Linear Weighted Kappa Coefficients Research Articles

Reliability of the assessment of the clinical dementia rating scale from the analysis of medical records in comparison with the reference method

BackgroundThe Clinical Dementia Rating (CDR) scale allows to detect the presence of dementia and to assess its severity, however its evaluation requires a significant time (45 min). We evaluated the agreement between two methods of collection of the CDR: face-to-face interview or based on the information available in the patient’s medical record.MethodsThe CLIMER study was conducted among patients attending a memory center. The CDR scale was evaluated during face-to-face interviews between neuropsychologists and patients and their caregivers and based on blind analysis of the information of the patients’ medical record by neuropsychologists. The agreement of the CDR sum of boxes (CDR-SB), the 5-point scale CDR and the different domains of the CDR evaluated between the different methods was measured using intraclass correlation (ICC) coefficient, Bland and Altman method, and linearly weighted Kappa.ResultsThe study included 139 patients (means ± SD age 80.1 ± 6, 58.3% women, 71.9% with dementia). The ICC for the CDR-SB score assessed by face-to-face and with all the information available in the patient’s medical record was 0.95 (95% CI: 0.93–0.97). The mean difference between the CDR-SB score assessed by face-to-face and with the medical record was 0.098 ± 1.036, and 92.4% of the patients lay within the 95% limits of agreement. The ICC for the 5-point scale CDR assessed by face-to-face and with the patient’s medical record was 0.92 (95% CI: 0.88–0.95) when all the available information of the patient’s medical record was used. The linear weighted Kappa coefficients was 0.79 (95% CI: 0.68–0.91) for the 5-point scale CDR comparison between the two evaluation methods. The analysis by domain of the CDR showed ICC ranging from 0.65 to 0.91 depending of the domains and the methods of evaluation.ConclusionThis study showed an excellent level of agreement of the evaluation of the CDR- SB and the 5-point scale CDR when using all the information of the patient’s medical record compared to the face-to-face interview.Trial registrationhttps//clinicaltrials.gov/ct2/show/NCT04763941 Registration Date 02/17/2021.

Validation of the Electronic Compassion Competence Scale: Paper-and-Pencil versus Web-Based Questionnaires

Purpose: This study aimed to determine the validity and reliability of the electronic Compassion Competence Scale (e-CCS).Methods: A cross-sectional, randomized, two-period crossover design was used. Nursing students from four South Korean universities were surveyed between June 2017 and April 2018. The participants were randomly assigned to one of three groups-paper/paper, electronic/electronic, and paper/electronic or electronic/paper-and a test-retest procedure was implemented. The reliability and validity of the e-CCS were evaluated using linear weighted kappa coefficients and intraclass correlation coefficients (ICCs). Internal consistency reliability was verified using linear weighted kappa coefficients and ICCs. Pearson’s correlation coefficients between the initial test and retest scores were all statistically significant.Results: The newly developed e-CCS was found to have good reliability and validity. We suggest that future research should increase sample heterogeneity by recruiting diverse age groups, nurses working in different nursing fields, and students from multiple colleges.Conclusion: This electronic instrument will help determine the differences in the level of compassion competence and devise interventions to improve compassion competence in nurses and nursing students. Further studies on enhancing compassion competence among nurses and nursing students may rely on the use of this electronic format.

Interrater agreement between children’s self-reported and their mothers’ proxy-reported dental anxiety: a Chinese cross-sectional study

