Intra-rater Test-retest Reliability Research Articles

Test-Retest Reliability of Pain Sensitivity Measures in Individuals with Shoulder Pain.

Central sensitization (CS) has been proposed as a possible contributor to persistent shoulder pain. Measures of sensitivity, such as quantitative sensory tests (QSTs) and sensitivity to movements evoked pain (SMEP), have been increasingly used to investigate CS in a wide range of painful conditions. However, there is a lack of data on whether QST and SMEP are reliable among individuals with shoulder pain. Therefore, the present study aimed to investigate the intra-rater test-retest reliability of QST and SMEP in individuals with chronic shoulder pain. Forty-seven individuals with chronic shoulder pain were enrolled in the study. The QST measures, including pressure pain threshold (PPT) and mechanical temporal summation (MTS), were tested, and SMEP was measured with a lifting task. Relative and absolute reliability were analyzed using intraclass correlation coefficients (ICC 3,1) and standard error of the measurement (SEM), respectively. The results showed that the ICC coefficients for all sensitivity measures were moderate to good, ranging from 0.63 to 0.86. The SEM% for the QST measures at all sites ranged from 21.4% to 36%, with TS at the forearm demonstrating a high SEM% (greater than 30%). The SMEP measure also showed a high SEM% (46%). The results showed that the sensitivity measures had moderate to good reliability among individuals with shoulder pain. Acceptable limits of accuracy of measurements were demonstrated for TS and PPT measures, while SMEP demonstrated high error, highlighting the need for further refinement of this measure among these populations.

Scapular muscle dynamic stiffness of asymptomatic subjects and subjects with chronic shoulder pain, at rest and isometric contraction conditions.

Muscle stiffness had a crucial role in joint stability, particularly, at the shoulder complex. Although changes in upper trapezius muscle stiffness have been described for shoulder pain, contradictory findings have been obtained. Also, existing data regarding scapular muscles are, majorly, about trapezius. Myotonometry is a method used to assess stiffness; however, the reliability values of scapular muscle stiffness through this method have not been assessed in shoulder pain conditions. The present study aims to compare scapular muscles' stiffness (trapezius, serratus anterior, and levator scapulae) between subjects with and without chronic shoulder pain and to evaluate the related test-retest reliability. Twenty-two symptomatic and twenty-two asymptomatic subjects participated in a cross-sectional study. The dynamic muscular stiffness of scapular muscles, at rest and during an isometric contraction, was measured bilaterally with myotonometry, in two moments. The differences in bilateral averaged values between symptomatic and asymptomatic subjects and the effect of the group (group presenting pain in the dominant or non-dominant side, and asymptomatic group) and of the limb (unilateral painful or asymptomatic limb, and bilateral asymptomatic limbs) were investigated. Test-retest intra-rater reliability was determined. An effect of the group was observed at rest, for middle trapezius stiffness, and during contraction, for middle and lower trapezius stiffness. For middle trapezius, increased values were observed in the group presenting pain in non-dominant side comparing to both groups or to group presenting pain in dominant side. The intraclass correlation coefficient, majorly, ranged between 0.775 and 0.989. Participants with pain in the non-dominant side presented an increased middle trapezius' stiffness. Globally, high reliability was observed for scapular muscles dynamic stiffness.

Reliability and Validity of Visual Estimation in Determining Thorax Rotation Mobility using the Quadruped Lumbar-Locked Position.

