Smallest Detectable Change Values Research Articles

The test-retest reliability of non-navigated transcranial magnetic stimulation (TMS) measures of corticospinal pathway excitability early after stroke

Purpose Motor evoked potential (MEP) characteristics are potential biomarkers of whether rehabilitation interventions drive motor recovery after stroke. The test-retest reliability of Transcranial Magnetic Stimulation (TMS) measurements in sub-acute stroke remains unclear. This study aims to determine the test-retest reliability of upper limb MEP measures elicited by non-neuronavigated transcranial magnetic stimulation in sub-acute-stroke. Methods In two identical data collection sessions, 1–3 days apart, TMS measures assessed: motor threshold (MT), amplitude, latency (MEP-L), silent period (SP), recruitment curve slope in the biceps brachii (BB), extensor carpi radialis (ECR), and abductor pollicis brevis (APB) muscles of paretic and non-paretic upper limbs. Test-retest reliability was calculated using the intra-class correlation coefficient (ICC) and 95% confidence intervals (CI). Acceptable reliability was set at a lower 95% CI of 0.70 or above. The limits of agreement (LOA) and smallest detectable change (SDC) were calculated. Results 30 participants with sub-acute stroke were included (av 36 days post stroke) reliability was variable between poor to good for the different MEP characteristics. The SDC values differed across muscles and MEP characteristics in both paretic and less paretic limbs. Conclusions The present findings indicate there is limited evidence for acceptable test-retest reliability of non-navigated TMS outcomes when using the appropriate 95% CI for ICC, SDC and LOA values. Clinical Trial Registration Current Controlled Trials: ISCRT 19090862, http://www.controlled-trials.com

Validity and Reliability of the Persian Adolescent Leisure Interest Profile in Adolescents with Cerebral Palsy

Background: This study was conducted to evaluate the psy-chometric properties of a Persian version of the Adolescent Leisure Interest Profile (ALIP) in Persian-speaking adolescents with Cerebral Palsy (CP).
 Methods: Thirty adolescents with CP participated. The test-retest reliability, construct validity of the ALIP with the Children’s Assessment of Participation and Enjoyment (CAPE), and discriminative validity were examined.
 Results: There were no floor and ceiling effects. Test-retest reliability of the Persian version of the ALIP for the total scores ranged from 0.69-0.94. Cronbach alpha for internal consistency of the Persian ALIP was obtained 0.98. Evidence for construct validity was found with significant correlations between the ALIP and the CAPE domains (r=-0.45-0.69). The standard error of measurement and the smallest detectable change values were 0.08-8.22 and 0.22-22.87, respectively.
 Conclusion: The Persian version of the Adolescent Leisure Interest Profile is a useful tool for measuring leisure activities in Persian-speaking adolescents with CP.

Reliability, Validity, Responsiveness, and Minimum Important Change of the Stair Climb Test in Adults With Hip and Knee Osteoarthritis.

The Osteoarthritis Research Society International (OARSI) recommends assessment of physical function using a performance-based test of stair negotiation but was unable to recommend any specific test. We assessed the reliability, validity, responsiveness, measurement error, and minimum important change (MIC) of the 6-step timed Stair Climb Test (SCT). We used pooled data from 397 participants with hip or knee osteoarthritis (54% women) from 4 clinical trials (86% retained at 12-week follow-up). Construct validity was assessed by testing 6 a priori hypotheses against other OARSI-recommended physical function measures. A self-reported Global Rating of Change scale was used to classify participants as worsened, improved, and stable. Participants who worsened in physical function were excluded from all analyses. Responsiveness and MIC were assessed using multiple anchor-based and distribution-based approaches. Test-retest reliability, standard error of measurement (SEM), and smallest detectable change (SDC) were assessed on stable participants. Five of 6 hypotheses (83%) for construct validity were met. Test-retest reliability was excellent (intraclass correlation coefficient2,1 0.83; 95% confidence interval 0.71-0.90). The SEM and SDC values were 0.44 and 1.21 seconds, respectively. We did not find adequate support for responsiveness. The MIC values ranged from 0.78 to 1.95 seconds using different approaches (median 1.37 seconds). The 6-step timed SCT adequately assesses the construct of physical function in individuals with hip or knee osteoarthritis with excellent 12-week test-retest reliability. However, support for its responsiveness was inadequate to recommend its use as an outcome measure in people with osteoarthritis for research and clinical practice.

