Single-measure Intraclass Correlation Research Articles

The Calf Raise App shows good concurrent validity compared with a linear encoder in measuring total concentric work.

The linear encoder and the Calf Raise App have been shown to be valid for measurements of plantar flexor muscular endurance in the heel raise test when compared with gold standard equipment. However, the validity of the Calf Raise App has not yet been compared with a linear encoder, an instrument commonly used in clinical and research settings. The purpose of this study was to determine the concurrent validity of the Calf Raise App compared with a linear encoder for the measurement of average heel raise height and total concentric work in the heel raise test. Fifty TeamGym athletes (82% females) from an on-going prospective study were included (mean [SD] age: 20 [7] years; body mass index (BMI) = 21.3 [2.5]). Concurrent validity was analysed with single measures intraclass correlation coefficient (ICC) using a two-way mixed effects, consistency model. Ninety-eight samples were included in the analysis. The mean (SD) average heel raise height and total concentric work measured by the linear encoder and Calf Raise App were 9.9 (1.4) and 7.5 (1.2) cm, and 1728 (584) and 1291 (450) J, respectively. The mean (SD) number of unilateral heel raises was 30 (7.5). The results showed poor to moderate concurrent validity for the measurement of average heel raise height (ICC: 0.62; 95% confidence interval [CI]: 0.48-0.73). Good to excellent concurrent validity was shown for the measurement of total concentric work (ICC: 0.89; 95% CI: 0.84-0.93). The Calf Raise App shows good concurrent validity in the heel raise test compared with a linear encoder in measuring total concentric work but not average height. While caution is recommended when comparing results from the different instruments, each instrument can be used separately to compare between-limb differences or changes over time in plantar flexor muscular endurance in clinical and research settings. Level III.

Development, scoring, and reliability for the Microscale Audit of Pedestrian Streetscapes for Safe Routes to School (MAPS-SRTS) instrument

BackgroundActive commuting to school can be a meaningful contributor to overall physical activity in children. To inform better micro-level urban design near schools that can support active commuting to school, there is a need for measures that capture these elements. This paper describes the adaptation of an observational instrument for use in assessing micro-scale environments around urban elementary schools in the United States.MethodsThe Micro-scale Audit of Pedestrian Streetscapes for Safe Routes to School (MAPS-SRTS) was developed from existing audit instruments not designed for school travel environments and modifications for the MAPS-SRTS instrument include the structure of the audit tool sections, the content, the observation route, and addition of new subscales. Subscales were analyzed for inter-rater reliability in a sample of 36 schools in Austin, TX. To assess reliability for each subscale, one-way random effects single-measure intraclass correlation coefficients (ICC) were used.ResultsCompared to the 30 original subscales, the adapted MAPS-SRTS included 26 (86.6%) subscales with revised scoring algorithms. Most MAPS-SRTS subscales had acceptable inter-rater reliability, with an ICC of 0.97 for the revised audit tool.ConclusionsThe MAPS-SRTS audit tool is a reliable instrument for measuring the school travel environment for research and evaluation purposes, such as assessing human-scale determinants of active commuting to school behavior and documenting built environment changes from infrastructure interventions.

Novel AI-Based Algorithm for the Automated Measurement of Cervical Sagittal Balance Parameters. A Validation Study on Pre- and Postoperative Radiographs of 129 Patients.

Retrospective, mono-centric cohort research study. The analysis of cervical sagittal balance parameters is essential for preoperative planning and dependent on the physician's experience. A fully automated artificial intelligence-based algorithm could contribute to an objective analysis and save time. Therefore, this algorithm should be validated in this study. Two surgeons measured C2-C7 lordosis, C1-C7 Sagittal Vertical Axis (SVA), C2-C7-SVA, C7-slope and T1-slope in pre- and postoperative lateral cervical X-rays of 129 patients undergoing anterior cervical surgery. All parameters were measured twice by surgeons and compared to the measurements by the AI algorithm consisting of 4 deep convolutional neural networks. Agreement between raters was quantified, among other metrics, by mean errors and single measure intraclass correlation coefficients for absolute agreement. ICC-values for intra- (range: .92-1.0) and inter-rater (.91-1.0) reliability reflect excellent agreement between human raters. The AI-algorithm could determine all parameters with excellent ICC-values (preop:0.80-1.0; postop:0.86-.99). For a comparison between the AI algorithm and 1 surgeon, mean errors were smallest for C1-C7 SVA (preop: -.3mm (95% CI:-.6 to -.1mm), post: .3mm (.0-.7mm)) and largest for C2-C7 lordosis (preop:-2.2° (-2.9 to -1.6°), postop: 2.3°(-3.0 to -1.7°)). The automatic measurement was possible in 99% and 98% of pre- and postoperative images for all parameters except T1 slope, which had a detection rate of 48% and 51% in pre- and postoperative images. This study validates that an AI-algorithm can reliably measure cervical sagittal balance parameters automatically in patients suffering from degenerative spinal diseases. It may simplify manual measurements and autonomously analyze large-scale datasets. Further studies are required to validate the algorithm on a larger and more diverse patient cohort.