Thoracic rotation mobility is crucial for athletes in rotational sports such as baseball, golf, and swimming to maintain the proper biomechanics associated with the sport. Accurate differentiation between normal mobility and active and passive physiological deficits in the thoracic region is critical for identifying the need for intervention to the thorax. To establish the reliability and discriminant validity of visual estimation of thorax rotation range of motion across clinicians of differing experience levels in determining normal mobility and active or passive physiological deficits when utilizing the quadruped lumbar-locked position. Cross-sectional. Thirty-eight subjects (21 female, 17 male) with a mean age of 27 years ± 6.67 were assessed with the quadruped lumbar-locked thorax rotation test by three examiners with various clinical experience in real-time and again one week later. Bilateral active and passive lumbar-locked thorax rotation mobility was assessed by all raters and categorized as "Unrestricted" (≥50°) or "Restricted" (<50°) while a research assistant simultaneously measured the motion with a digital inclinometer. All raters were blinded to the results. All results were analyzed for intra-rater reliability and agreement. Test-retest intra-rater reliability ranged from 0.55-0.72 and percent absolute agreement ranged from 0.82-0.89. Inter-rater reliability ranged from 0.45-0.59 while percent absolute agreement between raters ranged from 0.74-0.84. There was a significant difference in range of motion between "Unrestricted" and "Restricted" categories for both active (Unrestricted=54.6-58.9; Restricted=40.4-44.4; p<0.001) and passive motion (Unrestricted=61.3-63.5; Restricted=39.2-39.7; p<0.001). The only interaction effect was for passive left rotation [Rater A Restricted x ® =34.3(30.4-38.2); Rater C Restricted (x ) ®=43.8(41.3-46.4); p=.000]. The quadruped lumbar-locked thorax rotation test demonstrates moderate to substantial test-retest intra-rater and inter-rater reliability regardless of clinical experience. The quadruped lumbar-locked thorax rotation test can accurately discriminate between individuals with active and passive physiological deficits regardless of rater experience using visual estimation. 3b.

Greek Cross-Cultural Adaptation, Reliability, and Validity of the Quick Foot and Ankle Ability Measure Questionnaire.

An easy-to-administer, function-based questionnaire to assess patients with various foot problems was required for a Greek-speaking population. This study aimed to translate and cross-culturally adapt the Quick Foot and Ankle Ability Measure (Quick-FAAM) into Greek and evaluate its reliability and validity. Cross-sectional study. Established international guidelines for the cross-cultural adaptation of questionnaires were followed. The face and content validity of the Greek version of the Quick-FAAM (Quick-FAAM-GR), as well as the internal consistency and test-retest reliability upon repeated administration after 5days, were examined. In addition, the construct validity of the scale was examined via exploratory factor analysis as well as by testing for associations with the Manchester Foot Pain and Disability Index, the 12-item Short-Form Survey (version 2), and a functional balance assessment test-the Y-Balance Test. Sixty participants (18 women) with self-reported chronic ankle instability symptoms, with a median (interquartile range) age of 27 (7.7) years, participated in the study. Half of the participants were included in the test-retest reliability study. The Quick-FAAM-GR demonstrated face and content validity. Excellent internal consistency (Cronbach α = .961) and intrarater test-retest reliability (intraclass correlation coefficient ICC[2,1] = .93) were demonstrated, with a comparable error margin to the original version (standard error of the measurement = 2.1, 95% minimum detectable change = 5.9). Associations of the Quick-FAAM-GR scores to other questionnaires ranged from weak to strong (Spearman rho), all being statistically significant (Manchester Foot Pain and Disability Index from -.26, P = .04, to -.67, P < .001, and 12-item Short-Form Survey, version 2, between .41 and .72, P < .001), and to the Y-Balance Test between lower-limb differences (-.35 to -.58, P < .001). The exploratory factor analysis confirmed the single-factor structure of this scale. No floor/ceiling effects were observed. The Greek Quick-FAAM has proven to be a valid and reliable tool for evaluating chronic ankle instability and can be used for clinical and research purposes in Greek-speaking individuals.

The Intra-Rater Reliability of Ultrasonography for the Measurement of Lumbar Multifidus and Erector Spinae Thickness in Different Positions in People with and without Active Extension-Related Non-Specific Low Back Pain.

