Terms Of Test-retest Reliability Research Articles

The Effects of Different Types of Stimulus and its Test-Retest Reliability on Cervical Evoked Myogenic Potential (Cvemp) Results

Introduction: The Cervical Vestibular Evoked Myogenic Potential (cVEMP) is used to evaluate the integrity of saccule and inferior vestibular nerve. There are a lot of factors affecting cVEMP results including stimulus types. This study was carried out to determine the effects of different stimuli on cVEMP results and its test-retest reliability. Materials and method: 25 normal hearing subjects were recruited. The cVEMP testing were performed in 2 sessions with 1 week gap between each sessions. The cVEMP waveforms were recorded in sitting upright position with electrodes placed at; i) upper one-third of sternocleidomastoid muscle for active electrode, ii) suprasternal notch for inactive electrode and, iii) middle of forehead for the ground electrode. The stimuli (500Hz tone burst, click, narrowband chirp and broadband chirp) were presented via insert phone at 95dBnHL. The cVEMP results (P13-N23 peak-to-peak amplitude, P13 latency and N23 latency) were recorded. Results: Result showed; i) 500Hz tone burst produced significantly largest amplitude; ii) narrowband chirp produced significantly shortest P13 latency; iii) broadband chirp produced significantly shortest N23 latency; iv) no significant difference of P13 and N23 latency were observed between two sessions; and v) significant difference of P13-N23 amplitude were observed between two sessions for all stimuli except for narrowband chirp. Conclusion: The 500Hz tone burst was observed to be the most ideal stimulus (produce highest amplitude). All stimuli produced good test-retest reliability in terms of latency. However, most of the stimuli produced poor test-retest reliability in terms of amplitude except for narrowband chirps.

Validity and Responsiveness of the Single Alpha-numeric Evaluation (sane) for Shoulder Patients

Objectives:The is an ever-increasing demand within the emerging health care arena to demonstrate the efficacy of orthopedic interventions. Widespread implementation of patient reported outcomes are limited in part due to the barriers of clinical infrastructure and resources in a busy orthopedic practice. Prior studies have shown the single alpha-numeric evaluation (SANE) score to correlate at a single point in time with the American Shoulder and Elbow Surgeons(ASES) score. However, no study has validated the SANE in terms of test-retest reliability, responsiveness or clinical utility. Therefore, the purpose of this study was to validate SANE compared to the ASES across a sample of patients with the most common orthopedic shoulder diagnoses.Methods:Shoulder patients (n=105 age=52.7 ± 1.2; female=67) undergoing rotator cuff repair (cuff=44), total shoulder replacement (TSA=23), or physical therapy (PT=38) were administered the SANE and ASES less than 14 days apart prior to surgery and again at their 3 month follow up from initial care or surgery. Interclass Correlation Coefficients (ICC(2,1)) and standard error of the measure(SEM) were used to evaluate the test-retest reliability of the SANE and the validity between the SANE and ASES scores. An ANOVA (treatment group by time) was used to evaluate the responsiveness to treatment, and a Receiver Operating Curve was used to establish the minimally important clinical difference (MCID) for the SANE compared to the ASES (α =0.05).Results:The SANE demonstrated good reliability (ICC(2,1) =0.76 ± 3.4) similar to the ASES (ICC(2,1) =0.82 ± 3.4) pre-treatment. The SANE demonstrated good agreement with the SANE across all treatment groups (Cuff= ICC(2,1) 0.85 ± 3.4; TSA- ICC(2,1) =0.72 ± 5.2;PT- ICC(2,1) =0.82 ± 2.9) pre and post treatment. The SANE displayed similar responsiveness to the ASES after treatment (Figure 1) with similar mean change and standard deviations within each treatment group. The ROC curve revealed an area under the curve of .79 (SE, 0.62; P<.001) and a cutoff of 9.5% on the SANE with a sensitivity of 83% and a specificity of 31% to establish the MCID.Conclusion:Our study is the first to demonstrate the SANE is valid across a range of common shoulder diagnoses to assess patient outcomes across operative and non-operative treatment for shoulder complaints. The MCID of 9.5% is similar to the ASES (11%) suggesting that the SANE is a simple and efficient tool to assess treatment effects for shoulder disorders. Future studies are warranted to confirm these results and compare across other body parts and diagnoses.