BackgroundChildren's dental anxiety is common in dental clinics. This study aimed to determine the interrater agreement between children’s self-reported and their mothers’ proxy-reported dental anxiety and its affecting factors.MethodsIn this cross-sectional study performed in a dental clinic, primary school students and their mothers were assessed for enrollment eligibility. The Modified Dental Anxiety Scale plus Facial Image Scale (MDAS-FIS) was employed to test both the children’s self-reported and their mothers’ proxy-reported dental anxiety independently. The interrater agreement was analyzed using percentage agreement and the linear weighted kappa (k) coefficient. Factors affecting children’s dental anxiety were analyzed using univariate and multivariate logistic regression models.ResultsOne hundred children and their mothers were enrolled. The median ages of the children and mothers were 8.5 and 40.0 years old, respectively, and 38.0% (38/100) of the children were female. The scores of children’s self-reported dental anxiety were significantly higher than their mothers' proxy-reported dental anxiety (MDAS-Questions 1–5, all p < 0.05); moreover, there was no agreement between the two groups in terms of all anxiety hierarchies (kappa coefficient = 0.028, p = 0.593). In the univariate model, a total of seven factors (age, gender, maternal anxiety, number of dental visits, mother’s presence or absence, oral health status, and having siblings or not) were involved for analysis, and age [every 1-year increase, odds ratio (OR) = 0.661, 95% confidence interval (CI) = 0.514–0.850, p = 0.001], several dental visits (every 1 visit increase, OR = 0.409, 95% CI = 0.190–0.880, p = 0.022), and mother presence (OR = 0.286, 95% CI = 0.114–0.714, p = 0.007) were affecting factors. In the multivariate model, only age (every 1 year increase) and maternal presence were associated with 0.697-fold (95% CI = 0.535–0.908, p = 0.007) and 0.362-fold (95% CI = 0.135–0.967, p = 0.043) decreases in the risk of children’s dental anxiety during dental visits and treatment, respectively.ConclusionThere was no significant agreement between elementary school students’ self-reported dental anxiety and mothers’ proxy ratings of children’s dental anxiety, which suggests that self-reported dental anxiety by children should be encouraged and adopted, and the mother’s presence during dental visits is strongly recommended.

Automatic mammographic breast density classification in Chinese women: clinical validation of a deep learning model.

High breast density is a strong risk factor for breast cancer. As such, high consistency and accuracy in breast density assessment is necessary. To validate our proposed deep learning (DL) model and explore its impact on radiologists on density assessments. A total of 3732 mammographic cases were collected as a validated set: 1686 cases before the implementation of the DL model and 2046 cases after the DL model. Five radiologists were divided into two groups (junior and senior groups) to assess all mammograms using either two- or four-category evaluation. Linear-weighted kappa (K) and intraclass correlation coefficient (ICC) statistics were used to analyze the consistency between radiologists before and after implementation of the DL model. The accuracy and clinical acceptance of the DL model for the junior group were 96.3% and 96.8% for two-category evaluation, and 85.6% and 89.6% for four-category evaluation, respectively. For the senior group, the accuracy and clinical acceptance were 95.5% and 98.0% for two-category evaluation, and 84.3% and 95.3% for four-category evaluation, respectively. The consistency within the junior group, the senior group, and among all radiologists improved with the help of the DL model. For two-category, their K and ICC values improved to 0.81, 0.81, and 0.80 from 0.73, 0.75, and 0.76. And for four-category, their K and ICC values improved to 0.81, 0.82, and 0.82 from 0.73, 0.79, and 0.78, respectively. The DL model showed high accuracy and clinical acceptance in breast density categories. It is helpful to improve radiologists' consistency.

Inter-rater reliability of the Australian Spasticity Assessment Scale in poststroke spasticity.

To investigate the inter-rater reliability of the Australian Spasticity Assessment Scale (ASAS) in adult stroke patients with spasticity, two experienced clinicians rated the elbow flexor, wrist flexor, and ankle plantar flexor spasticity by using the ASAS in 85 persons with stroke. Unweighted and weighted (linear and quadratic) kappa statistics were used to calculate the inter-rater reliability for each muscle group. Unweighted kappa coefficients for elbow flexors (n = 83), wrist flexors (n = 80), and ankle plantar flexors (n = 77) were 0.67, 0.60, and 0.55, respectively. Linear and quadratic weighted kappa coefficients, respectively, were 0.77 and 0.87 for elbow flexors, 0.72 and 0.82 for wrist flexors, and 0.72 and 0.85 for ankle plantar flexors. The raters never disagreed by more than a single score in the rating of elbow flexors. On the contrary, the raters disagreed by more than a single score in three patients in the rating of ankle plantar flexors and in one patient in the rating of wrist flexors. The results suggested that inter-rater reliability of the ASAS differed according to the spastic muscle group assessed and the statistical method used. The strength of the agreement on the ASAS, an ordinal scale, ranged from good to very good when the weighted kappa values were considered.