Reliability and Validity of the Repetition-Counting Feature of the Push Band 2.0 at Different Repetition Speeds

Purpose: To assess the interdevice reliability and validity of the repetition-counting feature of the Push Band 2.0. Methods: Thirty college-aged participants (aged 18–24 years) simultaneously wore two Push Band 2.0 devices and performed 10 common resistance training exercises at four different tempos over the course of two testing sessions. Twelve repetitions were completed with visual confirmation for each set of exercises and compared with repetition estimates from the Push Band 2.0. Interdevice reliability was quantified using single measures intraclass correlation coefficients with 95% confidence intervals while validity was assessed via mean absolute percent error and mean percent error. Results: Interdevice reliability was found to be good to very good regardless of exercise type or tempo, as all intraclass correlation coefficients were >.770. Validity of the repetition-counting feature of the device was dependent on both exercise type and tempo, as exercises that did not involve rotation of the device throughout the movement demonstrated greater mean absolute percent error (31.0% average of all four tempos) and mean percent error (−29.9% average of all four tempos) than those that required such rotation (average mean absolute percent error of 3.5% and mean percent error of −1.6% across all four tempos). Conclusions: This study supports the reliability of the repetition-counting feature of the Push Band 2.0. However, device accuracy appears to be dependent on the type of movement and the speed at which the movement is performed, with greater accuracy observed during faster exercise tempos and exercises involving rotation of the device during movement execution.

Collecting evidence of validity for an assessment tool for Norwegian medical students’ non-technical skills (NorMS-NTS): usability and reliability when used by novice raters

BackgroundThe NorMS-NTS tool is an assessment tool for assessing Norwegian medical students’ non-technical skills (NTS). The NorMS-NTS was designed to provide student feedback, training evaluations, and skill-level comparisons among students at different study sites. Rather than requiring extensive rater training, the tool should capably suit the needs of busy doctors as near-peer educators. The aim of this study was to examine the usability and preliminary assess validity of the NorMS-NTS tool when used by novice raters.MethodsThis study focused on the usability of the assessment tool and its internal structure. Three raters used the NorMS-NTS tool to individually rate the team leader, a medical student, in 20 video-recorded multi-professional simulation-based team trainings. Based on these ratings, we examined the tools’ internal structure by calculating the intraclass correlation coefficient (ICC) (version 3.1) interrater reliability, internal consistency, and observability. After the rating process was completed, the raters answered a questionnaire about the tool’s usability.ResultsThe ICC agreement and the sum of the overall global scores for all raters were fair: ICC (3,1) = 0.53. The correlation coefficients for the pooled raters were in the range of 0.77–0.91. Cronbach’s alpha for elements, categories and global score were mostly above 0.90. The observability was high (95%-100%). All the raters found the tool easy to use, none of the elements were redundant, and the written instructions were helpful. The raters also found the tool easier to use once they had acclimated to it. All the raters stated that they could use the tool for both training and teaching.ConclusionsThe observed ICC agreement was 0.08 below the suggested ICC level for formative assessment (above 0.60). However, we know that the suggestion is based on the average ICC, which is always higher than a single-measure ICC. There are currently no suggested levels for single-measure ICC, but other validated NTS tools have single-measure ICC in the same range. We consider NorMS-NTS as a usable tool for formative assessment of Norwegian medical students’ non-technical skills during multi-professional team training by raters who are new to the tool. It is necessary to further examine validity and the consequences of the tool to fully validate it for formative assessments.

Family Physicians' Perceptions of Primary Health Care Use in Bosnia and Herzegovina during the Covid-19 Pandemic, a Cross-sectional Study.

