Standard Error Of Measurement Research Articles

Validity and reliability of the Valkyria Trainer Balance® portable force platform in its isometric mode

BACKGROUND: Isometric maximal voluntary force (IMVF) is essential for individuals’ health and physical performance. Therefore, there is a need for valid and reliable devices to assess IMVF. OBJECTIVE: To determine the validity and reliability of the Valkyria Trainer Balance® portable force platform in its isometric mode. METHODS: Fifty-eight physically healthy individuals (30 men and 28 women) participated in the study. A repeated measures design was used to compare the inter-day test-retest reliability of peak force. The validity of the Valkyria Trainer Balance® force platform was determined by comparing the peak force with the ArtOficio® force platform. The analysis consisted of the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and coefficient of variation (CV). A CV ⩽ 10% and ICC ⩾ 0.80 were considered acceptable reliability, while a ⩽ 5% and ICC ⩾ 0.90 were regarded as high reliability. RESULTS: CV the peak force showed high test-retest inter-day reliability (CV = 4.3% and ICC = 0.99). When comparing both force platforms, there was a 1.1% difference between the two devices. CONCLUSIONS: The results of this study demonstrate that the Valkyria Trainer Balance® force platform is valid and reliable for assessing IMVF in physically healthy individuals.

Establishing the minimal clinically important difference of the Brief Fatigue Inventory for brain or CNS cancer patients undergoing radiotherapy.

Minimal clinically important differences (MCIDs) quantify the clinical relevance of quality of life results at the individual patient and group level. The aim of this study was to estimate the MCID for the Brief Fatigue Inventory (BFI) and the Worst and Usual Fatigue items in patients with brain or CNS cancer undergoing curative radiotherapy. Data from a multi-site prospective registry was used. The MCID was calculated using distribution-based and anchor-based approaches. For the anchor-based approach, the fatigue item from the PROMIS-10 served as the anchor to determine if a patient improved, deteriorated, or had no change from baseline to end of treatment (EOT). We compared the unadjusted means on the BFI for the 3 groups to calculate the MCID. For the distribution-based approaches, we calculated the MCID as 0.5 SD of the scores and as 1.96 times the standard error of measurement. Three-hundred and fifty nine patients with brain or CNS tumors undergoing curative radiotherapy filled out the 9-item BFI at baseline and EOT. The MCID for the BFI was 1.33 (ranging from 0.99 to 1.70 across the approaches), 1.51 (ranging from 1.16 to 2.02) and 1.76 (ranging from 1.38 to 2.14) for the usual and worst fatigue items, respectively. This study provides the MCID ranges for the BFI and Worst and Usual fatigue items, which will allow clinically meaningful conclusions to be drawn from BFI scores. These results can be used to select optimal treatments for patients with brain or CNS cancer or to interpret BFI scores from clinical trials.

Simultaneous determination of picomolar level of dissolved silver with other key trace metals in seawater samples using solid phase extraction and isotope dilution methods

Simultaneous determination of dissolved silver (dAg) with other key GEOTRACES trace metals is difficult because dAg in seawater tends to form negatively charged chloride species that result in only 75% recovery efficiency with commonly used NOBIAS PA-1 chelating resins. In this study, we developed a method using solid phase extraction coupled with isotope dilution that enables full quantification (97.9 ± 2.1%) of dAg along with other major trace metals including cadmium (Cd), copper (Cu), manganese (Mn), nickel (Ni), and lead (Pb) (recovery efficiency = 100% to 102%) in seawater samples. Seawater samples were first spiked with Ag-109 and allowed to reach isotopic equilibrium before extraction using NOBIAS PA-1 chelating resin. Then, dAg isotope ratios (Ag-109/Ag-107) before and after solid phase extraction were determined and used to quantify dAg. Determination of dAg with dissolved Cd, Cu. Mn, Ni, and Pb in reference seawater material CASS-6 resulted in deviations of between 1.0% and 8.8% from the consensus values, which are well within the standard error of measurement. We then successfully determined the concentrations of dissolved Cd (0.05–0.2 nM), Cu (0.5–13 nM), Mn (10–140 nM), Ni (2–12 nM), Pb (5–110 nM), and Ag (10–40 pM) in Otsuchi Bay, Japan and its surrounding rivers. Evaluation of the behavior of dAg under a salinity gradient using estuarine samples collected from Samunsam River, Malaysia shows increasing dAg concentration with salinity (R2 = 0.68), which suggests release of sedimental Ag under high ambient chloride concentrations. Our new method enables rapid and simultaneous measurements of dAg with other key GEOTRACES trace metals in a single analysis, which is expected to expedite analysis and increase availability of oceanic dAg data globally.