SARC-F Capacity to Tracking Sarcopenia in Women From Manaus-Am

This study aimed to analyze the performance of SARC-F for the identification of sarcopenia in women from Manaus. For the analysis of the performance of the SARC-F, the criteria defined by the EWGSOP (2018) and the SDOC (2019) were considered. The sample consisted of 236 women aged 66.27±5.76 years. In addition to the SARC-F, a dynamometer was used to assess the muscle strength and gait speed was determined on a 2.44 m course. To identify sarcopenia, the following cut-off valueswere used: SARC-F ≥ 4 points; grip strength: EWGSOP <27kg for men and 16kg for women, SDOC <35.5kg for men and <20.0 kg for women; grip over body mass index (BMI, kg/m2) <1.05 for men and 0.79 for women; grip over body weight (BW, kg) <0.45 for men and <0.34 for women; gait speed ≤ 0.8 m/s for both men and women. The results revealed a prevalence of sarcopenia in 54% of the sample. The Kappa statistic intended to analyze the agreement between the SARC-F and the grip strength, the grip strength corrected for BMI or for BM, and the gait speed. The cross-classification analysis showed linear weighted Kappa coefficients near 0 with exception of gait speed (0.264±0.054, agreement in 61.2% of the participants) and grip strength when the cut off is 20 kg (0.248±0.062 - agreement in 63% of the participants). Cross-classification analysis between SARC-F and objective measures of physical capacity (grip strength and gait speed) showed linear weighted Kappa coefficients with slight or fair agreement in women from Manaus.

Interobserver and intraobserver variability in determining breast density according to the fifth edition of the BI-RADS® Atlas

ObjectiveTo determine the level of agreement within and between observers in the categorization of breast density on mammograms in a group of professionals using the fifth edition of the American College of Radiology’s BI-RADS® Atlas and to analyze the concordance between experts’ categorization and automatic categorization by commercial software on digital mammograms. MethodsSix radiologists categorized breast density on 451 mammograms on two occasions one month apart. We calculated the linear weighted kappa coefficients for inter- and intra-observer agreement for the group of radiologists and between the commercial software and the majority report. We analyzed the results for the four categories of breast density and for dichotomous classification as dense versus not dense. ResultsThe interobserver agreement among radiologists and the majority report was between moderate and nearly perfect for the analysis by category (κ = 0.64 to 0.84) and for the dichotomous classification (κ = 0.63 to 0.84). The intraobserver agreement was between substantial and nearly perfect (κ = 0.68 to 0.85 for 4 categories and k = 0.70 to 0.87 for the dichotomous classification). The agreement between the majority report and the commercial software was moderate both for the four categories (κ = 0.43) and for the dichotomous classification (κ = 0.51). ConclusionAgreement on breast density within and between radiologists using the criteria established in the fifth edition of the BI-RADS® Atlas was between moderate and nearly perfect. The level of agreement between the specialists and the commercial software was moderate.

Estudio de la variabilidad inter- e intraobservador en la determinación de la densidad mamaria según la 5.a edición del Atlas BI-RADS®

ObjectiveTo determine the level of agreement within and between observers in the categorization of breast density on mammograms in a group of professionals using the fifth edition of the American College of Radiology's BI-RADS® Atlas and to analyze the concordance between experts’ categorization and automatic categorization by commercial software on digital mammograms. MethodsSix radiologists categorized breast density on 451 mammograms on two occasions one month apart. We calculated the linear weighted kappa coefficients for inter- and intra-observer agreement for the group of radiologists and between the commercial software and the majority report. We analyzed the results for the four categories of breast density and for dichotomous classification as dense versus not dense. ResultsThe interobserver agreement among radiologists and the majority report was between moderate and nearly perfect for the analysis by category (κ=0.64 to 0.84) and for the dichotomous classification (κ=0.63 to 0.84). The intraobserver agreement was between substantial and nearly perfect (κ=0.68 to 0.85 for 4 categories and k=0.70 to 0.87 for the dichotomous classification). The agreement between the majority report and the commercial software was moderate both for the four categories (κ=0.43) and for the dichotomous classification (κ=0.51). ConclusionAgreement on breast density within and between radiologists using the criteria established in the fifth edition of the BI-RADS® Atlas was between moderate and nearly perfect. The level of agreement between the specialists and the commercial software was moderate.

