Low Intraclass Correlation Research Articles

Verifying the value of existing frameworks for formulary review at a large academic health system: assessing inter-rater reliability

BACKGROUND: The value assessment framework (VAF) is one approach to assessing the evidence and value of medications. VAFs are a way to measure and communicate the value of medications and other health care technologies for decision-making purposes. Given the increasing number of high-cost medications, challenging formulary inquiries, and critiques of currently available tools, health systems need to explore a standardized way to incorporate value assessment into formulary decision making. OBJECTIVES: To (a) evaluate existing VAFs by measuring inter-rater reliability among typical clinicians completing formulary reviews and (b) explore general implications of applying these tools to formulary decision making for all medications at a large academic health system. METHODS: This was a retrospective, observational study at a single health system. A list of medications added, denied, and removed from the system formulary from September 1, 2013, through August 31, 2018, was collected. Published VAFs, such as the American Society of Clinical Oncology (ASCO) Value Framework, European Society of Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale, National Comprehensive Cancer Network (NCCN) Evidence Blocks, American College of Cardiology/American Heart Association Value Framework, and the incremental cost-effectiveness ratio (ICER) calculation were applied by 3 different reviewer groups. The primary outcome was inter-rater reliability among the 3 different reviewers for a given framework. Cohen's weighted kappa and the intraclass correlation coefficient (ICC) were used to assess inter-rater reliability. RESULTS: The frameworks were applied to 94 medications. The VAFs with the highest ICCs between all 3 raters were NCCN (0.635; 95% CI = 0.387-0.823) and ASCO (0.634; 95% CI = 0.370-0.832), both indicating moderate inter-rater reliability. The VAFs with the lowest ICCs were ESMO (0.368; 95% CI = 0.126-0.611) and ICER (0.159; 95% = CI -0.018-0.365), with ICCs corresponding to poor reliability. CONCLUSIONS: Because high-cost medications are a challenge to health systems, VAFs may be beneficial to target formulary decision making in this setting. Applying VAFs proactively may improve interrater reliability and usability in formulary decision making. DISCLOSURES: No outside funding supported this study. The authors have nothing to disclose.

VALIDITY OF FIVE FORMULAS TO ESTIMATE 24-HOUR URINARY SODIUM BY SPOT URINE SAMPLES IN ADULTS LIVING IN NORTHEAST CHINA

Objective: Although several formulas from spot urine have been used to assess 24-hour urinary sodium excretion in order to estimate salt intake, the validity in Chinese adult population is uncertain. The objective was to evaluate the accuracy of five formulas, including INTERSALT without urine potassium, Kawasaki, Tanaka, Uechi simple-mean, and a new formula, by spot urinary to predict 24-hour sodium excretion in adults living in northeast China. Design and method: This was a multi-center clinical study, conducted from April 2016 to October 2019. There were 1092 hospitalized patients aged from 18 to 85 years enrolled. Five different formulas were used to predict 24-hour urinary sodium (UNa) excretions by spot morning urinary samples. Actual urinary sodium excretion was measured from 24-hour urine samples. The estimated value is compared with the actual value by examining bias (observed minus predicted UNa), the intraclass correlation coefficients (ICC), and Bland–Altman plots. The differences between actual and estimated sodium excretion across subgroups divided by salt intake were analyzed. Results: The average excretion of sodium was 2958.15 mg/d, which is equivalent to 7.51 g/day of sodium chloride intake. Formulas produced biases for actual urinary sodium were 328.31 mg/d for INTERSALT, 517.56 mg/d for new formula, 897.59 mg/d for Tanaka, 1169.06 mg/d for Uechi, 1971.12 mg/d for Kawasaki. The correlation was positive for all equations, the highest and lowest ICC were 0.37 for new formula and 0.3 for Uechi respectively. There was no significant difference in number of patients which were beyond the mean ± 1.96 standard deviation. The least mean biases in lower salt intake subgroup (UNa no more than 2362.20 mg/d) and middle salt intake subgroup of five equations were 1283.00 mg/d and 74.46 mg/d respectively, which are calculated by INTERSALT. The least mean biases in higher salt intake subgroup (UNa more than 4724.41 mg/d) was 147.62 mg/d for Uechi. Conclusions: INTERSALT without urine potassium and new formula may offer a good performance of mean 24-h sodium estimation in lower and middle salt intake subgroups for adults living in Northeast China. The Uechi simple-mean formula performed best in higher salt intake subgroup.