The paraspinal muscles, including multifidus (MF) and erector spinae (ES) play key roles in the stability and movement of the lumbar spine. This study aimed to determine the intra-rater reliability of the ES and MF muscle thickness measures of the rehabilitative ultrasound imaging (RUSI) in people with active extension pattern (AEP) non-specific chronic low back pain and controls. Fifteen females with AEP and 19 controls participated in this test-retest intra-rater reliability study, including two different testing sessions performed in four to seven days apart. The primary (raw) and derived (normalized) measures of the L4 MF and ES muscles`thickness were examined in three different positions (prone, sitting, and standing) on both days. A two-way mixed average of intra-class correlation coefficient (ICC3, K) with confidence interval (CI = 95%) was used to determine the relative reliability. The standard error of measurement (SEM) and minimal detectable change (MDC) values at a CI of 95% were computed to examine the absolute reliability. The ICC values for the primary thickness of the L4 ES and MF muscles were from 0.85 to 0.91, except for MF muscle thickness in standing (ICC = 0.67) and sitting (ICC = 0.66) positions . The ICC values for derived data were lower in both groups. The SEM and MDC values were small enough to confirm the absolute reliability of the primary data. This study supports the use of RUSI for examining the primary measures of the L4 MF and ES muscles in asymptomatic and AEP participants, but it should be used cautiously for assessing the derived measures.

Test-retest reliability of an Android application (Protractor) for range of motion evaluation

Several tools are used by physical therapists to assess the range of motion (ROM) for joints of the upper and lower limbs. However, most of them are costly, time-consuming, and difficult to use. The current study aimed to determine the within-visit test-retest reliability of an android application (App) (Protractor) for elbow, wrist and ankle joints range of motion evaluation in outpatients with post fracture fixation. We evaluated the Android App (Protractor) in twenty-six patients with a mean age of 30 years, who had undergone operative treatment for fractures around the elbow, wrist, and ankle. These patients were recruited from the physiotherapy outpatient clinic at the Faculty of Medicine, Tanta University. Repeated measures were performed within the same session, focusing on motions in the sagittal plane for the elbow, wrist, and ankle joints. All measurements were conducted by the same investigator. Pearson correlation coefficient (r) and intra-class correlation coefficient (ICC) were calculated. Within-visit test retest intra-rater reliability for elbow, ankle, and wrist joints, ROM was excellent (r and ICC≥0.99) except for wrist joint flexion ROM, it was weak and insignificant. The mean group difference of measures obtained in the first and second measurements was close to zero, with the exception of wrist joint flexion, which was -5 degrees, and ankle joint plantar flexion, which was +2 degrees. The Smartphone android App (Protractor) displayed reasonable within-visit reliability.

Test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain in patients with rotator cuff-related shoulder pain

BackgroundThe number of researchers and clinicians using movement-evoked pain and sensitivity to movement-evoked pain to assess shoulder pain has increased. However, the intrarater test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain in people with rotator cuff-related shoulder pain (RCRSP) is still unknown. ObjectiveWe examined the intrarater test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain in participants with RCRSP. MethodsSeventy-four participants with RCRSP performed five trials of active shoulder abduction to elicit pain under two experimental conditions: active shoulder abduction to the onset of pain and maximum range of motion (ROM). The primary outcome measures were pain intensity and ROM. Test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain was examined using intraclass correlation coefficient (ICC3,1) and minimal detectable change (MDC90). ResultsThe reliability of movement-evoked pain under both experimental conditions was good to excellent (ICC: 0.81 to 0.95), while the reliability of sensitivity to movement-evoked pain was poor in both conditions (ICC≤0.45). The MDC90 for pain intensity was 1.6 and 1.8 during shoulder abduction to the onset of pain and maximum ROM, respectively. The MDC90 for ROM was 17.5° and 11.2° during shoulder abduction to the onset of pain and maximum ROM condition, respectively. ConclusionThis study confirms movement-evoked pain testing during active shoulder abduction to the onset of pain or maximum ROM condition is reliable to assess pain associated with movement in patients with RCRSP. The minimal detectable change score of movement-evoked pain can guide clinicians and researchers on how to interpret changes in these outcomes.