Intra- and Interobserver Agreement in Hallux Valgus Angle Measurements on Weightbearing and Non-Weightbearing Radiographs

The choice of treatment of hallux valgus deformity is influenced by angles measured on radiographs. Angles of interest are the hallux valgus angle (HVA), 1,2-intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA), as well as the presence of first metatarsophalangeal joint (MTPJ) subluxation. Guidelines for measuring those angles have been distributed by American Orthopaedic Foot and Ankle Society (AOFAS), although the influence of weightbearing on these angles and its clinical relevance is not clear. We conducted a study to determine the influence of weightbearing and the inter- and intraobserver agreement in the measurement. A total of 104 patients were enrolled in this study. Both weightbearing and non-weightbearing radiographs were obtained. In 2 rounds, 2 orthopedic surgeons and 2 musculoskeletal radiologists measured the angles in blinded digital radiographs according to AOFAS guidelines. Agreement on measurement of HVA, IMA, and DMAA in both weightbearing and non-weightbearing radiographs, as well as the presence of MTPJ subluxation, was calculated using the linear-weighted kappa coefficient and the intraclass correlation coefficient (ICC). Examiner agreement strength was defined according to the guidelines of Landis and Koch. HVA decreases significantly with weightbearing, whereas IMA significantly increases. The change in magnitude was 1° to 2° on average. No significant influence on DMAA could be noted. Interobserver agreement was excellent in both weightbearing and non-weightbearing radiographs for HVA (ICC 0.99 and ICC 0.99, respectively), IMA (ICC 0.98 and ICC 0.86, respectively), and DMAA (ICC 0.95 and ICC 0.97, respectively). The agreement on presence of subluxation was moderate to good (Fleiss kappa 0.50 to 0.63). Weightbearing alters forefoot geometry significantly. Adhering to AOFAS guidelines yields excellent interobserver agreement on HVA, IMA, and DMAA. First MTPJ subluxation presence is not an alternative for DMAA. The magnitude of change in IMA and HVA is small and therefore not clinically important. Both weightbearing and non-weightbearing radiographs can be used for determination of the correct treatment of hallux valgus deformity.

Reliability of two functional clinical tests to evaluate trunk and lumbopelvic neuromuscular control and proprioception in a healthy population

ObjectivesThe need to accurately assess trunk and lumbopelvic proprioception and neuromuscular control is widely accepted. However, based on current literature, there is a lack of reliable clinical tests to evaluate these aspects in clinical practice. The objective of this study is to investigate intra- and inter-tester reliability of the lateral step down test and the lumbopelvic position–reposition test in a healthy population. MethodsProtocol and scoring methods were developed for the lateral step down test and lumbopelvic position–reposition test, used to assess trunk and lumbopelvic neuromuscular control and proprioception respectively. Each test was performed once by thirty participants and video analysis for test scoring was performed. Three items on the lateral step down test were scored to evaluate neuromuscular control and, four items on the lumbopelvic position–reposition test were scored to evaluate proprioception. Aggregate scores for each test were calculated based on the separate item scores. Intraclass correlation coefficients and linear weighted kappa coefficients were determined for intra- and inter-tester reliability. ResultsBased on the aggregate score, excellent intra- and inter-tester reliability (ICC (2,1)=0.73–0.88) was found for both tests. Moderate/almost perfect intra-and inter-tester agreement (K=0.62–0.91) was found for the separate items of the lateral step down test and fair/substantial agreement (K=0.25–0.76) for the items of the lumbopelvic position–reposition test. ConclusionCurrent testing protocol and scoring method for the lateral step down test is reliable. Adjustments for the scoring method of the lumbopelvic position–reposition test are warranted to improve reliability.

Interrater reliability of two gait performance measures in children with neuromotor disorders across two different settings.