Reference values, intrarater reliability, and measurement error for the closed kinetic chain upper extremity stability test and upper quarter y balance test in young adults

Aims: To describe reference values for the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) and Upper Quarter Y Balance Test (UQYBT) in young adults, and to determine whether there were differences in both tests based on gender and age. Intrarater reliability and measurement error were also assessed. Methods: Test-retest design with a sample of 146 young adults. The CKCUEST (number of touches, normalized score, and power) and the UQYBT (normalized reach in the medial, superolateral, and inferolateral direction, and the composite score) were used. Mean and standard deviation were calculated for both tests. A linear and a mixed regression model were applied to determine significant differences in test scores. Reliability was determined using Intraclass Correlation Coefficient (ICC) and error measurement through Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC). Results: Normative values were established and divided by gender and age. Men presented greater scores regarding the number of touches, power score, superolateral and inferolateral reaches. Good intrarater reliability was found for both tests. In the CKCUEST, the SEM and SDC values were 1 and 3 touches. In the UQYBT, the SEM values ranged from 3 to 7 cm, while the SDC ranged from 8 to 19 cm. Conclusion: Normative data were provided and men presented greater scores than women. Good intrarater reliability was found and values of SEM and SDC were established. Clinicians must use both tests in clinical practice since different aspects of the upper quarter are assessed.

Evaluation of the Responsiveness of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale.

Background:The Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale is a reliable and valid tool for evaluation of psychological readiness to return to sport after ACL injury, but its responsiveness to change has not been extensively evaluated.Purpose:To determine the responsiveness of the ACL-RSI scale.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:The ACL-RSI scale and the knee confidence question from the Knee injury and Osteoarthritis Outcome Score–Quality of Life subscale was completed at 6 and 12 months after ACL reconstruction surgery. Responsiveness was assessed using distribution and anchor-based methods for the full- and short-form versions of the scale and subgroup analyzed for sex. From distribution statistics, the standardized response mean (SRM) and the smallest detectable change (SDC) were calculated. Using the anchor-based method, the minimally important change (MIC) that was associated with an improvement in knee confidence was determined using receiver operating characteristic analysis.Results:A total of 441 patients (257 men, 184 women; mean age of 25 years) were included in this study. An SRM of 0.7 was found for both versions, indicating a moderate level of responsiveness. The MIC was 13.4 points for the full-form version and 15.1 points for the short-form version. These values were larger than SDC values at the group level but not at the individual patient level. Responsiveness was similar between male and female patients.Conclusion:The ACL-RSI scale had sufficient responsiveness to investigate the efficacy of an intervention at a group level, but it may be more limited at an individual patient level.

Intra- and Inter-Rater Reliability of a Well-Used and a Less-Used IsoMed 2000 Dynamometer for Knee Flexion and Extension Peak Torque Measurements in a Concentric Test in Athletes

This study aimed to evaluate the intra- and inter-rater reliability of a well-used and a less-used IsoMed-2000 dynamometer for knee flexion and extension peak torque (PT) measurements in a concentric test in athletes. Two IsoMed-2000 isokinetic dynamometers were used, an old one that was well-used and a new one that was less-used. Thirty-seven weight-lifting athletes (12 female, 25 male) were included in this study. Both legs of each athlete were tested twice on each isokinetic dynamometer at 60°/s and 180°/s. The Intraclass Correlation Coefficients (ICC), Standard Error Measurement (SEM), Smallest Detectable Change (SDC), SDC% and 95% limits of agreement were calculated to evaluate the intra- and inter-rater reliability of a well-used and a less-used IsoMed 2000 dynamometer for knee flexion and extension peak torque in athletes. Intra-rater reliability was moderate to excellent (ICCs: 0.516–0.928) for knee muscle strength parameters, and the highest SDC and SEM values were 0.76 N/kg and 0.28 N/kg, respectively. Inter-rater reliability was moderate to excellent (ICCs: 0.519–915) for knee muscle strength parameters, and the highest SDC and SEM values were 0.81 N/kg and 0.29 N/kg, respectively. At least 89.2% of the obtained values of parameters fell within the 95% limits of agreement. Our findings demonstrate the intra and inter-rater reliability of a Well-Used and a Less-Used IsoMed 2000 Dynamometer for Knee Flexion and Extension Peak Torque in Athletes.

