Reliability Of Repeated Measurements Research Articles

Intra-rater reliability of rehabilitative ultrasound imaging of erector spinae and gluteus medius muscles in patients with low back pain

BackgroundLow back pain (LBP) is one of the most common conditions in the United States. Dysfunctional patterns of the erector spinae (ES) and gluteus medius (GM) muscles often accompany episodes of LBP. ObjectivesTo evaluate the intra-rater reliability of rehabilitative ultrasound imaging (RUSI) in obtaining thickness measurements of the ES and GM muscles at rest and during submaximal contraction. DesignSingle-group repeated-measures reliability study. MethodsA volunteer sample of 30 adults with current LBP was examined. Thickness measurements of the ES and GM at rest and during contraction were obtained by using RUSI during a single session. Intraclass correlation coefficients (ICC) were used to estimate reliability. Reliability was further assessed by calculating standard error of measurement (SEM) and minimal detectable change (MDC). ResultsBy using a mean of 3 measures, intra-rater reliability estimates ranged from 0.999 to 0.999 for ES, and 0.998 to 0.999 for GM. Reliability estimates for single thickness measures ranged from 0.997 to 0.998 for ES, and 0.995 to 0.997 for GM. Reliability estimates were lower for percent thickness change measures than the corresponding single thickness measures for all conditions. ConclusionsRUSI thickness measurements of the ES and GM muscles in patients with LBP, when based on the mean of 3 measures, are highly reliable when taken by a single examiner in a single session.

No Difference in Two-Dimensional Kinematic Assessment of a 45-Degree Sidestep Cut Compared to Qualitative Assessment.

The Expanded Cutting Alignment Scoring Tool (E-CAST) is a two-dimensional qualitative scoring system that has demonstrated moderate inter-rater and good intra-rater reliability for the assessment of trunk and lower extremity alignment during a 45-degree sidestep cut. The primary purpose of this study was to examine the reliability of the quantitative version of the E-CAST among physical therapists and to compare the reliability of the quantitative E-CAST to the original qualitative E-CAST. The hypothesis was that the quantitative version of the E-CAST would demonstrate greater inter-rater and intra-rater reliability compared to the qualitative E-CAST. Observational cohort, repeated measures reliability study. Twenty-five healthy female athletes (age 13.8±1.4 years) performed three sidestep cuts with two-dimensional video capturing frontal and sagittal views. Two physical therapist raters independently scored a single trial using both views on two separate occasions. Based on the E-CAST criteria, select kinematic measurements were extracted using a motion analysis phone application. Intraclass correlation coefficients and 95% confident intervals were calculated for the total score, and kappa coefficients were calculated per kinematic variable. Correlations were converted to z-scores and compared to the six original criteria for significance (α<0.05). Cumulative intra- and inter-rater reliability were both good (ICC=0.821, 95% CI 0.687-0.898 and ICC=0.752, 95% CI 0.565-0.859). Cumulative intra-rater kappa coefficients ranged from moderate to almost perfect, and cumulative inter-rater kappa coefficients ranged from slight to good. No significant differences were observed between the quantitative and qualitative criteria for either inter- or intra-rater reliability (Zobs(intra)= -0.38, p=0.352 and Zobs(inter)= -0.30, p=0.382). The quantitative E-CAST is a reliable tool to assess trunk and lower extremity alignment during a 45-degree sidestep cut. No significant differences were observed in reliability of the quantitative versus qualitative assessment. 3b.

Reliability of Repeated Nordic Hamstring Strength in Rugby Players Using a Load Cell Device.