To examine the interrater agreement of the two gait performance measures - the Functional Mobility Scale (FMS) and Gillette Functional Assessment Questionnaire - walking scale (FAQ) - within health professionals and parents in children with neuromotor disorders, measured in an inpatient setting and at home. Seventy-one children with a neuromotor diagnosis (44 males, 27 females; median age 12y 11mo [interquartile range 4y-10mo]) were consecutively recruited when starting an inpatient active gait rehabilitation programme. Physiotherapists and nurses independently scored the level of children's gait performance with the FMS and the FAQ, while parents' scores regarding the children's gait performance at home were obtained by interview or telephone call at the same measurement points. Linear weighted kappa coefficients were substantial to almost perfect for all comparisons. Kappa coefficients ranged from 0.62 to 0.85 for the FMS-5, from 0.79 to 0.92 for the FMS-50, from 0.83 to 0.90 for the FMS-500, and from 0.69 to 0.77 for the FAQ. Friedman tests did not reveal significant differences between the different rater groups. The unexpectedly high level of interrater agreement between parents, physiotherapists, and nurses demonstrates that the FMS and FAQ can reliably assess gait performance in an inpatient setting. Inpatient scores correspond well to the children's performance in their usual environment. The Functional Mobility Scale and Gillette Functional Assessment Questionnaire - walking scale measure gait performance reliably at home and in an inpatient setting. Physiotherapists, nurses, and parents reliably score gait performance. Inpatient gait performance scores correspond well to children's performance at home. Physiotherapists and nurses in an inpatient setting can reliably estimate gait performance at home.

Intraobserver and Interobserver Agreement of Magnetic Resonance Imaging for Reparability of Peripheral Meniscal Tears: What Criteria Really Matter?

The objective of the study was the determination of the intra- and interobserver agreement of three magnetic resonance imaging (MRI) criteria for reparability: a peripheral rim smaller than 4 mm, a tear longer than 10 mm, and homogenous aspect of meniscal tissue. In two rounds with an interval of at least 6 weeks, three orthopedic surgeons and three musculoskeletal radiologists studied the preoperative MRI scans of 63 patients with a longitudinal full-thickness medial or lateral meniscal tear. All patients had an arthroscopic meniscal repair. The blinded images were evaluated measuring the tear length and rim width and meniscal aspect was classified. Agreement was calculated using the linear-weighted kappa coefficient (κ) and the intraclass correlation coefficient (ICC). Examiner agreement strength was defined according to the guidelines of Landis and Koch. Intraobserver agreement was poor to good (κ, 0.12-0.72) for the classification of the meniscal aspect and decreased in lateral meniscal tears. The interobserver agreement for meniscal aspect was mainly poor to fair (κ, 0.09-0.53). The intraobserver reliability for measurement of the length of the meniscal tear was moderate to excellent (ICC, 0.51-0.80) for all observers in both rounds and moderate to good (ICC, 0.59-0.73) for measurement of the peripheral rim width. The interobserver agreement on tear length and rim width was moderate in both rounds (ICC, 0.58 and 0.50 in round 1; 0.50 and 0.50 in round 2, respectively). Tear length and rim width are the only two measurements with moderate to good agreement. However, these measurements do not predict reparability of longitudinal meniscal tears on MRI images.

The Verbal Rating Scale Is Reliable for Assessment of Postoperative Pain in Hip Fracture Patients.

Background. Hip fracture patients represent a challenge to pain rating due to the high prevalence of cognitive impairment. Methods. Patients prospectively rated pain on the VRS. Furthermore, patients described the changes in pain after raising their leg, with one of five descriptors. Agreement between paired measures on the VRS at rest and by passive straight leg raise with a one-minute interval between ratings at rest and three-minute interval for straight leg raise was expressed by kappa coefficients. Reliability of this assessment of pain using the VRS was compared to the validity of assessing possible change in pain from the selected descriptors. Cognitive status was quantified by the short Orientation-Memory-Concentration Test. Results. 110 patients were included. Paired scores with maximum disagreement of one scale point reached 97% at rest and 95% at straight leg raise. Linear weighted kappa coefficients ranged from 0.68 (95% CI = 0.59–0.77) at leg raise to 0.75 (95% CI = 0.65–0.85) at rest. Unweighted kappa coefficients of agreement in recalled pain compared to agreement of paired VRS scores ranged from 0.57 (95% CI = 0.49–0.65) to 0.36 (95% CI = 0.31–0.41). Interpretation. The VRS is reliable for assessment of pain after hip fracture. The validity of intermittent questioning about possible change in pain intensity is poor.