Development and Validation of a Perceived Barriers to Physical Activity Scale for Low-Income Adolescents.

Low-income adolescents' physical activity (PA) levels fall below current recommendations. Perceived barriers to physical activity (PBPA) are likely significant predictors of PA levels; however, valid and reliable measures to assess PA barriers are lacking. This manuscript describes the development of the PBPA Survey for Low-Income Adolescents. A mixed-method approach was used. Items identified from the literature and revised for clarity and appropriateness (postcognitive interviews) were assessed for test-retest reliability with 74 adolescents using intraclass correlation coefficient. Items demonstrating low intraclass correlation coefficients or floor effects were removed. Both exploratory factor analysis and confirmatory factor analysis analyses (n = 1914 low-income teens) were used to finalize the scale; internal consistency was assessed by Cronbach's alpha. Concurrent validity was established by correlating the PBPA with the PA questionnaire for adolescents using a Spearman correlation. The exploratory factor analysis yielded a 38-item, 7-factor solution, which was cross-validated by confirmatory factor analysis (comparative-fit index, nonnormed fit index = .90). The scale's Cronbach's alpha was .94, with subscales ranging from .70 to .88. The PBPA Survey for Low-Income Adolescents' concurrent validity was supported by a negative PA questionnaire for adolescents' correlation values. The PBPA Survey for Low-Income Adolescents can be used to better understand the relationship between PBPA among low-income teens. Further research is warranted to validate the scale with other adolescent subgroups.

Stepwise tailoring and test-retest of reproducibility of an ethnic-specific FFQ to estimate nutrient intakes for South Asians in New Zealand.

To develop and test-retest the reproducibility of an ethnic-specific FFQ to estimate nutrient intakes for South Asians (SA) in New Zealand (NZ). Using culturally appropriate methods, the NZFFQ, a validated dietary assessment tool for NZ adults, was modified to include SA food items by analysing foods consumed by SA participants of the Adult Nutrition Survey, in-person audit of ethnic food stores and a web scan of ethnic food store websites in NZ. This was further refined via three focus group discussions, and the resulting New Zealand South Asian Food Frequency Questionnaire (NZSAFFQ) was tested for reproducibility. Auckland and Dunedin, NZ. Twenty-nine and 110 males and females aged 25-59 years of SA ethnicity participated in the focus group discussions and the test-retest, respectively. The development phase resulted in a SA-specific FFQ comprising of 11 food groups and 180 food items. Test-retest of the NZSAFFQ showed good reproducibility between the two FFQ administrations, 6 months apart. Most reproducibility coefficients were within or higher than the acceptable range of 0·5-0·7. The lowest intraclass correlation coefficients (ICC) were observed for β-carotene (0·47), vitamin B12 (0·50), fructose (0·55), vitamin C (0·57) and selenium (0·58), and the highest ICC were observed for alcohol (0·81), iodine (0·79) and folate (0·77). The ICC for fat ranged from 0·70 for saturated fats to 0·77 for polyunsaturated fats. The ICC for protein and energy were 0·68 and 0·72, respectively. The developed FFQ showed good reproducibility to estimate nutrient intakes and warrants the need for validation of the instrument.

Test-retest reproducibility of dopamine transporter density measured with [18F]FP-CIT PET in patients with essential tremor and Parkinson's disease.

