement skills (FMS) play a crucial role in a child's motor skill development, as their mastery is related to the acquisition and mastery of specialized sport skills and to a child's general health through the prevention of weight gain and increased level of physical activity. Thus, the accurate and reliable measurement of FMS is of related importance. This article presents the results of two studies intended to assess expert-rater agreement and inter-/intrarater scoring reliability in the administration of a new observational FMS instrument, the Furtado-Gallagher Computerized Observational Movement Pattern Assessment System (FG-COMPASS). In Study 1, we found that four of the six scales that underwent modifications in a previous study yielded acceptable expert agreement, permitting their retention in the revised test, while the two remaining scales measuring side sliding and leaping yielded insufficient expert agreement, leading to their removal from the test. In Study 2, weighted kappa values reflected very good interrater agreement among three raters across two test administrations for the Locomotor and Manipulative subtests and the Total score (all skills combined). Future studies should (a) collect validity and reliability evidence for two additional skills planned for inclusion in the Locomotor subtest, (b) assess the impact of varying the number of trials given when assessing motor skill performances in life settings, and

Intra- and inter-rater reliability of the Modified Frenchay Scale to measure active upper limb function in hemiparetic patients

The Modified Frenchay Scale (MFS) measures active upper limb function in hemiparesis based on a video review of 10 everyday living tasks, each rated on a 10-point visual analogic scale. Six tasks are bimanual and four are unimanual performed with the paretic hand. We measured intra- and inter-rater reliability of MFS in hemiparetic patients among trained raters. After a group training session consisting in reviewing and commenting upon ten patient videos, 10 raters assessed the videos of 10 adults with chronic hemiparesis (age 52 ± 13, mean ± SD) on two occasions one week apart. Intra- and inter-rater reliability was assessed using interclass correlation coefficients, mean intra- and inter-rater differences, coefficients of variation between raters and the agreement frequency procedure, agreement being defined as a difference equal or less than 0.5 between two individual ratings. For the overall MFS scores, mean intra- and inter-rater ICC coefficients were respectively 0.99 [0.95; 1.00] (mean [95%CI]) and 0.98 [0.98; 1.00]. The mean intra-rater score difference between two ratings one-week apart was 0.26 ± 0.08 and the mean inter-rater standard deviation was 0.61 ± 0.17. Inter-rating differences of less than 0.5 were found in 86% of cases of intra-rater comparisons and in 52% of inter-rater comparisons. Mean inter-rater coefficient of variation was 0.11 ± 0.03. After a group training session in using the scale, the Modified Frenchay Scale has excellent intra- and inter-rater reliability.

Development of a Physical Therapy Patient-Interview Student Assessment Tool: A Pilot Study

