Smallest Real Difference Research Articles

Reproducibility of vertical jump data from an instrumented platform

To assess the reproducibility of data collected from a newly created instrumented platform that measures vertical jump performance, healthy college-age subjects (n = 178) made three visits to our laboratory. Per jump, the platform offered six performance-related variables: static weight, time to takeoff, peak takeoff force, and maximum jump heights as they ascended, remained in the air and landed. Per subject, the two highest jumps from the final two visits were used to assess data reproducibility. Prior to the reproducibility assessment, Z-scores identified statistical outliers that were removed from subsequent analyses. Paired intra- and inter-jump session data per variable were assessed with the following statistical test-retest tools: intraclass correlation coefficients, coefficient of variation, standard error of measurement, smallest real difference and critical difference. Current results show most data had a high level of reproducibility with few exceptions. Since the platform also has potential applicability in the rehabilitation of disabled persons, future research should assess the data reproducibility associated with gait, balance and mobility collected from the device.

The Relative and Absolute Reliability of Leg Muscle Strength Testing by a Handheld Dynamometer

To examine the relative and absolute interrater reliability of handheld dynamometers (HHD) for assessing the lower extremity muscle strength, maximal voluntary contractions (MVCs) of 16 young adults for bilateral hip and knee muscles were tested using the break method. Three MVCs of each muscle group were required for obtaining the muscle strength. Participants' muscle strengths were tested by 2 raters. The intraclass correlation coefficients (ICCs) and the smallest real differences (SRD) were used to examine the relative and absolute reliabilities, and the Bland-Altman analyses were used to check whether systematic bias exists. The results showed that the relative reliabilities of all muscle groups were excellent (ICCs = 0.83-0.92) except for the knee extensors (ICC = 0.60). The SRD represents the smallest difference that indicates a real change for a single subject. The SRD% of all muscle groups was acceptable (ranging from 8.4 to 22.8 %), with the hip extensors being the smallest and knee extensors being the largest. The reliability of the knee extensors was unsatisfactory because of poor relative and absolute reliabilities and systematic bias. In addition to assessing the relative reliability in strength measurement, the absolute reliability provides the data of the measurement error, which is useful information in clinical practice to know whether the change in strength of a subject is real. Hand-held dynamometer is a reliable tool for quantifying most of the hip and knee strength except for the knee extensors. Modifying the measuring technique for knee extension is needed in future studies to improve the reliability.

The Reproducibility and Convergent Validity of the Walking Index for Spinal Cord Injury (WISCI) in Chronic Spinal Cord Injury

Background. The Walking Index for Spinal Cord Injury II (WISCI II) is a hierarchical scale that measures improvements in walking following spinal cord injury (SCI). The WISCI II has good face validity, concurrent validity, and reliability following acute SCI; however, psychometric properties need to be determined for chronic SCI. Because prior studies have demonstrated a relationship between lower-extremity motor scores (LEMS) and walking, outcome measures for walking should demonstrate a linkage between the underlying impairment (weakness) and walking—convergent validity. Objective. To determine convergent validity and reproducibility of the WISCI II. Methods. Self-selected and maximum WISCI levels were assessed for 76 patients with chronic SCI (34 paraplegia, 42 tetraplegia); 10-m walking speeds were calculated. Convergent validity was assessed by correlating WISCI II levels to LEMS and walking speed. Reproducibility was assessed with the intraclass correlation coefficient (ICC) and the smallest real difference (SRD). Results. Convergent validity of the self-selected and maximum WISCI II with LEMS was moderate for paraplegia (ρ = 0.479 and ρ = 0.533) and strong for tetraplegia (ρ = 0.852 and ρ = 0.816). Tetraplegia, but not paraplegia, demonstrated convergent validity of walking speed at the self-selected and maximum WISCI levels with LEMS (ρ = 0.752 and ρ = 0.813). WISCI reproducibility was excellent (self-selected ICC = 0.994; maximum ICC = 0.995), resulting in SRDs of 0.785 (self-selected) and 0.597 (maximum), suggesting that a change of one WISCI level can be interpreted as real in a chronic patient. Conclusions. Results suggest that the WISCI II should be a very useful outcome measure for detecting changes in walking function following chronic SCI.