18F-labeled fluoropropyl-carbomethoxylodopropyl-nor-ß-tropane ([18F]FP-CIT) positron emission tomography (PET) is a useful tool for evaluating disease progression in Parkinson's disease (PD) patients. We evaluated the test-retest reproducibility of [18F]FP-CIT PET measures in essential tremor (ET) and PD patients. Fifteen ET (68.9 ± 6.6years) and 10 PD patients (70.5 ± 6.3years; Hoehn and Yahr stage, 2.3 ± 0.8) underwent two [18F]FP-CIT PET/CT scans with an interval of 48 ± 7day. For both the test and retest studies, standardized uptake value ratios were estimated for 90-min and 3-h acquisitions for the caudate, anterior putamen, and posterior putamen using T1-MRI-based normalization (automatic) and fixed-VOI (manual) methods, with the occipital lobe as a reference. Reproducibility was evaluated by the bias, variability, percent test-retest, within-subject coefficient of variation, repeatability coefficient, and intraclass correlation coefficient (ICC). Reproducibility was excellent, with low variability (ET: 6.99-8.02%, PD: 3.51-6.94%) and high reliability (ICC; ET: 0.88-0.96, PD: 0.98-0.99). The ET group showed higher variability and lower ICCs than the PD group. The variability in the 90-min images (ET: 7.85-8.59%, PD: 1.52-2.75%) was comparable to that in the 3-h images (ET: 6.99-8.02%, PD: 3.51-6.94%). There were no differences in variability among the subregions in the ET group. In the PD group, the variability was high in the posterior putamen (automatic method: 6.94%, manual method: 11.80%). The test-retest variability and ICCs were similar for the manual and automatic methods. [18F]FP-CIT PET is reproducible for the quantitative measurement of DAT binding in both ET and PD individuals, independent of the acquisition time or analysis method. Also, the automaticmethod is more suitable for evaluating early loss of DAT binding inpatients with PD.

Reliability of Peg Restrained Intrinsic Muscle Evaluator for Measurement of Intrinsic Hand Muscle Strength in Adults with Tetraplegia

Background: The manual muscle test (MMT) is the traditional method to assess the intrinsic hand muscle test. However, this test is qualitative and subjective. A device capable of rapidly measuring motor output along a linear scale may be of value in the evaluation of hand recovery from any neurological impairment. Objective: To demonstrate inter-rater reliability of the Peg Restrained Intrinsic Muscle Evaluator (PRIME) device for measuring intrinsic hand muscle strength in adults with impaired hand functions. Methods: 16 subjects (2 female, 14 male, mean age=47±15 years) with cervical spinal cord injury were enrolled. Intrinsic hand muscle strength of adults were performed by two-tester with use of PRIME device and manual muscle testing, within the same session. Inter-tester correlation was tested by Pearson's correlation and Intraclass correlation coefficient (ICC). Results: Intraclass correlation coefficients for hypothenar, first dorsal interosseous, abductor pollicis brevis and opponence pollicis muscles ranged from 0.7 to 0.8 with hypothenar muscle test being lowest ICC=0.7 and thumb opposition highest, ICC=0.81. Conclusion: Results from this study suggest that PRIME device demonstrates good reliability within testers for quantified measuring of intrinsic hand muscle strength. Further use of PRIME in clinic will aid in diagnostics, medical decision making and evaluation of rehabilitation progress in patients with cervical spinal cord injury.

Reproducibility of fluid status measured by bioelectrical impedance analysis in healthy volunteers: akey requirement to monitor fluid status in the intensive care unit.

Little is known about the use of bioelectrical impedance analysis (BIA) in critically ill patients. The objective of this study was to evaluate the reproducibility of BIA measurements by comparing non-dominant versus dominant body-side measurements at 2 separate time points in healthy volunteers in order to extrapolate key elements that may be of relevance in critically ill patients. Aprospective observational validation experiment was carried out in healthy volunteers. Full-body and segmental multiple frequency BIA measurements were carried out at the non-dominant and the dominant body side, consecutively, and on 2 separate occasions within 1 week. Parameters of interest were both raw data (impedance and phase angle) at the individual frequencies (5-50-100-200 kHz) and body fluid compartment volume estimations (total body water, extracellular water volume, intracellular water volume, volume excess). Atotal of 42 measurements were performed in 22 volunteers. Median (interquartile range) age and time between measurements was 26 years (24; 35) and 2.07 days (1.00; 2.99), respectively. The intraclass-correlation coefficients (ICCs) for body fluid compartment volumes estimated by full-body BIA, were greatly above 90%, showing excellent agreement, except for volume excess which showed moderate agreement. Full-body raw impedance and phase angle measurements showed highly variable and much lower ICCs. For both estimated body fluid compartment volumes and raw measurements, segmental BIA showed also highly variable and low ICCs. Overall this study showed that in healthy volunteers, BIA-derived fluid parameters are reproducible, and differences can be attributed to the changes in clinical status.