Chinese translation and validation of the Oxford Knee Scale for patients with knee osteoarthritis.

Background:Oxford Knee Scale (OKS) is a commonly used instrument to assess the symptoms and functional status in people with knee osteoarthritis. However, a Chinese version of this scale is not yet available.Objective:The objective of this study was to translate the OKS into Chinese and validate the Chinese version of OKS.Methods:The Chinese OKS was translated from the original English version following the recommendations of the International Society for Pharmacoeconomics and Outcomes Research. One hundred Chinese reading patients with knee osteoarthritis were recruited from local hospitals and physiotherapy clinics. Psychometric properties were evaluated in terms of test–retest reliability and internal consistency. Convergent validity was examined by Spearman rank correlation coefficient tests by comparing its score with the validated Chinese version of the Western Ontario and McMaster Universities Osteoarthritis Index and Health Outcome Survey Short Form-36.Results:Chinese OKS demonstrated excellent reliability (intraclass correlation coefficient = 0.88). Cronbach α of individual questions was > 0.7. Strong correlation was found between the Chinese OKS and the Western Ontario and McMaster Universities Osteoarthritis Index (ρ > 0.553, p < 0.001). Fairly strong negative correlation was also found between Chinese OKS and Health Outcome Survey Short Form-36 (ρ = −0.273 to −0.666, p < 0.05).Conclusion:The Chinese translated version of OKS is a reliable and valid instrument for clinical evaluation in Chinese reading patients with knee osteoarthritis.

A New Questionnaire (QRFPC25) Regarding the Religiosity and Spirituality in People with Life-Threatening Disease: Reliability and Validity in a Population of Cancer Patients Undergoing Radiotherapy.

The development of a questionnaire (QRFPC25) assessing the religiosity of cancer patients. The method used for the questionnaire comprises seven multi-item and three single-item scales formed from a 25-question module. The questionnaire was completed on-site and a week after antineoplastic therapy. The final sample included 156 patients. The main topics of the QRFPC25 are the following: worship, relationship with the divine, spiritual discussion, hope, participation in holly communion, faith, life after death, love, bioethics and global quality of life (QoL). The average time of both times taken to complete the questionnaire was approximately 10min. All multi-item scales met the minimal standards of reliability (Cronbach's alpha coefficient ≥.70) before or after treatment. Test-retest reliability in terms of the intraclass correlation coefficient was also satisfactory (p<0.01). Validity was assured by inter-item correlations and correlations with the European Organisation for Research and Treatment of Cancer's Core Quality of Life Questionnaire (QLQ-C30, version 3.0), along with factor analysis which showed eight factors incorporated in the model. The QRFPC25 is a reliable and valid gauge for the assessment of religiosity in cancer patients undergoing radiotherapy.

Assessing the Reliability and Validity of Television and Game Violence Exposure Measures

This study evaluated whether common self-report measures of television and game violence exposure represent reliable and valid measurement tools. Three self-report measures—direct estimates, user-rated favorites, and agency-rated favorites—were assessed in terms of test-retest reliability, criterion validity (their relationship with coded media diaries), and construct validity (their relationship with aggression and gender). A total of 238 adolescents participated in a two-wave survey and completed two media diaries. For game violence, the three self-report measures were reliable and valid. For television violence, only direct estimates achieved test-retest reliability and construct validity. Criterion validity could not be established for the television violence measures because the media diary was not a valid criterion for television violence. Our findings indicate that both direct estimates and favorites are valid measures for game violence, whereas for television violence, only direct estimates are valid. We conclude with a discussion about ways to further improve upon and reconceptualize media violence exposure measurement.

Psychometric Evaluation of a Turkish Version of the Diabetes Fear of Self-injecting and Self-testing Questionnaire (D-FISQ)