Intrarater Reliability and Analysis of Learning Effects in the Y Balance Test.

While the general reliability of the Y balance test has been previously found to be excellent, earlier reviews highlighted a need for a more consistent methodology between studies. The purpose of this test-retest intrarater reliability study was to assess the intrarater reliability of the YBT using different methodologies regarding normalisation for leg length, number of repetitions, and score calculation. Sixteen healthy adult novice recreational runners aged 18-55 years, both women and men, were reviewed in a laboratory environment. Mean calculated scores, intraclass correlation coefficient, standard error of measurement, and minimal detectable change were calculated and analysed between different leg length normalisation and score calculation methods. The number of repetitions needed to reach a plateauing of results was analysed from the mean proportion of maximal reach per successful repetition. The intrarater reliability of the YBT was found to be good to excellent, and it was not affected by the method of score calculation or leg length measurement. The test results plateaued after the sixth successful repetition. Based on this study, it is suggested to use anterior superior iliac spine-medial malleolus length for leg length normalisation because this method was proposed in the original YBT protocol. At least seven successful repetitions should be performed to reach a result plateau. The average of the best three repetitions should be used to mitigate possible outliers and account for the learning effects seen in this study.

Physical testing in patients with acute whiplash-associated disorders: A within session test-retest reliability study

BackgroundPeople with whiplash-associated disorders (WAD) commonly present with a variety of physical impairments. However, the reliability of physical tests has not been established for patients with acute WAD. ObjectiveTo assess test-retest reliability of different physical tests in acute WAD. DesignIntra-rater test-retest reliability. MethodsPatients with acute WAD were recruited. Physical tests were used to evaluate articular, muscular and neural systems in two blocks of measurements separated by 10 min. Bland-Altman plots were performed to assess intrarater agreement, which included calculation of the mean difference (d) between rates, the 95% CI for d, the standard deviation of the differences and the 95% limits of agreement. Reliability was calculated via the standard error of measurement, the minimal detectable change, percent of agreement, the intraclass-correlation coefficient, and kappa coefficient. Results47 patients participated. Test-retest reliability was excellent or good for almost all measures, except for extension ROM, ULTT for the radial nerve, and active cervical extension and upper cervical rotation performed in 4-point kneeling, which presented moderate reliability. Systematic bias was found in cervical ROM in flexion, left and right lateral-flexion, left and right rotation; left ULTT for radial nerve; right trapezius, suboccipitalis and temporalis muscles, left temporalis; C3, both sides of C1–C2, left C3–C4. ConclusionThe majority of physical tests achieved good or excellent test-retest intra-rater reliability when tested in patients with acute WAD. Findings must be considered with caution for those tests which demonstrated systematic bias. Additional research is warranted to evaluate inter-rater reliability.

Reliability of a Global Gait Symmetry Index Based on Linear Joint Displacements

Gait symmetry is commonly used as an informal measure to assess functional gait recovery. As other outcome measures used for the evaluation of clinical change over time, gait symmetry indices must be reliable. However, studies assessing the reliability of symmetry indices are scarce and focused on discrete and local indices (i.e., peak joint angle, step length), which fail to assess overall gait symmetry. On the other hand, the repeatability of global symmetry indices (using multiple continuous waveforms) based on joint angles may be hampered by the sensitivity of these variables to marker placement imprecision. The aim of this study is to evaluate the test–retest intra-rater reliability and measurement error of an alternative global symmetry index. Two 3D gait analyses were performed on separate days (a week interval) on twenty-three healthy adults. Reliability and measurement error were assessed by calculating the intraclass correlation coefficient and the 95% limits of agreement, standard error of measurement and smallest detectable change, respectively. The new symmetry index presented acceptable results in terms of reliability (ICC = 0.71, 95% CI 0.33–0.88) and measurement error (95% LOA between −30.2% and 29.1%, SEM = 10.7% and SDC = 29.7%), thus being a more promising tool to assess overall gait symmetry.