Test-retest reliability of force plate-derived measures of reactive stepping

Characterizing reactive stepping is important to describe the response’s effectiveness. Timing of reactive step initiation, execution, and termination have been frequently reported to characterize reactive balance control. However, the test–retest reliabilities of these measures are unknown. Accordingly, the purpose of this study was to determine the between- and within-session test–retest reliabilities of various force plate-derived measures of reactive stepping. Nineteen young, healthy adults responded to 6 small (~8–10% of body weight) and 6 large perturbations (~13–15% of body weight) using an anterior lean-and-release system. Tests were conducted during two visits separated by at least two days. Participants were instructed to recover balance in as few steps as possible. Step onset, foot-off, swing, and restabilization times were extracted from force plates. Relative test–retest reliability was determined through intraclass correlation coefficients (ICCs) and 95% confidence intervals (CIs). Absolute test–retest reliability was assessed using the standard error of the measurement (SEM). Foot-off and swing times had the highest between- and within-session test–retest reliabilities regardless of perturbation size (between-session ICC = 0.898–0.942; within-session ICC = 0.455–0.753). Conversely, step onset and restabilization times had lower ICCs and wider CIs (between-session ICC = 0.495–0.825; within-session ICC = -0.040–0.174). Between-session test–retest reliability was higher (ICC = 0.495–0.942) for all measures than within-session test–retest reliability (ICC = -0.040–0.753). Time to restabilization had the highest SEM, indicating the worst absolute reliability of the measures. These findings suggest multiple baseline sessions are needed for measuring restabilization and step onset times. The minimal detectable changes reported provide an index for measuring meaningful change due to an intervention.

The staging and grading system in defining periodontitis cases: consistency and accuracy amongst periodontal experts, general dentists and undergraduate students.

The objective of this study was to evaluate consistency and accuracy of the periodontitis staging and grading classification system. Thirty participants (10 periodontal experts, 10 general dentists and 10 undergraduate students) and a gold-standard examiner were asked to classify 25 fully documented periodontitis cases twice. Fleiss kappa was used to estimate consistency across examiners. Intraclass correlation coefficient (ICC) was used to calculate consistency across time. Quadratic weighted kappa and percentage of complete agreement versus gold standard were computed to assess accuracy. Fleiss kappa for stage, extent and grade were 0.48, 0.37 and 0.45 respectively. The highest ICC was provided by students for stage (0.91), whereas the lowest ICC by general dentists for extent (0.79). Pairwise comparisons against gold standard showed mean value of kappa >0.81 for stage and >0.41 for grade and extent. Agreement with the gold standard for all three components of the case definition was achieved in 47.2% of cases. The study identified specific factors associated with lower consistency and accuracy. Diagnosis was highly consistent across time and moderately between examiners. Accuracy was almost perfect for stage and moderate for grade and extent. Additional efforts are required to improve training of general dentists.

Stability of Early Auditory Evoked Potential Components Over Extended Test-Retest Intervals in Young Adults.

Synaptic damage from noise exposures can occur even in the absence of changes in hearing sensitivity in animal models. There is an unmet clinical need for measurements sensitive to such damage to the human auditory system that can augment the pure-tone audiogram. Early components (i.e., <10 msec) of the auditory evoked potential (AEP) may be useful noninvasive indicators of synaptic integrity. Wave I is a measure of synchronous neural activity at the level of the synapse between cochlear inner hair cells and the auditory nerve and may be of particular clinical utility. This amplitude measure has historically been classified as too variable in humans to be used for clinical waveform interpretation, though several recent reliability studies have challenged this view. The focus of the present study is to examine across-session stability of early AEP amplitude measures. In this study, amplitudes of early components (wave I, wave V, summating potential [SP]) of the AEP were measured in a cohort of 38 young adults aged 19 to 33 years (21 female). Stability of these amplitude measures was examined in a subset of 12 young adults (8 female), at time intervals ranging from 15 hr to 328 days between tests. Eligibility criteria included normal pure-tone hearing sensitivity, normal tympanometry, and intact acoustic reflexes. Participants were tested at up to four time points. Each evaluation included pure-tone thresholds, tympanometry, speech-in-noise testing, distortion-product otoacoustic emissions (DPOAE), and early AEPs. AEPs were collected in response to click and tone burst stimuli, with both ear canal and mastoid electrode montages. No clinical changes in pure-tone hearing were found between baseline and follow-up visits. Intraclass correlation coefficients (ICCs) indicated good to excellent reliability for wave I and wave V peak-to-trough amplitudes within individuals across time, with greatest reliability (0.92, 95% confidence interval [0.81 to 0.96]) and largest amplitudes for wave I when measured from the ear canal in response to a click stimulus. Other measures such as amplitude ratios of waves V/I and the SP and action potential (AP) showed lower ICC values when measured from the ear canal, with SP/AP ratio demonstrating the lowest reliability. The results of this study suggest that, when recorded under certain conditions, wave I amplitude can be a stable measure in humans. These findings are consistent with previous work and may inform the development of clinical protocols that utilize wave I amplitude to infer inner ear integrity.

