Relative Standard Error Of Measurement Research Articles

Reliability of 3D freehand ultrasound to assess lower limb muscles in children with spastic cerebral palsy and typical development.

This study investigated the reliability of 3-dimensional freehand ultrasound (3DfUS) to quantify the size (muscle volume [MV] and anatomical cross-sectional area [aCSA]), length (muscle length [ML], tendon length [TL], and muscle tendon unit length [MTUL]), and echo-intensity (EI, whole muscle and 50% aCSA), of lower limb muscles in children with spastic cerebral palsy (SCP) and typical development (TD). In total, 13 children with SCP (median age 14.3 (7.3) years) and 13 TD children (median age 11.1 (1.7) years) participated. 3DfUS scans of rectus femoris, semitendinosus, medial gastrocnemius, and tibialis anterior were performed by two raters in two sessions. The intra- and inter-rater and intra- and inter-session reliability were defined with relative and absolute reliability measures, that is, intra-class correlation coefficients (ICCs) and absolute and relative standard error of measurement (SEM and SEM%), respectively. Over all conditions, ICCs for muscle size measures ranged from 0.818 to 0.999 with SEM%s of 12.6%-1.6%. For EI measures, ICCs varied from 0.233 to 0.967 with SEM%s of 15.6%-1.7%. Length measure ICCs ranged from 0.642 to 0.999 with SEM%s of 16.0%-0.5%. In general, reliability did not differ between the TD and SCP cohort but the influence of different muscles, raters, and sessions was not constant for all 3DfUS parameters. Muscle length and muscle tendon unit length were the most reliable length parameters in all conditions. MV and aCSA showed comparable SEM%s over all muscles, where tibialis anterior MV was most reliable. EI had low-relative reliability, but absolute reliability was better, with better reliability for the distal muscles in comparison to the proximal muscles. Combining these results with earlier studies describing muscle morphology assessed in children with SCP, 3DfUS seems sufficiently reliable to determine differences between cohorts and functional levels. The applicability on an individual level, for longitudinal follow-up and after interventions is dependent on the investigated muscle and parameter. Moreover, the semitendinosus, the acquisition, and processing of multiple sweeps, and the definition of EI and TL require further investigation. In general, it is recommended, especially for longitudinal follow-up studies, to keep the rater the same, while standardizing acquisition settings and positioning of the subject.

Reliability of the kinematic theory parameters during handwriting tasks on a vertical setup

BackgroundThe Kinematic Theory and its Sigma–Lognormal model have been used extensively in motor control analyses. It has recently shown promise in its ability to detect neuromuscular fatigue in the shoulder. The use of an ergonomic setup composed of a vertically oriented tablet offers a good demonstration for use in future clinical applications. However, parameters’ reliability of this theory needs to be evaluated. The aim of this study is to assess the test–retest reliability of these parameters in the specific case of fatigue detection. MethodForty participants performed two sessions of fast strokes handwriting (simple strokes, triangles, horizontal and vertical oscillations) on a tablet placed at shoulder’s height. Reliability was assessed using the intraclass correlation coefficient (ICC), their relative standard error of measurement (SEM) and coefficient of variation. The minimal detectable change was also reported.Findings: In general, a moderate to excellent reliability was denoted in the main parameters of each test (ICC: 0.54–0.91). The parameters related to shoulder fatigue detection had good to excellent reliability (ICC: 0.77–0.90) with low SEM (SEM: 4.75–6.99%). ConclusionMost of the parameters have good test–retest reliability, and the setup seems adequate for shoulder fatigue detection.

Measurement error and reliability of TMS metrics collected from biceps and triceps in individuals with chronic incomplete tetraplegia.