The Forgotten Joint Score Is a Valid Outcome Measure for Total Ankle Arthroplasty: A Prospective Study.

The success of total ankle arthroplasty (TAA) involves objective and subjective parameters such as joint motion and implant survival. Patient-reported outcome measures provide key context from the patient's perspective so that we can evaluate the results of these procedures. The Forgotten Joint Score (FJS) has demonstrated validity and reliability in other arthroplasties, but the existing evidence on the FJS in TAA is very limited. We aimed to assess the reliability, validity, responsiveness to change, and floor and ceiling effects, as well as to perform a gender analysis, of the FJS in patients who had undergone TAA. A prospective, observational study enrolled patients who underwent TAA at our institution between June 2021 and May 2023. The three-component TAA was performed through an anterior approach. A total of 120 patients (mean age 62 ± 10 years) participated, which was 83% (120 of 145) of those eligible, and 77% (92 of 120) of those patients underwent follow-up assessments at 12 ± 1 months after surgery. A cross-culturally adapted and validated version of the FJS in our language (Italian) was used. Additionally, three other commonly used patient-reported outcome measures for TAA were administered: the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the Manchester-Oxford Foot Questionnaire (MOXFQ), and the VAS. Reliability was demonstrated by excellent internal consistency (Cronbach α coefficient = 0.95) and excellent test-retest reliability (intraclass correlation coefficient = 0.99; standard error of measurement = 2.7). Robust validity was observed, in that the FJS had a strong correlation with the AOFAS ankle-hindfoot score, the MOXFQ, and the VAS (Pearson and Spearman values consistently above 0.7 or below -0.7). Responsiveness to change was observed between 6 and 12 months (Cohen d = 0.37). Low ceiling and floor effects at both 6 months (4% and 3% reached top and bottom scores, respectively) and 12 months (10% and 0% reached top and bottom scores, respectively) were demonstrated, below the recommended 15% interpretability threshold. No association between outcomes and patient gender was observed. Test properties and validity of the FJS were strong in patients who underwent TAA. It seems suitable for clinical use, although future studies should seek to replicate or refute our findings in other patient populations. Level II, therapeutic study.

Cross-cultural adaptation and psychometric evaluation of the social frailty scale in Iranian older adults

BackgroundSocial frailty is a holistic concept encompassing various social determinants of health. Considering its importance and impact on health-related outcomes in older adults, the present study was conducted to cross-culturally adapt and psychometrically evaluate the Social Frailty Scale in Iranian older adults in 2023.MethodsThis was a methodological study. The translation and cross-cultural adaptation of the Social Frailty Scale 8-item (SFS-8) was conducted according to Wild’s guideline. Content and face validity were assessed using qualitative and quantitative methods. Then, 250 older adults covered by comprehensive health centers were selected using multistage random sampling. Participants completed the demographic questionnaire, the Abbreviated Mental Test score, the SFS-8, and the Lubben Social Network Scale. Construct validity was assessed by principal component analysis (PCA) and known-group comparisons. The Mann‒Whitney U test was used to compare social frailty scores between the isolated and non-isolated older adults. Internal consistency, equivalence, and stability were assessed using the Kuder-Richardson method, the intraclass correlation coefficient (ICC), the standard error of measurement (SEM), and the minimum detectable change (MDC). The ceiling and floor effects were also assessed. The data were analyzed using JASP 0.17.3.ResultsThe ratio and index of content validity and the modified kappa coefficient of all the items were 1.00. The impact score of the items was greater than 4.6. PCA identified the scale as a single component by removing two questions that could explain 52.9% of the total variance in the scale score. The Persian version of the Social Frailty Scale could distinguish between isolated and non-isolated older adults (p < 0.001). The Kuder–Richardson coefficient, ICC, SEM, and MDC were 0.606, 0.904, 0.129, and 0.358, respectively. The relative frequencies of the minimum and maximum scores obtained from the scale were 34.8 and 1.2, respectively.ConclusionsThe Persian version of the Social Frailty Scale (P-SFS) can be used as a valid and reliable scale to assess social frailty in Iranian older adults.