Test-Retest Reliability of Handgrip Strength Measurement in Children and Preadolescents.

The reliability of handgrip strength (HGS) measurement has been confirmed in adults but has been sparsely addressed in pediatric populations. The aims of this study are twofold: to determine whether sex, age and/or hand-dominance influence the test–retest differences and to establish the reliability level of the HGS measurement in typical developing pediatric participants. A total of 338 participants aged 7–13 years were tested using a digital handgrip strength (HGS) dynamometer (Jamar Plus+ Dynamometer) by the same rater on two testing trials separated by a one-day interval between sessions. The HGS testing was conducted according to the American Society of Hand Therapists recommendations. Relative and absolute reliability statistics were calculated. Age influenced the test–retest difference of the HGS measurement as children compared to preadolescents had lower intraclass correlation coefficients (0.95 vs. 0.98), standard error of measurement (SEM) (0.74 vs. 0.78 kg), smallest detectable difference (SDD) (2.05 vs. 2.16 kg) and higher values of the percentage value of SEM (5.48 vs. 3.44%), normalized SDD (15.52 vs. 9.61%) and a mean difference between the test and retest values (0.50 vs. 0.02 kg) for the dominant hand. The results indicate that the protocol using the Jamar digital handgrip dynamometer is a reliable instrument to measure HGS in participants aged 7–13 years with typical development. Clinicians and researchers therefore can have confidence in determining the minimally clinical effect for HGS.

Validity and Reliability of StriveTM Sense3 for Muscle Activity Monitoring During the Squat Exercise

Background: Recent innovations in surface electromyographic (sEMG) technology have enabled the measurement of muscle activity using smart textiles. Objective: In this study, the StriveTM Sense3 performance monitoring system is evaluated against a research-grade system, NoraxonTM, in measuring activity during the back squat exercise. Method: Seventeen participants performed three total trials of the squat exercise with a progressive load for individual trials equal to 30%, 60%, and 80% of their estimated maximum 1RM (one-repetition maximum). sEMG measurements from the rectus femoris were captured for the left and right leg by both systems. Pearson product-moment correlation coefficient (r) and intraclass correlation coefficient (ICC) values were computed for each trial to assess concurrent validity and interrater reliability of the StriveTM Sense3 device. Additionally, five coaches at the collegiate- and professional-level of Men’s Basketball speak from an autoethnographic frame to the findings from this study. Results: Results ranged from “Poor” to “Excellent” validity and “Poor to Moderate” to “Excellent” reliability, with a majority of trials achieving “Good” or better results across all loads [93% trials: r &gt;= 0.7; 87% trials: lower ICC 95% CI bound &gt;= 0.75 (absolute sEMG); 98% trials: lower ICC 95% CI bound &gt;= 0.75 (normalized sEMG)]. Higher validity and reliability for medium and heavy loads were observed in comparison to the light load, and several outliers indicate the need for coaches to lubricate sensors and ensure proper fit to collect accurate data. Conclusion: Examining results alongside practitioner feedback indicate the StriveTM Sense3 system is capable of tracking sEMG activity in comparison to a research-grade system.

VARIABILITY, GENETIC COMPONENTS AND SELECTION RESPONSE IN SEGREGATING GENERATIONS AMONG SOME COTTON CROSSES

The successful breeding program depends on genetic variability response to selection, heritability and genetic advance. The present investigation aimed to estimate these components in two intra-specific cotton crosses (Giza 92 x Giza 87 and Giza 96 x Giza 87) during early segregating generation. Most of the studied traits showed high broad sense heritability coupled with low or moderate genetic advance as percent of mean in F2 generation. So, these traits controlled by non additive gene action. The analysis of variances for F3 families showed highly significant differences between F3 families and variance within F3 was lower than among families for all the studied traits over the two crosses. All F3 families had low intra-class correlation values over the two crosses, so selection between families is better than within families. The additive genetic variance was larger than dominance variance for all the studied traits except for seed cotton yield / plant and lint %, also, these traits showed partial degree of dominance for cross I. While, cross II has higher values of dominance genetic variance than additive variance for all traits except for boll weight and fiber length, so that showed overdominance. Selection differential and response to selection were found to be positive for all traits during F2 and F3. The probability of new recombinant lines falling outside parental range was higher in cross I than cross II for all traits except for boll weight and fiber length. The study reveals that judicious selection leads to improvement in next generation.