Transcranial magnetic stimulation (TMS) is used to investigate corticomotor neurophysiology associated with functional recovery in individuals with spinal cord injury (SCI). There is insufficient evidence about test-retest measurement properties of TMS in SCI. Therefore, we investigated test-retest agreement and reliability of TMS metrics representing corticomotor excitability, output, gain, map (representation), and inhibition in individuals with cervical SCI. We collected TMS metrics from biceps and triceps muscles because of the relevance of this proximal muscle pair to the cervical SCI population. Twelve individuals with chronic C3-C6 SCI participated in two TMS sessions separated by ≥ 2weeks. Measurement agreement was evaluated using t tests, Bland-Altman limits of agreement and relative standard error of measurement (SEM%), while reliability was investigated using intra-class correlation coefficient (ICC) and concordance correlation coefficient (CCC). We calculated the smallest detectable change for all TMS metrics. All TMS metrics except antero-posterior map coordinates and corticomotor inhibition were in agreement upon repeated measurement though limits of agreement were generally large. Measures of corticomotor excitability, output and medio-lateral map coordinates had superior agreement (SEM% < 10). Metrics representing corticomotor excitability, output, and inhibition had good-to-excellent reliability (ICC/CCC > 0.75). The smallest detectable change for TMS metrics was generally high for a single individual, but this value reduced substantially with increase in sample size. We recommend use of corticomotor excitability and recruitment curve area owing to their superior measurement properties. A modest group size (20 or above) yields more stable measurements, which may favor use of TMS metrics in group level modulation after SCI.

Reliability of different electromyographic normalization methods for pelvic floor muscles assessment.

To evaluate the reliability of different methods to normalize pelvic floor muscles (PFM) electromyography (EMG). Thirty nulliparous women (23.9 ± 3.2 years), free from PFM dysfunction, completed two test sessions 7 days apart. For EMG normalization, signals were acquired during four different tasks using a vaginal probe in situ: PFM maximal voluntary contraction (MVC) and three daily activities with increased intra-abdominal pressure (coughing, Valsalva maneuver, and abdominal contraction). The intraclass correlation coefficients (ICC), standard error of measurement (SEM), relative standard error of measurement (%SEM), and minimal detectable change (MDC) were calculated for each variable. ICC values for test-retest reliability of normalization methods ranged from 0.61 to 0.95. The highest values were obtained for mean root mean square (RMS) of the abdominal contraction and peak RMS of PFM-MVC. Normalization using RMS of PFM-MVC showed the lowest values of SEM and MDC. The normalization of EMG data is considered a fundamental part of EMG investigations. These findings suggest that the normalization of PFM-EMG by either peak RMS of PFM-MVC or mean and peak RMS of abdominal contraction has excellent reliability and it can be applied in studies involving the evaluation of young women.

Intra- and inter-tester reliability of spasticity assessment in standing position in children and adolescents with cerebral palsy using a paediatric exoskeleton

Background The L-STIFF tool of the Lokomat evaluates the hip and knee flexors and extensors spasticity in a standing position. It moves the lower limb at a controlled velocity, measuring joint resistance to passive movements. Since its reliability in children with cerebral palsy remains unknown, our goal was to evaluate the relative and absolute reliability of L-STIFF in children with cerebral palsy. Methods Reliability was determined in 16 children with cerebral palsy by two experienced therapists. The changes in resistive torque in hip and knee in both flexion and extension were measured. Relative and absolute reliability were estimated using the intraclass correlation coefficient, standard error of measurement, and minimal detectable change. Reliability was assessed on three levels: (1) intra- and (2) inter-tester within session, and (3) intra-tester between sessions. Results Intraclass correlation coefficients were moderate to excellent for intra-tester reliability (all p ≤ 0.01). The standard error of measurement ranged from 0.005 to 0.021 Nm/° (i.e., 7–16%) and minimal detectable change from 0.014 to 0.059 Nm/°. Inter-tester intraclass correlation coefficients ranged from 0.32 to 0.70 (all p ≤ 0.01), standard error of measurement ranged from 0.012 to 0.029 Nm/° (i.e., 6–39%), and minimal detectable change ranged from 0.033 to 0.082 Nm/°. L-STIFF reliability was better during fast and medium movement speeds compared to slow speeds. Conclusions The assessment tool L-STIFF is a promising tool for quantifying lower limb spasticity in children with cerebral palsy in a standing position. However, the results should be interpreted carefully. Implications for Rehabilitation L-STIFF is a promising tool for evaluating lower limb spasticity in standing position. A special care must be given to the installation and alignment of the participant into the Lokomat to minimize erroneous spasticity measurement. Relative standard error of measurement and minimal detectable change should be used to analyze changes spasticity.

