Standard Error Of The Measurement Values Research Articles

Reliability of intracortical inhibiton measured using threshold tracking technique

Background. Paired-pulse transcranial magnetic stimulation allows assessing intracortical inhibition. However, a high variability of motor evoked potential (MEP) amplitude is a limitation of its use. Therefore, a new threshold tracking technique became of particular interest, which is based on the measurement not of the amplitude, but of the change of test stimulus intensity required to induce a MEP of a given amplitude.Aim. The assessment of absolute and relative reliability of short-interval intracortical inhibition (SICI) using threshold tracking technique in healthy volunteers.Materials and methods. All healthy volunteers included into the study (n = 12) underwent diagnostic paired-pulse transcranial magnetic stimulation in two consecutive days. The procedure included registration of passive motor threshold; the registration of 30 MEPs with supra-threshold intensity and determination of SICI using threshold tracking technique. At the first day the procedure was performed twice (T1, T2), at the second day – once (T3). Standard error of the measurement (SEM) and SEM% were calculated to assess absolute reliability, and intra-class correlation coefficient – for the assessment of relative reliability.Results. A good or excellent relative reliability were observed for SICI averaged at intervals 1.0–3.0 ms and 1.0–7.0 ms when assessed within a day or at different days. Relative reliability of SICI at separate interstimulus intervals varied in a wide range. SEM% was more than 10 % both for averaged SICI and SICI at all interstimulus intervals. Motor threshold had excellent reliability both assessed within a day and at different days, and low SEM values (5.6 % for Т1–Т2 and 4.39 % for Т1–Т3). High SEM and SEM% were observed for average MEP amplitude, it also had a moderate relative reliability when assessed within a day and a poor one – at different days.Conclusion. Calculation of averaged SICI can be recommended in further studies because of its high reliability values.

Skeletal muscle analysis of panoramic ultrasound is reliable across multiple raters

Ultrasound devices are common in muscle physiology laboratories due to their ease of use and validity to assess skeletal muscle characteristics. The current study assessed the reliability of ultrasound skeletal muscle image analysis across multiple raters with limited experience. Vastus lateralis (VL), rectus femoris (RF), and first dorsal interosseus (FDI) images were separately analyzed by three novice raters to determine muscle thickness (MT), cross-sectional area (CSA), and echo-intensity (EI). Separate analyses of variance (ANOVA) assessed statistical differences between and within raters. Intra-class correlation coefficients (ICC) between (inter-rater) and within (intra-rater) raters, the standard error of the measurement (SEM) and minimal difference needed to be considered real were calculated. Inter-rater reliability was high for the VL and RF (ICC: 0.984–0.999), while the FDI was lower (0.614–0.962). Further, intra-rater reliability was greater than 0.961 for each rater. SEM values calculated for inter-rater reliability expressed as a percentage of the mean ranged from 0.4–5.8% across variables. Similarly, SEM values for intra-rater reliability were between 0.8–5.8%, 0.6–3.6%, and 0.4–3.2% for Raters 1, 2 and 3, respectively. Despite this, significant differences (p<0.05) between raters were observed for RF MT and EI, VL CSA and EI, and FDI MT, suggesting that potentially more measurement trials or greater practice time may be necessary to reduce systematic error among multiple raters. Post-image acquisition processing is reliable among and within raters as determined through ICCs and SEMs. This study provided consistent results among three separate novice raters given the same training, a unique yet realistic setting in muscle physiology laboratories.

Submaximal contractions can serve as a reliable technique for shoulder electromyography normalization

There are a number of ways to normalize electromyographical data, the most common of which is using a maximal contraction as a reference. However, this technique is not always practical. The purpose of the present study was to assess the reliability of an electromyographical data normalization technique using standardized submaximal contractions. Twenty healthy subjects (ten male, ten female) were used for testing, which was performed using both surface and fine-wire electromyography over two sessions at 15, 30, 45, and 60 percent of the day 1 maximum force. There was a mean of 5.3 days between test days. Data were compared between days, and the resulting ICC and standard error of the measurement values indicate varying levels of reliability at each submaximal percent. All heads of the deltoid, the upper trapezius and the serratus anterior demonstrated good reliability for at least one submaximal condition. The latissimus dorsi and supraspinatus demonstrated moderate reliability for at least one submaximal condition. Finally, the infraspinatus demonstrated poor reliability under all conditions. For situations in which MVC is impractical or anticipated to change, EMG amplitude normalization to one of these submaximal percentages appears to be a viable technique, at least for most muscles.