To examine the psychometric properties of a Turkish version of the Diabetes Fear of Injecting and Self-testing Questionnaire (D-FISQ). Forward-backward translation of the D-FISQ from English into Turkish was conducted. Original English and translated forms were examined by a panel group. Validity was investigated using content, confirmatory factor analysis, and divergent validity. Reliability was assessed using Cronbach α values, item-total correlations, and intraclass correlations. The sample comprised 350 patients with diabetes. Data were analyzed using SPSS 15.0 for Windows and LISREL 8. The content validity index for the panel members was .90, which indicated perfect content validity; items in D-FISQ were clear, concise, readable, and distinct. Confirmatory factor analysis confirmed the original construct of the D-FISQ. All items had factor loadings higher than the recommended level of .40. The D-FISQ scores were discriminated by the level of anxiety. Reliability results were also satisfactory. Cronbach α values were within ideal limits. Item-total correlation coefficient ranged from .72 to .86. In terms of test-retest reliability, intraclass correlation coefficient was found to be over .90. D-FISQ is a valid and reliable questionnaire in assessing needle-prick fear among Turkish patients with diabetes. We recommend performing the Turkish D-FISQ in determining and screening patients with diabetes who have fear related to self-insulin injection and finger-prick test. Thus, health care professionals should be aware of the potential consequences of injection fear such as insulin misuse and poor self-monitoring of blood glucose, which may have unfavorable effects on optimal diabetes management.

Subjective Mental Health, Peer Relations, Family, and School Environment in Adolescents with Intellectual Developmental Disorder: A First Report of a New Questionnaire Administered on Tablet PCs

ABSTRACTFew studies have explored the subjective mental health of adolescents with intellectual disabilities, while proxy ratings indicate an overrepresentation of mental health problems. The present study reports on the design and an initial empirical evaluation of the Well-being in Special Education Questionnaire (WellSEQ). Questions, response scales, and an application for tablet PCs were developed in cooperation with students and teachers in special education schools. One hundred and thirteen students (age 12–16) and their parents and teachers participated. Positive results in terms of test-retest reliability, internal consistency of scales, and response rates were obtained. Level of reading appeared to affect the students’ understanding of items. Teachers’ and parents’ ratings on the WellSEQ correlated well with established measures. Correlations between proxy ratings and students’ reports varied. The questionnaire and technology of WellSEQ may enable students with IDD to participate independently in research with good completion rates and reliable responding.

Test-retest, inter- and intra-rater reliability of the flexicurve for evaluation of the spine in children.

Introduction: The early evaluation of the spine in children is desirable because it is at this stage of development that the greatest changes in the body structures occur. Objective: To determine the test-retest, intra- and inter-rater reliability of the Flexicurve instrument for the evaluation of spinal curvatures in children. Method: Forty children ranging from 5 to 15 years of age were evaluated by two independent evaluators using the Flexicurve to model the spine. The agreement was evaluated using Intraclass Correlation Coefficients (ICC), Standard Error of the Measurement (SEM), and Minimal Detectable Change (MDC). Results: In relation to thoracic kyphosis, the Flexicurve was shown to have excellent correlation in terms of test-retest reliability (ICC2,2=0.87) and moderate correlation in terms of intra-(ICC2,2=0.68) and inter-rater reliability (ICC2,2=0.72). In relation to lumbar lordosis, it was shown to have moderate correlation in terms of test-retest reliability (ICC2,2=0.66) and intra- (ICC2,2=0.50) and inter-rater reliability (ICC=0.56). Conclusion: This evaluation of the reliability of the Flexicurve allows its use in school screening. However, to monitor spinal curvatures in the sagittal plane in children, complementary clinical measures are necessary. Further studies are required to investigate the concurrent validity of the instrument in order to identify its diagnostic capacity.

The Reliability of Pharyngeal High Resolution Manometry with Impedance for Derivation of Measures of Swallowing Function in Healthy Volunteers.

Purpose. We evaluated the intra- and interrater agreement and test-retest reliability of analyst derivation of swallow function variables based on repeated high resolution manometry with impedance measurements. Methods. Five subjects swallowed 10 × 10 mL saline on two occasions one week apart producing a database of 100 swallows. Swallows were repeat-analysed by six observers using software. Swallow variables were indicative of contractility, intrabolus pressure, and flow timing. Results. The average intraclass correlation coefficients (ICC) for intra- and interrater comparisons of all variable means showed substantial to excellent agreement (intrarater ICC 0.85–1.00; mean interrater ICC 0.77–1.00). Test-retest results were less reliable. ICC for test-retest comparisons ranged from slight to excellent depending on the class of variable. Contractility variables differed most in terms of test-retest reliability. Amongst contractility variables, UES basal pressure showed excellent test-retest agreement (mean ICC 0.94), measures of UES postrelaxation contractile pressure showed moderate to substantial test-retest agreement (mean Interrater ICC 0.47–0.67), and test-retest agreement of pharyngeal contractile pressure ranged from slight to substantial (mean Interrater ICC 0.15–0.61). Conclusions. Test-retest reliability of HRIM measures depends on the class of variable. Measures of bolus distension pressure and flow timing appear to be more test-retest reliable than measures of contractility.