Hamstring strain injuries are one of the most common injuries in Rugby Union players, representing up to 15% of all sustained injuries. The Nordic eccentric hamstring test assesses the maximal hamstring eccentric strength and imbalances between limbs. Asymmetries and deficits in hamstring strength between legs are commonly assessed and used as screening methods to prevent injuries which can only be proven effective if hamstring strength measures are reliable over time. We conducted a repeated-measures reliability study with 25 male Rugby Union players. Nordic eccentric strength and bilateral strength balance was assessed. Three testing sessions were undertaken over three consecutive weeks. Intrasession and intersession reliabilities were assessed using typical errors (TE), coefficient of variations (CV), and intraclass correlation coefficients (ICC). Our results showed good intrasession reliability (ICC = 0.79-0.90, TE = 26.8 N to 28.9 N, CV = 5.5% to 6.7%), whilst intersession reliability was fair for mean and the max (ICC = 0.52-0.64, TE = 44.1 N to 55.9 N, CV from 7.4% to 12.5%). Regarding the bilateral strength balance ratios, our results showed good intrasession reliability (ICC = 0.62-0.89, TE = 0.5, CV = 4.4% to 7.2%), whilst the intersession reliability for mean and max values was fair (ICC = 0.52-0.54) with a good absolute intersession reliability CV ranging from 8.2% to 9.6%. Assessing the Nordic eccentric hamstring strength and the bilateral strength balance in Rugby players using a load cell device is a feasible method to test, and demonstrated good intrasession and fair intersession reliability. Nordic eccentric strength assessment is a more practical and functional test than isokinetic; we provide data from Rugby Union players to inform clinicians, and to establish normative values in this cohort.

Reliability of Repeated Isometric Neck Strength in Rugby Union Players Using a Load Cell Device.

Concussion is the most common injury in professional Rugby Union (RU) players, with increasing incidence and severity each year. Strengthening the neck is an intervention used to decrease concussion incidence and severity, which can only be proven effective if strength neck measures are reliable. We conducted a repeated-measures reliability study with 23 male RU players. Neck strength was assessed seated in a ‘make’ test fashion in flexion, extension, and bilateral-side flexion. Flexion-to-extension and left-to-right side ratios were also computed. Three testing sessions were undertaken over three consecutive weeks. Intrasession and intersession reliabilities were assessed using typical errors, coefficient of variations (CV), and intraclass correlation coefficients (ICC). Intrasession reliability demonstrated good-to-excellent relative (ICC > 0.75) and good absolute (CV ≤ 20%) reliability in all directions (ICC = 0.86–0.95, CV = 6.4–8.8%), whereas intersession reliability showed fair relative (ICC: 0.40 to 0.75) and acceptable absolute (CV ≤ 20%) reliability for mean and maximal values (ICC = 0.51–0.69, CV = 14.5–19.8%). Intrasession reliability for flexion-to-extension ratio was good (relative, ICC = 0.86) and acceptable (absolute, CV = 11.5%) and was fair (relative, ICC = 0.75) and acceptable (absolute, CV = 11.5%) for left-to-right ratio. Intersession ratios from mean and maximal values were fair (relative, ICC = 0.52–0.55) but not always acceptable (absolute, CV = 16.8–24%). Assessing isometric neck strength with a head harness and a cable with a load cell device seated in semi-professional RU players is feasible and demonstrates good-to-excellent intrasession and fair intersession reliability. We provide data from RU players to inform practice and assist standardisation of testing methods.

Self-performed Five Times Sit-To-Stand test at home as (pre-)screening tool for frailty in cancer survivors: Reliability and agreement assessment.

The self-performance of a Five-Times-Sit-To-Stand (FTSTS)-test, without the usual supervision by a medical professional, provides valuable opportunities for clinical practice and research. This study aimed: (1) to determine the validity of the self-performed FTSTS test in comparison to a supervised reference test and (2) to determine the reliability of a self-performed FTSTS test by cancer survivors. Early detection of frailty in cancer survivors may enable prehabilitation interventions before surgery or intensive treatment, improving cancer outcomes. A repeated measures reliability and agreement study, with one week in between measures, was performed. Cancer survivors (n=151) performed two FTSTS tests themselves. One additional reference FTSTS test was supervised by a physical therapist. The intraclass correlation coefficient (ICC), structural error of measurement (SEM) and minimally important clinical difference (MID) were calculated comparing a self-performed FTSTS test to the reference test, and comparing two self-performed FTSTS tests. The Guidelines for Reporting Reliability and Agreement Studies (GRASS) have been used. Mean age of cancer survivors was 65.6 years (SD=9.3), 54.6% were female, median time since diagnosis was 2 years [IQR=1], and tumour type varied (e.g., breast cancer (31.8%), prostate cancer (17.2%), gastrointestinal cancer (11.9%) and haematological cancer (11.9%)). Validity of the self-performed FTSTS test at home was acceptable in comparison with the reference test (ICC=.74; SEM=3.2; MID=3.6) as was the reliability of the self-performed FTSTS test (ICC=.70; SEM=2.2; MID=3.8). The self-performed FTSTS test is a valid and reliable measure to assess lower body function and has potential to be used as objective (pre-)screening tool for frailty in cancer survivors. The self-performed FTSTS test at home may indicate the cancer survivors in need of prehabilitation in advance of surgery or intensive treatment. The feasibility, short amount of time needed and potential cost-effectiveness of the self-performed FTSTS test can make it a valuable contribution to personalised care and precision medicine.