Validity of ultrasound imaging for intrinsic foot muscle cross-sectional area measurements demonstrated by strong agreement with MRI

PurposeIntrinsic foot muscles maintain foot structural integrity and contribute to functional movement, posture and balance. Thus, assessing intrinsic foot muscle size and strength are important. Magnetic resonance imaging (MRI) has been shown to accurately image the individual muscles but is costly and time consuming. Ultrasound (US) imaging may provide an alternative that is less costly and more readily available. The purpose of this study was to investigate the validity and intratester reliability of US imaging in measuring intrinsic foot muscle size in comparison to MRI.MethodsUS and MRI were employed to measure the intrinsic foot muscle size involving 35 participants (females = 13; males = 22). The scanned intrinsic foot muscles included the flexor hallucis brevis (FHB), abductor hallucis (ABDH), flexor digitorum brevis (FDB), quadratus plantae (QP) and abductor digiti minimi (ADM). Pearson product correlation (r), intraclass correlation coefficients (ICC), standard error of the measurement (SEm) and minimal detectable difference (MDD) were calculated.ResultsHigh correlations were detected between the US and MRI cross-sectional area (CSA) measurements (r = .971 to 0.995). Test reliability was excellent for both MRI and US (ICC = 0.994 to 0.999). Limits of agreement between MRI and US measurements from ranged from 5.7 to 12.2% of muscle size. SEm values for US ranged from 0.026 to 0.044 cm2, while the SEm for MRI ranged from 0.018 to 0.023 cm2. MDD values for US ranged from 0.073 to 0.122 cm2, while MRI ranged from 0.045 to 0.064 cm2.ConclusionsUS appears to be a valid and reliable alternative to MRI when measuring intrinsic foot muscle CSA. While US is less costly and more readily available, the MRI results were shown to be slightly more precise.

Clinimetric properties of a postural assessment software in older people: reliability, standard error of measurement, and minimal detectable change

Objective: To evaluate intra- and inter-rater reliability, standard error of the measurement (SEM), and minimal detectable change (MDC) of the angles obtained with a Postural Assessment Software (SAPO) in older people. Methods: Postural evaluation of 32 older adults was performed using Postural Assessment Software (SAPO). Two raters performed the procedure independently, and one of the raters repeated the process 7 to 10 days later. Reliability was assessed through the intraclass correlation coefficient (ICC) and paired and independent t-tests. SEM and MDC95 values were calculated, and Bland-Altman plots were generated. Results: The inter-rater analysis showed that the raters were not different in any of the angles. Most angles achieved good to excellent inter-rater reliability (ICC = 0.34 – 0.81) and intrarater reliability (ICC = 0.33 – 0.88) and were not different between days. The SEM was lower than 10º in most angles. The MDC95 ranged from 2.88º to 18.49º. Bland-Altman analysis indicated that most angles were within the limits of agreement. Overall, angles generated in lateral view had better reliability properties. Conclusion: Postural Assessment Software (SAPO) showed angles with distinct reliability properties in older adults. Angles that reached good to excellent intra- and inter-reliability and exhibited lower variability could be considered for assessing postural changes in older adults. MDC95 values could be used as a reference for indicating changes greater than the variability of the measurement.

Modified conventional gait model vs. Six degrees of freedom model: A comparison of lower limb kinematics and associated error.