Validity and reliability of EQ-5D-3L for breast cancer patients in Korea.

BackgroundRecently, breast cancer incidence and prevalence has been increasing. Patients' health related quality of life is important considerations in the treatment of breast cancer. The EQ-5D-3L is one of most popular instruments to measure health related quality of life. This study was aimed to evaluate the validity and reliability of EQ-5D-3L in post-operative breast cancer patients from Korea.MethodsA total of 827 patients visiting the ambulatory cancer center of 1 tertiary hospital after breast cancer surgery self-administered the EQ-5D-3L and Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B). We evaluated known-group validity using differences in the EQ-5D-3L index and EQ-VAS score according to demographic and clinical data. The discriminatory ability of the EQ-5D-3L was determined by comparing the mean FACT-B subscale scores between subjects with no problems and subjects with moderate or severe problems in each EQ-5D-3L dimension. Construct validity was evaluated by Pearson correlation coefficients among the EQ-5D-3L index and FACT-B subscales, respectively. Reliability was assessed in terms of test-retest reliability using Cohen’s kappa value and intra-class correlation coefficient (ICC).ResultsThe EQ-5D-3L index and EQ-VAS score were higher in the educated, current radiotherapy and unmarried groups. The correlation of EQ-5D-3L index and subscales for the FACT-B was highest in physical well-being (r = 0.553) and lowest in social well-being (r = 0.199). For reliability, the Kappa values’ range was from 0.32 to 0.70, and ICCs of the EQ-5D-3L index and EQ-VAS scores were 0.70 and 0.48, respectively.ConclusionsThis study indicated that the EQ-5D-3L could be a valid health related quality of life instrument for postoperative breast cancer patients.

Translation, adaptation and validation of a Portuguese version of the Moorehead-Ardelt Quality of Life Questionnaire II.

The prevalence of obesity has increased worldwide. An assessment of the impact of obesity on health-related quality of life (HRQoL) requires specific instruments. The Moorehead-Ardelt Quality of Life Questionnaire II (MA-II) is a widely used instrument to assess HRQoL in morbidly obese patients. The objective of this study was to translate and validate a Portuguese version of the MA-II.The study included forward and backward translations of the original MA-II. The reliability of the Portuguese MA-II was estimated using the internal consistency and test-retest methods. For validation purposes, the Spearman's rank correlation coefficient was used to evaluate the correlation between the Portuguese MA-II and the Portuguese versions of two other questionnaires, the 36-item Short Form Health Survey (SF-36) and the Impact of Weight on Quality of Life-Lite (IWQOL-Lite).One hundred and fifty morbidly obese patients were randomly assigned to test the reliability and validity of the Portuguese MA-II. Good internal consistency was demonstrated by a Cronbach's alpha coefficient of 0.80, and a very good agreement in terms of test-retest reliability was recorded, with an overall intraclass correlation coefficient (ICC) of 0.88. The total sums of MA-II scores and each item of MA-II were significantly correlated with all domains of SF-36 and IWQOL-Lite. A statistically significant negative correlation was found between the MA-II total score and BMI. Moreover, age, gender and surgical status were independent predictors of MA-II total score.A reliable and valid Portuguese version of the MA-II was produced, thus enabling the routine use of MA-II in the morbidly obese Portuguese population.

An Adaptive Australian Sentence Test in Noise (AuSTIN)

The aim of this research is to describe the development of an adaptive Australian Sentence Test in Noise and to validate the test in terms of test-retest reliability and efficiency using data obtained from its clinical application. The relative intelligibility of 1264 Bamford-Kowal-Bench (BKB)-like sentences in the presence of competing four-talker babble was assessed with cochlear implant recipients. Intensity adjustments to the babble segments were made to reduce intersentence variability. Computer software was developed to administer an adaptive speech reception threshold (SRT) test using these adjusted sentence/babble pairs and test-retest SRT data from a separate group of 23 cochlear implant recipients was analyzed, comparing different SRT calculation and test stopping rules. The adjusted sentence/babble pairs were used in clinical studies to obtain an SRT by presenting 32 sentences. Analysis of test-retest pairs of SRT data from 23 recipients indicated that a psychometric fit SRT calculation rule provided better reliability than did the Hearing in Noise Test (HINT) calculation rule, or rules based on mean turns. This rule, using the morpheme correct scores for each sentence, gave a standard deviation for a single SRT of 0.76 dB. Further analyses revealed that the test could be shortened to 20 sentences with an increase of 0.19 dB in variability, while reducing the median test time by approximately 2 min. This article reports validation data for a new Australian Sentence Test In Noise. When 20 BKB-like sentences are used with a psychometric fit calculation rule, a standard deviation of approximately 1 dB is obtained in approximately 3 min 36 sec.