Reliability of capturing foot parameters using digital scanning and the neutral suspension casting technique

BackgroundA clinical study was conducted to determine the intra and inter-rater reliability of digital scanning and the neutral suspension casting technique to measure six foot parameters. The neutral suspension casting technique is a commonly utilised method for obtaining a negative impression of the foot prior to orthotic fabrication. Digital scanning offers an alternative to the traditional plaster of Paris techniques.MethodsTwenty one healthy participants volunteered to take part in the study. Six casts and six digital scans were obtained from each participant by two raters of differing clinical experience. The foot parameters chosen for investigation were cast length (mm), forefoot width (mm), rearfoot width (mm), medial arch height (mm), lateral arch height (mm) and forefoot to rearfoot alignment (degrees). Intraclass correlation coefficients (ICC) with 95% confidence intervals (CI) were calculated to determine the intra and inter-rater reliability. Measurement error was assessed through the calculation of the standard error of the measurement (SEM) and smallest real difference (SRD).ResultsICC values for all foot parameters using digital scanning ranged between 0.81-0.99 for both intra and inter-rater reliability. For neutral suspension casting technique inter-rater reliability values ranged from 0.57-0.99 and intra-rater reliability values ranging from 0.36-0.99 for rater 1 and 0.49-0.99 for rater 2.ConclusionsThe findings of this study indicate that digital scanning is a reliable technique, irrespective of clinical experience, with reduced measurement variability in all foot parameters investigated when compared to neutral suspension casting.

Data Reliability From an Instrumented Vertical Jump Platform

A Vertec jump measurement and training system measures vertical jump heights but not additional variables that would reveal how the performance was achieved. Technology advances to equipment now include additional variables that elucidate how jump performance is achieved. However, acceptance of new jump-related equipment is predicated on the reliability of the vertical heights it measures in relation to those assessed by the Vertec. Thus, our study compared vertical jump height reliability data from a newly created instrumented platform to those concurrently derived from the Vertec. Methods required subjects (n = 105) to perform 2 jump trials separated by at least 2 days of rest. Trials began with a warm-up, followed by 3 to 5 maximal-effort jumps. The Vertec was placed directly over the platform so, as jumps occurred, subjects took off and landed on the instrumented device. At the jump apex subjects contacted the highest Vertec slapstick possible to assess maximum height attained. Four height measurements were derived from each jump: 3 platform-based calculations (from subject's take-off, hang time, and landing) and 1 Vertec. The platform-based calculations were compared to Vertec data to assess the reliability of the instrumented device. Intraclass correlation coefficient (0.90), coefficient of variation (17.3%), standard error of measurement (0.9 cm), and smallest real difference (3.7 cm) results showed heights calculated from platform take-offs were most reliable to Vertec values. It was concluded take-off from the platform yielded jump heights that are a viable alternative to those derived from the Vertec. Practical applications suggest coaches may use the platform to derive reliable vertical jump data in addition to other variables to better understand the performance of their athletes.

Reliability of knee joint range of motion and circumference measurements after total knee arthroplasty: does tester experience matter?