Test-retest reliability of a hip strength assessment system in varsity soccer players

ObjectiveTo investigate test-retest reliability of a hip strength assessment system (GroinBar). DesignTest-retest reliability study. SettingLaboratory. ParticipantsTwenty asymptomatic varsity soccer players. Main outcome measuresMaximal isometric hip strength (adduction, abduction, internal and external rotation, flexion and extension) was assessed using the GroinBar. Intraclass correlation coefficient (ICC) and relative standard error of measurement (SEM) were calculated to evaluate reliability of peak (ICC3,1) (highest peak within 3 trials) and average peak (ICC3,3) (average of 3 trials) force and rate of force development (RFD). Hotelling's T2, were also used to compare bilateral and reciprocal ratios between dominant and non-dominant leg. ResultsICC for both peak force and RFD values revealed moderate to good reliability (0.53–0.88 and 0.61–0.84, respectively), whereas reliability was good to excellent regarding their average values (0.77–0.95 and 0.81–0.92, respectively). SEM of average peak force and RFD values (4.1–9.4% and 8.2–13.9%, respectively) were lower than that of peak force and RFD values (5.7–13.0% and 10.7–19.1%, respectively). No significant difference was found in bilateral and reciprocal force ratios between dominant and non-dominant leg. ConclusionsThe GroinBar is a reliable tool to assess hip muscle function in athletic populations and could be used for player screening and follow-up.

Repeatability of electromyography normalization of the neck and shoulder muscles in symptomatic office workers

Purpose. The purpose of the study was to examine the repeatability of electromyography (EMG) normalization in office workers with neck and shoulder symptoms. Methods. Fifteen female office workers with neck/shoulder symptoms were recruited to participate in two separate days of testing. Maximum voluntary isometric contraction (MVIC) was used for the normalization of EMG data on the following muscles: cervical erector spinae, upper trapezius, lower trapezius and anterior deltoid. Repeatability was calculated using the intra-class correlation (ICC), relative standard error of measurement (%SEM) and relative coefficient of variation (%CV). Results. Peak root mean square (rms) and median frequency (MF) showed good to high repeatability in the UT, AD and CES (ICC = 0.87–0.95, %SEM= 2.65–9.48, %CV= 0.2–5.9). The repeatability of peak rms was good (ICC = 0.87, %SEM = 12.56, %CV = 3.3) and the MF of the LT was fair (ICC = 0.76, %SEM = 5.71, %CV = 2.9). Conclusion. Peak rms and MF from the MVIC normalization method can be measured with sufficient repeatability in symptomatic office workers.

Reproducibility of 3D kinematics and surface electromyography measurements of mastication

The aim of this study was to determine the measurement reproducibility for a procedure evaluating the mastication process and to estimate the smallest detectable differences of 3D kinematic and surface electromyography (sEMG) variables. Kinematics of mandible movements and sEMG activity of the masticatory muscles were obtained over two sessions with four conditions: two food textures (biscuit and bread) of two sizes (small and large). Twelve healthy adults (mean age 29.1years) completed the study. The second to the fifth chewing cycle of 5 bites were used for analyses. The reproducibility per outcome variable was calculated with an intraclass correlation coefficient (ICC) and a Bland–Altman analysis was applied to determine the standard error of measurement relative error of measurement and smallest detectable differences of all variables.ICCs ranged from 0.71 to 0.98 for all outcome variables. The outcome variables consisted of four bite and fourteen chewing cycle variables. The relative standard error of measurement of the bite variables was up to 17.3% for ‘time-to-swallow’, ‘time-to-transport’ and ‘number of chewing cycles’, but ranged from 31.5% to 57.0% for ‘change of chewing side’. The relative standard error of measurement ranged from 4.1% to 24.7% for chewing cycle variables and was smaller for kinematic variables than sEMG variables.In general, measurements obtained with 3D kinematics and sEMG are reproducible techniques to assess the mastication process. The duration of the chewing cycle and frequency of chewing were the best reproducible measurements. Change of chewing side could not be reproduced. The published measurement error and smallest detectable differences will aid the interpretation of the results of future clinical studies using the same study variables.