Test-Retest Reliability, Repeatability, and Sensitivity of an Automated Deformation-Controlled Indentation on Pressure Pain Threshold Measurement

ObjectiveThe purpose of this study was to construct a computerized deformation-controlled indentation system and compare its test-retest reliability, repeatability, and sensitivity with a manual algometer for pressure pain threshold (PPT) measurements. MethodsPressure pain threshold measurements were made on 16 healthy subjects for 2 sessions on bilateral erector spinae muscles at L1, L3, and L5 spinal levels, consisting of 5 repeated trials each using computerized algometry on one side and manual algometry on the other side. Mean, SD, coefficient of variation, standard error of measurement, minimal detectable change, and intraclass correlation coefficient were calculated for both manual and computerized PPT measurements. Effects of session, level, method, and side on PPT measurements were evaluated using analysis of variance. ResultsManual PPT measurements were significantly larger than computerized PPT measurements (P = .017), and session 2 was significantly larger than session 1 (P = .021). Coefficient of variation, intraclass correlation coefficient, standard error of measurement, and minimal detectable change of the manual and computerized PPT measurements were 10.3%, 0.91, 0.19 kg/cm2, and 0.54 kg/cm2 and 15.6%, 0.87, 0.26 kg/cm2, and 0.73 kg/cm2, respectively. ConclusionsAlthough computerized algometry offers the benefits of eliminating the effects of operator reaction time, operator anticipation, alignment error, and variation in indentation rate on PPT measurements, these results indicate that manual algometry using load-controlled strategy may be better than computerized deformation-controlled algometry in terms of test-retest reliability, repeatability, and sensitivity. Constant load-controlled indentation protocol may be more favorable for PPT measurements. Future computerized instrumentation for PPT measurements should adopt a load-controlled mechanism.

Evaluating trauma center structural performance: The experience of a Canadian provincial trauma system

Background:Indicators of structure, process, and outcome are required to evaluate the performance of trauma centers to improve the quality and efficiency of care. While periodic external accreditation visits are part of most trauma systems, a quantitative indicator of structural performance has yet to be proposed. The objective of this study was to develop and validate a trauma center structural performance indicator using accreditation report data.Materials and Methods:Analyses were based on accreditation reports completed during on-site visits in the Quebec trauma system (1994-2005). Qualitative report data was retrospectively transposed onto an evaluation grid and the weighted average of grid items was used to quantify performance. The indicator of structural performance was evaluated in terms of test-retest reliability (kappa statistic), discrimination between centers (coefficient of variation), content validity (correlation with accreditation decision, designation level, and patient volume) and forecasting (correlation between visits performed in 1994-1999 and 1998-2005).Results:Kappa statistics were >0.8 for 66 of the 73 (90%) grid items. Mean structural performance score over 59 trauma centers was 47.4 (95% CI: 43.6-51.1). Two centers were flagged as outliers and the coefficient of variation was 31.2% (95% CI: 25.5% to 37.6%), showing good discrimination. Correlation coefficients of associations with accreditation decision, designation level, and volume were all statistically significant (r = 0.61, -0.40, and 0.24, respectively). No correlation was observed over time (r = 0.03).Conclusion:This study demonstrates the feasibility of quantifying trauma center structural performance using accreditation reports. The proposed performance indicator shows good test-retest reliability, between-center discrimination, and construct validity. The observed variability in structural performance across centers and over-time underlines the importance of evaluating structural performance in trauma systems at regular intervals to drive quality improvement efforts.