Background and Purpose. While multiple medical school patient-interviewing tools exist for assessment of student competence in conducting histories, no validated or reliable physical therapy-specific tool has been found in the literature. Physical therapist education requires assessment and attainment of patient-interviewing competence before physical therapist students begin care. The purpose of this qualitative study was to develop and validate a physical therapy-specific tool to assess student patient-interviewing skill and to pilot its reliability.Method/Model Description and Evaluation. Literature review, qualitative assessment of existing medical tools for interviews, tool development, content validation, and pilot estimation of test-retest intrarater reliability were performed. Literature review results for history taking, expert clinical practice, and medical-based interviewing assessment instruments served as basis for the ECHOWS tool (E [Establishing Rapport], C [Chief Complaint], H [Health history], O [Obtain Psychosocial Perspective], W [Wrap-Up] , and S [Summary of Performance [).Content validity was established using 5 content experts, including entry-level and residency/fellowship faculty. These experts reviewed ECHOWS twice, leading to final revision and creation of a user guide. Five different reviewers assessed a convenience sample of 5 taped interviews for reliability. This pilot testing of ECHOWS allowed for the determination of necessary tool modifications, and an estimate of the variability of the inter and intrarater scores, which will be used to calculate a sample size for future reliability studies.Outcomes. ECHOWS and Guide to ECHOWS were developed and validated. Pilot testing revealed the need for additional alterations to ECHOWS. Statistical analysis revealed moderate to good instrument intrarater reliability.Discussion and Conclusion. The ECHOWS physical therapy student-assessment instrument for interviews also has the potential to provide PT faculty with additional strategies to teach interviewing skills. Future research will need to establish interrater reliability and construct validity.Key Words: Student evaluation, Patient interview, Competence.BACKGROUND AND PURPOSEConducting an interview, or what is commonly referred to as the patient history, is an important element of patient/client management by physical therapists.1 Accordingly, the American Physical Therapy Association (APTA) lists history-taking and communication competencies in the Minimum Required SkilL· of Physical Therapist Graduates at Entry Level.2 To conduct comprehensive and effective interviews, physical therapist (PT) students obtain information needed to: (1) determine whether physical therapy is appropriate for the patient, (2) proceed with appropriate tests and measures, (3) develop appropriate patient/client goals, (4) assist in making diagnoses, and (5) identify contextual factors that might influence the patient's/ client's prognosis and the nature of the practitioner-patient/client interaction. In addition, effective interviewing also requires skill in communication, including attentive listening, establishment of practitioner-client rapport, attention to cultural congruency in interactions, and the ability to convey information at appropriate medicalliteracy levels.3Patient interviewing, or history-taking, has long been recognized as critically important to the delivery of health care. Beattie et al4 investigated satisfaction with physical therapy services. The authors noted enhanced satisfaction when patients perceived that PTs spent adequate time with them, demonstrated good listening and communication skills, and offered clear treatment explanations. These findings were similar to Goldstein et al5 who reported that patients felt that being treated with respect and involvement in treatment decisions were the most important components of their physical therapy experience. …

Inter and intra‐rater repeatability of the scoring of foot pain drawings

BackgroundFoot pain drawings (manikins) are commonly used to describe foot pain location in self-report health surveys. Respondents shade the manikin where they experience pain. The manikin is then scored via a transparent overlay that divides the drawings into areas. In large population based studies they are often scored by multiple raters. A difference in how different raters score manikins (inter-rater repeatability), or in how an individual rater scores manikins over time (intra-rater repeatability) can therefore affect data quality. This study aimed to assess inter- and intra-rater repeatability of scoring of the foot manikin.MethodsA random sample was generated of 50 respondents to a large population based survey of adults aged 50 years and older who experienced foot pain and completed a foot manikin. Manikins were initially scored by any one of six administrative staff (Rating 1). These manikins were re-scored by a second rater (Rating 2). The second rater then re-scored the manikins one week later (Rating 3). The following scores were compared: Rating 1 versus Rating 2 (inter-rater repeatability), and Rating 2 versus Rating 3 (intra-rater repeatability). A novel set of clinically relevant foot pain regions made up of one or more individual areas on the foot manikin were developed, and assessed for inter- and intra-rater repeatability.ResultsScoring agreement of 100% (all 50 manikins) was seen in 69% (40 out of 58) of individual areas for inter-rater scoring (range 94 to 100%), and 81% (47 out of 58) of areas for intra-rater scoring (range 96 to 100%). All areas had a kappa value of ≥0.70 for inter- and intra-rater scoring. Scoring agreement of 100% was seen in 50% (10 out of 20) of pain regions for inter-rater scoring (range 96 to 100%), and 95% (19 out of 20) of regions for intra-rater scoring (range 98 to 100%). All regions had a kappa value of >0.70 for inter- and intra-rater scoring.ConclusionsIndividual and multiple raters can reliably score the foot pain manikin. In addition, our proposed regions may be used to reliably classify different patterns of foot pain using the foot manikin.