Automatic 3D dense phenotyping provides reliable and accurate shape quantification of the human mandible

Automatic craniomaxillofacial (CMF) three dimensional (3D) dense phenotyping promises quantification of the complete CMF shape compared to the limiting use of sparse landmarks in classical phenotyping. This study assesses the accuracy and reliability of this new approach on the human mandible. Classic and automatic phenotyping techniques were applied on 30 unaltered and 20 operated human mandibles. Seven observers indicated 26 anatomical landmarks on each mandible three times. All mandibles were subjected to three rounds of automatic phenotyping using Meshmonk. The toolbox performed non-rigid surface registration of a template mandibular mesh consisting of 17,415 quasi landmarks on each target mandible and the quasi landmarks corresponding to the 26 anatomical locations of interest were identified. Repeated-measures reliability was assessed using root mean square (RMS) distances of repeated landmark indications to their centroid. Automatic phenotyping showed very low RMS distances confirming excellent repeated-measures reliability. The average Euclidean distance between manual and corresponding automatic landmarks was 1.40 mm for the unaltered and 1.76 mm for the operated sample. Centroid sizes from the automatic and manual shape configurations were highly similar with intraclass correlation coefficients (ICC) of > 0.99. Reproducibility coefficients for centroid size were < 2 mm, accounting for < 1% of the total variability of the centroid size of the mandibles in this sample. ICC’s for the multivariate set of 325 interlandmark distances were all > 0.90 indicating again high similarity between shapes quantified by classic or automatic phenotyping. Combined, these findings established high accuracy and repeated-measures reliability of the automatic approach. 3D dense CMF phenotyping of the human mandible using the Meshmonk toolbox introduces a novel improvement in quantifying CMF shape.

Consistency and variability in human performance during simulate infant CPR: a reliability study

BackgroundPositive outcomes from infant cardiac arrest depend on the effective delivery of resuscitation techniques, including good quality infant cardiopulmonary resuscitation (iCPR) However, it has been established that iCPR skills decay within weeks or months after training. It is not known if the change in performance should be considered true change or inconsistent performance. The aim of this study was to investigate consistency and variability in human performance during iCPR.MethodsAn experimental, prospective, observational study conducted within a university setting with 27 healthcare students (mean (SD) age 32.6 (11.6) years, 74.1% female). On completion of paediatric basic life support (BLS) training, participants performed three trials of 2-min iCPR on a modified infant manikin on two occasions (immediately after training and after 1 week), where performance data were captured. Main outcome measures were within-day and between-day repeated measures reliability estimates, determined using Intraclass Correlation Coefficients (ICCs), Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC95%) for chest compression rate, chest compression depth, residual leaning and duty cycle along with the conversion of these into quality indices according to international guidelines.ResultsA high degree of reliability was found for within-day and between-day for each variable with good to excellent ICCs and narrow confidence intervals. SEM values were low, demonstrating excellent consistency in repeated performance. Within-day MDC values were low for chest compression depth and chest compression rate (6 and 9%) and higher for duty cycle (15%) and residual leaning (22%). Between-day MDC values were low for chest compression depth and chest compression rate (3 and 7%) and higher for duty cycle (21%) and residual leaning (22%). Reliability reduced when metrics were transformed in quality indices.ConclusioniCPR skills are highly repeatable and consistent, demonstrating that changes in performance after training can be considered skill decay. However, when the metrics are transformed in quality indices, large changes are required to be confident of real change.