Chinese translation and validation of the Kujala scale for patients with patellofemoral pain

Purpose: This study translated and validated the Kujala scale, a well-documented questionnaire for patients with patellofemoral pain, into Chinese version. Method: Chinese Kujala scale was translated from the original English version following the recommendations of the International Society for Pharmacoeconomics and Outcomes Research. Sixty four Chinese reading patients who are diagnosed of patellofemoral pain were recruited from multiple hospitals and physiotherapy clinics. Psychometric property was evaluated in terms of test-retest reliability and internal consistency. Convergent validity was examined by Spearman rank correlation coefficient tests by comparing its score with the validated Chinese version of WOMAC Osteoarthritis Index and SF-36. Results: Chinese Kujala scale demonstrated excellent reliability (ICC = 0.968, p < 0.001). Cronbach’s α of individual questions and its overall value were above 0.7. Strong correlation was found between the Chinese Kujala scale and the WOMAC Osteoarthritis Index (rho = −0.708, p < 0.001). Fairly weak correlations were also found between Chinese Kujala scale with the “physical” (rho = 0.413–0.498, p < 0.001) and “energy vitality” (rho = 0.290, p = 0.02) domains of SF-36. However, the relationship between the “bodily pain” was not significant (rho = 0.136, p = 0.284). Conclusion: The Chinese translated version of Kujala scale is a reliable and valid instrument for assessing the patellofemoral pain associated functional disturbances among the patient cohort.Implications for RehabilitationThe Chinese translated version of Kujala scale is a reliable and valid instrument for assessing the functional disturbances associated with patellofemoral pain among the patient cohort.This instrument facilitates research among Chinese population and multinational studies.

Comparing the psychometric properties of the EQ-5D-3L and EQ-5D-5L in cancer patients in Korea

This study was conducted to assess the redistribution properties of the EQ-5D-3L when using the EQ-5D-5L and to compare the validity, informativity, and reliability of both EQ-5D-3L and EQ-5D-5L in Korean cancer patients. Patients visiting one ambulatory cancer center self-administered the two versions of the EQ-5D and the EORTC QLQ-C30 questionnaire. Redistribution properties in each dimension of EQ-5D were analyzed between EQ-5D-3L and EQ-5D-5L. Informativity was evaluated using the Shannon entropy and ceiling effect. Convergent validity was evaluated by comparing the EQ-VAS, ECOG performance status, and EORTC QLQ-C30 subscales. Reliability was also evaluated in terms of test-retest reliability. All levels of the EQ-5D-3L substantially partitioned into associated levels of the EQ-5D-5L. The average inconsistency rate of the two versions was 3.5%. Absolute informativity was higher for the EQ-5D-5L than for the EQ-5D-3L, but their informative efficiency tended to be similar. The proportion of 'perfect health' (11111) decreased from 16.8% in the EQ-5D-3L to 9.7% in the EQ-5D-5L. EQ-5D-5L demonstrated similar or higher correlations with the EQ-VAS, ECOG performance status, and EORTC QLQ-C30, than the EQ-5D-3L. The intraclass correlation coefficient of the EQ-5D-5L index was 0.77. The EQ-5D-5L had greater informativity and lower rate in the ceiling effect than those values of the EQ-5D-3L. The EQ-5D-5L showed good construct validity and reasonable reliability. Therefore, considering these findings, the EQ-5D-5L may be preferable to the EQ-5D-3L.

Anal Acoustic Reflectometry: A New Reproducible Technique Providing Physiological Assessment of Anal Sphincter Function

Anal acoustic reflectometry is a new technique of assessing anal sphincter function. Five new variables reflecting anal canal function are measured: the opening and closing pressure, the opening and closing elastance, and hysteresis. This study aimed to compare the reproducibility of this new technique, in terms of test-retest and interrater reliability, with manometry, the current standard test of sphincter function. This is a comparative study of reproducibility between anal acoustic reflectometry and manometry. This study was conducted at a university hospital (outpatient clinic and endoscopy unit). Twenty-six (21 female) subjects were assessed with both anal acoustic reflectometry and manometry on 2 separate occasions (test-retest reliability) and 22 (16 female) subjects were assessed with both methods by 2 separate investigators (interrater reliability). Reproducibility was assessed according to the Bland-Altman method. All of the measured novel anal acoustic reflectometry parameters had acceptable mean differences and repeatability coefficients. Comparison of the 2 methods of sphincter assessment (anal acoustic reflectometry vs manometry) was made for measurements taken at rest and during voluntary contraction. There was no significant difference in terms of test-retest reliability between the manometry maximum resting pressure vs the reflectometry opening pressure (P = .57) or manometry maximum squeeze pressure vs the reflectometry squeeze opening pressure (P = .68). No significant difference between methods was found in interrater reliability during assessments at rest (P = .62) and voluntary contraction (P = .96). Anal acoustic reflectometry is limited, as with all tests of anorectal function, in that the device is placed within the anal canal, causing stimulation of sensory and stretch receptors. Anal acoustic reflectometry has a reproducibility comparable to manometry in terms of both test-retest and interrater reliability. Anal acoustic reflectometry is a promising technique that allows an assessment of anal canal physiology that is not available with manometry.