172. Development and Psychometric Testing of a British English Version of the Disabilities Arm Shoulder and Hand Questionnaire

Background: The DASH (developed in Canada) is a widely used outcome measure for upper limb conditions, consisting of 30 items: 21 regarding daily activity and 9 regarding impact of condition. The aim of this study was to develop a British English DASH and psychometrically test it in a UK population of people with rheumatoid arthritis (RA). Methods: The Institute of Work and Health (IWH) cross-cultural adaptation methods were followed: forward translation to British English; synthesis; expert review of equivalence and cognitive debriefing. Psychometric testing included internal consistency (Cronbach’s alpha); test-retest reliability (ICC(2,1), and concurrent validity (Pearson/Spearman Correlations). Adults with RA were recruited from 17 Rheumatology out-patient departments, who completed two test booklets three weeks apart, including the DASH, Health Assessment Questionnaire (HAQ20), SF36v2 and numeric rating scales for disease activity, hand pain, general pain and fatigue. Results: During translation and equivalence review, changes to use plain English and British English terminology were made (eg “do” not “perform”; jumper rather than pullover sweater). 31 people with RA were interviewed (age=63.42 (SD12.04) years, RA duration= 15.71(SD12.61) years). All DASH items were considered understandable and relevant. 340 completed the test 1 booklet: 251 women, 89 men; mean age = 62 (SD12); RA duration=14.44 (SD11.73); average pain score = 5 (IQR 2-7) and 273 completed the re-test. Reliability was good: alpha =0.98; ICC(2,1) = 0.98 (95% CI 0.97, 0.98). Linear weighted kappa coefficients were mostly good (i.e. 0.61 - 0.77) for the activity items (Q1-21), although one (Q17) was marginally lower at 0.58. Coefficients for the symptom/self-image items (Q22-30) were generally lower and mostly moderate, ranging from 0.50 - 0.66. DASH concurrent validity was strong: HAQ20 rs = 0.91; SF36v2 Physical Function r=-0.84; SF36v2 Bodily Pain r = -0.71; hand pain r = 0.75; pain r = 0.70; fatigue r=0.64. The DASH discriminated between good, moderate and poor self-reported disease activity (p=0.001). The MDC95 DASH score = 9.26. There were no floor and ceiling effects. Conclusion: The British English version of the DASH required some modifications, but then was deemed appropriate by people with RA in the UK. It had good reliability and validity. A British English DASH is available for the first time. Results were comparable to DASH studies in RA in other countries.

Inter-rater agreement between children's self-reported and parents' proxy-reported dental anxiety.

Healthcare professionals often rely on parents to provide accurate dental anxiety assessment for their children. To date no studies have reported on inter-rater agreement between children's self-reported and their parents'/guardians' proxy-reported dental anxiety in the UK. To assess the frequency of self-reported dental anxiety in 7-16-year-old children and the inter-rater agreement between children's self-reported and parent/guardian proxy-reported dental anxiety for their children. Data were collected prospectively from 7-16-year-old children and their parents/guardians attending two community dental clinics in Fife, Scotland (July 2012-January 2013). Dental anxiety was assessed using faces version of Modified Child Dental Anxiety Scale. Questionnaires were separately and independently completed by children and their accompanying parent or guardian. One hundred and thirty-two child-parent/guardian pairs participated in this study. Children's self-reported dental anxiety was 18% (n=24, 95% CI 12-25). Inter-rater agreement between children and their parent/guardian was poor for dental filling (linear weighted kappa coefficient 0.17) and tooth extraction (0.20), whereas other questions had fair inter-rater agreement (0.21-0.34). Parents' proxy-reported assessments significantly failed to recognise dental anxiety in 46% (n=11) dentally anxious children (p=0.0004). Parent/guardian proxy-reported dental anxiety differs from children's self-reported dental anxiety suggesting children should be encouraged to self-report their dental anxiety.