A randomised observational study of individualised variations in the start position of the closed-kinetic chain upper extremity stability test

ObjectivesTo assess the reliability, precision and differences between scores produced using the standard 36″ start position and 3 modified start positions of the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), towards normalisation to the individual. DesignRCT of 4 conditions. SettingClinical. ParticipantsThirty-four asymptomatic individuals. Main outcome measuresUsing an RCT method, variations in CKCUEST starting hand position were tested using hand spacing at standard 36″, 50% height, bi-acromial distance, and bi-acromial distance with reach to 36″. The average number of touches over 3 × 15 s maximal efforts were used to assess the intra-variation reliability, minimum detectable change (MDC) and differences to the standard 36″ start position. ResultsThe most reliable variation was the 50% height (ICC: 0.93) and with the smallest MDC (14%). 36″ results were second-most reliable (ICC: 0.90), with a low MDC (19%). Significant differences were found between bi-acromial and 50% height to the 36″ standard setup. ConclusionsA setup position where the hand separation is 50% of the individual’s height offers excellent repeated measures reliability and the smallest MDC, suggesting it is the most sensitive to change and is a recommendation to clinicians. Conversion calculations between start variations are presented.

Intra-rater reliability of transversus abdominis measurement by a novice examiner: Comparison of "freehand" to "probe force device" method of real-time ultrasound imaging.

A "free hand" real-time-ultrasound method is commonly applied to measure transversus abdominis. Potentially, this increases transversus abdominis measurement error due to uncontrolled variability in probe to skin force, inclination, and roll, particularly for novice examiners. This single-group repeated-measures reliability study compared the intra-rater reliability of transversus abdominis thickness and activation measurement by a novice examiner between free hand and a standardized probe force device method. The examiner captured ultrasound videos of transversus abdominis in a single session in healthy participants (n = 33). Free hand ultrasound featured uncontrolled probe force, inclination, and roll, while probe force device method ultrasound standardized these parameters. Images of transversus abdominis at rest and contracted were measured and transversus abdominis activation calculated. Intraclass correlation coefficient, coefficient of variation, standard error of measurement, and worthwhile differences were calculated. The probe force device method resulted in greater reliability (intraclass correlation coefficient = 0.75-0.96) and lower measurement error (coefficient of variation = 8.89-28.7%) compared to free hand (intraclass correlation coefficient = 0.63-0.93; coefficient of variation = 6.52-29.4%). Reliability was good for all measurements except free hand TrA-C, which was moderate. TrA-C had the lowest reliability, followed by contracted thickness of the transverse abdominis, with resting thickness of the transverse abdominis being highest. Worthwhile differences were lower using a probe force device method versus free hand for resting thickness of the transverse abdominis and contracted thickness of the transverse abdominis and similar for TrA-C. Standardization using probe force device method ultrasound to measure transversus abdominis improved intra-rater reliability in a novice examiner. Use of a probe force device method is recommended to improve reliability through reduced sources of measurement error. Probe force device method intra- and inter-rater reliability in examiners of varying experience, in clinical populations, and to visualize other structures merits exploration.

Intra- and inter-rater reliabilities for novel muscle thickness assessment during Co-contraction with dual-rehabilitative ultrasound imaging

ObjectivesThis study aimed to investigate the intra- and inter-rater reliabilities of dual-rehabilitative ultrasound imaging (D-RUSI) for the simultaneous measurement of the thickness of the tibialis anterior (TA) and gastrocnemius (GCM) muscles in healthy young adults. DesignA single-group repeated-measures reliability study. SettingRehabilitative ultrasound imaging analysis laboratory. ParticipantsThirty-six healthy participants (23 males; age = 26.36 ± 5.57 years). Main outcome measuresD-RUSI was used for the simultaneous measurement of the muscle thickness of the TA and GCM at rest and during maximum voluntary contraction. Two examiners acquired data from all participants during three separate testing sessions. ResultsIn the results for the intra-examiner reliability of the TA and GCM muscle thickness for two sessions, all ICC values (95% CI) were good to very good, ranging from 0.72 to 0.95 (SEM 0.01–0.05 mm, MDC 0.02–0.13 mm, respectively). In the results for the inter-examiner reliability of the TA and GCM muscle thickness for three sessions, all ICC values (95% CI) were good to very good, ranging from 0.78 to 0.97 (SEM 0.01–0.10 mm, MDC 0.02–0.15 mm, respectively). ConclusionsThese results suggest the potential usefulness of D-RUSI measurements for making management decisions related to muscle function, including muscle co-contraction.