The main objective of this paper was to examine the perceptions of family physicians on the use of primary health care in Bosnia and Herzegovina during the COVID-19 pandemic. A cross-sectional study was conducted using a short online questionnaire that was sent to primary care physicians in Bosnia and Herzegovina from April 20th, 2022, to May 20th, 2022. The research sample consisted of 231 doctors of primary health care from Bosnia and Herzegovina, with an average age of 45 years and 85% women. About 70% of participants reported having COVID-19 at least once from March 2020 to March 2022. Participants had an average of 1,986 registered patients and approximately 50 encounters per day. The study revealed a high degree of reliability between test-retest measurements, with a single measure Intraclass correlation coefficient of 0.801, and internal consistency determined using Cronbach's alpha of 0.89. Participants reported that the following health services were most affected during the COVID-19 pandemic: care for patients with chronic diseases, home visits, navigating the health system with patients making appointments with specialists, cancer screening, and preventive health services. The study also found statistically significant perceived differences in the use of these health services based on age, gender, postgraduate education in family medicine, participation in COVID-19 clinics, and personal history of Covid-19. There were significant disturbances to the use of primary health care during the COVID-19 pandemic. Future research could investigate patient outcomes compared to family physician perceptions.

Quantitative and qualitative image quality assessment in shoulder examinations with a first-generation photon-counting detector CT

Photon-counting detector (PCD) CT allows for ultra-high-resolution (UHR) examinations of the shoulder without requiring an additional post-patient comb filter to narrow the detector aperture. This study was designed to compare the PCD performance with a high-end energy-integrating detector (EID) CT. Sixteen cadaveric shoulders were examined with both scanners using dose-matched 120 kVp acquisition protocols (low-dose/full-dose: CTDIvol = 5.0/10.0 mGy). Specimens were scanned in UHR mode with the PCD-CT, whereas EID-CT examinations were conducted in accordance with the clinical standard as “non-UHR”. Reconstruction of EID data employed the sharpest kernel available for standard-resolution scans (ρ50 = 12.3 lp/cm), while PCD data were reconstructed with both a comparable kernel (11.8 lp/cm) and a sharper dedicated bone kernel (16.5 lp/cm). Six radiologists with 2–9 years of experience in musculoskeletal imaging rated image quality subjectively. Interrater agreement was analyzed by calculation of the intraclass correlation coefficient in a two-way random effects model. Quantitative analyses comprised noise recording and calculating signal-to-noise ratios based on attenuation measurements in bone and soft tissue. Subjective image quality was higher in UHR-PCD-CT than in EID-CT and non-UHR-PCD-CT datasets (all p < 0.001). While low-dose UHR-PCD-CT was considered superior to full-dose non-UHR studies on either scanner (all p < 0.001), ratings of low-dose non-UHR-PCD-CT and full-dose EID-CT examinations did not differ (p > 0.99). Interrater reliability was moderate, indicated by a single measures intraclass correlation coefficient of 0.66 (95% confidence interval: 0.58–0.73; p < 0.001). Image noise was lowest and signal-to-noise ratios were highest in non-UHR-PCD-CT reconstructions at either dose level (p < 0.001). This investigation demonstrates that superior depiction of trabecular microstructure and considerable denoising can be realized without additional radiation dose by employing a PCD for shoulder CT imaging. Allowing for UHR scans without dose penalty, PCD-CT appears as a promising alternative to EID-CT for shoulder trauma assessment in clinical routine.

The Implementation and Testing of a Reliable and Valid Oral Fat Tolerance Test (OFTT) for Research and Clinical Purposes

Background: Increased fat intake leads to a greater risk of atherosclerosis due to the increase in circulating triglycerides (TG), which damages the endothelial lining. An oral fat tolerance test (OFTT) is usually employed to evaluate postprandial lipid metabolism. However, there has yet to be a standardized procedure for doing an OFTT. This investigation assists in the determination of a standardized, reliable, and valid OFTT. Methods: All participants (n=20) were free of any known cardiovascular or metabolic disease. Participants were allotted 20 minutes to complete the OFTT. Baseline and subsequent blood analyses postfeeding were collected at 1, 2, 3, and 4 hours. One of the three OFTT loads of varying fat concentrations was administered to each participant in a randomized crossover design, containing fat loads of 150 g, 100 g, and 50 g of fat. A single-measure consistency intraclass correlation coefficient was used to determine significance (r&gt;0.75). Results: The test-retest reliability of the OFTT loads (150 g, 100 g, and 50 g) were all significant (p&lt;0.001), with ICC at 0.745, 0.923, and 0.715, respectively. Face Validity was confirmed upon repeat analysis. Conclusions: The 100 g OFTT load was the most reliable and valid measure for observing TG elevation. It is proposed that the 100 g load would be a reliable tool for further research investigation and eventual use for clinical purposes.