Development of a scale for “difficulties felt by ICU nurses providing end-of-life care” (DFINE): A survey study

To develop a scale for assessing "difficulties felt by intensive care unit (ICU) nurses providing end-of-life care" (DFINE). A questionnaire survey of nurses in ICUs at general hospitals in the Kanto region, Japan. The scale was evaluated by exploratory factor analysis, calculation of Cronbach's α and test-retest reliability. The Frommelt Attitudes Toward Care of the Dying Scale (FATCOD-B-J) and the Nursing Job Stressor Scale (NJSS) were used to investigate concurrent validity. Respondents were 224 ICU nurses (response rate, 78%) at 18 hospitals. Five factors comprising 28 items were identified, involving difficulties related to: "the purpose of the ICU is recovery and survival"; "nursing system and model nurse for end-of-life care"; "building confidence in end-of-life care"; "caring for patients and families at end-of-life"; and "converting from curative care to end-of-life care". Cronbach's α for each factor ranged from 0.61 to 0.8. In terms of test-retest reliability, intraclass correlations for each factor ranged from 0.62 to 0.72. "Building confidence in end-of-life care" in DFINE showed a negative correlation with "positive attitudes towards caring for dying patient" in the FATCOD-B-J (r=-0.4). "Nursing system and model nurse for end-of-life care" in DFINE showed a positive correlation with "conflict with other nursing staffs" (r=0.32) and "conflict with physicians/autonomy" (r=0.31) in the NJSS. DFINE demonstrated acceptable reliability and validity. However, additional surveys need to be conducted with a larger sample to further characterise the scale.

Cluster analysis for test-retest reliability

Conventional statistical model for assessing test-retest reliability of questionnaire is to compare composite scores of matched subtests or items between periods. Current study examined test-retest reliability in terms of both subtest and item wise comparison through paired t-test statistics. Data were collected from 72 students twice within 8 months intervals using reading motivation questionnaire (Dutta Roy, 2003). The questionnaire includes 3 intrinsic (rApp, rKnow,rAch) and 4 extrinsic (rAes, rRecog, rAff and rHarm) reading motivation subtests. Finding inconsistency between both subtest and item wise comparison, I propose a model of clustering items between periods. Hierarchical clustering with complete linkage shows that more than 55% of both test and retest items are assembled in the primary cluster suggesting high test retest reliability among 6 reading motivation variables.

Comparison of the ETDRS logMAR, ‘compact reduced logMar’ and Snellen charts in routine clinical practice

To compare the performance of the ETDRS logMAR, compact reduced logMAR and Snellen charts in an ophthalmic outpatient setting. The reliability and reading times of the charts were compared in a stratified sample of 40 eyes of 40 ophthalmic patients with a variety of stable eye diseases. In order to simulate a clinical setting, forced-choice testing was not used. Similar acuity results were recorded from all three charts, suggesting a lack of a systematic bias as regards chart design. A small practice effect was observed for all charts but was greatest for Snellen and least for ETDRS. The test-retest variability of the charts was similar, with the 95% tolerance limit for change being +/-0.14 logMAR for ETDRS, +/-0.16 for reduced logMAR and +/-0.18 for Snellen. The mean reading times for the subjects were 34.65 s for ETDRS, 21.17 s for reduced logMAR and 18.67 s for Snellen. The performance of the compact reduced logMAR chart was intermediate between Snellen and ETDRS. The theoretical advantages of the ETDRS design were still measurable in a clinical setting but the magnitude of the advantage in terms of test-retest reliability was fairly small and the time taken to complete the EDTRS was 1.86 times that of the Snellen chart.