Determining minimal clinically important differences in the Hammersmith Functional Motor Scale Expanded for untreated spinal muscular atrophy patients: An international study.

Spinal muscular atrophy (SMA) is a rare and progressive neuromuscular disorder with varying severity levels. The aim of the study was to calculate minimal clinically important difference (MCID), minimal detectable change (MDC), and values for the Hammersmith Functional Motor Scale Expanded (HFMSE) in an untreated international SMA cohort. The study employed two distinct methods. MDC was calculated using distribution-based approaches to consider standard error of measurement and effect size change in a population of 321 patients (176 SMA II and 145 SMA III), allowing for stratification based on age and function. MCID was assessed using anchor-based methods (receiver operating characteristic [ROC] curve analysis and standard error) on 76 patients (52 SMA II and 24 SMA III) for whom the 12-month HFMSE could be anchored to a caregiver-reported clinical perception questionnaire. With both approaches, SMA type II and type III patients had different profiles. The MCID, using ROC analysis, identified optimal cutoff points of -2 for type II and -4 for type III patients, whereas using the standard error we found the optimal cutoff points to be 1.5 for improvement and -3.2 for deterioration. Furthermore, distribution-based methods uncovered varying values across age and functional status subgroups within each SMA type. These results emphasize that the interpretation of a single MCID or MDC value obtained in large cohorts with different functional status needs to be made with caution, especially when these may be used to assess possible responses to new therapies.

Tran slation , cultural adap tation an d psycho metric anal ysis of U rd u ver sion of Vic torian; institu te of sp or ts ass es sme nt: Achill es quest i onnaire fo r athletes with achilles tendinopathy.

To translate, culturally adapt and psychometrically analyse the Urdu version of the Victorian Institute of Spor t Assessment-Achilles questionnaire. The cross-sec tional study was conducted at the Pak istan Sports Board, Lahore, Pakistan, from June 17, 2021, to February 15, 2022, and comprised patients with Achilles tendinopathy in group A and healthy controls in group B. Beaton's guidelines for cultural adaptation and validation for self-repor ted measures were followed to translate and validate the Victorian Institute of Sport Assessment-Achilles questionnaire in Urdu language. Data was analysed using SPSS 23. Of the 180 subjects with mean age 28.06±5.95 years, 125(69.6%) were males. There were 130(72.2%) patients in group A and 50(27.8%) controls in group B. The overall mean score of the Victorian Institute of Sport Assessment- Achille s questionnaire was 55.99±25.43; group A 41.14±9.54 and group B 94.60±4.22. The Urdu version exhibited excellent internal consistency with Cronbach's alpha values 0.95, and excellent test-retest reliability (p<0.001). Absolute reliability was expressed by standard error of measurement 5.317 and minimal detectable change (6.38). Convergent validity demonstrated strong correlation with the physical domain (r=0.81) of the Urdu version of the World Health Organisation Quality of Life Brief Version. The Victorian Institute of Sport Assessment-Achilles questionnaire could be utilised for assessing severity of Achilles tendinopathy among Urdu-speaking population for clinical as well as research purposes.