Establishing Immediate Reliability of Sonographic Measurements of the Transversus Abdominis in Asymptomatic Adults Performing Upright Loaded Functional Tasks in a Clinical Context Without Delayed Recorded Measurement.

This study examined the reliability of sonographic measurements of the transversus abdominis of adults without low back pain during upright loaded functional tasks in real time, without relying on delayed recorded images. A single-group repeated-measures reliability study was conducted on 12 healthy participants without low back pain. Six of these adults reported a prior history of abdominal drawing-in maneuver training without sonographic measurement. The participants performed 3 trials of neutral standing, a loaded forward reach, and a loaded box lift under rest and with abdominal drawing-in maneuver instructions; task order was randomized. Transversus abdominis thickness measurements were obtained by an experienced rater using B-mode sonography in real-time via electronic calipers twice on the same static image during all trials by a rater. The rater was masked to group assignment and on-screen measurement output and required to respond to trivia questions between repeated measurements. The participants included 6 male and 6 female adults with a mean age ± SD of 26.3 ± 3.7 years. Intra-rater intraclass correlation coefficients (2,3) were high and precise for the rater's first and second measurements for all tasks and instruction conditions for mean transversus abdominis thickness and percent change in thickness measurements (eg, ranges were 0.968-0.997 for intraclass correlation coefficients, 0.01-0.21 mm for standard errors of the measurement, and 0.01-0.58 mm for minimal detectable changes). Calipers cleared by the rater or a research assistant produced similar findings of excellent reliability and precision. High intra-rater reliability and precision of transversus abdominis thickness measurements were obtained by a physical therapist in real time from asymptomatic adults performing upright loaded functional tasks under rest and with abdominal drawing-in maneuver instructions.

Intra-Rater Reliability of Rehabilitative Ultrasound Imaging for Multifidus Muscles Thickness and Cross Section Area in Healthy Subjects.

Introduction:Rehabilitative Ultrasound Imaging (RUSI) must be valuable method for research and rehabilitation. So, the reliability of its measurements must be determined. The purpose of this study was to evaluate the intra-rater reliability of RUSI for measurement of multifidus (MF) muscles cross section areas (CSAs), bladder wall diameter, and thickness of MF muscles between 2 sessions in healthy subjects.Method:Fifteen healthy subjects through simple non-probability sampling participated in this single-group repeated-measures reliability study. MF muscles thickness at rest and during contraction, MF muscles CSAs at rest, and bladder diameters at rest and during pelvic floor muscles (PFM) contraction were measured through RUSI. Pearson’s correlation coefficient test was used to determine intra-rater reliability of variables.Finding:The results showed that intra-class correlation Coefficient (ICCs) values with 95% confidence interval (CI) and the standard error of the measurement (SEM) were good to excellent agreement for a single investigator between measurement occasions. The intra-rater reliability for the bladder wall displacement was high (ICCs for rest and PFM contraction state: 0.96 and 0.95 respectively), for the MF muscles CSAs at the L4 level was good to high (ICCs 0.75 and 0.91 for right (Rt) and left (Lt) side respectively), and for the thickness of MF muscles at two levels, at rest and during two tasks was moderate to high (ICCs: 0.64 to 0.87).Conclusion:The Trans-Abdominal (TA) method of RUSI is a reliable method to quantify the PFM contraction in healthy subjects. Also, the RUSI is a reliable method to measure the MF muscles CSAs, the MF muscles thickness at rest and during functional tasks in healthy subjects.