Cultural adaptation and validation of the Malay Chronic Kidney Disease Self-management instrument (MCKD-SM)

BackgroundThere is growing evidence that self‐management behaviour can improve outcomes for patients with chronic kidney disease (CKD). However, no measures are available in Malay to effectively assess the self-management of CKD. The aim of this study was to translate, culturally adapt and validate the Malay Chronic Kidney Disease Self-Management (MCKD-SM) instrument for Malay-speaking health professionals and patients.MethodsThis study was carried out in two phases: the translation and cultural adaptation phase and the validation phase. The instrument was translated from English to Malay and then adapted and validated in a sample of 337 patients with CKD stages 3–4 attending a nephrology clinic in a tertiary hospital in Malaysia. Structural validity was evaluated by exploratory factor analysis. The instrument’s reliability was assessed by internal consistency and test–retest reliability. The correlations between the MCKD-SM and kidney disease knowledge and the MCKD-SM and self-efficacy were hypothesised a priori and investigated.ResultsThe MCKD-SM instrument has 29 items grouped into three factors: ‘Understanding and Managing My CKD’, ‘Seeking Support’ and ‘Adherence to Recommended Regimen’. The three factors accounted for 56.3% of the total variance. Each factor showed acceptable internal reliability, with Cronbach’s α from 0.885 to 0.960. The two-week intra-rater test–retest reliability intraclass correlation coefficient values for all items ranged between 0.938 and 1.000. The MCKD-SM scores significantly correlated with kidney disease knowledge (r = 0.366, p < 0.01) and self-efficacy (r = 0.212, p < 0.01).ConclusionThe MCKD-SM was found to be a valid and reliable patient‐reported outcome measure of pre-dialysis CKD self-management behaviour in the Malay-speaking population.

Circumferential Measurements to Calculate Lower Limb Volume in Persons with Lymphedema: What Segment Length Is to Be Recommended?

Background: Circumferential measurements (CMs) every 4th cm are commonly used to assess lower limb volume (LLV), but fewer measurements would be less time-consuming. The aim of this study was therefore to establish the agreement between LLV measurements derived from CM every 4th cm (V4), 8th cm (V8), and 12th cm (V12), and to evaluate the intrarater test-retest reliability for each of the three measurement methods in persons with lower limb lymphedema (LLL). Methods and Results: Forty-two persons with unilateral or bilateral LLL were measured twice, 2 weeks apart. Volume measurements for the V4, V8, and V12 methods were derived using CM. The agreement was evaluated using intraclass correlation coefficient (ICC3.1) and Bland-Altman graphs including 95% limits of agreement (LOA). The reliability was evaluated using ICC2.1 and standard error of measurement (SEM%) and smallest real difference (SRD%). The agreement was high for the V4 and V8 methods (ICC 0.999), and for the V4 and V12 methods (ICC 0.998). The graphs revealed slightly higher agreement between the V4 and V8 than between the V4 and V12 methods visualized by the 95% LOA (-117 to 62 and -236 to 132 mL, respectively). For all three measurement methods, the test-retest reliability was high (ICC 0.993-0.995) and the measurement error low (SEM%: 1.2%-1.4% and SRD%: 3.4%-3.8%). Conclusions: The higher agreement between the V4 and V8 methods than between V4 and V12, and the high test-retest reliability in LLV measurements support the V8 method to replace the V4 method in persons with LLL.

Reliability of a pediatric sleep endoscopy scoring system.