Minimally important change and smallest detectable change of the OSTRC questionnaire in half- and full-marathon runners.

The purpose of this study was to evaluate the smallest detectable change (SDC), minimally important change (MIC), and factor structure of the Oslo Sports Trauma Research Center (OSTRC) questionnaire severity score in half‐ and full‐marathon runners. Data came from a prospective cohort study, the SUcces Measurement and Monitoring Utrecht Marathon (SUMMUM) 2017 study. Two external anchors, the global rating of change (GRC) and global rating of limitations (GRL), were used to classify the running‐related injuries (RRI) as truly improved, unchanged, or truly worsened. SDC values were calculated at individual and group levels. MIC values were calculated using the visual anchor‐based MIC distribution and mean change methods. Confirmatory factor analysis (CFA) was used to study the a priori hypothesized factor structure. A total of 132 runners who reported the same RRI on two occasions 2 weeks apart were included in the analysis. SDC values at individual and group levels were ≤35.06 and ≤9.30, respectively. With the visual anchor‐based MIC distribution method, the MIC values for RRIs that truly improved according to the GRC and GRL anchors were 13.50 and 18.50, respectively. With the mean change method, the MIC values for RRIs that truly improved according to the GRC and GRL anchors were 15.49 and 45.38, respectively. The CFA confirmed that the OSTRC was a unidimensional questionnaire. The change score of the OSTRC severity score can be used to distinguish between important change and measurement error at a group level using the MIC value 18.50. Because the SDC of the OSTRC severity score was larger than the MIC, it is not advised to use the MIC at an individual level.

New evidence on the minimal important change (MIC) for the Hand Eczema Severity Index (HECSI).

How changes in hand eczema (HE) severity correlate with the single scores on the Hand Eczema Severity Index (HECSI) is sparsely investigated and particularly needed in clinical trials. To find the minimal important change (MIC) for HECSI based on patient's and physician's assessments using different methods. In this prospective follow-up study, three different anchors were used: two anchor questions for patients and physician, respectively, and the Physician Global Assessment (PGA) with a photographic guide. MIC was estimated by mean change in patients with a one-step increase to anchor-questions, receiver-operating characteristic (ROC) plot, and smallest detectable change (SDC). One hundred fifty-two patients with HE (63.8% female) were included at baseline (89% completed follow-up). The mean change, ROC cutoff, and SDC values were 7.1, 4.5, 21.4 (patient-rating), 8.2, 4.5, 8.3 (physician-rating), and 16.6, 6.5, 27.1 points (PGA), respectively. SDC stratified by baseline severity was 2.9 and 11 points for mild and moderate-severe HE (physician-rating), respectively. Identification of the MIC for the HECSI is important in relation to evaluation of treatment, intervention, and sample-size calculations. An improvement of 8.3 points on the HECSI is recommended as the MIC. MIC values may differ according to baseline severity, and this variation should be clarified in future studies.

Reliability and Structural Validity of the Movement Assessment Battery for Children-2 in Croatian Preschool Children.

Monitoring and assessment of the development of motor skills is an important goal for practitioners in many disciplines as well as researchers interested in motor development. A well-established tool for such purpose is the Movement Assessment Battery for Children Second Edition (MABC-2) which covers three age ranges and contains eight motor items in each range related to the manual dexterity, aiming and catching, and balance. The main aim of the study was to investigate the reliability and validity of the MABC-2 age band one in a sample of Croatian preschool children. Structural validity was assessed using confirmatory factor analysis (CFA). Measures of relative and absolute reliability were established by computing the intraclass correlation coefficients (ICC), standard error of the measurement (SEM), and smallest detectable change (SDC). About 17% of the children of the total sample fall into the categories of motor impairment and risk for impairment, respectively, while 83% were found to be in the category of normally developing children. Intraclass correlation coefficient for the total standard score was 0.79 while individual items, all except one, ranged from 0.70 to 0.83. Drawing trail, but also throwing beanbag and one-leg balance items presented large SEM and SDC values. CFA initially yielded a model with questionable fit to the data. After re-specification, excellent model fit was attained confirming the proposed three-factor model. Satorra–Bentler χ2(26) reached 38.56 (p = 0.054), root mean square error of approximation (RMSEA) was 0.028, non-normed fit index (NNFI) was 0.98, adjusted goodness of fit (AGFI) was 0.97, and standardized root mean residual (SRMR) was 0.030. All the variables loaded significantly, and only two significant standardized residuals have been found. Correlations between the factors were weak, supporting discriminant validity of the test. We found MABC-2 to be an appropriate instrument to assess the development of motor competences of preschool children.