The conventional gait model (CGM) is commonly utilised within clinical motion analysis but has a number of inherent limitations. To overcome some of these limitations modifications have been made to the CGM and six-degrees of freedom models (6DoF) have been developed. How comparable are lower limb kinematics calculated using modified CGM and 6DoF models and what is the error associated with the output of each model during walking? Ten healthy males attended two gait analysis sessions, in which they walked at a self-selected pace, while a 10-camera motion capture system recorded lower limb kinematics. Hip, knee and ankle joint kinematics in all three anatomical planes were calculated using a modified CGM, with medial anatomical markers and a three-dimensional foot added, and 6DoF. Mean absolute differences were calculated on a point-by-point basis over the walking gait cycle and interpreted relative to a 5° threshold to explore the comparability of model outputs. The standard error of the measurement (SEM) was also calculated on a point-by-point basis over the walking gait cycle for each model. Mean absolute differences above 5° were reported between the two model outputs in 58-86% of the walking gait cycle at the knee in the frontal plane, and over the entire walking gait cycle at the hip and knee in the transverse plane. SEM was typically larger for the modified CGM compared to the 6DoF, with the highest SEM values reported at the knee in the frontal plane, and the hip and the knee in the transverse plane. Caution should be taken when looking to compare findings between studies utilising modified CGM and 6DoF outside of the sagittal plane, especially at the hip and knee. The reduced SEM associated with the 6DoF suggests this modelling approach may be preferable.

Reliability of ultrasound imaging of pelvic floor morphology and function among females who have undergone pelvic radiotherapy.

To investigate the intra- and inter-rater reliability of two-dimensional (2D) transperineal ultrasound imaging (USI) measures of bladder wall thickness (BWT), urethral length (UL), and parameters related to levator plate length (LP) and transient changes in LP during pelvic floor muscle (PFM) contraction, and on Valsalva in women who received radiation therapy (RT) for treatment of pelvic cancer. Twenty women with a history of RT for the treatment of pelvic cancer were assessed independently by two raters on the same day. Five outcomes were assessed for reliability:BWT,UL, and LP at rest (LP-R), during a maximal voluntary contraction of the PFMs (LP-MVC), and during a maximal-effort Valsalva maneuver (LP-MVM). Reliability was determined using intra-class correlation coefficients (ICC) and Bland-Altman analyses. Measurement error was determined using standard error of the measurement (SEM) and minimal detectable difference. Intra-rater reliability was very good for LP-R, LP-MVC, LP-MVM, and UL(ICC: 0.97 [0.93-0.99], 0.95 [0.88-0.98], 0.84 [0.59-0.94], and 0.96 [0.89-0.98], respectively). Inter-rater reliability was very good for LP-R (ICC: 0.82 [0.55-0.93]), and good for LP-MVC, LP-MVM, and UL (ICC: 0.79 [0.46-0.92], 0.79 [0.49-0.92], and 0.75 [0.36-0.90], respectively). BWT had poor intra- and inter-rater reliability. The variability between measurements was the smallest for LP-R, LP-MVC, and UL for intra-rater assessments, and for LP-Rand UL for inter-rater assessments. SEM values for intra-rater assessments were LP-R: 1.5 mm, LP-MVC: 1.84 mm, LP-MVM: 4.33 mm, and UL: 1.16 mm. Althoughthese results support the reliability of 2D-transperineal USI for the evaluation of UL and PFM parameters, they do not support its use for the assessment of BWT.

Mobility Measures in Older Cancer Survivors: An Examination of Reliability, Validity, and Minimal Detectable Change

Background: Cancer and its treatment contribute to multiple sequelae affecting physical function, including difficulty in balance and walking. Although clinical tests should be used to assess fall risks in older cancer survivors, the literature describing the validity, reliability, measurement error, and minimal detectable change (MDC) of mobility measures is lacking. Objective: The purpose of this study was to describe the reliability, validity, standard error of the measurement (SEM), and minimal detectable change at 95% confidence (MDC95) of mobility measures in older cancer survivors. Methods: Fifty cancer survivors (breast, prostate, lung, or colorectal) aged 65+ years participated. Measures of gait speed (GS) (usual, fast, and dual-task) and mobility (Timed Up and Go [TUG], TUG-cognitive, and TUG-manual) were performed once and then repeated 2 weeks later. Test-retest reliability was assessed using intraclass correlation coefficient (ICC2,1). MDC95 and SEM were calculated. Construct validity was examined using Pearson's correlation coefficient with 6-item Activities-specific Balance Confidence scale and Short Physical Performance Battery performance. Results: Test-retest reliability was excellent for all mobility measures, with ICC values ranging from 0.89 to 0.94 for GS and 0.95 to 0.98 for TUG measures. Construct validity was present for TUG (r = −0.53 to −0.73) and GS (r = 0.29 to 0.5) measures. Low SEM values demonstrated excellent reproducibility. To be considered real change, usual GS should be 0.14 m/s or more and TUG 2.49 seconds or more. Conclusions: Measures of GS and TUG have excellent reliability and construct validity and should be considered for use in older cancer survivors. Further study is indicated to establish the psychometric values of mobility measures by cancer type.