Summary of: Inter-rater agreement between children's self-reported and parents' proxy-reported dental anxiety.

Background Healthcare professionals often rely on parents to provide accurate dental anxiety assessment for their children. To date no studies have reported on inter-rater agreement between children's self-reported and their parents'/guardians' proxy-reported dental anxiety in the UK. Aims To assess the frequency of self-reported dental anxiety in 7–16-year-old children and the inter-rater agreement between children's self-reported and parent/guardian proxy-reported dental anxiety for their children. Methods Data were collected prospectively from 7–16-year-old children and their parents/guardians attending two community dental clinics in Fife, Scotland (July 2012–January 2013). Dental anxiety was assessed using faces version of Modified Child Dental Anxiety Scale. Questionnaires were separately and independently completed by children and their accompanying parent or guardian. Results One hundred and thirty-two child-parent/guardian pairs participated in this study. Children's self-reported dental anxiety was 18% (n = 24, 95% CI 12–25). Inter-rater agreement between children and their parent/guardian was poor for dental filling (linear weighted kappa coefficient 0.17) and tooth extraction (0.20), whereas other questions had fair inter-rater agreement (0.21–0.34). Parents' proxy-reported assessments significantly failed to recognise dental anxiety in 46% (n = 11) dentally anxious children (p = 0.0004). Conclusion Parent/guardian proxy-reported dental anxiety differs from children's self-reported dental anxiety suggesting children should be encouraged to self-report their dental anxiety.

Reproducibility of Peripapillary Retinal Nerve Fiber Layer Thickness Measured by Spectral Domain Optical Coherence Tomography in Pseudophakic Eyes

PurposeTo assess the reproducibility of circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurement (measurement agreement) and its color-coded classification (classification agreement) by Cirrus spectral domain optical coherence tomography (OCT) in pseudophakic eyes.MethodsTwo-hundred five participants having glaucoma or glaucoma suspected eyes underwent two repeated Cirrus OCT scans to measure cpRNFL thickness (optic disc cube 200 × 200). After classifying participants into three different groups according to their lens status (clear media, cataract, and pseudophakic), values of intra-class coefficient (ICC), coefficient of variance, and test-retest variability were compared between groups for average retinal nerve fiber layer (RNFL) thicknesses and that corresponding to four quadrant maps. Linear weighted kappa coefficients were calculated as indicators of agreement of color code classification in each group.ResultsICC values were all excellent (generally defined as 0.75 to 1.00) for the average and quadrant RNFL thicknesses in all three groups. ICC values of the clear media group tended to be higher than those in the cataract and pseudophakic groups for all quadrants and average thickness. Especially in the superior and nasal quadrants, the ICC value of the cataract group was significantly lower than that of the clear media and pseudophakic groups. For average RNFL thickness, classification agreement (kappa) in three groups did not show a statistically significant difference. For quadrant maps, classification agreement (kappa) in the clear media group was higher than those in the other two groups.ConclusionsAgreement of cpRNFL measurement and its color code classification between two repeated Cirrus OCT scans in pseudophakic eyes was as good as that in eyes with clear crystalline lens. More studies are required to ascertain the effect of lens status on the reproducibility of Cirrus OCT according to different stages of glaucoma patients.

Translation, cross-cultural adaptation to Brazilian- Portuguese and reliability analysis of the instrument Rapid Entire Body Assessment-REBA.