Novel AI-Based Algorithm for the Automated Computation of Coronal Parameters in Adolescent Idiopathic Scoliosis Patients: A Validation Study on 100 Preoperative Full Spine X-Rays.

Retrospective, mono-centric cohort research study. The purpose of this study is to validate a novel artificial intelligence (AI)-based algorithm against human-generated ground truth for radiographic parameters of adolescent idiopathic scoliosis (AIS). An AI-algorithm was developed that is capable of detecting anatomical structures of interest (clavicles, cervical, thoracic, lumbar spine and sacrum) and calculate essential radiographic parameters in AP spine X-rays fully automatically. The evaluated parameters included T1-tilt, clavicle angle (CA), coronal balance (CB), lumbar modifier, and Cobb angles in the proximal thoracic (C-PT), thoracic, and thoracolumbar regions. Measurements from 2 experienced physicians on 100 preoperative AP full spine X-rays of AIS patients were used as ground truth and to evaluate inter-rater and intra-rater reliability. The agreement between human raters and AI was compared by means of single measure Intra-class Correlation Coefficients (ICC; absolute agreement; >.75 rated as excellent), mean error and additional statistical metrics. The comparison between human raters resulted in excellent ICC values for intra- (range: .97-1) and inter-rater (.85-.99) reliability. The algorithm was able to determine all parameters in 100% of images with excellent ICC values (.78-.98). Consistently with the human raters, ICC values were typically smallest for C-PT (eg, rater 1A vs AI: .78, mean error: 4.7°) and largest for CB (.96, -.5mm) as well as CA (.98, .2°). The AI-algorithm shows excellent reliability and agreement with human raters for coronal parameters in preoperative full spine images. The reliability and speed offered by the AI-algorithm could contribute to the efficient analysis of large datasets (eg, registry studies) and measurements in clinical practice.

Novel artificial intelligence algorithm: an accurate and independent measure of spinopelvic parameters.

The analysis of sagittal alignment by measuring spinopelvic parameters has been widely adopted among spine surgeons globally, and sagittal imbalance is a well-documented cause of poor quality of life. These measurements are time-consuming but necessary to make, which creates a growing need for an automated analysis tool that measures spinopelvic parameters with speed, precision, and reproducibility without relying on user input. This study introduces and evaluates an algorithm based on artificial intelligence (AI) that fully automatically measures spinopelvic parameters. Two hundred lateral lumbar radiographs (pre- and postoperative images from 100 patients undergoing lumbar fusion) were retrospectively analyzed by board-certified spine surgeons who digitally measured lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope. The novel AI algorithm was also used to measure the same parameters. To evaluate the agreement between human and AI-automated measurements, the mean error (95% CI, SD) was calculated and interrater reliability was assessed using the 2-way random single-measure intraclass correlation coefficient (ICC). ICC values larger than 0.75 were considered excellent. The AI algorithm determined all parameters in 98% of preoperative and in 95% of postoperative images with excellent ICC values (preoperative range 0.85-0.92, postoperative range 0.81-0.87). The mean errors were smallest for pelvic incidence both pre- and postoperatively (preoperatively -0.5° [95% CI -1.5° to 0.6°] and postoperatively 0.0° [95% CI -1.1° to 1.2°]) and largest preoperatively for sacral slope (-2.2° [95% CI -3.0° to -1.5°]) and postoperatively for lumbar lordosis (3.8° [95% CI 2.5° to 5.0°]). Advancements in AI translate to the arena of medical imaging analysis. This method of measuring spinopelvic parameters on spine radiographs has excellent reliability comparable to expert human raters. This application allows users to accurately obtain critical spinopelvic measurements automatically, which can be applied to clinical practice. This solution can assist physicians by saving time in routine work and by avoiding error-prone manual measurements.

Laying the foundation for enhancing safety of desmopressin in older people: Validation of capillary blood sodium levels.