The surgical management of Obstructive Sleep Apnea (OSA) may be guided by Drug Induced Sleep Endoscopy (DISE), but there is no universally accepted scoring system for DISE in children. The purpose of this study is to compare a novel system to the more commonly used VOTE (Velum, Oropharynx, Tongue base, Epiglottis) system. A total of thirty pediatric DISE videos were reviewed and scored twice by 5 raters with a range of experience levels. The videos were scored using both the VOTE and the new scoring systems. The raters were also asked to recommend surgical intervention based on the DISE exam alone. Intra-rater test-retest analysis of the responses was conducted using weighted kappa (WK) statistic and percentage agreement (PA), respectively. Inter-rater reliability analysis of responses was evaluated using Krippendorff's alpha reliability coefficient (KA). Using a proportional odds model, a comparison of the weighted kappa statistic for the VOTE and the novel scoring systems was conducted. For the novel scoring system, the intra-rater test-retest WK coefficient was 0.62 and 0.87 and the PA was 64% and 82% at the 25th and 75th percentiles, respectively. For the VOTE system, the intra-rater test-retest WK coefficient was 0.50 and 1.00 and PA was 75% and 100% at the 25th and 75th percentiles, respectively. KA was 0.36 and 0.77at the 25th and 75th percentiles. In addition, responses to the surgical intervention survey analysis yielded a test-retest WK coefficient of 0.40 and 1.00 and a PA 71%-100% at the 25th and 75th percentiles, respectively. KA was 0.40 and 0.61at the 25th and 75th percentiles, respectively. There was no significant difference between the 2 scoring systems on the WK statistic (p=.15), but significant difference on PA (p=.01). Our novel scoring system demonstrated intra-rater test-retest and inter-rater reliability similar to the VOTE system, includes more sites of potential airway obstruction, and has potential for widespread use.

Reliability and Convergent Validity of Digital Photography in Assessing Postural Orientation of Children with Cerebral Palsy: A Methodological Study

Background: This study aimed to assess the test-retest intra-rater reliability and convergent validity of digital photography (DP) in detecting the postural orientation of children with cerebral palsy (CP). Methods: The study recruited children with various types of CP with the Gross Motor Function Classification System level I or II and spasticity &lt; 2 on the Ashworth Scale, without any visual or cognitive impairments. Children who had undergone any surgical intervention or received a botulinum toxin injection within the previous six months were excluded. A digital camera was fixed at 1.5 meters from the participants at the height of 90 cm. Non-reflective markers were attached to eight anatomical landmarks to localize the upper and lower center of mass on both sides. The same examiner took three digital photos to detect intra-rater reliability using the intraclass correlation coefficient (ICC). Pearson's correlation and linear regression analysis were used to assess the convergent validity of the DP method compared with the Pediatric Balance Scale (PBS) scores. Results: Thirty children (7.44 ± 2.38 years) were assessed to test the reliability of DP, and 55 others (8.06 ± 2.19 years) participated in the convergent validity study. Intra-rater reliability was found to be perfect (ICC &gt; 0.995) and there was a strong significant negative correlation between DP measures and PBS scores (Pearson's correlation &gt; 0.75) with high adjusted R2 (R2 &gt; 0.567), indicating goodness of fit between the measures. Conclusions: Digital photography (DP) is a reliable and valid method for assessing postural orientation in children with various types of CP.

Measuring the Reliability of Postural Sway Measurements for a Static Standing Task: The Effect of Age