Two of the most utilized outcome measures to assess knee joint range of motion (ROM) and intra-articular effusion are goniometry and circumference, respectively. Neither goniometry nor circumference of the knee joint have been examined for both intra-tester and inter-tester in patients with total knee arthroplasty (TKA). The purpose of this study was to determine the intra-tester and inter-tester reliability of active and passive knee joint ROM and circumference in patients with TKA when administered by physiotherapists (testers) with different clinical experience. The design was an intra-tester, inter-tester and intra-day reliability study. Nineteen outpatients (10 females) having received a TKA were examined by an inexperienced and an experienced physiotherapist. Following a standardized protocol, active and passive knee joint ROM and circumference measurements were obtained using a universal goniometer and a tape measure, respectively. To establish reliability, intraclass correlation coefficients (ICC(2,1)) and smallest real difference (SRD) were calculated. The knee joint ROM and circumference measurements were generally reliable (ICC > 0.8) within and between physiotherapists (except passive knee extension). Changes in knee joint ROM of more than 6.6 degrees and 10 degrees (except active knee flexion) and knee joint circumference of more than 1.0 cm and 1.63 cm represent a real clinical improvement (SRD) or deterioration for a single individual within and between physiotherapists, respectively. Generally, the experienced tester recorded larger knee joint ROM and lower circumference values than that of the inexperienced tester. In clinical practice, we suggest that repeated knee goniometric and circumferential measurements should be recorded by the same physiotherapist in individual patients with TKA. Tester experience appears not to influence the degree of reliability.

The craniocervical flexion test: intra‐tester reliability in asymptomatic subjects

The deep neck flexor muscles (DNFs) stabilize the cervical spine and cervicogenic pain appears to adversely affect their endurance capacity. They are inaccessible to direct palpation, thereby making assessment difficult. However, the cranio-cervical flexion test (CCFT) provides an indirect method of assessing the endurance capacity of the DNFs. The purpose of the present study was to evaluate the intratester reliability of the CCFT in asymptomatic subjects. The clinical protocol of the CCFT was measured on two occasions with 7 days between measurements. Prior to testing, participants were trained and compensation strategies were corrected. Nineteen asymptomatic participants (mean age 24.9 years; range 22-36) were recruited. The test had excellent intratester reliability (intraclass correlation coefficient = 0.983; standard error of the mean = 8.94; smallest real difference = 24.7). A Bland and Altman's limits of agreement analysis confirmed the high reliability of the test. The CCFT results demonstrated excellent intra-tester reliability in asymptomatic subjects, thus contributing to the normative data regarding the test.

Reliability of Gait Performance Tests in Individuals With Late Effects of Polio

To assess the reliability of 4 gait performance tests in individuals with late effects of polio. An intrarater (between occasions) test-retest reliability study. University hospital. Thirty men and women (mean age 63 +/- 6.4 years) with clinically and electrophysiologically verified late effects of polio. Not applicable. The Timed "Up & Go" test, the Comfortable and the Fast Gait Speed tests, and the 6-Minute Walk test were assessed 7 days apart. Reliability was evaluated with the intraclass correlation coefficient (ICC(2,1)), the mean difference between the test sessions (d), and the 95% confidence intervals for d, the standard error of measurement (SEM and SEM%), the smallest real difference (SRD and SRD%) and the Bland & Altman graphs. Test-retest agreements were high (ICC(2,1) 0.82-0.97) and measurement errors generally small. The standard error of measurement (SEM%), representing the smallest change that indicates a real (clinical) improvement for a group of individuals, was small (4%-7%). The smallest real difference (SRD%), representing the smallest change that indicates a real (clinical) improvement for a single individual also was small (12%-21%). These commonly used gait performance tests are highly reliable and can be recommended to evaluate improvements in various aspects of gait performance in groups of individuals as well as single individuals with late effects of polio.

Reproducibility of a measurement for latissimus dorsi muscle length

ABSTRACTLatissimus dorsi is a muscle theorized to undergo length changes due to shoulder region pathology or treatment such as stretching. A latissimus dorsi length measurement would be valuable to determine if length changes have occurred within an individual over time. With no such measurement known, we examined a proposed technique believed to isolate latissimus dorsi. The aim of this study was to determine how accurately a rater could reproduce this measurement in the same individual over a 6-week interval. Thirty subjects without shoulder symptoms were measured at 6-week intervals by either an experienced or novice clinician. A repeated-measures analysis of variance estimated the measurement error used for calculating intrarater correlation coefficients (ICC3,1). The standard error of measurement (SEM), confidence intervals (CI), and the smallest real difference (SRD) were also determined. The ICCs for all raters combined and for the separate groups indicated poor reliability. The SEM and SRD values were similar between groups, but they suggest poor measurement reproducibility in the same subject over a 6-week interval. This technique is not recommended for measuring latissimus dorsi length clinically to assess within-subject change over time.