Reliability of Hop Distance and Frontal-Plane Dynamic Knee Valgus Angle during Single-leg Horizontal Hop Test

Context: Single-leg hop for distance (SHD) performance and twodimensional (2-D) video assessment of frontal-plane knee valgus, during the single-leg landings, have been reported to identify the risk of knee injuries such as patellofemoral pain syndrome and/ or anterior cruciate ligament tears. There are limited studies investigating the reliability and measurement error in single-leg hop for distance test and the 2-D video analysis of knee valgus angle on landing from this maximal forward hop. Objective: To evaluate the reliability and measurement error of hop distance and 2-D video assessment of lower limb frontal-plane dynamic knee valgus on landing during the SHD task. Design: Repeated measures reliability study. Participants: 12 recreationally active university students (8 men and 4 women 34.2 ± 3.1 y, height 170.8 ± 6.5 cm; mass 82.1 ± 15.9 kg). Main outcome measurement: Within and between-days reliability and measurement error values of hop performance and 2-D frontalplane projection angle (FPPA) during SHD test. Methods: For hop and 2-D tests: participants performed maximal SHD with standard 2-D digital video recording of the landing for assessment of FPPA. Results: For hop test distance: the within-day ICCs showed good to excellent reliability (0.89-0.93), and between-days ICCs were good, (0.85- 0.90). Standard error of measurement for SHD value ranged from 6.52- 9.83 cm. FPPA on landing: the within-day ICCs showed good reliability (0.87 to 0.90), and between-days ICCs were good, (0.81-0.88). Standard error of measurement for 2-D values ranged from 1.33-1.61°. Conclusions: Hop distance and 2-D FPPA on landing during SHD were shown to be a reliable measure of lower extremity performance and dynamic knee valgus. Using the measurement error values existing along with previously published normative data, clinicians can now make informed decisions about individual performance and variations in performance/injury risk following interventions.

Interrater and intrarater reliability of transverse abdominal and lumbar multifidus muscle thickness in subjects with and without low back pain.

Two-group, repeated-measures reliability study. To determine interrater and intrarater reliability of ultrasound measurements of transverse abdominal (TrA) and lumbar multifidus (LM) muscle thickness, during rest and contraction, in subjects with low back pain (LBP) and healthy subjects over 3 consecutive days, performed by an experienced and a novice rater. Previous reliability studies of TrA or LM thickness did not simultaneously account for muscle state, rater experience, and multiday assessment in large subject samples. The 2 raters measured TrA and LM thickness on 3 consecutive days in 42 healthy subjects and 56 subjects with LBP, during rest and contraction, and calculated the percent thickness change from rest to contraction. Intraclass correlation coefficients (ICC(2,k)) and 95% minimal detectable change in thickness were derived for a single measure (day 1) and an average measure (days 1-3). The interrater ICC(2,1) values for single-measure thickness (LBP group, 0.71-0.87; healthy group, 0.94-1.00) were similar to those for average-measure thickness (LBP group, 0.73-0.84; healthy group, 0.93-1.00). Both interrater ICC(2,1) and ICC(2,3) were lower for the relative thickness change (0.61-0.96). Intrarater ICC(2,1) values across 3 consecutive days were high for both raters across the 2 groups (LBP group, 0.95-1.00; healthy group, 0.93-1.00), albeit lower for the relative thickness change (0.79-0.99). The 95% minimal detectable changes were < 0.3 mm for the TrA and < 2 mm for the LM (but, in most cases, less than 10% of average thickness). Both experienced and trained novice raters provided reliable measurements of TrA and LM thickness in participants with LBP and healthy participants, during rest and contraction. One-time measurements were similar to averaged measurements. Small absolute errors were observed. Public trial registry: Australian New Zealand Clinical Trials Registry ACTRN12613001077752.