Multidisciplinary group performance in the context of integrated care: measurement of integration intensity

BackgroundIn the context of integrated care, multidisciplinary group (MDG) meetings involve participants who are not only from different professional groups but also from different organisational backgrounds within a complex local health economy. Such meetings therefore provide opportunities for participants to discuss complex care of individual patients, as well as ways to improve working within that local health economy—ie, working in a more integrative manner. We used an innovative coding scheme and method to explore the communication patterns within MDGs of a large-scale integrated care pilot (the North-West London Integrated Care Pilot). We investigated the extent to which case discussions foster an integrative way of working between MDG participants. MethodsCase discussions in four MDG meetings were audio recorded and transcribed. Scripts were divided into utterances, or units of meaning, of about equal length representing a complete phrase or sentence. A second researcher then checked these utterances, and disagreements were resolved through consensus. Two coders independently coded utterances according to their integrative potential, which was defined against three independent domains: the level (ie, individual, collective, and systems); the valence (problem, information, and solution); and the focus (concrete and abstract). Utterances were coded first with respect to level, then valence, and then focus, to avoid any bias to code preferentially towards one permutation of the three codes. Inter-rater and intra-rater reliability was tested with kappa scores on one randomly selected case discussion. Intra-rater scores were taken 2 weeks apart to avoid possible code recall. We developed an ordinal scale based on mathematical weights for the 18 permutations of level, valence, and focus. Standardised mean integration scores were calculated for case discussions across utterance deciles, corresponding roughly to time deciles, indicating how integrative intensity changed during the conversation. FindingsWe transcribed and coded 23 case discussions in four different MDG groups. Inter-rater and intra-rater reliability was good, as shown by the prevalence and bias-adjusted kappa scores for one randomly selected case discussion. We coded 4209 utterances. The proportion of utterances differed according to participant type (consultant 14·6%; presenting general practitioner 38·8%; chair 7·8%; non-presenting general practitioner 2·3%; allied health professional 4·8%). Utterances were predominantly coded at low levels of integrative intensity. Allied health professionals accounted for a fairly low proportion of utterances; however, they tended to speak at higher integrative levels. We noted evidence for a gradual increase (R2 0·66) in integrative intensity during the case discussions, but on the basis of analysis of the minutes and action points arising from these discussions, this evidence did not translate into future actions. InterpretationWe characterise the MDGs as having consultative characteristics with some trend towards collaboration, but best resemble community-based ward rounds. The increase in integration scores did not tend to translate into actions for the groups to take forward. The role of the chair and the improved participation of non-presenting general practitioners and allied health professionals seem important, especially because allied health professionals contribute greatly to higher integrative scores. Traditional communication patterns of medical dominance are being perpetuated in the MDGs, suggesting that more could be done to sensitise participants to the value of full participation from all members of the group. Case discussions in integrated care MDGs are opportunities for health professionals to learn from each other's cases and explore how services could work together better to improve care generally. Our characterisation of these MDGs shows that more could be done in this regard. Reviews of decision making and communication in primary and community care show a dearth of empirical research examining real-time dynamics. Our method enables researchers to detect evolutionary changes in the integrative intensity of the group over time and make comparisons between MDGs. FundingImperial College Healthcare Charity.

Development and Validation of a 6-Point Grading Scale in Patients Undergoing Correction of Nasolabial Folds with a Collagen Implant

Various scoring techniques prone to subjective interpretation have been used to evaluate soft tissue augmentation of nasolabial folds (NLFs). To design and validate a reliable wrinkle assessment scoring scale. Six photographed wrinkles of varying severity were electronically copied onto the same facial image to become a 6-point grading scale (GGS). A pilot training program (13 investigators) determined reliability, and a 12-week multicenter survey study validated the GGS scoring method. Pilot study inter- and intrarater scoring reliability were high (weighted kappa scores of 0.85 and 0.86, respectively). Seventy-five percent of survey investigators and independent review panel (IRP) members considered a GGS score difference of 0.5 to be a minimally perceivable difference. Interrater weighted kappa scores were 0.91 for the IRP and 0.80 for investigators. Intrarater agreements after repeat testing were 0.91 and 0.89, respectively. The baseline "live" assessment GGS mean score was 3.34, and the baseline blinded photographic assessment GGS mean score was 2.00 for the IRP and 2.16 for the investigators. The GGS is a reproducible method of grading the severity of NLF wrinkles. Treatment effectiveness of a dermal filler can be reliably evaluated using the GGS by comparing "live" assessments with the standard GGS photographic panel.