Reliability of knee extensor and flexor muscle strength measurements in persons with late effects of polio

To assess the reliability of knee extensor and flexor muscle strength measurements in persons with late effects of polio. A test-retest reliability study. Thirty men and women (mean age 63 (standard deviation 6.4) years) with verified late effects of polio. Knee extensor and flexor muscle strength in both lower limbs were measured twice 7 days apart using a Biodex dynamometer (isokinetic concentric contractions at 60 degrees /sec and isometric contractions with knee flexion angle 90 degrees) and a Leg Extension/Curl Rehab exercise machine with pneumatic resistance (HUR) (isotonic contractions). Reliability was assessed with the intraclass correlation coefficient (ICC1,1), the mean difference between the test sessions (d) together with the 95% confidence intervals for d, the standard error of measurement (SEM and SEM%), the smallest real difference (SRD and SRD%) and Bland-Altman graphs. Test-retest agreements were high, (ICC1,1 0.93-0.99) and measurement errors generally small. The SEM% was 4-14% and the SRD% 11-39%, with the highest values for the isokinetic measurements. Knee muscle strength can be measured reliably and can be used to detect real changes after an intervention for a group of persons with late effects of polio, whereas the values may be too high for single individuals or to detect smaller short-term changes over time for a group of individuals.

High intertester reliability of the Cumulated Ambulation Score for the evaluation of basic mobility in patients with hip fracture

Objective: To examine the intertester reliability of the three activities of the Cumulated Ambulation Score (CAS) and the total CAS, and to define limits for the smallest change in basic mobility that indicates a real change in patients with hip fracture. Design: An intertester reliability study. Setting: An acute 20-bed orthopaedic hip fracture unit. Subjects: Fifty consecutive patients with a median age of 83 (25—75% quartile, 68—86) years. Interventions: The CAS, which describes the patient’s independency in three activities — (1) getting in and out of bed, (2) sit to stand from a chair, and (3) walking ability — was assessed by two independent physiotherapists at postoperative median day 3. Each activity was assessed on a three-point ordinal scale from 0 (not able to) to 2 (independent of human assistance). The cumulated score for each activity provides a total CAS from 0 to 6, with 6 indicating independent ambulation. Main measures: Reliability was evaluated using weighted kappa statistics, the standard error of measurement (SEM) and the smallest real difference (SRD). Results: The kappa coefficient, the SEM and the SRD in the three activities and the total CAS were ≥0.92, ≤0.20 and ≤0.55 CAS points, respectively. Conclusions: The intertester reliability of the CAS is very high, and a change of more than 0.20 and 0.55 CAS points for the total CAS indicates a real change in basic mobility, at group level and for an individual patient, respectively.

Inter-rater reliability and smallest real difference of the Chinese Psychoeducational Profile-third edition for children with Autism Spectrum Disorder