Background: A force plate is used to determine the ability to balance ability. However, only some medical centers or laboratories are equipped with force plates because they are costly so a low-cost force plate is required for home care or health care institutes. Few studies compare the reliability of postural sway measurements in terms of age. This study proposes a low-cost force plate to select reliable parameters to evaluate postural sway. Objectives: To determine the intra-rater reliability of a novel force plate and the effect of age difference on the intra-rater test-retest reliability for the center of pressure (COP). Methods: Forty participants were enrolled for this study: 20 youths and 20 older adults. Participants stood on a custom-made and low-cost force plate with eyes opened and eyes closed to measure COP-related parameters. The within-day test-retest reliability was measured at two sessions on the same day and the between-days reliability was measured on two different days. The COP-related parameters include the average velocity of COP, the average velocity in the antero-posterior and medio-lateral directions, the mean distance of COP and the mean distance in the antero-posterior and medio-lateral directions. An intra-class correlation coefficient test with one-way random model was performed to determine the reliability of different variables within-days and between-days. The results were presented in single measurement of intraclass correlation coefficient (ICC), the standard error of measurements, and the minimal detectable changes of each COP-related parameters. Results: The novel low-cost force plate demonstrates excellent reliability in terms of the COP velocity related parameters for within- and between-day measurements. The ICC of COP distance related parameters were good to excellent reliability for between-day measurements (range: 0.43–0.84). Older adults demonstrated excellent reliability in terms of the mean distance for antero-posterior and the results were better than those for younger participants for the eyes-opened and eyes-closed conditions. The reliability in terms of the mean distance for medio-lateral was poor to good for older adults (range: 0.38–0.55), and excellent for younger participants. Conclusion: The novel and low-cost force plate reliably measured balance and age affects the reliability of different COP variables, so the results of this study were pertinent to the selection of COP measures.

Intrarater reliability of the Abilitator—a self-report questionnaire on work ability and functioning aimed at the population in a weak labour market position: a test–retest study

ObjectivesThe Abilitator is a patient-reported outcome measure (PROM) of work ability and functioning of those in a weak labour market position. It covers items for work ability and self-rated health,...

Test-Retest Reliability of the Coronary Heart Disease Damp Phlegm and Blood Stasis Pattern Questionnaire: Results from a Multicenter Clinical Trial.

Background Damp phlegm and blood stasis pattern (DPBSP) is the main pattern in coronary heart disease (CHD) patients. To quantify and standardize the diagnosis of DPBSP, questionnaires are usually administered. The CHD Damp Phlegm and Blood Stasis Pattern Questionnaire (CHD-DPBSPQ) is the standard metric for measuring CHD-DPBSP signs and symptoms in practice and clinical research. The CHD-DPBSPQ has moderate diagnostic efficiency, as evidenced by its receiver operating characteristic curves. Furthermore, and high reliability and validity have been shown in some studies but not in a multicenter clinical trial. Our purpose was to evaluate the test-retest reliability of a proprietary CHD-DPBSPQ. Methods The CHD-DPBSPQ uses a standard procedure for measuring symptoms. The (interrater) reliability and validity of this questionnaire have been previously studied. Here, we evaluated the test interval and weighted kappa value of items of test-retest (intrarater) reliability of the CHD-DPBSPQ. The test-retest reliability was evaluated by the intraclass correlation coefficient (ICC) for the total CHD-DPBSPQ score and the phlegm domain and blood stasis domain scores. Weighted kappa statistics were calculated for the individual CHD-DPBSPQ items. Results Using the CHD-DPBSPQ, 79 patients with late-stage CHD who were participating in a multicenter clinical trial were assessed twice. The ICCs for the CHD-DPBSPQ score were as follows: 0.827 for the total CHD-DPBSPQ, 0.778 for the phlegm domain score, and 0.828 for the blood stasis domain score. The reliability was slightly better in patients whose test interval was ≤14 days. The weighted kappa values of individual items showed moderate consistency. Conclusions The CHD-DPBSPQ was found to have excellent test-retest reliability in this sample of patients.

Rehabilitative ultrasound imaging of the levator scapula muscle at rest and during contraction: Technical description and reliability