Reliability and Reproducibility of Neuromelanin-Sensitive Imaging of the Substantia Nigra: A Comparison of Three Different Sequences.

BackgroundNeuromelanin‐sensitive MRI (NM‐MRI) of the substantia nigra provides a noninvasive way to acquire an indirect measure of dopamine functioning. Despite the potential of NM‐MRI as a candidate biomarker for dopaminergic pathology, studies about its reproducibility are sparse.PurposeTo assess the test–retest reproducibility of three commonly used NM‐MRI sequences and evaluate three analysis methods.Study TypeProspective study.PopulationA total of 11 healthy participants age between 20–27 years.Field Strength/Sequence3.0T; NM‐MRI gradient recalled echo (GRE) with magnetization transfer (MT) pulse; NM‐MRI turbo spin echo (TSE) with MT pulse; NM‐MRI TSE without MT pulse.AssessmentParticipants were scanned twice with a 3‐week interval. Manual analysis, threshold analysis, and voxelwise analysis were performed for volume and contrast ratio (CR) measurements.Statistical TestsIntraclass correlation coefficients (ICCs) were calculated for test–retest and inter‐ and intrarater variability.ResultsThe GRE sequence achieved the highest contrast and lowest variability (4.9–5.7%) and showed substantial to almost perfect test–retest ICC (0.72–0.90) for CR measurements. For volume measurements, the manual analysis showed a higher variability (10.7–17.9%) and scored lower test–retest ICCs (–0.13–0.73) than the other analysis methods. The threshold analysis showed higher test–retest ICC (0.77) than the manual analysis for the volume measurements.Data ConclusionNM‐MRI is a highly reproducible measure, especially when using the GRE sequence and CR measurements. Volume measurements appear to be more sensitive to inter/intrarater variability and variability in placement and orientation of the NM‐MRI slab. The threshold analysis appears to be the best alternative for volume analysis.Level of Evidence2Technical Efficacy Stage1

Radiographic Evaluation of Cervical Disk Replacement: The Impact of Preoperative Arthrosis and Implant Positioning on Patient-report Outcomes.

This was a retrospective review. Provide a validated method of radiographic evaluation of cervical disk replacement (CDR) patients linked to outcomes. Preoperative radiographic criteria for CDRs and the impact of intraoperative positioning remain without formalized guidelines. The association between preexisting degenerative changes, optimal implant positioning, and patient-reported outcome measures (PROMs) are not well understood. Our study establishes a systematic radiographic evaluation of preoperative spondylosis, implant placement, and associated clinical outcomes. Preoperative radiographs for CDR patients were evaluated for disk height, facet arthrosis, and uncovertebral joint degeneration. Postoperative radiographs were scored based on the position of the CDR implant on anterior-posterior (AP) and lateral radiographs. PROMs including Visual Analogue Scale (VAS) arm pain, VAS neck pain, Neck Disability Index (NDI), Short Form 12 physical health (SF12-PCS) and mental health (SF12-M) were collected preoperatively, at early follow, and at late follow-up. A total of 115 patients were included. Preoperative disk height had the highest reliability, intraclass correlation coefficient of 0.798). Facet arthrosis had the lowest intraclass correlation coefficient at 0.563. Preoperative disk height scores showed a significant correlation with AP radiographs and implant positioning score. Patients with more advanced uncovertebral degenerative changes showed less improvement 6 months postoperatively, based on SF-12 PCS scores (R=0.446, P=0.025). Postoperative implant position on lateral radiograph showed a significant correlation with SF-12 MCS scores at follow-up beyond 6 months (R=0.385, P=0.011). Overall postoperative implant position scores demonstrated significant correlation with SF-12 PCS (R=0.350, P=0.046) scores. This study provides a systematic method of evaluation of preoperative and intraoperative radiographs that can optimize outcomes. On the basis of our study, spine surgeons performing cervical disk replacement surgery should consider: (a) the presence of preexisting uncovertebral joint degeneration can negatively impact outcomes, (b) achieving optimal implant positioning can be increasingly difficult with more severe loss of disk height, and (c) overall implant position as judged on AP and lateral fluoroscopy can impact outcomes.