Validity and reliability of serratus anterior hand held dynamometry

BackgroundStrength testing of the serratus anterior muscle with hand held dynamometry (HDD) in supine subjects has low reproducibility, and is influenced by compensatory activity of other muscles like the pectoralis major and upper trapezius. Previously, two manual maximum voluntary isometric contraction tests of the serratus anterior muscle were reported that recruited optimal surface electromyography (sEMG) activity in a sitting position. We adapted three manual muscle tests to make them suitable for HHD and investigated their validity and reliability.MethodsTwenty-one healthy adults were examined by two assessors in one supine and two seated positions. Each test was repeated twice. Construct validity was determined by evaluating force production (assessed with HHD) in relation to sEMG of the serratus anterior, upper trapezius and pectoralis major muscles, comparing the three test positions. Intra- and interrater reliability were determined by calculating intra-class correlation coefficients (ICC) smallest detectable change (SDC) and standard error of measurement (SEM).ResultsSerratus anterior muscle sEMG activity was most isolated in a seated position with the humerus in 90° anteflexion in the scapular plane. This resulted in the lowest measured force levels in this position with a mean force of 296 N (SEM 15.8 N). Intrarater reliability yielded an ICC of 0.658 (95% CI 0.325; 0.846) and an interrater reliability of 0.277 (95% CI -0.089;0.605). SDC was 127 Newton, SEM 45.8 Newton.ConclusionThe results indicate that validity for strength testing of the serratus anterior muscle is optimal with subjects in a seated position and the shoulder flexed at 90° in the scapular plane. Intrarater reliability is moderate and interrater reliability of this procedure is poor. However the high SDC values make it difficult to use the measurement in repeated measurements.

Intraexaminer and Interexaminer Reproducibility of the Downing Test for Sacroiliac Joint Evaluation of Symptomatic and Asymptomatic Individuals

ObjectiveThis study aimed to assess the intraexaminer and interexaminer reproducibility of the Downing test in sacroiliac joint evaluation in symptomatic and asymptomatic individuals. MethodsA reliability study was conducted with a test–retest design in 54 college students of both sexes. To assess the intraexaminer reproducibility, each participant was evaluated twice by the same examiner with a 7-day interval, and to assess the interexaminer reproducibility, each participant was evaluated by 2 examiners. ResultsOf the 54 participants included in the study, 18 (33.3%) were asymptomatic and 36 (66.7%) were symptomatic; a total of 108 sacroiliac joints were evaluated. Sacroiliac joint diagnosis based on the Downing test presented low intraexaminer reproducibility in all participants (κ = 0.12, 95% confidence interval [CI] 0.03-0.22), in asymptomatic individuals (κ = 0.18, 95% CI 0.02-0.34), and in symptomatic individuals (κ = 0.28, 95% CI 0.17-0.39). The interexaminer reproducibility also was low in all participants (κ = 0.18, 95% CI 0.09-0.27), in asymptomatic individuals (κ = 0.22, 95% CI 0.15-0.37), and in symptomatic individuals (κ = 0.16, 95% CI 0.05-0.27). The standard error of the measurement values were not lower than smallest detectable change values considering a CI of 95% for all participants. ConclusionFor this group of asymptomatic and symptomatic participants, the reproducibility of the Downing test was poor. The clinical utility of this test used in isolation is not supported by the present study.

Smallest detectable change and test-retest reliability of a self-reported outcome measure: Results of the Center for Epidemiologic Studies Depression Scale, General Self-Efficacy Scale, and 12-item General Health Questionnaire.