We aim to make desmopressin a safe treatment option for (older) patients at risk for hyponatremia, by introducing a new way of sodium monitoring. The goal is to reduce the risk of hyponatremia, enhance patient safety and ultimately introduce self-monitoring of sodium levels. The first step in the aforementioned is to validate capillary sodium. 100 randomly selected patients admitted to the urology department received a single finger prick to collect capillary blood (250 µl) in a lithium-heparin tube. Each patient acted as its own control for the capillary and venous blood sample. Venous and capillary plasma sodium were analyzed by indirect ion-selective electrodemeasurement. The primary outcome was the agreement between capillary and venous sodium measurements, measured by the intra-class correlation coefficient (ICC). One hundred paired blood samples were obtained of which four were excluded. There was no significant statistical difference observed between venous and capillary sodium (-0.23 mmol/L, p = 0.374). The ICCfor single measures between capillary and venous sodium was 0.82 (95% confidence interval 0.75-0.88). Inter-method differences analyzed by a Bland-Altman plot and a Passing-Bablock regression did not reveal a statistically significant difference between both groups. We demonstrated that venous and capillary sodium levels are interchangeable, taken into account the inter- and intravariability between analyses. We provided the first step towards a simple and safe solution for frequent sodium monitoring through a minimal invasive capillary blood collection. The results are of direct clinical relevance to safely use desmopressin in (older) patients at risk.

140. Automated measurement technique for coronal parameters using a novel artificial intelligence algorithm: an independent validation study on 100 preoperative AP spine X-rays

140. Automated measurement technique for coronal parameters using a novel artificial intelligence algorithm: an independent validation study on 100 preoperative AP spine X-rays

Reliability of a three-dimensional spinal proprioception assessment for patients with adolescent idiopathic scoliosis

PurposeAlthough it is evident that some patients with adolescent idiopathic scoliosis (AIS) have proprioceptive deficit in peripheral joints, knowledge on the proprioceptive function of the deformed spine is limited. Nonetheless, spinal proprioception in AIS may be affected three-dimensionally, prior studies only focussed on evaluating peripheral proprioception in single plane. Therefore, this study aimed to develop a novel spinal proprioception assessment using three-dimensional motion analysis in patients with AIS.MethodsParticipants were included if they had a primary diagnosis of AIS who did not receive or failed conservative treatments. Three trunk repositioning tests involving flexion-extension, lateral-flexion, and axial-rotation were conducted. A three-dimensional kinematics of the trunk was used as the outcome measures. The proprioceptive acuity was quantified by the repositioning error. The intra-examiner and test-retest reliability were analysed by the intraclass correlation coefficient (ICC).ResultsFifty-nine patients with AIS were recruited. Regarding the trunk flexion–extension test, the single measure ICC showed moderate reliability (0.46) and the average measures ICC demonstrated good reliability (0.72). As for the trunk lateral-flexion test, the reliability of single measure and average measures ICC was moderate (0.44) and good (0.70) reliability, respectively. For the trunk axial-rotation test, the single measure ICC indicated fair reliability (0.32), while the average measures ICC showed moderate reliability (0.59).ConclusionThis is the first study to evaluate the reliability of novel three-dimensional spinal proprioception assessments in patients with AIS. The trunk flexion-extension repositioning test may be preferable clinical test given its highest reliability.

Test–retest reliability of selected HBSC items in Vietnam: well-being, physical and sedentary activities, and eating behaviours

BackgroundValid and reliable research tools to assess children’s and adolescent’s health-related behaviour are highly needed across the globe. Rapid economic development, globalization, and associated lifestyle challenges observed in most countries support the need for high-quality evidence in adolescents to target health-promoting policies and interventions. This study aims to examine the test–retest reliability of selected well-being, physical and screen-time related siting activities, and eating behaviour items of the Health Behaviour in School-Aged Children (HBSC) questionnaire in a sample of Vietnamese adolescents.MethodsData were collected in autumn 2018 in Vietnam (3-week interval). The sample consisted of 410 adolescents (41.0% of boys; mean age = 12.61; SD = 1.24).Test–retest reliability was evaluated using the single measure Intraclass Correlation Coefficients (ICC) and Cohen’s kappa statistic stratified by sex, grade and place of residence (urban or rural).ResultsThe reliability analyses of the well-being items were poor to good ICC values (0.43–0.79) and moderate to large Cohen’s kappa values (0.33–0.77). The physical activity and eating behaviour items were moderate (ICC = 0.54–0.65; Cohen’s kappa = 0.38–0.57). The screen-time related siting activities items were moderate to large (ICC = 0.51–0.72; Cohen’s kappa = 0.42–0.53). There was more item stability among females than males. The social media item was not as stable for 6th graders (ICC = 0.45) compared with older adolescents (ICC 0.68–0.77).ConclusionsThe findings show that with regards to age, sex and place of residence, self-reported health, life satisfaction, physical and screen-time related siting activities, as well as eating behaviour items of the HBSC questionnaire have a sufficient test–retest reliability to be used in national self-report surveys for Vietnamese adolescents while health complaints items showed borderline reliability.