The concurrent validity and test-retest reliability of a submaximal exercise test in adolescents with autism

Purpose There is a need for valid and reliable clinical assessment tools to assess cardiorespiratory fitness (CRF) levels in adolescents with autism. Therefore, this study aimed to examine the concurrent validity and test-retest reliability of the Astrand-Rhyming Test (ART) in this population. Materials and methods 45 adolescents with autism aged 12–18 years (n = 32 males, 14.47 ± 1.79 years) performed the ART twice (test-retest reliability) and completed a maximal cardiopulmonary exercise test (CPET) (concurrent validity). Reliability parameters included Pearson correlations, intraclass correlation coefficients (ICCs), standard error of measurements (SEM), minimal detectable changes (MDC), coefficients of variation, paired sample t-tests, linear regressions and Bland-Altman plots. The concurrent validity was evaluated with Pearson correlations, ICCs, paired sample t-tests, linear regressions and Bland-Altman plots. Results Strong test-retest reliability (r = 0.84–0.85, ICC = 0.84–0.85) was found for the ART, but the wide limits of agreement intervals suggest the presence of substantial variability. The large SEM (4.73–5.08 mL/kg/min) and MDC (13.20-14.07 mL/kg/min) values suggest lower absolute reliability. Moderate to strong levels of association (r = 0.74–0.75) and agreement (ICC = 0.59–0.66) were found between estimated (ART1) and measured (CPET) VO2 max levels, but significant systematic differences (5.71–8.82 mL/kg/min) were observed. Conclusion The ART is an accessible and promising method to monitor submaximal CRF levels over time but is less appropriate to estimate maximal CRF levels in this population.

FreDESS: a clinical tool for perceptual evaluation of stuttering

Aim Stuttering is a communication disorder that involves both manifest speech disfluencies and associated symptoms. The purpose of the present study was to introduce an easily administered and ecologically valid assessment tool designed for perceptual evaluation of stuttered speech, FreDESS (frequency of stuttering events, duration of events, effort, secondary behaviours, and severity). More specifically, we wanted to study its reliability and validity. Method Video recordings of conversations with 38 people who stutter (PWS), 19 females and 19 males aged 13–25, were assessed by three speech language pathologists (SLP). Inter- and intrajudge reliability was estimated with intraclass correlation, standard error of measurement, and agreement between listeners. Internal consistency for the FreDESS parameters was estimated with Cronbach’s alpha (α). To test the validity of FreDESS, the relationships between the average estimated parameters of frequency, duration, secondary behaviours, and severity of FreDESS and the Stuttering Severity Instrument (SSI-3), were analysed using intraclass correlation. Results The interjudge reliability was good, especially for the frequency, duration, and severity parameters (90 per cent + agreement given 1 scale point difference). All parameters of the FreDESS had strong intrajudge reliability (ICC = 0.86–0.94) and the overall internal consistency was high (α = 0.98). The average ratings on the two assessment scales were in line with each other (r = 0.90–0.96), indicating high concurrent validity. Conclusion The FreDESS scale for the assessment of stuttered speech may be a valuable tool in clinical and research contexts. It is a valid and more time-efficient assessment instrument than the more commonly used SSI.

Evaluation of Reliability of Dynamic Scapholunate Distance Measured on 4D CT-Acquired Images

Abstract Purpose A technique to measure scapholunate distance based on four-dimensional computed tomography (4D CT)-acquired images is presented. Methods Intra-observer variability was evaluated through a repeated-measures study. A 4D CT of seven patients suspected of scapholunate lesion was performed. Anatomical landmarks were identified on a three-dimensional reconstructed model of the wrist. All 4D CT datasets were evaluated thrice by two observers. Standard deviation of the differences between two measurements, interclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated. Results Intra-observer variability for the expert observer (ICC &gt; 0.95) was lower than that of the novice observer (ICC &gt; 0.77) and interobserver variability was low (ICC &gt; 0.85). For the expert observer, measurement error (SEM &lt; 0.13 mm and MDC &lt; 0.36 mm) was smaller than that of the novice observer (SEM &lt; 0.45 mm and MDC &lt; 1.24 mm). Both SEM and MDC values were low, compared to the scan resolution and the absolute value of intervals. Conclusion The proposed assessment results in a reproducible and reliable measurement of scapholunate distance.