Background: Observational instruments, such as the Rapid Entire Body Assessment, quickly assess biomechanical risks present in the workplace. However, in order to use these instruments, it is necessary to conduct the translational/cross-cultural adaptation of the instrument and test its measurement properties. Objectives: To perform the translation and the cross-cultural adaptation to Brazilian-Portuguese and test the reliability of the REBA instrument. Method:The procedures of translation and cross-cultural adaptation to Brazilian-Portuguese were conducted following proposed guidelines that involved translation, synthesis of translations, back translation, committee review and testing of the pre-final version. In addition, reliability and the intra- and inter-rater percent agreement were obtained with the Linear Weighted Kappa Coefficient that was associated with the 95% Confidence Interval and the cross tabulation 2×2. Results: The procedures for translation and adaptation were adequate and the necessary adjustments were conducted on the instrument. The intra- and inter-rater reliability showed values of 0.104 to 0.504, respectively, ranging from very poor to moderate. The percentage agreement values ranged from 5.66% to 69.81%. The percentage agreement was closer to 100% at the item 'upper arm' (69.81%) for the Intra-rater 1 and at the items 'legs' and 'upper arm' for the Intra-rater 2 (62.26%). Conclusions: The processes of translation and cross-cultural adaptation were conducted on the REBA instrument and the Brazilian version of the instrument was obtained. However, despite the reliability of the tests used to correct the translated and adapted version, the reliability values are unacceptable according to the guidelines standard, indicating that the reliability must be re-evaluated. Therefore, caution in the interpretation of the biomechanical risks measured by this instrument should be taken.

Effect of signal strength on reproducibility of circumpapillary retinal nerve fiber layer thickness measurement and its classification by spectral-domain optical coherence tomography

To assess the effect of signal strength (SS) on the reproducibility of circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurement (measurement agreement) and its color-coded classification (classification agreement) by Cirrus spectral-domain optical coherence tomography (OCT). Seven hundred and eighty-nine participants, consecutively enrolled from December 2009 to August 2010, underwent two repeated Cirrus OCT scans to measure cpRNFL thickness (optic disc cube 200 × 200). Intraclass correlation (ICC) and linear-weighted kappa coefficient (κ) were calculated as indicators for cpRNFL measurement and classification agreement. The difference in cpRNFL thickness measurements between repeated OCT scans (inter-scan measurement difference) was correlated with mean SS, SS change or difference between repeated OCT scans (inter-scan SS difference), and average cpRNFL thickness. Mean SS was negatively correlated with inter-scan SS difference and was positively correlated with the inter-scan measurement difference. Repeated scans with SS change (inter-scan SS difference = 1 or 2) showed larger variability than scans without SS change (inter-scan SS difference = 0) in total average cpRNFL and all quadrant maps except for the nasal quadrant. Multivariate analysis revealed that inter-scan measurement differences increased in subjects with thinner cpRNFL thicknesses and in scans with lower mean SS and higher inter-scan SS differences. Measurement agreement (ICC) in groups with larger inter-scan SS differences (=2) was lower than those with smaller inter-scan SS differences (=0 or 1) in their average cpRNFL and inferior quadrant maps. Classification agreement (κ) in groups with larger inter-scan SS differences (=2) was lower than those with smaller inter-scan SS differences (=0 or 1) in their average cpRNFL and quadrant maps (superior and inferior quadrant) although statistically not significant. Special attention should be paid when comparing the cpRNFL thickness measurement and color-coded classification of 2 or more Cirrus OCT scans as the agreements may be susceptible to SS differences.

Effect of signal strength on reproducibility of peripapillary retinal nerve fiber layer thickness measurement and its classification by time-domain optical coherence tomography

To assess the effect of signal strength (SS) on reproducibility of peripapillary retinal nerve fiber layer (RNFL) thickness measurement (measurement agreement) and its color-coded classification (classification agreement) by time-domain optical coherence tomography (OCT). Two consecutive Stratus OCT scans with the Fast RNFL protocol were performed in 658 participants. Intraclass correlations and the linear-weighted kappa coefficient were calculated as indicators of RNFL measurement and classification agreement in participants grouped according to the difference in SS between consecutive OCT scans (interscan SS difference). Groups with a larger interscan SS difference (= 2) had lower measurement agreement than those with a smaller interscan SS difference (0 or 1) for the temporal quadrant and total average RNFL. Classification agreement for the nasal quadrant was lower in the groups with a larger interscan SS difference (= 2) than in those with a smaller interscan SS difference. The tendency of SS to affect classification and measurement agreement remained similar in the group with thinner RNFL thickness (≤85 μm), but not in the group with thicker RNFL. Careful attention should be paid when comparing two or more OCT scans for RNFL thickness measurement or its color-coded classification as the agreement may be sensitive to SS differences.