Toward Development of a Tinnitus Magnitude Index

The aim of the study was to provide preliminary evidence of a unique "tinnitus magnitude" domain describing intensity of tinnitus perception that will assist in the development of a cognitive-behavioral mediation model of psychological distress associated with tinnitus. A sample of 347 participants with tinnitus was previously recruited from four audiology clinics for the purpose of developing a tinnitus distress measure, the Tinnitus Functional Index (TFI). From the questions used for TFI development, potential tinnitus magnitude items were selected by including those that minimally overlapped with tinnitus reactions. The three items having the least overlap were analyzed retrospectively to assess internal consistency, test-retest reliability, group differences using demographics and tinnitus-relevant descriptive variables, and discriminant validity. The three-item scale was developed in an effort to establish a model for prospective development of a Tinnitus Magnitude Index (TMI) that would assess the magnitude of tinnitus variables independent of reactions to tinnitus. Internal consistency (α = 0.86) and repeated measures tests (r = 0.74, df = 29, p < 0.001) indicate the three-item scale is reliable. Discriminant validity was supported by only moderate correlations (r≥ 0.30 and r ≤ 0.69) of the scale with the Tinnitus Handicap Inventory (r = 0.62), the Beck Depression Inventory for Primary Care (r = 0.38), and the seven independent domains of tinnitus reactions measured using subscales of the TFI (r = 0.49 to 0.72). Correlations between the scale and two tinnitus reactions (distress) subscales were high (r > 0.70) as compared with moderate correlations. This study involved a retrospective analysis of data from questions that were originally evaluated for use in a tinnitus outcome questionnaire. The analysis was conducted to establish a model for prospective development of a TMI. Results of this analysis suggest that a TMI can be developed that would provide a reliable and valid measure of tinnitus magnitude that overlaps minimally in content with measures of cognitive, behavioral, and emotional tinnitus reactions. A fully validated TMI would provide a measure of tinnitus magnitude that is not confounded by emotional reactions to tinnitus or general depressive symptoms and would be useful in developing a testable model of psychological distress due to tinnitus. Although the primary goal is to develop a measure of tinnitus magnitude that predicts cognitive, behavioral, and emotional reactions to tinnitus, a TMI may also have utility in assessing this construct in clinical settings.

Comparative reliability of the make and break tests for hip abduction assessment

Objective: To investigate the reliability of “make test” (MT) and “break test” (BT) of hip abduction using hand-held dynamometry. Design: A repeated measures reliability assessment design for the estimation of inter-rater reliability, in which pairs of testers rated each subject in a 2/3 fractional factorial was used. Both tests (“BT” and “MT”) were performed on both legs twice by 2 testers, for a total of 16 ratings for each participant. Participants: 39 healthy subjects between the ages of 21 and 70 years old volunteered. Main outcome measure: Variance components were computed from the repeated measures to assess inter-rater reliability of measurement. Reliability was estimated as a ratio of variance components. Results: Both tests proved to be highly reliable in nature with values above 0.87 overall. Further examination revealed that gender had a small effect on reliability, yet differences in results were noted between raters on the BT more than the MT. Conclusions: Hip abduction strength can be measured and reproduced between testers reliably using both a “MT” and “BT” and a long lever arm with pelvic stabilization. Statistically, the “MT” appears to be slightly more reliable than the “BT”, but clinically, the “BT” is more practical and convenient.

Dynamic Lumbar Curvature Measurement in Acute and Chronic Low Back Pain Sufferers

Williams JM, Haq I, Lee RY. Dynamic lumbar curvature measurement in acute and chronic low back pain sufferers. Objectives(1) To determine the reliability of a novel fiber-optic method to dynamically measure lumbar curvature in low back pain (LBP) sufferers, and (2) to investigate the dynamic lumbar curvature in acute and chronic LBP sufferers. DesignCross-sectional study. SettingPhysiotherapy clinic. ParticipantsAcute (n=20) and chronic (n=20) LBP sufferers recruited from general practitioner and therapist referrals. InterventionsNot applicable. Main Outcome MeasuresA fiber-optic device was used to measure curvature through time during flexion, lifting, and extension movements. Repeated-measures reliability for curvature-time curves was tested using coefficients of multiple correlation (CMCs) and root mean square error, and for peak curvature values intraclass correlation coefficients (ICCs) and mean absolute errors were used. Acute and chronic LBP groups were compared using peak curvatures and sequencing of curvature change. ResultsThe fiber-optic method was shown to be highly reliable in measuring both whole lumbar and lower lumbar curvature with CMC values >.81 and ICC values >.99. Chronic LBP sufferers displayed greater peak curvatures during flexion and lifting for the whole lumbar spine and lifting for the lower lumbar spine. The sequencing behavior demonstrated that the quartile of movement associated with the greatest curvature change was the second for flexion and lifting and first and second for extension across both groups. No significant differences in sequencing were demonstrated between the 2 groups. ConclusionsThis method is reliable for dynamic lumbar curvature measurement in back pain sufferers and is a viable option for clinicians. Acute LBP sufferers display less kyphosis during flexion and lifting. Sequencing of curvature change is similar across the 2 groups.