Validity and reliability of the modified four square step test in total HIP arthroplasty

IntroductionThe Modified Four Square Step Test (mFSST) evaluates dynamic stabilization by using tape instead of canes to prevent people from tripping over obstacles and losing their balance. There was no study investigating reliability and validity in primary total hip arthroplasty (THA). This study aimed to evaluate the test-retest reliability, concurrent validity, and minimum detectable change in the mFSST for individuals with primary THA. MethodThis study was cross-sectional in design. A total of 29 individuals aged 56.86 ± 10.14 years participated. The study used the test-retest method to determine the reliability of the mFSST and concurrent validity. The Timed Up and Go Test (TUGT) and Berg Balance Scale (BBS) were applied for concurrent validity. The minimum detectable change (MDC95) and the standard error measurement (SEM) were calculated. ResultsThe mFSST showed excellent intra-rater reliability (ICC = 0.925). The SEM and MDC95 of the mFSST were 1.56 and 4.32. The test had a strong correlation with TUGT (r = 0.881) and BBS (r = −0.718) (p < 0.001). ConclusionThe mFSST is a valid and reliable assessment tool that can be used for individuals with primary THA.

Reliability of Corticospinal and Motoneuronal Excitability Evaluation during Unfatiguing and Fatiguing Cycling Exercise.

Central nervous system excitability depends on the task performed, muscle group solicited, and contraction type. However, little is known on corticospinal and motoneuronal excitability measured during locomotor exercise. This study aimed at determining the reliability of motor-evoked potentials (MEP) and thoracic motor-evoked potentials (TMEP) in dynamic mode during unfatiguing and fatiguing cycling exercise. Twenty-two participants completed four visits. Visit 1 comprised familiarization and an incremental cycling test to determine maximal power output ( Wmax ). The remaining visits encompassed unfatiguing evaluations, which included a total of eight brief bouts of moderate- (50% Wmax ) and high-intensity cycling (80% Wmax ), four at each intensity. In each bout, a set of two TMEPs, five MEPs, and one M-max were obtained. Subsequently, a fatiguing exercise to exhaustion at 80% Wmax was performed, with four sets of measurements 3 min through the exercise and four additional sets at exhaustion, both measured at 50% Wmax . Intraclass correlation coefficients (ICCs) for 5, 10, 15, and 20 MEP·Mmax -1 revealed excellent reliability at both intensities and during cycling to exhaustion (ICC ≥0.92). TMEP·Mmax -1 showed ICCs ≥0.82 for moderate and high intensity, and it was not affected by fatigability. Overall standard error of measurement was 0.090 (0.083, 0.097) for MEP·Mmax -1 and 0.114 (0.105, 0.125) for TMEP·Mmax -1 . A systematic bias associated with the number of stimulations, especially at high intensity, suggested that the evaluation itself may be influenced by fatigability. A mean reduction of 8% was detected in TMEP·Mmax -1 at exhaustion. Motoneuronal and corticospinal excitability measured in dynamic mode presented good to excellent reliability in unfatiguing and fatiguing exercise. Further studies inducing greater fatigability must be conducted to assess the sensitivity of central nervous system excitability during cycling.

Cross-cultural validity of the Dutch sleep-related breathing disorder scale of the Pediatric Sleep Questionnaire in a general population

BackgroundPediatric sleep-disordered breathing is associated with multiple health problems. Polysomnography is the reference standard for identifying this disorder, but availability is limited. Therefore, an alternative screening tool is needed. Globally, the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ) has proven to be a feasible tool. Consequently, this study aimed to translate and culturally adapt the PSQ into Dutch and then to examine the cultural validity, internal consistency, and test-retest reliability of the Dutch version among a general population visiting oral healthcare centers. MethodsThe translation, review, adaptation, pretest, and documentation approach was used to ensure cross-cultural adaptation of the PSQ. Then, 220 children (2.4–18 years) were sampled for clinimetric evaluation. We estimated the cross-cultural validity by comparing the factor analyses of the original PSQ and the Dutch version. Reliability was assessed using Cronbach's alpha, Spearman's correlation, the intraclass correlation coefficient, the standard error of measurement, and a Bland-Altman plot. ResultsThe factor loading patterns of the Dutch version matched with the original study around the four predetermined factors: breathing, sleepiness, behavior, and other. The internal consistency, with a Cronbach's α of 0.77, was acceptable. The test-retest reliability with an intraclass correlation coefficient and Spearman's correlation of 0.89 and 0.93, respectively, was good to excellent. ConclusionsCultural adaptation was ensured and the results support cross-cultural validity, internal consistency, and test-retest reliability of the Dutch Sleep-Related Breathing Disorder scale of the PSQ. This questionnaire could therefore be a valuable tool for screening disordered breathing in Dutch children.

