Level Of Interexaminer Agreement Research Articles

Concordância inter-avaliador de testes musculoesqueléticos e viscerais para avaliar a região pélvica em mulheres com incontinência urinária de esforço

An accurate assessment of the pelvic region is necessary to provide reproducibility in research and clinical practice. The aim of this study, which is part of a randomized controlled trial, was to test the level of inter-examiner agreement of musculoskeletal and visceral tests to assess the pelvic region in women with stress urinary incontinence. A cross-sectional study was conducted with 20 women between 30 and 60 years old. Nine musculoskeletal tests were performed (standing and sitting flexion tests, Gillet test, iliac, sacral, and bladder position and mobility tests, psoas test, and abdomen assessment) and one pain provocation test for the sacroiliac joint (Patrick Faber test). Descriptive statistics were used, and the inter-examiner agreement was assessed using the Kappa coefficient (k). Significant agreement was found for the Patrick-Faber test and abdomen type (k = 0.649, p< 0.0001 and k = 0.342, p< 0.342, respectively). No significant agreement was observed in the remaining tests. In general, the tests' reproducibility in this study among evaluators to assess women's pelvic region with stress urinary incontinence is very weak.

Remote diagnosis of traumatic dental injuries using digital photographs captured via a mobile phone.

Intra-oral photographs have been aided diagnosis of several pathologies in teledentistry. Mobile phone cameras may produce high-quality photographs, presenting itself as a viable tool for remote diagnosis of traumatic dental injuries. To evaluate the levels of interexaminer agreement in cases of traumatic dental injuries when comparing diagnoses conducted in person and remotely. The sample included 40 patients with 73 traumatized teeth, and a total of 90 diagnoses, who had presented to two dental clinics, one private, and the other public, in Brazil's Federal District. The dental history and clinical examination data were registered in electronic forms, and digital photographs were captured with a mobile phone camera and uploaded to a cloud drive. Six remote examiners formulated their diagnoses based solely on photographic analysis. Thereafter, they were provided with additional clinical data and asked to provide a second round of diagnoses. These diagnoses were compared to those conducted in person, which were considered the gold standard. The data were analyzed with Gwet's AC1 interexaminers' measure to evaluate the agreement between the in-surgery and remote diagnoses. The levels of interexaminer agreement between the in-surgery and remote diagnoses formulated exclusively with images were 0.83 or higher (95% confidence interval: 0.73-0.91), and 0.93 or higher (95% confidence interval: 0.88-0.97), when clinical information was available. The precision of the remote diagnoses was comparable to the diagnoses conducted in person. The levels of interexaminer agreement were higher when clinical data were included with the images. Mobile phones may be an effective tool for capturing images that assist in the remote diagnosis of traumatic dental injuries.

Evaluating the reliability of multiple assessments of PTSD symptomatology: Multiple examiners, one patient

The objective of this investigation was to assess the inter-examiner reliability of PTSD symptomatology by 12 clinical examiners who evaluated independently a single-case Vietnam-Era veteran, using videotaped clinician interviews with The Clinician Administered PTSD Scale-1 (CAPS-1). A second patient was utilized for cross-validation purposes. Data were analyzed using a specially designed Kappa statistic. In previous reliability assessments of the CAPS-1, a pair of examiners assessed multiple patients, and demonstrated evidence of high reliability and validity. As in previous reliability assessments, reliability was assessed both for frequency and intensity of PTSD symptomatology in both patients. Results indicated that the reliability levels of the CAPS-1 were consistently and almost exclusively in the excellent to perfect levels of inter-examiner agreement, as based upon both global assessments and on a symptom-by-symptom basis. The results of this investigation are interpreted in the broader framework of their applicability to assessing inter-examiner agreement in clinical trials or other large multi-site studies.

The effect of training on the inter-examiner and intra-examiner reliability of the seated flexion test and assessment of pelvic anatomical landmarks with palpation

Objective To investigate the effect of training and standardisation of technique on the inter-examiner and intra-examiner reliability of static palpation of pelvic landmarks and the seated flexion test (SFT), which are commonly advocated for the detection of sacroiliac dysfunction. Methods Two groups of final year osteopathic students ( N = 10) examined 10 asymptomatic female subjects for symmetry of pelvic landmarks and the SFT. One group of examiners ( n = 5) attended two training sessions in order to standardise their examination techniques, whereas those in the ‘untrained’ group ( n = 5) did not. Three assessments of the symmetry of the anterior superior iliac spine (ASIS), posterior superior iliac spine (PSIS), medial malleoli (MM), sacral inferior lateral angle (SILA) and SFT were performed on every subject by all examiners. Examiner agreement was analysed using Cohen's weighted kappa ( κ) statistic. Results The trained group produced slightly higher intra-examiner reliability for three of the four landmarks and the SFT, and slightly higher inter-examiner reliability for two of the four landmarks and the SFT. Intra-examiner reliability was higher than inter-examiner reliability. The level of inter-examiner agreement in the trained group was fair for palpation of the MM (trained, κ = 0.31; untrained, κ = 0.28) and ASIS (trained, κ = 0.24; untrained, κ = −0.01), slight for the SFT (trained, κ = 0.14; untrained, κ = 0.07), PSIS (trained, κ = 0.08; untrained, κ = 0.15) and SILA (trained, κ = 0.04; untrained, κ = −0.01). Conclusions Those examiners who attended training sessions achieved a marginal increase in intra-examiner and inter-examiner reliability, but concordance was still less than acceptable for a clinical test. The osteopathic profession should reconsider the use of these clinical tests purported to indicate sacroiliac dysfunction in view of their unestablished validity and poor inter-examiner reliability.