This study aims to examine the smallest detectable change (SDC) and test-retest reliability of the Center for Epidemiologic Studies Depression Scale (CES-D), General Self-Efficacy Scale (GSES), and 12-item General Health Questionnaire (GHQ-12). We tested 154 young adults at baseline and 2weeks later. We calculated the intra-class correlation coefficients (ICCs) for test-retest reliability with a two-way random effects model for agreement. We then calculated the standard error of measurement (SEM) for agreement using the ICC formula. The SEM for agreement was used to calculate SDC values at the individual level (SDCind ) and group level (SDCgroup ). The study participants included 137 young adults. The ICCs for all self-reported outcome measurement scales exceeded 0.70. The SEM of CES-D was 3.64, leading to an SDCind of 10.10 points and SDCgroup of 0.86 points. The SEM of GSES was 1.56, leading to an SDCind of 4.33 points and SDCgroup of 0.37 points. The SEM of GHQ-12 with bimodal scoring was 1.47, leading to an SDCind of 4.06 points and SDCgroup of 0.35 points. The SEM of GHQ-12 with Likert scoring was 2.44, leading to an SDCind of 6.76 points and SDCgroup of 0.58 points. To confirm that the change was not a result of measurement error, a score of self-reported outcome measurement scales would need to change by an amount greater than these SDC values. This has important implications for clinicians and epidemiologists when assessing outcomes.

Reproducibility of ultrasound-derived muscle thickness and echo-intensity for the entire quadriceps femoris muscle

IntroductionMuscle thickness (MT) and muscle echo-intensity (EI) allow the study of skeletal muscle adaptive changes with ultrasound. This study investigates the intra- and inter-session reliability and agreement of MT and EI measurements for each of the four heads of the quadriceps femoris in transverse and longitudinal scans, using two sizes for the region of interest (ROI); EI measurements only. MethodsThree B-mode images from two views were acquired from each head of quadriceps femoris from twenty participants (10 females) in two sessions, 7 days apart. EI was measured using a large and a small ROI. Reliability was examined with the mixed two-way intra-class correlation coefficient (ICC), the standard error of mean (SEM) and the smallest detectable change (SDC). Bland–Altman's plots were used to study agreement. ResultsHigh to very high inter-session ICC values were found for MT for all muscle heads, particularly for measurements from transverse scans. For EI measurement, ICC values ranged from low to high, with higher ICC values seen with the largest ROI. SDC values ranged between 0.19 and 0.53 cm for MT and between 3.73 and 18.56 arbitrary units (a.u.) for two ROIs. Good agreement existed between MT measurements made in both scans. A small bias and larger 95% limits of agreement were seen for EI measurements collected with the two ROI sizes. ConclusionUltrasound measures of MT and EI show moderate to very high reliability. The reliability and agreement of MT and EI measurements are improved in transverse scans and with larger ROIs.

Validity and Reliability of Surface Electromyography in the Assessment of Primary Muscle Tension Dysphonia

The study aims to evaluate the reliability and the discriminative validity of surface electromyography (sEMG) in the assessment of patients with primary muscle tension dysphonia (MTD). The study design is cross-sectional. Fifteen patients with primary MTD (mean age: 34.07 ± 10.99 years) and 15 healthy volunteers (mean age: 34.53 ± 10.63 years) were included. All participants underwent evaluation of sEMG to record the electrical activity of the thyrohyoid and cricothyroid muscles. The outcome measures were the root mean square (RMS), activity peak, duration, and time to the peak activity, which were obtained during /a/ and /i/ prolongation for test-retest reliability. The test-retest reliability was good to excellent for the RMS and peak activity measures (intraclass correlation coefficient [agreement] [ICCagreement] = 0.49-0.98). The reliability for the activity duration was poor to excellent (ICCagreement = 0.19-0.9). Poor test-retest reliability was found for the time to peak measure (ICCagreement = 0.15-0.37). The standard error of measurement for all sEMG measures was between 0.41 and 2.05. The smallest detectable change (SDC) was calculated between 1.13 and 5.66. The highest SDC values were obtained for the peak and the lowest SDCs were documented for the duration (5.66 and 1.13, respectively). All sEMG measures were not able to discriminate between the MTD patients and healthy subjects (P > 0.05). The sEMG is a reliable tool to measure the RMS, the peak activity, and the activity duration in primary MTD. However, it is not able to discriminate the patients with primary MTD from healthy subjects.