The Effects of Active Range of Motion on Upper Trapezius’ Fasciae Displacement among Individuals with and without Myofascial Pain Syndrome

Aim: This study determined the differences in upper trapezius' superficial and deep fascia slides among MPS and non-MPS participants after performing cervical active range of motion (AROM). The association between the fascia slides, age, sex, occupation, clinical diagnosis, and symptoms’ chronicity were determined. Methods: This retrospective study constituted a reliability and case-control study. Three hundred participants (174 MPS: 126 non-MPS) were included. For each fascia level, six physiotherapy interns read 19 MSUS videos. Bland Altman Plot and Single Measures Intraclass Correlation Coefficient (ICC) determined the physiotherapy interns' intratester and intertester reliability. Twelve physiotherapy interns quantified the fascia slides in 3,600 MSUS videos. MPS and non-MPS groups were compared against differences in fascia slides using independent samples t-test. A p-value of &lt;0.05 indicated significant differences in fascia slides. Multiple regression analyses determined fascia slides and independent variables’ relationship. Results: Intertester reliability in tracking the superficial and deep fasciae was very good (ICC = 0.90 to 1.00). Intratester reliability showed minimal to no individual bias (95% CI). A significant difference in superficial fascia displacement between groups was only observed during active cervical extension (p&lt; 0.05). No difference in cervical AROM was reported in deep fascia displacement between groups (p&gt; 0.05). No associations were found between superficial fascia slides and independent variables (p &gt;0.05). Sex was the only variable associated with deep fascia slide difference (p &lt;0.05). Conclusion and Implications: Limited fascia slide is not a characteristic of individuals with MPS. There is no association between differences in fascia slides and independent variables.

Computer-aided Measurement System Using Image Processing for Measuring Cobb Angle in Scoliosis

Background: One of the spine deformities is scoliosis, and Cobb angle is generally used to assess it. Objectives: In this study, a computer-aided measurement system (CAMS) was presented as a new repeatable and reproducible approach to assess the Cobb angle in idiopathic scoliosis patients. Methods: Python libraries, including OpenCV and Numpy were used for image processing and design of the software. To assess the repeatability and reproducibility of the CAMS, a series of 98 anterior-posterior radiographs from patients with idiopathic scoliosis were used. Assessments were done by five independent observers. Each radiograph was assessed by each observer three times with a minimum break of two weeks among assessment. The single measure intraclass correlation coefficient (ICC), the mean absolute difference (MAD), and the standard error measurement (SEM) values were used for intra- and inter-observer reliability. Results: The inter-observer analysis indicated that the ICCs ranged from 0.94 - 0.99, and the MAD between manual and CAMS were less than 3°. For intra-observer measurements, the combined SEM between all observers for the manual and CAMS was 1.79° and 1.27°, respectively. An ICC value of 0.97 with 95% confidence interval (CI) was excellent in CAMS for inter-observer reliability. The MAD of CAMS was 2.18 ± 2.01 degrees. Conclusions: The CAMS is an effective and reliable approach for assessing scoliotic curvature in the standing radiographs of thoraco-lumbar. Moreover, CAMS can accelerate clinical visits, and its calculation results are reliable.