Seated Single-Arm Shot-Put Test to Measure the Functional Performance of the Upper Limbs in Exercise Practitioners With Chronic Shoulder Pain: A Reliability Study

ObjectiveTo measure the intra- and interrater reliability of the seated single-arm shot-put test (SSPT) in the functional performance of the upper limbs of regular physical exercise practitioners with shoulder pain. MethodsThis is a reliability study. Thirty individuals regularly practicing any sports modality that uses the upper limb effectively for at least 6 months, both sexes, ages between 18 and 30 years, with chronic shoulder pain were included. Chronic shoulder pain was measured by means of the shoulder pain and disability index, numerical rating scale, and catastrophic thoughts about pain scale. Functional performance of the upper limbs was measured by means of SSPT. ResultsExcellent intrarater reliability was found, with intraclass correlation coefficient ≥0.93, standard error of the measurement values ≤4.63%, and minimum detectable change values for absolute and normalized score of 45.11 cm and 9.97, respectively. Excellent interrater reliability was found, with intraclass correlation coefficient ≥0.96, standard error of the measurement values ≤3.55%, and minimum detectable change values for absolute and normalized score of 32.29 cm and 7.70, respectively. ConclusionSSPT is a reliable tool for measuring the functional performance of the upper limbs in regular exercise practitioners with chronic shoulder pain.

Feasibility and reliability of a physical fitness tests battery for adults with intellectual disabilities: The SAMU DIS-FIT battery

BackgroundPeople with intellectual disability (ID) have lower performances in physical fitness (PF) tests than people without ID, a situation that exists during all the life stages. However, the assessment of the FP of persons with ID often uses instruments that were designed for non-disabled people. AimTo check the reliability and feasibility of 8 PF tests in adults with mild to moderate ID. MethodsA cross-sectional study was carried out with a test-retest design in a maximum interval of 2 weeks with 240 adults (160 men and 80 women) with mild to moderate ID in order to assess the feasibility and reliability of the following 8 tests: body mass index (BMI), waist circumference (WC), the timed up & go test (TUG), the deep trunk flexion test (DTF), the hand grip test (HG), the timed stand test (TST), the 30-s sit-up (SUP) test, and the 6-min walk test (6MWT). The complete battery was called the SAMU-Disability Fitness Battery (SAMU-DISFIT). The psychometric properties of the battery, feasibility, reliability, the standard error of the measurement (SEM) and the minimal detectable change (MDC) were calculated. ResultsThe TUG, DTF, HG, TST, and 6MWT showed an intraclass correlation coefficient (ICC) from fair to high reliability. Only the SUP test in men had an ICC lower than 0.7 and high SEM values. ConclusionThe psychometric properties provide robust data on the use of the SAMU-DISFIT battery in people with ID and can be considered a useful tool for assessing PF in adults with mild to moderate ID in future research.

Evaluating measurement accuracy and repeatability with a new device that records spatial knee movement

A novel portable system has been used to evaluate spatial knee movement, but its accuracy and repeatability is not known. The aim of this study was to investigate the accuracy and repeatability of the measurement. Ten healthy participants were included, and the knee motion trajectory during walking were assessed. Six evaluations were conducted (three days by two raters) for each participant. The motion parameters at the key points and the range of motion were statistically analyzed. Intraclass correlation coefficients (ICC), standard error of the measurement (SEM), and the Bland-Altman method were used. For intra-rater repeatability, 1) the ICC values range from 0.75 to 0.9 for rotations; and 0.64 to 0.96 for translations. Among the ICC values, 100% of rotations and 90% of translations were not less than 0.70; 2) among the SEM values, 100% of rotations were not more than 5°, while 73.3% of translations were less than 3 mm. For inter-rater repeatability, 1) the ICC values range from 0.68 to 0.99 for rotations; and 0.57 to 0.93 for translations. Among the ICC values, 95.6% of rotations and 82.2% of translations were not less than 0.70; 2) among the SEM values, 100% of rotations were not more than 5°, and 48.9% of translations were less than 3 mm. The Bland-Altman plots showed good agreement for intra- and inter- repeatability. The results indicated that the accuracy and repeatability of the measurement were acceptable, except for the inter-rater repeatability for translation. This may help researchers and physicians better interpret the measurement data.