BackgroundAltered scapular muscle activity is associated with abnormal scapular motions and shoulder pain. Hence, quantification of these activities is a challenging issue. Objectives: The purposes of this study were to establish the reliability of measuring levator scapula muscle thickness and to examine how thickness of this muscle changes with contraction. MethodsTwenty-one asymptomatic individuals (mean age 22.29 ± 2.17 years) participated in this study. Three separate ultrasound images of the levator scapula muscle were captured at the neck-shoulder junction at rest and during a loaded isometric contraction. The procedures were repeated twice, four to seven days apart to establish intra-rater test-retest reliability. Interclass correlation coefficients (ICC) and standard error of measurement (SEM) were used to determine the reliability, and a paired t-test was performed to examine the difference in muscle thickness between two conditions. ResultsThe results demonstrated that intra-examiner reliability was good at rest (ICC = 0.88, SEM = 1.16 mm) and excellent during loaded isometric contraction (ICC = 0.95, SEM = 0.91 mm). Furthermore, the thickness of levator scapula muscle significantly increased from rest to the loaded isometric contraction (Effect size = 1.99, P < 0.001). ConclusionThis study demonstrates that the thickness of the levator scapula muscle can be measured reliably at the neck-shoulder junction. Furthermore, ultrasound measures can reliably detect changes in muscle thickness from rest to a contracted state. Therefore, if the need exists to evaluate muscle morphology before and after any treatment strategy, thickness measurement of levator scapula can be determined reliably using ultrasound.

Investigator's Global Assessment of Chronic Prurigo: A New Instrument for Use in Clinical Trials.

Chronic prurigo is a pruritic disease characterized by the development of pruriginous lesions due to scratching. The number of lesions is representative of the stage of the disease, while the presence of excoriations reflects the scratching activity. Aim of this study was to validate a new developed tool for the objective assessment of chronic prurigo. Investigator’s Global Assessment scales for stage and activity were completed for 187 patients with chronic prurigo, who also reported patient-reported outcomes for itch intensity and quality of life. To assess the reliability and objectivity of the Investigator’s Global Assessment, 5 independent raters completed the Investigator’s Global Assessment scales for 8 patients twice. The scores increased with increased intensity of pruritus. The Investigator’s Global Assessment stage scales correlated strongly with each other (Kendall’s-tau-b 0.62) and moderately with the Investigator’s Global Assessment activity scale (Kendall’s-tau-b 0.47). Intra-rater test–retest reliability was excellent for all items, while the congruence among raters was very good for Investigator’s Global Assessment – chronic prurigo activity (Kendall’s W 0.84) and good for Investigator’s Global Assessment stage scales (Kendall’s W 0.747). Investigator’s Global Assessment – chronic prurigo stage and activity are thus the best Investigator’s Global Assessment instruments for use in assessing chronic prurigo.

Hand-held dynamometry for assessment of muscle strength in patients with inflammatory myopathies.

Muscle weakness in idiopathic inflammatory myopathies (IIMs) is conventionally assessed using manual muscle testing (MMT). However, more objective tools must be developed to accurately and reliably quantify muscle strength in myositis patients. Hand-held dynamometry (HHD) is a quantitative, portable device with reported reliability in neuromuscular disorders. Our aim was to assess the reliability, validity and responsiveness of HHD in myositis. Myositis patients [DM, necrotizing myopathy (NM), PM and anti-synthetase syndrome] evaluated at the University of Pittsburgh myositis centre were prospectively enrolled. Each patient was assessed at 0, 3 and 6 months for validated outcome measures of myositis disease activity and physical function. At each visit, muscle strength was assessed using both MMT and HHD (Micro FET2, Hoggan Health Industries, Draper, UT, USA). The reliability, validity and responsiveness of the HHD was assessed using standard statistical methods. Fifty IIM patients (60% female; mean age 51.6 years; 6 PM, 9 NM, 24 DM and 11 anti-synthetase syndrome) were enrolled. HHD showed strong test-retest intrarater reliability (r = 0.96) and interrater reliability (r = 0.98). HHD correlated significantly with the MMT score (r = 0.48, P = 0.0006) and myositis disease activity and functional measures. Longitudinal analysis showed a significant and strong association between the HHD and MMT as well as 2016 ACR/EULAR myositis response criteria (r = 0.8, P < 0.0001) demonstrating responsiveness. The mean effect size and standardized response mean of HHD was large: 0.95 and 1.03, respectively. MMT had a high ceiling effect compared with HHD. HHD demonstrated strong reliability, construct validity and responsiveness in myositis patients. External validation studies are required to confirm these findings.