The reliability of a portable clinical force plate used for the assessment of static postural control: repeated measures reliability study

BackgroundForce plates are frequently used for postural control assessments but they are expensive and not widely available in most clinical settings. Increasingly, clinicians are using this technology to assess patients, however, the psychometric properties of these less sophisticated force plates is frequently unknown. The purposes of the study were to examine the test-retest reliability of a force plate commonly used by clinicians and to explore the effect of using the mean value from multiple repetitions on reliability.MethodsThirty healthy volunteer adults were recruited. Postural control measures were obtained using the Midot Posture Scale Analyzer (MPSA). Data were collected in 2 sessions. Five successive repetitions each of 60 seconds duration were obtained from each participant in each session.ResultsThe reliability coefficients obtained using single measures were low (ICC3,1 = 0.06 to 0.53). The average of two measures allowed for reliable measurements of COP mean velocity and average location of COP. The average of three and five measures was required to obtain acceptable reliability (ICC ≥ 0.70) of relative weight bearing on legs and sway area, respectively. Higher measurement precision values were seen by averaging four or five repetitions for all variables.ConclusionSingle measures did not provide reliable estimates of postural sway, and the averaging of multiple repetitions was necessary to achieve acceptable levels of measurement error. The number of repetitions required to achieve reliable data ranged from 2 to 5. Clinicians should be wary of using single measures derived from similar equipment when making decisions about patients.

Determination of the Interday and Intraday Reliability of Serum Cartilage Oligomeric Matrix Protein in a Physically Active Population.

Objective:To determine the intraday and interday reliability of serum cartilage oligomeric matrix protein (sCOMP) in a physically active population with no history of lower extremity surgery.Design:A repeated-measures reliability study was employed to determine the intraday and interday reliability of sCOMP in a physically active cohort. A total of 23 subjects were recruited to the laboratory on 3 separate occasions for nonfasting serum collection. Subjects had no history of lower extremity surgery and were free from acute injury within the last 3 months.Results:Our results indicate strong reliability for both intraday intraclass correlation coefficient (ICC) (0.76) and interday ICC (0.74) sCOMP values.Conclusion:Our results demonstrate that following 30 minutes of inactivity, nonfasting serum samples remain stable over the course of 1 day and between 2 consecutive days in a healthy population with no history of lower extremity surgery. Future research studies are needed to further investigate the magnitude of change in this biomarker for patients with acute articular cartilage damage to determine its appropriateness for use in this population and for varying degrees of articular cartilage severity.

The retest reliability of the six‐minute walk test in patients referred to a cardiac rehabilitation programme

The purpose of this paper was to determine if the Six-minute Walk Test (6MWT) was a reliable exercise test for patients referred to cardiac rehabilitation when up to three tests were performed and to determine if test scores differed according to between-test time interval. Thirty adults aged 63 ± 7.9 years referred to cardiac rehabilitation participated in a repeated measures reliability trial. Participants completed three 6MWTs within a one-week period. Participants were randomly allocated to one of three groups: on the first day, Group A completed three walks, Group B completed two walks and Group C completed one walk. Relative reliability was expressed in a ratio (ICC(2,1) ), and absolute reliability was expressed in metres (95% confidence intervals) for group and individuals. The 6MWT demonstrated a high level of relative reliability (intraclass correlation coefficients [ICC] = 0.94) across the three walks. There was no statistically significant difference between the test scores of the three groups. However, there was an increase in distance walked from the first to the second to the third 6MWT. Absolute reliability indicated that a change of at least 44 m would be required to be interpreted as true change in a group, and at least 95 m to be interpreted as true change in an individual with 95% confidence. Three 6MWTs completed in relatively short timeframes were not sufficient for reliable results as there was an increase in the distance walked, and relatively large increases in distances would be required to be interpreted as change. It did not make any difference whether the tests were all completed on one day or over one week. This study highlighted problems that may arise when relying on reliability coefficients alone to interpret reliability. These results suggest that the 6MWT may not have sufficient reliability to be a suitable test to evaluate exercise tolerance in patients referred to cardiac rehabilitation.