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.

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.

Reliability of skeletal muscle ultrasound in critically ill trauma patients.

ObjectiveTo evaluate the safety and feasibility of the ultrasound assessment of quadriceps in the emergency setting. To assess the intra- and interrater reliability for the acquisition and analysis of ultrasound images of muscle thickness and echogenicity in critically ill trauma patients between health professionals with different levels of expertise.MethodsDiagnostic accuracy study. Two examiners (expert and novice) acquired ultrasound images from ten patients; an experienced, blinded analyst quantified the images. In a separate group of ten patients, two analysts (expert and novice) quantified quadriceps muscle thickness and echogenicity (square or trace method) from images acquired by one examiner.ResultsExcellent reliability was found for image acquisition and analysis (intraclass correlation coefficients > 0.987; p < 0.001). The standard error of the measurement values ranged from 0.01 - 0.06cm for muscle thickness and from 0.75 - 2.04 arbitrary units for muscle echogenicity. The coefficients of variation were < 6% for thickness and echogenicity. The echogenicity values were higher when using the square technique than when using the tracing technique (p = 0.003).ConclusionUltrasound is safe, feasible, and reliable for muscle assessment in critically ill trauma patients, regardless of the assessor's level of expertise.

Reliability of a Method to Measure Neck Surface Electromyography, Kinematics, and Pain Occurrence in Participants With Neck Pain

ObjectiveTo investigate the reliability of a novel method to measure neck surface electromyography (SEMG), kinematics, and pain during active movements in participants with neck pain. MethodsThis test-retest study evaluated 23 participants with chronic neck pain. Each was measured twice within a single session. Three-dimensional kinematics and SEMG were recorded in 10° increments during forward and side flexion, extension, and rotation of the neck. Neck position during pain occurrence was also measured. ResultsIntraclass correlation coefficients were >0.80 for 96% and 100% of SEMG and kinematic data, respectively. The percentage of standard error of the measurement (SEM) values were <25% for 91% of all SEMG measures; most were <15%, and some were <10%. For ranges of motion in the primary plane, percentage of SEM values were all <6% (SEM 1°-3°). Intraclass correlation coefficients for neck position during pain occurrence were all >0.60, except for right rotation (0.48) (SEM values 2°-8°). Pain occurred approximately 59% to 75% into the total range of motion and persisted to its end. ConclusionsThis methodology showed good reliability. It may be suitable for neck pain subclassification to evaluate the effects of treatment on pain, kinematics, and muscle activity during functional neck movements. The point of pain occurrence suggests increasing mechanical load on tissues may be one of the causative factors for movement-associated neck pain.

RELIABILITY OF TWO-DIMENSIONAL VIDEO-BASED RUNNING GAIT ANALYSIS

While two-dimensional (2D) video running analysis is commonly performed in the clinical setting, the reliability of quantitative measurements as well as effect of clinical experience has not been studied. The purpose of this study was to assess the intra-rater and inter-rater reliability of six different raters using 2D video analysis of sagittal and frontal plane kinematic variables while running on a treadmill. Cross-sectional Study. Running videos from 10 individuals (five female, five male) with a mean age of 22.8 years were selected for analysis. Two raters had over 10 years of experience with running video analysis and the other four raters had no prior experience. Before beginning analyses, the senior investigator conducted two hours of training with all raters to review the measurement procedures and the movement analysis software program. After completing training and one practice analysis, each rater assessed four 60-second video clips for the 10 runners twice (20 total). A minimum of one week separated the two assessments on each runner. The order of the runner analyses were randomly assigned and each rater completed a single analysis within 24 hours. After the rater had completed their initial assessment on all 10 runners, a second analysis was completed one week later with a different order of randomization. Eight sagittal plane (SAG) and four frontal plane (FRT) quantitative variables were measured for the left and right lower extremities on all 10 runners. Intra- and inter-rater reliability was assessed using intraclass correlation coefficients (ICC) and standard error of the measurement (SEM). The intra-rater ICC values for experienced raters ranged from 0.75 to 0.98 for the SAG and 0.45 to 0.96 for FRT variables. The inter-rater ICC values between the experienced raters ranged from 0.76 to 0.99 for the SAG and 0.82 to 0.98 for FRT variables. The intra-rater ICC values for inexperienced raters ranged from 0.54 to 0.99 for the SAG and 0.08 to 0.97 for FRT variables. The inter-rater ICC values between the inexperienced raters ranged from 0.93 to 0.99 for the SAG and 0.79 to 0.98 for FRT variables. Intra-rater SEM values based on average means of all raters ranged from 1 to 47% of the mean values obtained for the SAG and from 6 to 158% for the FRT variables. The intra-rater and inter-rater reliability levels were higher for SAG quantitative variables assessed in this study in comparison to FRT variables. Experience does not appear to be a factor when consistency is required with repeated analyses on the same runner. 4, Controlled laboratory study.