Reliability of postural control during double-leg standing in subjects with nonspecific chronic low back pain: Dual-task paradigm and manipulated visual and somatosensory inputs

BackgroundThe aim of this study is to evaluate the test-retest reliability of the Center of Pressure (COP) parameters in quiet double-leg standing in subjects with Non-Specific Chronic Low Back Pain (NSCLBP) during dual taking associated with manipulated visual and somatosensory inputs. Materials and methodsIn this observational cross-sectional study, the static balance of thirty NSCLBP patients were assessed during a double-leg stance by using the force platform. Subjects were accosted by manipulated somatosensory and visual inputs during dual taking in eight different conditions (with and without vibration, eyes-open and eyes-closed, and with and without auditory Stroop test). The COP parameters were recorded as follows: range sideways and range fore-aft as well as mean velocity and area variables. The cognitive task parameters included the reaction time and error ratio. The intra-class correlation coefficient (ICC) was computed to assess the intersession reliability of COP parameters. Resultsin intersession, range sideways, range fore-aft, and mean velocity measures possessed moderate to high ICC, but area owned high ICC only in one condition (double-leg stance, eyes-close, with vibration, and with auditory Stroop test). Notably, other conditions had low ICC, and moderate to high and low to very high ICC were reported for reaction time and error ratio. ConclusionAmong the parameters studied in the present study, the mean velocity measure seems to be the most reliable variable of postural control in the subjects with NSLBP especially in more challenging conditions, i.e., quiet double-leg standing with eyes closed and adding vibratory inputs during dual-tasking.

Assessing the Palliative and End-of-Life Care Education-Practice-Competence Triad in Intensive Care Units: Content Validity, Feasibility, and Reliability of a New Tool.

To date, a comprehensive, psychometrically robust instrument to assess palliative and end-of-life (PEOL) care education, practice, and perceived competence among intensive care unit (ICU) nurses does not exist. To examine content validity and reliability of a proposed instrument to assess the PEOL care education-practice- competence triad among ICU nurses. An international modified e-Delphi and a cross-sectional pilot questionnaire survey. The Delphi involved 23 panelists from 11 countries. The pilot study involved 40 staff nurses and 3 nurse managers from 3 adult ICUs in a randomly selected hospital in Egypt. An instrument was developed and judged for content validity by international panelists, and then pretested in a pilot study, where data were collected at 2 time points using self-administered questionnaires, followed by cognitive interviews. Test-retest reliability was examined using intraclass correlation (ICC), standard error of measurement (SEM), and repeatability coefficient (RC). The panelists confirmed content validity of the proposed instrument, and staff nurses confirmed its comprehensibility. At the level of the instrument's total scores, the lowest ICC was .9 (95% confidence interval: .8-.9); and the highest SEM and RC were 4.8 and 13.3, respectively. The PEOL Care Index is a comprehensive, comprehensible, content valid, and reliable instrument to assess the PEOL care education-practice-competence triad among ICU nurses. Construct and criterion validities need to be confirmed in future studies. Applicability of the PEOL Care Index in different settings and cultures needs to be examined.

Reproducibility of macular retinal nerve fiber layer and ganglion cell layer thickness measurements in a healthy pediatric population.

To evaluate the reproducibility of Spectralis spectral domain-OCT segmented ganglion cell layer (GCL) and macular retinal nerve fiber layer (mRNFL) measurements in a healthy children population. An observational, cross-sectional study was carried out on 79 children to measure the intraobserver reproducibility and the repeatability between a novel and an experienced operator of the segmented macular GCL and mRNFL. Interobserver and intraobserver reproducibility were defined by the intraclass correlation coefficient (ICC) and coefficients of variation (COV). Kruskal-Wallis test was used to determine statistical significance in the COV of three age groups children (younger than 6 years, between 6 and 12, and older than 12 years old). The results from the intraoperator GCL thickness analysis were highly reproducible (COV < 6%) and reliable (ICCs > 0.81). When the measurements were compared between a novel and an experienced examiner lower ICCs and higher COV were found. COVs ranged from 1.85% (total volume area) to 5.57% at the central ETDRS subfield while the ICC vary from 0.632 (outer inferior) to 0.832 (inner inferior). The repeatability and reproducibility of the mRNFL thickness were lower, with ICCs ranging from 0.428 to 0.872 in the interobserver analysis and from 0.897 to 0.346 in the interobserver one. In the present study, we establish substantial reliability of the GCL thickness in children with Spectralis® SD-OCT in all the sectors, albeit lower than the reported in the literature with other SD-OCTs and in adults. The reproducibility and repeatability of the mRNFL were significantly lower. We were unable to find consistent statistical significant differences between the COV of the three age groups.