74. Novel artificial intelligence algorithm can accurately and independently measure spinopelvic parameters

<h3>BACKGROUND CONTEXT</h3> Preoperative and postoperative sagittal plane assessment is crucial in both spinal deformity and degenerative pathologies. Sagittal malalignment is a well-established cause of poor patient reported outcomes. There is a growing need for an automated analysis tool that measures pelvic parameters with speed, precision and reproducibility without relying on user identified landmarks. A new AI algorithm has been developed to measure important radiographic parameters independently. <h3>PURPOSE</h3> The analysis of sagittal alignment by measuring spinopelvic parameters has been widely adopted among spine surgeons globally. The currently available spine measurement software programs require users to identify several landmarks prior to calculating parameters, making them time consuming and more reliant upon user experience. This study evaluates and demonstrates that an algorithm based on artificial intelligence (AI) can independently determine spinopelvic parameters. This allows for precise radiographic measurement without time-intensive human input. We hypothesize that the novel, fully automatic method will have a high agreement with human measurements for lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). <h3>STUDY DESIGN/SETTING</h3> Evaluation of the inter-rater reliability and mean error between radiographic measurements of the AI algorithm and expert human raters. Radiographs were retrospectively reviewed from a single site, multisurgeon center. <h3>PATIENT SAMPLE</h3> In this study, preoperative and postoperative X-rays were evaluated in 100 patients undergoing a lumbar fusion procedure. <h3>METHODS</h3> From a total of 200 lateral lumbar radiographs (preoperative and postoperative images from 100 patients undergoing fusion) 5 independent observers (4 spinal surgeons, 1 senior researcher) digitally measured LL, PI, PT and SS. Their parameters were compared with AI algorithm generated parameters. Mean error (95% confidence interval, standard deviation) and inter-rater reliability were assessed using 2-way mixed, single-measure intraclass correlation (ICC). ICC values larger than 0.75 were considered excellent. <h3>RESULTS</h3> The novel algorithm's spinopelvic parameter ICC values were excellent in 98% of preoperative and in 95% of postoperative radiographs (PreOp range: 0.85–0.92, PostOp range: 0.81–0.87). Exemplarily, mean errors are smallest for the PI (PreOp: -0.5° [95%-CI: -1.5°–0.6°]; PostOp: 0.0° [-1.1°–1.2°]) and largest for LL (1.3° [0.3°–2.4°]; 3.8° [2.5°–5.0°]). <h3>CONCLUSIONS</h3> Novel AI algorithm automated spinopelvic parameter measurements from spine radiographs have a high degree of accuracy comparable to digital measurements by experts. This algorithm can improve physician workflow efficiency and reduce inter-rater and intra-rater measurement errors <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Reliability of forearm medial-anterior surface dimensional changes at different isometric hand grip forces

Indirect techniques of predicting hand grip force are fundamental to develop hand control systems for assistive devices. The purpose of this study was to determine the reliability of 3D position of forearm surface at different isometric hand grip forces. Three-dimensional motion analysis was used to measure displacement of 24 discrete and standardized surface markers placed on forearm in 20 healthy participants. The relative displacements were measured for isometric grip forces at 0%, 5%, 20% 50% and 80% of maximum voluntary contraction (MVC). Intraclass correlation coefficient (ICC) for relative radial displacement (RRD) of each marker was calculated. Averaged single measure ICC of 24 markers at five grip forces was 0.61; while the highest averaged single measure ICC (0.80) for all markers was achieved at 80% of MVC and the lowest (0.47) at 0% of MVC. The average measure ICC for each grip force across the 24 markers also increased with grip force from 0.80 at 0% of MVC to the maximum of 0.95 at 80% of MVC. In conclusion, RRD showed moderate and high ICCs for single and average measures respectively. Overall, this study suggests that the reliable dimensional changes of 3D positions of forearm surface might be considered as an indirect and non-invasive method to predict hand grip force in future.

An evaluation of the repeatability of electric pulp sensibility tests.

The accuracy, reliability and reproducibility of electric pulp tests (EPT) have been investigated but there is conflicting information about their repeatability. The aim of this study was to investigate whether EPT are repeatable over time. EPT results from 180 healthy teeth in 39 patients with 2-10 readings per tooth (total 692 readings) were analysed. Single measures intraclass correlation coefficients (ICC) ranged from 0.776 to 0.845 in teeth with 2-7 repeated measures (P < 0.001), indicating good repeatability. With eight or more measures per tooth, the ICC was low, indicating poor repeatability over longer follow-up times, but only seven teeth in two subjects were included in this analysis. The Pearson correlation showed no statistically significant correlation for 2-7 readings but when all readings were included, there was a statistically significant negative correlation. Hence, EPT has good repeatability.