The purpose of this study was to examine the inter-rater reliability of the Chinese version of the Psychoeducational Profile-third edition (CPEP-3) in children with Autism Spectrum Disorder. We also calculated the smallest real difference (SRD) for users to determine whether the change score rated by different raters for an individual child is valid. The CPEP-3 was administered to 42 children aged from 2 years 4 months to 7 years 7 months by two independent therapists twice, with an 11- to 21-day interval. The high internal consistency for performance subtests (Cronbach's alpha = 0.92–0.98) and composites (Cronbach's alpha = 0.92–0.95) in the CPEP-3 indicates the homogeneity of all the items in each subtest and composite. The inter-rater reliability of the CPEP-3, examined by intra-class correlation coefficient, ranged from 0.57 to 0.94 for the performance subtests, and 0.63 to 0.89 for the composites. The SRDs of the CPEP-3 ranged from 5.8 to 12.8 for the performance subtests, and 7.3 to 18.0 for the composites. The SRDs of the CPEP-3 were 14.4–51.8% of the possible highest scores of each subtest and composite. The substantial SRDs indicate that clinicians should consider such SRD values in determining whether a child's change score of the CPEP-3 indicates real change when the CPEP-3 is administered by different raters. Further studies to examine the construct validity, responsiveness, and minimally important difference of the CPEP-3 are needed to improve the utility of the CPEP-3.

The Maastricht social participation profile: development and clinimetric properties in older adults with a chronic physical illness

To develop and test the Maastricht Social Participation Profile (MSPP), an instrument measuring the actual social participation by older adults with a chronic physical illness, in accordance with their own definition of social participation. The development process consisted of a number of steps, ending with a field test in two waves (n = 412 and n = 125) among a random sample of people older than 59 years with either COPD or diabetes mellitus. Reproducibility was evaluated with intraclass correlation coefficients (ICCs) and smallest real differences at group level (SRDs(group)). Convergent and discriminant validity were evaluated with Pearson correlation coefficients between the MSPP and the Frenchay Activities Index (FAI). The MSPP consists of four indices: consumptive participation, formal social participation, informal social participation-acquaintances and informal social participation-family. Each index measured diversity and frequency of participation. ICCs ranged between 0.63 and 0.83. SRDs(group) ranged between 0.05 and 0.09. Convergent and discriminant validity were supported by the correlations between the MSPP(frequency) and the FAI. The MSPP has good validity and acceptable reproducibility. Its distinguishing features are its focus on actual social participation and the possibility to calculate both diversity and frequency scores.

The reliability of lung crackle characteristics in cystic fibrosis and bronchiectasis patients in a clinical setting

Lung sounds provide useful information for assessing and monitoring respiratory patients, but standard auscultation is subjective. Computer aided lung sound analysis (CALSA) enables the quantification and characterisation of added lung sounds (e.g. crackles). At present, little is known about the reliability of these sound characteristics. Therefore, the aim of this study was to explore the reliability of crackle initial deflection width (IDW) and two-cycle deflection (2CD) in a clinical population. Fifty-four subjects (37 bronchiectasis, 17 cystic fibrosis) were recruited from out-patient clinics. Three repeated lung sound recordings were taken at seven anatomical sites with a digital stethoscope connected to a laptop computer. The intra-subject reliability of crackle IDW and 2CD was found to be ‘good’ to ‘excellent’, estimated by the analysis of variance, intraclass correlation coefficient (IDW 0.76;0.85, 2CD 0.83;0.94), Bland and Altman 95% limits of agreement (IDW −0.50;0.47 ms, 2CD −2.12;1.87 ms) and smallest real difference (IDW 0.30;0.66 ms, 2CD 1.57;2.42 ms). Crackle 2CD was found to be more reliable than IDW. It is concluded that crackle IDW and 2CD characterized by CALSA have good test–retest reliability. This technique requires further evaluation since CALSA has potential to diagnose or monitor respiratory conditions, and provide an objective physiological measure for respiratory interventions.

Reliability of Two Visual–Perceptual Tests for Children With Cerebral Palsy

We examined the reliability of the Motor-Free Visual Perception Test-Revised (MVPT-R) and the Test of Visual-Perceptual Skills-Revised (TVPS-R) in 52 children with cerebral palsy. The MVPT-R and TVPS-R were initially assessed by a single rater and then randomly assigned to the same rater or another rater after 6 to 14 days. For scale-level reliability of both tests, the intraclass correlation coefficients (ICCs) were high. The smallest real differences (SRDs) were largely acceptable. The OICCs of most subscale-level reliability of the TVPS-R were satisfactory. The SRD of each TVPS-R subscale score was notable (>29%). The internal consistency was high for both tests. The scale-level reliabilities of both tests were satisfactory in children with cerebral palsy. Although most subscales of the TVPS-R had acceptable test-retest or interrater agreement, all subscales of the TVPS-R had large SRDs, limiting their clinical utility.