Reliability, validity, responsiveness, and minimal important change of the Disabilities of the Arm, Shoulder and Hand and Constant-Murley scores in patients with a humeral shaft fracture

The Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley scores are commonly used instruments. The DASH is patient-reported, and the Constant-Murley combines a clinician-reported and a patient-reported part. For patients with a humeral shaft fracture, their validity, reliability, responsiveness, and minimal important change (MIC) have not been published. This study evaluated the measurement properties of these instruments in patients who sustained a humeral shaft fracture. The DASH and Constant-Murley instruments were completed 5 times until 1 year after trauma. Pain score, Short Form 36, and EuroQol-5D were completed for comparison. Internal consistency was determined by the Cronbach α. Construct and longitudinal validity were evaluated by assessing hypotheses about expected Spearman rank correlations in scores and change scores, respectively, between patient-reported outcome measures (sub)scales. The smallest detectable change (SDC) was calculated. The MIC was determined using an anchor-based approach. The presence of floor and ceiling effects was determined. A total of 140 patients were included. Internal consistency was sufficient for DASH (Cronbach α = 0.96) but was insufficient for Constant-Murley (α = 0.61). Construct and longitudinal validity were sufficient for both patient-reported outcome measures (>75% of correlations hypothesized correctly). The MIC and SDC were 6.7 (95% confidence interval, 5.0-15.8) and 19.0 (standard error of measurement, 6.9), respectively, for DASH and 6.1 (95% CI -6.8 to 17.4) and 17.7 (standard error of measurement, 6.4), respectively, for Constant-Murley. The DASH and Constant-Murley are valid instruments for evaluating outcome in patients with a humeral shaft fracture. Reliability was only shown for the DASH, making this the preferred instrument. The observed MIC and SDC values provide a basis for sample size calculations for future research.

The Longitudinal Reliability and Responsiveness of the OMERACT Hand Osteoarthritis Magnetic Resonance Imaging Scoring System (HOAMRIS).

To evaluate the interreader reliability of change scores and the responsiveness of the OMERACT Hand Osteoarthritis (OA) Magnetic Resonance Image (MRI) Scoring System (HOAMRIS). Paired MRI (baseline and 5-yr followup) from 20 patients with hand OA were scored with known time sequence by 3 readers according to the HOAMRIS: Synovitis, erosive damage, cysts, osteophytes, cartilage space loss, malalignment, and bone marrow lesions (BML; 0-3 scales with 0.5 increments for synovitis, erosive damage, and BML). Interreader reliability for status and change scores were assessed by intraclass correlation coefficients (ICC), percentage exact agreement and percentage close agreement (PEA/PCA), and smallest detectable change (SDC). Responsiveness was assessed by standardized response means (SRM). Cross-sectional interreader ICC were good to very good (≥ 0.74) for all features except synovitis, cysts, and malalignment (ICC 0.50-0.58). The range of change values was small, leading to low ICC for change scores. The SDC values for sum scores (total range 0-24) varied between 1.97-3.05 (except 1.08 for malalignment). For status scores, PEA/PCA on scores in individual joints across the readers were 8.1-50.0 and 43.8-78.1, respectively. Similarly, PEA/PCA for change scores were 20.6-63.8 and 66.3-93.1, respectively. All features except cysts and BML demonstrated good responsiveness with higher SRM for sum scores (range 0.46-1.62) than for scores in individual joints (range 0.24-0.73). Good to very good interreader ICC values were found for cross-sectional readings, whereas the longitudinal reliability was lower because of a smaller range of change scores. All features, except cysts and BML, showed good responsiveness.

Reproducibility of a battery of commonly used clinical tests to evaluate lumbopelvic motor control

ObjectiveTo determine reproducibility of a battery of clinical tests for evaluating lumbopelvic motor control (LMC). DesignTest-retest design. ParticipantsFifty healthy subjects. Outcome MeasuresTwo raters independently examined performance on 12 clinical tests for evaluating LMC. All tests were scored on a seven-point scale, based on qualitative and quantitative performance. Subjects were measured twice, with a two week interval between examinations. Intra- and inter-rater reproducibility of each test were determined using intraclass correlation coefficients (ICCs), standard error of measurement, smallest detectable change (SDC) and limits of agreement. ResultsReliability of the tests ranged from poor to excellent. Intra-rater ICCs ranged from 0.00 to 0.82, whereas inter-rater ICCs varied from 0.00 to 0.96. SDC values were smallest for supine leg raising, bent knee fall out, prone bridge and unilateral prone bridge (<2 points). ConclusionThis study shows limited reproducibility of a battery of 12 clinical tests for the evaluation of LMC in a healthy population. Supine leg raising, bent knee fall out, prone bridge, and unilateral prone bridge showed the smallest measurement errors. The other 8 tests were found to have large measurement errors. Based on these results, dichotomization of the rating method might be considered in order to improve reproducibility values.