Validation of the Modified Self-Administered Pediatric Bleeding Assessment Questionnaire (Self-PBQ) in Children Aged 8-12 Years

IntroductionIn the pediatric population, pathologic bleeding is often more challenging to identify than in adult patients. Hemorrhagic symptoms are seen in healthy children as well as those with bleeding disorders and children have fewer exposures to events such as surgery that would cause symptoms to manifest. A pediatric bleeding assessment tool may facilitate the accurate evaluation of bleeding symptoms in children.The Pediatric Bleeding Questionnaire (PBQ) was developed as a screening tool for von Willebrand Disease (VWD), the most common hereditary bleeding disorder. The PBQ provides a quantitative score for bleeding symptoms based on the type and severity of episodes. When administered by experts, the PBQ had a sensitivity of 83% and a specificity of 79%. Recently, the expert-administered PBQ was modified to generate a self-administered PBQ which can be completed by children/parents themselves. A prospective multicentre study was undertaken to validate the Self-PBQ and found it to have a high level of agreement with the expert-administered PBQ, with an intraclass correlation (ICC) of 0.917. However, only children above age 12 yrs completed the Self-PBQ by themselves while those under 12 had a parent fill out the Self-PBQ on their behalf.The present study is sub-study of the recent multicentre study. Our objectives were to determine whether a modified school age Self-PBQ can be completed by younger children with minimal adult assistance, and to validate the school age Self-PBQ in the 8-12 year-old population.MethodologyThis sub-study was conducted in two phases. Phase 1 involved pre-testing and optimizing the Self-PBQ to be suitable for 8-12 year-olds. Seven subjects aged 8-11 yrs, 5 with a confirmed diagnosis of type 1 VWD and 2 healthy controls, underwent cognitive debriefing to identify any problems in the questionnaire. Based on respondent feedback, item reduction was performed to simplify the PBQ, and modifications were made to the question wording and response options.In Phase 2, the school age Self-PBQ was tested at 5 participating treatment centres across Canada. Patients aged 8-12 yrs with a known diagnosis of an inherited bleeding disorder were eligible for inclusion. Children completed the Self-PBQ independently or with assistance from their parent and the amount of help required was noted. Parents also filled out the Self-PBQ separately to serve as a comparison. Bleeding scores (BSs) derived from the child self-report were compared to those of the parent proxy. A single measure ICC based on absolute agreement was used to determine the degree of agreement between the child and parent reports. In addition, subgroup analyses were performed to examine whether the correlation differed in younger (8-9 yrs) versus older (10-12 yrs) age groups or based on the severity of the disease. An ICC ≥ 0.70 was considered the minimum standard for reliability based on existing quality criteria.ResultsThirty-one patients aged 8-12 yrs and their parents completed the Self-PBQ. Two pairs were excluded from the analysis because they did not answer portions of the PBQ and their BSs could not be calculated. Total BSs were used for reliability analysis, performed on a final sample size of 29 pairs. Child and parent scores demonstrated a high level of agreement with an ICC of 0.825. In the age subgroup analysis, the ICC was 0.834 and 0.824 for the 8-9 year-old and 10-12 year-old groups respectively. The ICC was also determined in children with type 1 VWD (ICC = 0.829) versus those with more severe bleeding disorders (ICC = 0.802). Thus, age and disease severity had no significant effect on degree of agreement (Figure).ConclusionOur study evaluated the effectiveness of a school age Self-PBQ when completed by children aged 8-12 yrs. The BSs derived from the child self-report were found to have sufficient concordance with those from the parent proxy report. Moreover, the agreement was maintained in younger children aged 8-9 yrs and in children on the more severe spectrum of bleeding disorders. These results indicate that the Self-PBQ is suitable to be incorporated into routine clinical care for the 8-12 year-old population.Figure: Agreement between child and parent (proxy) total reported bleeding scores (BSs). The difference between child and parent-derived BSs is plotted against the mean of the two measurements. The average of the differences is shown by the red line. The numbers plotted reflect ages of the children. [Display omitted] DisclosuresJames:Shire: Research Funding; Bayer: Research Funding; CSL Behring: Research Funding. Klaassen:Baxalta: Honoraria; Agios Pharmaceuticals: Consultancy; Octapharma: Honoraria; Biogen Canada LTD: Consultancy; Amgen: Consultancy; Hoffman-La Roche LTD: Consultancy.