Reliabilty, smallest real difference and concurrent validity of indices computed from GRF components in gait of stroke patients

We analysed reliability, smallest real difference (SRD) and concurrent validity of indices computed from the ground reaction force (GRF) vertical and fore–aft components in a sample of 56 patients with hemiparesis secondary to stroke. These parameters have been recommended for the assessment of weight-bearing and propulsion. The sample size was calculated based on guidelines for reliability studies and patient levels of impairment ranged from mild to severe. Reliability was assessed by the intraclass correlation coefficient (ICC), SRD was computed as the 95% confidence interval (CI) of the standard error and concurrent validity was assessed using the Spearman correlation coefficient between each index and gait speed, with the latter being used as the criterion standard. Excellent reliability (ICC > 0.90) for all indices was achieved by averaging values of three consecutive gait trials. SRD ranged between 5% and 10% of the sample grand mean for vertical GRF-based indices, and between 20% and 40% for fore–aft GRF-based indices. All indices but one showed concurrent validity with walking speed, with correlation coefficients ranging from 0.423 ( p < 0.01) to 0.834 ( p < 0.01). Amongst studied indices, the mean value of vertical GRF and the mean value of the propulsive part of the fore–aft component showed the best performance in terms of ICC, SRD and concurrent validity. These appear to be the most appropriate indices to assess weight-bearing and propulsive ability, respectively, in this group.

Test-Retest Reproducibility and Smallest Real Difference of 5 Hand Function Tests in Patients With Stroke

Objective. To investigate the test-retest reproducibility and smallest real difference (SRD) of 3 hand strength tests (grip, palmar pinch, and lateral pinch) and 2 dexterity tests (the Box and Block test [BBT] and the Nine Hole Peg test [NHPT]) in patients with stroke. Methods. The 5 tests were administered on 62 stroke patients in 2 sessions, 3 to 7 days apart. The intraclass correlation coefficient (ICC) was used to determine the level of reproducibility between measurements on 2 sessions. The SRD was used to determine the extent of measurement error because of chance variation in individual patients. SRD percentage (SRD relative to mean score) was used to compare test-retest reliability across tests. We analyzed the group as a whole, then in 2 subgroups (hand spasticity vs none). Results. The test-retest reproducibility of all 5 tests was high for all the patients, with ICCs ranging from 0.85 to 0.98. The SRDs for the more/less affected hand were: 2.9/4.7 kg for the grip test; 1.2/1.3 kg for the palmar pinch test; 1.4/1.0 kg for the lateral pinch test; 5.5/7.8 blocks/minute for the BBT; and 32.8/6.2 seconds for the NHPT. Unacceptably high SRD percentages (>30%) were found for the affected hand using the NHPT (54%), palmar pinch (35%), and lateral pinch (34%). When comparing these indices for participants with spasticity versus none for all 5 tests, the ICCs were lower and the SRD and SRD percentage were higher for the spasticity group. Conclusions. All 5 tests demonstrated satisfactory test-retest reproducibility for a diverse group of patients with stroke. However, all tests showed higher levels of measurement error when performed with the more affected hand and in patients with hypertonicity of that hand. Thus, baseline and postrehabilitation change scores using these common tests of strength and dexterity must be interpreted with some caution, especially in poorly controlled clinical trials. Repeated measures ought to be incorporated to examine reliability within a trial that includes participants with a hypertonic hand.