Intra- and inter-reliability of fleximetry in individuals with chronic shoulder pain

ObjectiveTo evaluate the intra- and inter-rater reliability of fleximetry in the measurement of range of motion (ROM) in individuals with chronic shoulder pain. DesignReliability study. SettingPhysiotherapy clinic. ParticipantsThirty individuals of both genders, ages between 18 and 45 years, with chronic shoulder pain. Main outcome measuresFleximetry was used to measurement shoulder ROM (flexion, hyperextension, abduction, medial and lateral rotation, and horizontal abduction and adduction). Two examiners performed the evaluations of the shoulder ROM at two time points (interval of one week between them). ResultsIn the intra-rater reliability, substantial to excellent reliability was found, with intraclass correlation coefficient (ICC) values ranging from 0.79 to 0.92, standard error of the measurement (SEM) values ranging from 5.70 to 8.72°, and minimum detectable change (MDC) values varying between 15.80 and 25.18°. Regarding the inter-rater reliability, moderate to excellent reliability was observed, with ICC values ranging from 0.68 to 0.96, SEM values ranging from 4.98 to 11.53°, and MDC values ranging from 13.82 to 31.97°. ConclusionThe use of the fleximeter to measure shoulder ROM presents acceptable reliability values in individuals with chronic shoulder pain, which supports the use of this method of evaluation in research and clinical practice.

Ultrasound estimates of muscle quality in older adults: reliability and comparison of Photoshop and ImageJ for the grayscale analysis of muscle echogenicity.

Background. Quantitative diagnostic ultrasound imaging has been proposed as a method of estimating muscle quality using measures of echogenicity. The Rectangular Marquee Tool (RMT) and the Free Hand Tool (FHT) are two types of editing features used in Photoshop and ImageJ for determining a region of interest (ROI) within an ultrasound image. The primary objective of this study is to determine the intrarater and interrater reliability of Photoshop and ImageJ for the estimate of muscle tissue echogenicity in older adults via grayscale histogram analysis. The secondary objective is to compare the mean grayscale values obtained using both the RMT and FHT methods across both image analysis platforms.Methods. This cross-sectional observational study features 18 community-dwelling men (age = 61.5 ± 2.32 years). Longitudinal views of the rectus femoris were captured using B-mode ultrasound. The ROI for each scan was selected by 2 examiners using the RMT and FHT methods from each software program. Their reliability is assessed using intraclass correlation coefficients (ICCs) and the standard error of the measurement (SEM). Measurement agreement for these values is depicted using Bland-Altman plots. A paired t-test is used to determine mean differences in echogenicity expressed as grayscale values using the RMT and FHT methods to select the post-image acquisition ROI. The degree of association among ROI selection methods and image analysis platforms is analyzed using the coefficient of determination (R2).Results. The raters demonstrated excellent intrarater and interrater reliability using the RMT and FHT methods across both platforms (lower bound 95% CI ICC = .97–.99, p < .001). Mean differences between the echogenicity estimates obtained with the RMT and FHT methods was .87 grayscale levels (95% CI [.54–1.21], p < .0001) using data obtained with both programs. The SEM for Photoshop was .97 and 1.05 grayscale levels when using the RMT and FHT ROI selection methods, respectively. Comparatively, the SEM values were .72 and .81 grayscale levels, respectively, when using the RMT and FHT ROI selection methods in ImageJ. Uniform coefficients of determination (R2 = .96–.99, p < .001) indicate strong positive associations among the grayscale histogram analysis measurement conditions independent of the ROI selection methods and imaging platform.Conclusion. Our method for evaluating muscle echogenicity demonstrated a high degree of intrarater and interrater reliability using both the RMT and FHT methods across 2 common image analysis platforms. The minimal measurement error exhibited by the examiners demonstrates that the ROI selection methods used with Photoshop and ImageJ are suitable for the post-acquisition image analysis of tissue echogenicity in older adults.