Physical performance tests have excellent reliability in frail and non-frail patients with prostate cancer

Purpose Our aim was to investigate the test-retest reliability of the 2-min walk test (2MWT), timed up and go test (TUG), and five times sit-to-stand test (FTSST) in prostate cancer (PC) patients. Methods This study was conducted with 73 patients who were classified into two groups as frail and non-frail determined by the Geriatric-8 questionnaire. Patients performed the 2MWT, TUG, and FTSST tests for two times. The test-retest reliability of the 2MWT, TUG, and FTSST was assessed by calculating the intraclass correlation coefficient (ICC). The standard error of measurement (SEM95) and minimal detectable change (MDC95) values were calculated. Results All tests showed excellent test-retest reliability for both groups (ICC(2.1) > 0.90). The SEM95 and MDC95 values of 2MWT were 3.09, 8.57, and 3.15 m, 8.73 m for frail and non-frail groups. The SEM95 and MDC95 values of TUG for the frail group were 0.6 and 1.66 and 0.43 and 1.19 for the non-frail group, respectively. The SEM95 and MDC95 values of FTST for the frail group were 0.68 and 1.88 and for the non-frail group 0.86 and 2.38. Conclusions The 2MWT, TUG, and FTSST showed excellent reliability in frail and non-frail older adults with PC which can be used to assess physical performance.

Psychometric Evaluation of the Bahasa Malaysia Version of the Lymphedema Functioning, Disability, and Health Questionnaire for Upper Limb Lymphedema in Patients with Breast Cancer-Related Lymphedema.

Background: Breast cancer-related lymphedema (BCRL) is the most prevalent comorbidity that occurs following breast cancer treatments and has negative impact on the patients' quality of life (QoL). The Lymphedema Functioning, Disability, and Health Questionnaire for Upper Limb Lymphedema (Lymph-ICF-UL) is a valid and reliable instrument in assessing the QoL of patients with BCRL. However, the Bahasa Malaysia (BM) version is not available yet. This study aimed to translate the Lymph-ICF-UL into BM and to evaluate its validity and reliability. Methods and Results: A forward-backward translation was performed based on Sousa's guideline, and then, the face, content, construct validity, internal consistency, and test-retest reliability were tested. Face validity was assessed by five patients, and content validity was evaluated by six experts. Then, construct validity and internal validity were assessed in 107 patients. Finally, test-retest reliability was analyzed in 21 patients. Two items were eliminated following suggestions from the patients and experts. All patients found the scoring system and items clear and relevant. The results showed sufficient content validity index and modified kappa statistics value. Confirmatory factor analysis showed acceptable fit indices. Cronbach's alpha values ranged from 0.67 to 0.95, intraclass correlation coefficient ranged from 0.88 to 0.99, standard error measurement was 2.29-6.15, and the Bland-Altman plot showed an agreement between two test occasions. Conclusion: These results suggested that the Lymph-ICF-UL BM has good validity and reliability in evaluating the QoL of patients with BCRL in Malaysia.

Measures of acromiohumeral distance with wireless ultrasound machine in subacromial impingement syndrome: an inter-machine reliability study.

Shoulder pain is the third most prevalent musculoskeletal condition that impairs function. Subacromial impingement syndrome is among the most typical causes of shoulder pain. The aim of this study was to evaluate inter-machine reliability of acromiohumeral distance measurements performed with standard ultrasound and wireless ultrasound devices in patients with subacromial impingement syndrome. A total of 61 participants diagnosed with subacromial impingement syndrome were included. Acromiohumeral distance was measured with wireless and standard ultrasound devices in a neutral position and at 60-degree abduction, respectively. The inter-machine intraclass correlation coefficient, standard error of measurements, and minimum detectable changes were calculated. Inter-machine reliability measured in the neutral position was excellent (ICC = 0.97, 95% CI = 0.95-0.98); the standard error of measurement was 0.23 mm, and the minimum detectable change was 0.63 mm. Inter-machine reliability measured at 60 degrees abduction was excellent as well (ICC = 0.96; 95% CI; 0.93-0.97). The standard error of measurements was 0.20 mm, and the minimum detectable change was 0.55 mm. The mean difference between the two machines was 0.04 mm for the neutral position and 0.02 mm for the 60-degree abduction position. The study showed that wireless ultrasound devices were similar to standard ultrasound devices in measuring the acromiohumeral distance in patients with subacromial impingement syndrome. The findings could contribute to a significant improvement in the clinical use of wireless ultrasound devices.