Interrater and Intrarater Reliability of the Modified Ashworth Scale in Children with Hypertonia

The Modified Ashworth Scale (MAS) is a six-point scale used to assess spasticity. This study assessed interrater and intrarater reliability of the MAS for children with hypertonia. Five raters participated in this examination of interrater and intrarater reliability. The study included 17 children who showed hypertonus. Elbow flexor, hip adductor, quadriceps, hamstring, gastrocnemius, and soleus muscles were tested bilaterally. Results demonstrated good interrater reliability (intraclass correlation coefficient [ICC] >0.75) for elbow flexors and hamstrings and poor interrater reliability (ICC <0.50) for other muscles. Intrarater scores were good (ICC >0.75) for hamstrings and moderate (ICC = 0.50 to 0.75) for other muscles. Interrater reliability of the MAS may be lower than desired for clinical use for muscles other than hamstrings and elbow flexors, and intrarater reliability may also be lower than desired for muscles other than the hamstrings.

The Cancode interaction analysis system in the oncological setting: reliability and validity of video and audio tape coding

Cancode is a computerized interaction analysis system developed for cancer consultations. This paper assesses its reliability and validity, and compares the use of audio versus video tape; by assessing 30 consultations between an actor and 10 oncologists. Weighted Kappa inter- and intra-rater scores ranged from 0.5 to 1.0 and 0.58–1.0, respectively, and use of video tape did not alter verbal coding. Factor analysis of verbal codes revealed two factors, ‘verbal control’ and ‘verbal support’. Verbal and non-verbal doctor behavior differed by patient type (‘verbal support’ P=0.007, ‘verbal control’ P=0.004, ‘Responsiveness’ P=0.000, and ‘Immediacy’ P=0.000). Inter-doctor variation was noted for ‘verbal support’ ( P=0.000) and ‘Relaxation’ ( P=0.000). ‘Responsiveness’ was negatively correlated with ‘verbal support’ (−0.58) and ‘verbal control’ (−0.65). Cancode is reliable, valid and sensitive to doctors behavioral changes. For a more passive patient, the doctor may switch from a ‘cure’ to ‘care’ oriented consult, responding to psycho-social instead of informational needs.

Interobserver Reliability of General Practice Physiotherapists in Rating Aspects of the Movement Patterns of Skilled Violinists

In the music medicine literature, experienced clinicians recommend the visual observation of musicians performing on their instruments to identify movement patterns that potentially increase the risk of an injury. Visual assessment of functional task performance is a skill used clinically by many health care professionals to enhance decision-making regarding the best management and treatment strategies for a particular client. Little research exists, however, to identify whether consistent movement patterns would be identified during such a procedure and whether there are particular injury risk features that can be identified reliably by a group of practitioners. This study asked a group of experienced clinical physiotherapists to rate movement patterns of 30 skilled violinists performing a violin-playing task to evaluate whether similar scores would result. Results indicated that these therapists varied widely in their rating methods, and interrater reliability scores ranged from mostly poor to fair. These scores occurred regardless of the presence or absence of playing-related injuries in the violinists. A small sample of available intrarater scores showed better consistency, although still not of high reliability. Further research may indicate whether physiotherapists or health care practitioners experienced in observing a complex task such as violin playing would show greater interrater reliability in using such a scoring system.

Development of the Physical Education Observation Instrument Using Generalizability Study Theory

Abstract In this exploratory study, the rater reliability of the Physical Education Observation Instrument (PEOI) was satisfactorily established. Three raters coded the frequency of occurrences of selective teacher (9) and student (4) behaviors and one catchall category when male teachers were instructing male pupils in volleyball. A 3 Rater × 3 Teacher × 2 Occasion Generalizability Study design indicated high stability of both inter- and intra-rater scores on 13 of 14 variables from Ěp 2 .65 to .99, establishing the appropriateness of the PEOI for further observational research on teacher and student behaviors in physical education.