Development and preliminary validation of the spondyloarthritis research consortium of Canada magnetic resonance imaging sacroiliac joint structural score.

There is an unmet need for reliable assessment of structural progression in the sacroiliac joints (SIJ) of patients with spondyloarthritis (SpA), but radiography is unreliable and lacks responsiveness. We aimed to develop and validate a new scoring method for structural lesions based on magnetic resonance imaging (MRI), the Spondyloarthritis Research Consortium of Canada (SPARCC) SIJ Structural Score (SSS). The SSS method for assessment of structural lesions is based on T1-weighted spin echo MRI, validated lesion definitions, slice selection according to well-defined anatomical principles, and dichotomous scoring (lesion present/absent) of 5 consecutive slices through the cartilaginous portion of the joint. Scoring ranges are fat metaplasia (0-40), erosion (0-40), backfill (0-20), and ankylosis (0-20). We progressively conducted 3 validation exercises with 2-4 readers on baseline, and either 2-year (exercises 1 and 2) or 1-year (exercise 3) scans from 147 patients with SpA assessed blinded to timepoint. Interobserver reliability was assessed by intraclass correlation coefficient (ICC) and smallest detectable change (SDC). Interobserver reliability for status score was good to excellent for ankylosis (ICC 0.79-0.98), consistently good for fat metaplasia (ICC 0.71-0.78), moderate to good for erosion (ICC 0.58-0.62), and fair to good for backfill (ICC 0.35-0.66). Reliability for change scores was moderate to good for all structural lesions despite the relatively small changes in scores, and was highest for fat metaplasia when both ICC and SDC values were compared. The new SPARCC MRI SSS method can detect structural changes in the SIJ with acceptable reliability over a 1-2-year timeframe, and should be further validated in patients with SpA.

Reliability of sagittal pelvic position assessments in standing, sitting and during hip flexion using palpation meter

The objective of this study was to investigate reliability of assessing sagittal pelvic position using the palpation meter (PALM) in healthy subjects while sitting, standing and while in different hip flexion angles in standing. Twenty healthy subjects were assessed two times by the same examiner, with a 48-hinterval between test sessions. Reliability indices of PALM measures (intraclass correlation coefficient, ICC), standard error of measurement (SEM) and smallest detectable change (SDC) were calculated. ICC values showed excellent intra-rater reliability for measurements of sagittal pelvic position in standing and sitting position and for both standing hip flexion angles (ICC=.89-.96). SEM values ranged from .5° (hip flexion 90°) to 1.5° (sitting position). SDC values ranged from 1.5° (hip flexion 90°) to 4.0° (sitting position). The results of this study showed excellent intra-rater reliability for assessing sagittal pelvic position in standing, sitting and hip flexion in healthy subjects using the PALM.

High intra- and inter-rater chance variation of the movement assessment battery for children 2, ageband 2

The aim of the present study was to evaluate the intra- and inter-tester reliability of the movement assessment battery for children-second edition (MABC-2), ageband 2. We wanted to analyze the collected data, with adequate statistical methods, to provide relevant recommendations for physical therapists who are interpreting changes in the context of daily clinical practice. Forty-five healthy children, 23 girls and 22 boys with a mean age of 8.7±0.7 years, participated in the study, the inter-tester procedures were performed the same day and the intra-tester procedures within a one to two week interval. The statistical methods used were intra-class correlation coefficient (ICC), standard error of measurement (SEM), and smallest detectable change (SDC). The children had no failed items during the tests. The ICC values ranged from 0.23 to 0.76. The items "treading lace" and "one-board balance" showed the highest measurement errors both for the intra- and inter-rater reliability. The SDC(90%) values were 9.7 and 18.5 for the intra- and inter-rater reliability, respectively. The present study showed high intra- and inter-rater chance variation MABC-2, ageband 2. A change of more than ±9.7 and ±18.5 on the total test score (TTS) should be required to state (with a 90% confidence) that a real change in a single individual has occurred, for intra- and inter-rater testing, respectively. These findings may indicate that the MABC-2 might be more suitable for diagnostic or clinical decision making purposes, than for evaluation of change over time.