Self-assessment using 30-second chair stand test for patients with knee osteoarthritis – an intra- and inter-rater reliability study

Background We aimed to evaluate the intra-rater reliability in 30-second chair stand test (30CST) as a self-test, and the inter-rater reliability comparing a self-test with a physiotherapist-assessed 30CST for patients with knee osteoarthritis (KOA). The second purpose was to evaluate the classification ability of the 30CST as self-test to distinguish between reduced physical function and normal function. Methods Patients with KOA performed two self-tests of 30CST at home and thereafter a physiotherapist assessed the patient. Absolute agreements were presented with intraclass correlation coefficient (ICC), 95% confidence interval (CI) and standard error of measurement (SEM). Post-hoc analyses were conducted to calculate minimal detectable change (MDC). The classification ability was analysed with receiver operating characteristic (ROC)-curves and area under the ROC-curve (AUC). The significance level was p < 0.05. Results In total, 114 followed the protocol. Intra-rater and inter-rater reliability were good (ICC 0.97, CI 0.95–0.99, SEM 0.89 and ICC 0.81, CI 0.72–0.87, SEM 2.29 respectively). MDC were 2.5 stands when comparing self-test results individually and 0.23 on a group level. The MDC between self-tests and physiotherapist assessment were 6.4 stands for individual comparison and 0.59 for group comparison. The self-test was 80% likely to detect reduced physical function compared to a physiotherapist assessing physical function with 30CST (AUC = 0.79–0.80). Conclusions The results indicate that 30CST can be a reliable self-assessment of physical function in lower extremities for patients with KOA. These findings can be useful in areas such as self-screening for reduced physical function, self-assessment in digital physiotherapy, and as measurement in research projects.

Investigating the internal structure of multiple mini interviews-A perspective from Pakistan.

Healthcare professionals require many personal attributes in addition to cognitive abilities and psychomotor skills for competent practice. Multiple Mini- Interviews are being employed globally to assess personality attributes of candidates for selection in health professions education at all level of entry; these attributes are namely, communication skills, critical thinking, honesty, responsibility, health advocacy, empathy and sanctity of life. Considering the high stakes involved for students, faculty, institutions and the society, rigorous quality assurance mechanisms similar to those used for student assessment must be employed for student selection, throughout the continuum of medical education. It is a difficult undertaking as these psychological constructs are difficult to define and measure. Though considered to yield reliable and valid scores, studies providing multiple evidences of internal structure especially dimensionality of Multiple Mini-Interviews are sparse giving rise to questions if they are measuring a single or multiple constructs and even if they are measuring what they are purported to be measuring. The main objective is to provide statistical support of the multi-dimensional nature of our Multiple Mini Interviews, hypothesized a-priori, through CFA. Another objective is to provide multiple evidences for the internal structure. Our study highlights the link between content and internal structure evidences of the constructs, thus establishing that our Multiple Mini Interviews measure what they were intended to measure. After securing permission from the Institutional review board, an a-priori seven factor-model was hypothesized based on the attributes considered most essential for the graduating student of the institution. After operationally defining the attributes through extensive literature search, scenarios were constructed to assess them. A 5-point rating scale was used to rate each item on the station. A total 259 students participated in the multiple mini interviews over a period of three days. A training workshop had been arranged for the participating faculty. The reliability coefficient using Cronbach's alpha were calculated (range from 0.73 to 0.94), Standard Error of Measurement (ranged from 0.80 to1.64), and item to station-total correlation ranged from 0.43-0.50 to 0.75-0.83. Inter-station correlation was also determined. Confirmatory factor analysis endorsed the results of Exploratory factor analysis in the study revealing a seven model fit with multiple indices of Goodness-of-fit statistics such as Root mean square error of approximation (RMSEA) value 0.05, Standardized root mean square residual (SRMR) value with less than 0.08. All these indices showed that model fit is good. The Confirmatory factor analysis confirmed the multi-dimensional nature of our MMIs and also confirmed that our stations measured the attributes that they were supposed to measure. This study adds to the validity evidence of Multiple Mini-Interviews, in selection of candidates, with required personality traits for healthcare profession. It provides the evidence for the multi-dimensional structure of Multiple Mini interviews administered with multiple evidences for its internal structure and demonstrates the independence of different constructs being measured.