RELIABILITY OF SURFACE EMG MEASUREMENTS OF THE QUADRICEPS DURING MAXIMAL ISOMETRIC CONTRACTIONS FOLLOWING WATER IMMERSION

Background: The influence of water immersion on neuromuscular function is of importance to a number of disciplines; however, the reliability of surface electromyography (SEMG) following water immersion is not known. This study examined the reliability of SEMG amplitude during maximal voluntary isometric contractions (MVICs) of the vastus lateralis following water immersion. Methods: Using a Biodex isokinetic dynamometer and in a randomized order, 12 healthy male subjects performed four MVICs at 60° knee flexion on both the dominant and nondominant kicking legs, and the SEMG was recorded. Each subject's dominant and nondominant kicking leg was then randomly assigned to have SEMG electrodes removed or covered during 15 min of water immersion (20°C–25°C). Following water immersion, subjects performed a further four MVICs. Results: Intraclass correlation coefficient (ICC) and the relative standard error of measurement (%SEM) of SEMG amplitude showed moderate to high trial-to-trial reliability when electrodes were covered (0.93% and 2.79%) and removed (0.95% and 2.10%, respectively). Conclusions: The results of the this study indicate that SEMG amplitude of the vastus lateralis may be accurately determined during maximal voluntary contractions following water immersion if electrodes are either removed or covered with water-resistive tape during the immersion.

Examination of EMG normalisation methods for the study of the posterior and posterolateral neck muscles in healthy controls

The purpose of this study was to examine the reliability of normalisation methods used in the study of the posterior and posterolateral neck muscles in a group of healthy controls. Six asymptomatic male subjects performed a total of 12 maximum voluntary isometric contractions (MVIC) and 60%-submaximal isometric contractions (60%-MVIC) against the torque arm of an isokinetic dynamometer whilst surface and intramuscular electromyography (EMG) was recorded unilaterally from representative posterior and posterolateral locations. Reliability was calculated using intra-class correlation coefficient (ICC), relative standard error of measurement (%SEM) and relative coefficient of variation (%CV). Maximal torque output was found to be highly reliable in the directions of extension and right lateral bending when the first of three MVIC contractions was excluded. When averaged across contraction direction, high reliability was found for both surface (MVIC: ICC=0.986, %SEM=7.5, %CV=9.2; 60%-MVIC: ICC=0.975, %SEM=10, %CV=13.7) and intramuscular (MVIC: ICC=0.910, %SEM=20, %CV=19.1; 60%-MVIC: ICC=0.952, %SEM=16.5, %CV=13.5) electrodes. Intramuscular electrodes displayed the least reliability in right lateral bending. The use of visual feedback markedly increased the reliability of 60%-MVIC contractions.

Cervical Motion in Patients With Chronic Disorders of the Cervical Spine: A Reproducibility Study

Test-retest of cervical motion in patients with chronic disorders of the cervical spine. To determine the reproducibility of cervical motion and examine the feasibility of its representation by a single parameter. Reproducibility of cervical motion findings has been largely limited to normal subjects, leaving a conspicuous void regarding the measurement error in clinical groups. There were 2 groups of 25 chronic patients with whiplash and degenerative changes of the cervical spine tested twice (4-7 days). Head movement was measured along the 6 directions, as well as during rotation out of flexion and extension (cervical degenerative changes only). Compared to normal subjects, both groups had a 25% to 35% reduction in cervical motion. High intraclass correlation coefficients (ICCs) (range 0.8-0.92) were derived for all directions. The ICCs for rotation out of flexion and extension were low. The relative standard error of measurement ranged from 15% to 28% for all directions, whereas the corresponding scores of the total cervical motion excursion were 10.6 (cervical degenerative changes) and 13.6% (whiplash). Judged by the ICCs cervical motion, findings were reproducible. However, in view of the measurement error as well as the homogenous reductions, total cervical range of motion should be considered a suitable parameter for interpretation of cervical motion limitations in these patients.

High-performance liquid chromatographic determination of doxorubicin in tissues after solid phase extraction

A method is described for the determination of doxorubicin in tissues. The drug was selectively extracted from the biological matrix by solid phase extraction using 1-ml octadecyl silane extraction columns. Prior to extraction, tissue samples were digested by an enzymic digestion procedure. Daunorubicin was used as an internal standard. Quantitation was by high-performance liquid chromatography (HPLC) using ion-pair chromatography on a reversed-phase column. Detection was by fluorescence. Recovery of doxorubicin from tissue was 81.7 ± 2.1% mean ±SD. Doxorubicin concentrations as low as 0.01 mg kg −1 could be determined. A typical value of the relative standard error of measurement was 3.7% at 2.1 mg kg −1.