Influence of Testing Position on the Reliability of Hip Extensor Strength Measured by a Handheld Dynamometer

Hip extensors belong to an important muscle group that controls standing, walking and other functional activities. The prone position (PP) is commonly used to measure the strength of the hip extensors; however, the reliability of such measurements is poor. The aim of this study was to determine the effect of different testing positions, that is, the PP and the prone standing position (PSP), on the reliability of measurements of hip extensor strength. Intrasession reliability and interrater reliability studies were performed on 47 and 16 normal subjects, respectively. The muscle strength of the hip extensors was tested in both the PP and PSP. A handheld dynamometer and break test were used to measure the strength. Relative reliability and absolute reliability were assessed in both PP and PSP. For relative reliability, the intraclass correlation coefficient (ICC) was used to examine the level of reproducibility among measurements. Absolute reliability, the smallest real difference (SRD), was used to provide information on measurement error. The results showed that the reliability was better in PSP than in PP. For relative reliability, the values of ICCs were excellent in the intrasession reliability study, in both PP (ICC1,3 = 0.92) and PSP (ICC1,3 = 0.94). However, the interrater reliability was only excellent in PSP; the ICC2,3 were 0.92 in PSP and 0.65 in PP. For absolute reliability, the values of the SRD were much lower in PSP (29.8) than in PP (71.8), indicating that the measurement of muscle strength in PSP was more stable and had smaller measurement error than in PP. Changing the testing position from the traditional "prone" to "prone-standing" effectively improved both the relative reliability and the absolute reliability.

Reliability of transcranial magnetic stimulation-related measurements of tibialis anterior muscle in healthy subjects

The main purpose of this study was to determine the reliability of transcranial magnetic stimulation (TMS)-related measurements linked to the corticospinal control of the tibialis anterior (TA) muscle in healthy subjects. Inter-investigator and intra-investigator (within-session with a 1.5-h interval; between-session with a 4-week interval) reliability of the motor threshold, recruitment curve with its slope and MEP area at the plateau, MEP latency, maximum MEP (MEPmax) area, and duration of the maximum and minimum silent period (SPmax and SPmin) were assessed in 50 (29 men and 21 women) healthy subjects (mean age 44.8 years, range 22-74 years) using intraclass correlation coefficients (ICC), standard error of measurement (SEM) and smallest real difference (SRD). The high ICC values and lower SEM and SRD values indicate a good intra- and inter-investigator reliability for motor threshold (ICC range 0.94-0.98), MEP latency (ICC range 0.79-0.93), SPmax (ICC range 0.89-0.95) and SPmin (ICC range 0.79-0.81) in healthy subjects. These results suggest that the TMS-related measurements investigated are reliable in healthy subjects. These data could be useful in further studies on cortical excitability changes, such as those induced by therapeutic interventions (e.g. rehabilitative treatment).

Development and reproducibility of a short questionnaire to measure use and usability of custom-made orthopaedic shoes

To develop a short and easy to use questionnaire to measure use and usability of custom-made orthopaedic shoes, and to investigate its reproducibility. Development of the questionnaire (Monitor Orthopaedic Shoes) was based on a literature search, expert interviews, 2 expert meetings, and exploration and testing of reproducibility. The questionnaire comprises 2 parts: a pre part, measuring expectations; and a post part, measuring experiences. The pre part of the final version was completed twice by 37 first-time users before delivery of their orthopaedic shoes. The post part of the final version was completed twice by 39 first-time users who had worn their orthopaedic shoes for 2-4 months. High reproducibility scores (Cohen's kappa > 0.60 or intra class correlation > 0.70) were found in all but one question of both parts of the final version of the Monitor Orthopaedic Shoes questionnaire. The smallest real difference on a visual analogue scale (100 mm) ranged from 21 to 50 mm. It took patients approximately 15 minutes to complete one part. Monitor Orthopaedic Shoes is a practical and reproducible questionnaire that can measure relevant aspects of use and usability of orthopaedic shoes from a patient's perspective.