Meta-Analysis of Distortion Product Otoacoustic Emission Retest Variability for Serial Monitoring of Cochlear Function in Adults

Distortion product otoacoustic emissions (DPOAEs) have long been heralded as a means to objectively monitor cochlear function and increasingly are becoming a key component in hearing surveillance programs for individuals at risk for ototoxic- and occupational noise-related hearing loss. Yet clinicians are unsure how to define clinically meaningful shifts in DPOAE level. In this study, a meta-analysis approach is used to synthesize the DPOAE level test-retest literature to construct a set of DPOAE level shift reference limits that can be used clinically to define a statistically significant emission change. The authors reviewed all published articles identified through a Medline search using the terms "Otoacoustic Emission Variability," "Otoacoustic Emission Reliability," "Otoacoustic Emission Repeatability," and "Otoacoustic Emission Test Retest" restricted to DPOAEs, adults, and English language. Articles with DPOAE level data elicited by moderate stimulus levels for f2 frequencies of 1000, 2000, 4000, or 6000 Hz were selected because these stimulus parameters were relatively well represented in the literature. The authors only included articles that reported the standard error of the measurement (SEM) or from which the SEM could be calculated. Meta-analysis was used to estimate the population mean SEM over the included studies. Models were fit separately for each f2 primary and included days since baseline and study-specific random effects. Ten DPOAE test-retest studies met inclusion criteria for this meta-analysis. The SEM values varied widely across published studies (0.57 to 3.9 dB) and were provided for relatively short time intervals (less than 15 days on average). Time, or days since baseline, was statistically significant at higher f2 frequencies (4000 and 6000 Hz). From the model results, 90% reference limits specific to the f2 and elapsed time between baseline and follow-up measurements were established. Reference limits provided correspond to negative (emission decrement) and positive (emission enhancement) shifts indicative of the amount of measurement variability that, using this approach, must be tolerated as "normal" fluctuations over time. Changes larger than the reference limits are considered significant and warrant follow-up testing. The meta-analysis presented provides reference limits that are appropriate for a set of specific f2 frequencies and time intervals. The meta-analysis concerns the SEM statistic directly, so that any preferred reference limit can be computed from the results and should be predicated upon the screening application. The presumed advantage of this meta-analytic approach is increased precision relative to limits suggested by any of the individual studies included in the analysis.

Measurement properties of the lower extremity motor coordination test in individuals with stroke

To evaluate the construct validity, inter- and intra-rater reliabilities, best scoring method and testing methods (direct vs video observations), and to determine the smallest real difference (SRD) and standard error of the measurement (SEM) of the lower Extremity Motor Coordination Test (LEMOCOT). Methodological study. Thirty-six stroke subjects. Outcomes include measures of motor recovery, muscular tone, strength, motor coordination, foot tactile sensation, and gait speed. The LEMOCOT scores were able to discriminate between stroke individuals from those predicted for healthy subjects, between the paretic and non-paretic limbs for both the sub-acute and chronic groups and differentiated between individuals with different functional levels and degrees of motor recovery. For the intra- and inter-rater reliabilities, very high and significant coefficients were found for both the paretic and non-paretic lower limbs for both groups (intra-class correlation coefficients (ICC) > 0.97, p < 0.0001). Significant differences were found regarding all scoring methods (18.91 < F < 27.49, p < 0.0001), but they were not clinically important and all showed adequate test-retest reliability and acceptable SRD and SEM (< 15%) values. There was also agreement between the scores from the direct and video observations. The LEMOCOT demonstrated adequate measurement properties in stroke subjects and, therefore, could be an appropriate measure for research and clinical purposes.