Repeatability and comparability of keratometry measurements obtained with swept-source optical coherence and combined dual Scheimpflug-Placido disk-based tomography.

To assess the repeatability of keratometric measurements obtained using a reflectance and swept-source optical coherence tomography (SS-OCT) based biometer and to compare these values with those obtained with a dual Scheimpflug-Placido (S-P) disk-based tomographer/topographer. Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania, USA. Prospective consecutive case series. Patients undergoing cataract evaluation were prospectively enrolled. Surgery-naive eyes without corneal pathology were measured 3 times with the reflectance/SS-OCT biometer and once with the dual S-P disk tomographer/topographer. Intradevice repeatability for anterior (K), posterior (PK), and total corneal keratometry (TK) readings were evaluated using within-eye SDs, test-retest repeatability (TRT), coefficients of variance, and intraclass correlation coefficients (ICCs). Bland-Altman analysis was used to assess agreement between devices. Eighty-two eyes from 48 patients met inclusion criteria. The TRT for the anterior, posterior, and total corneal powers were 0.33, 0.08, and 0.36 diopter (D), respectively. TRT for the anterior, posterior, and total keratometric astigmatism were 0.58, 0.14, and 0.64 D, respectively. Anterior keratometric indices had higher ICCs than posterior indices. Bland-Altman analysis revealed that the SS-OCT consistently reported flatter posterior corneal curvatures than the S-P. The SS-OCT posterior keratometric measurements contain more noise (lower ICCs), but still have lower within-eye SDs and TRTs than that of anterior measurements. This may be due to the small index of refraction change at the cornea-aqueous interface. Although keratometric indices from the 2 devices are highly correlated, measurements taken using SS-OCT and S-P devices were not interchangeable.

Test-retest reliability and minimal detectable change of the Contextual Memory Test in older adults with and without mild cognitive impairment.

BackgroundThe ability to detect one’s own memory capacity and develop strategies based on daily contexts is important for daily activities. The Contextual Memory Test (CMT) assesses self-awareness, self-efficacy, self-perception/evaluation of performance, recall, and strategy use that are associated with daily contexts, and could be a potentially suitable measurement for assessing memory and meta-memory in older adults with and without cognitive impairment. Nevertheless, the test-retest reliability and minimal detectable change (MDC) remain unknown in these individuals.ObjectiveThe purpose of this study was to examine test-retest reliability and calculate MDC of the CMT in healthy older adults and those with mild cognitive impairment (MCI).MethodsEighty-three participants completed the CMT twice with a one-month interval. Test-retest reliability was examined using intraclass correlation coefficient (ICC) in all seven domains of the CMT and the recognition subtest. The standard error of measurement (SEM) and MDC were calculated. The Bland-Altman analysis was performed to evaluate the degree of agreement between measurements.ResultsThe ICC of five domains (self-awareness, self-perception/evaluation of performance, immediate/delayed/total recall) and the recognition subtest were good to excellent (ICC = 0.63–0.94) in healthy and MCI participants and the MDC% were less than 30% The ICC of the other two domains (self-efficacy and total strategy use, TSS) were low (ICC = 0.07–0.59) and the MDC% exceeded 30%. The Bland-Altman analysis showed generally better performance in the 2nd than the 1st measurement in most CMT domains.ConclusionsOur results revealed sufficient test-retest reliability and acceptable MDC in most CMT domains in healthy and MCI participants. Only the self-efficacy and TSS domains demonstrated low ICC and large MDC. Possible practice effects were found between repeated measurements. Clinicians should be cautious when evaluating self-efficacy and strategy use using the CMT in older adults. Further improvements are needed for these two domains.