Shear wave elastography for assessing the anterior scalene elasticity in patients with neck pain

PurposeShear-wave elastography (SWE) provides quantitative and absolute metrics for analyzing the elasticity of soft tissues. Despite the anterior scalene muscle (AS) is a key structure in patients with neck pain and nerve compressive syndromes, the majority of SWE studies only included asymptomatic subjects. This study aimed to analyze the Young’s modulus and shear wave speed test–retest reliability in a sample of patients with neck pain symptoms to characterize the AS stiffness. MethodsA diagnostic accuracy study acquiring a set of ultrasound images at C7 level in 42 patients with mechanical neck pain by one experienced examiner. After blinding the participants’ identity, trial and side, the Young’s modulus and shear wave velocity were measured by an independent experienced rater in randomized order. Intra-class correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable changes (MDC) and coefficient of variation (CV%) were calculated. ResultsThe sample reported moderate pain intensity (5.9/10 points) and disability (17.38/100 points). AS stiffness metrics assessed showed no significant differences between males and females, left and right side nor painful and non-painful side. (all, p > 0.05). Intra-examiner reliability was excellent for calculating the Young’s modulus for shear wave speed (ICC > 0.90). ConclusionThe results support the use of this procedure for assessing the AS stiffness in populations with mechanical neck pain as excellent reliability estimates were obtained. However, future research should analyze case-control differences and the association between SWE metrics with clinical severity indicators.

Test-Retest Reliability of a Bilingual Arabic-English Pittsburgh Sleep Quality Index among Adolescents and Young Adults with Good or Poor Sleep Quality

Abstract Introduction The Pittsburg Sleep Quality Index (PSQI) is widely used in different population groups to assess self-reported sleep quality over the previous month. As the Arabic language is spoken by more than 400 million people, the PSQI has been translated into Arabic for its optimal application to Arabic-speaking individuals. However, the test-retest reliability of the Arabic version of the PSQI has not been reported yet. Objective To examine the reliability and agreement of a bilingual Arabic-English version of the PSQI (AE-PSQI) among bilingual Arabic-English-speaking adolescents and young adults of the United Arab Emirates (UAE) with good or poor sleep quality. Materials and Methods We included 50 bilingual Arabic-English-speaking adolescents and young adults (mean age of 20.82 ± 2.7 years; 30/50 subjects classified as poor sleepers [PSQI &gt; 5] at baseline) who filled put the AE-PSQI twice, 7 days apart. The internal consistency of the AE-PSQI was assessed through the Cronbach's alpha. The intraclass correlation coefficient (ICC[3,1]) was used to assess the test-retest reliability. The standard error of measurement (SEM), the smallest real difference (SRD), and the Bland-Altman plots were used to report agreement measures. Results The global score on the AE-PQSI showed an acceptable level of internal consistency with a Cronbach's alpha value of 0.65, and no floor and ceiling effects were observed. The 95% confidence intervals (95%CI: 0.63-0.87) of the ICC(3,1) revealed moderate to strong reliability estimates for overall AE-PSQI scores. The SEM and SRD were of 1.6 and 4.5 respectively, and the Bland-Altman plots revealed a moderate agreement between the baseline and retest global AE-PQSI scores. Conclusion The AE-PSQI is a reliable instrument to assess sleep quality in bilingual Arabic-English-speaking adolescents and young adults with good or poor sleep quality. Further studies on the validity and responsiveness of the AE-PSQI are warranted in individuals with and without sleep disorders.