Test-retest Intraclass Correlation Research Articles

Longitudinal validation of the Fear of COVID-19 Scale in a nationwide United States sample: An item response theory model across three inflection points of the pandemic.

The COVID-19 pandemic's global emergence/spread caused widespread fear. Measurement/tracking of COVID-19 fear could facilitate remediation. Despite the Fear of COVID-19 Scale (FCV-19S)'s validation in multiple languages/countries, nationwide United States (U.S.) studies are scarce. Cross-sectional classical test theory-based validation studies predominate. Our longitudinal study sampled respondents to a 3-wave, nationwide, online survey. We calibrated the FCV-19S using a unidimensional graded response model. Item/scale monotonicity, discrimination, informativeness, goodness-of-fit, criterion validity, internal consistency, and test-retest reliability were assessed. Items 7, 6, and 3 consistently displayed very high discrimination. Other items had moderate-to-high discrimination. Items 3, 6, and 7 were most (items 1 and 5 the least) informative. [Correction added on 18 May 2023, after first online publication: In the preceding sentence, the term 'items one-fifth least' has been changed to 'items 1 and 5 the least'.] Item scalability was 0.62-0.69; full-scale scalability 0.65-0.67. Ordinal reliability coefficient was 0.94; test-retest intraclass correlation coefficient 0.84. Positive correlations with posttraumatic stress/anxiety/depression, and negative correlations with emotional stability/resilience supported convergent/divergent validity. The FCV-19S validly/reliably captures temporal variation in COVID-19 fear across the U.S.

Test-Retest and Inter-Rater Reliability of the 20-Meter Ambulation Test in Patients with Parkinson's Disease

In patients with Parkinson's disease, limited sit-to-stand, walk and turn contribute to decreased independence and quality of life. The 20-meter Ambulation Test (AT20) evaluates walking a total of 20 m, over a 10-m distance, back and forth between 2 chairs, starting and ending in a seated position. The aim of this study was to evaluate test-retest and inter-rater reliability of the AT20 in patients with Parkinson's disease. Patients with idiopathic Parkinson's disease performed the AT20 in 3 conditions: free speed, fast speed, and with large steps, twice 1 week apart. The total number of steps and the time to complete the task were recorded manually by 4 independent raters. The main outcome criteria were the test-retest and inter-rater intraclass correlation coefficients and coefficients of variation for speed, step length and cadence in the 3 conditions. Twenty participants completed the 2 visits. Across all conditions, test-retest and inter-rater intraclass correlation coefficients for step length and speed were > 95%. Test-retest and inter-rater coefficients of variation were < 0.08. The AT20 is a reliable ambulation test in Parkinson's disease, with excellent test-retest and inter-rater reliability for step length and speed in all 3 conditions: at free speed, fast speed, and with large steps. The AT20 might be useful to assess ambulation in parkinsonism in clinical practice.

Development and Psychometric Properties of an Extended Theory of Planned Behavior Questionnaire for Childbearing Intentions and Behaviors in Iran.

Childbearing is the most important determinant of population fluctuations, and its study is more important than other population phenomena. Owing to the lack of a valid questionnaire based on the extended theory of planned behavior, this mixed-method study was conducted to determine the validity and reliability of a questionnaire designed to examine related belief-based factors on the intention to bear children in Iranian society. This study was conducted in two phases in Hamadan city, western Iran, in 2021. Phase 1 consisted of an extensive literature review and a qualitative study using a directed content analysis approach to generate an item pool. Psychometrics were measured in phase 2, including content, face, and construct validity. Reliability was assessed based on internal consistency and stability. The collected data were analyzed using IBM SPSS and AMOS ver. 24.0. Mean content validity ratio and content validity index were 0.7 and 0.85, respectively. Exploratory factor analysis of the 32 items identified an eight-factor solution. These factors jointly accounted for 79.1% of the observed variance in the outcome variables. Confirmatory factor analysis indicated a good fit for the data. The internal consistency based on Cronbach's α was 0.85 (0.71-0.93). In addition, stability was confirmed using the test-retest method and intraclass correlation coefficient (0.74-0.94). The designed questionnaire is a valid and reliable instrument for evaluating related belief-based factors on the intention and behavior of childbearing among married men and women in Iran.

Development and Psychometric Properties of the Chronic Uveitis-Specific Quality of Life Instrument for Patients with Chronic Uveitis

ABSTRACT Purpose To develop and assess psychometric properties of a disease-specific quality of life (QOL) assessment tool for patients with chronic uveitis. Methods The initial 42-item chronic uveitis-related QOL questionnaire (CUQOL) was developed by literature review, semi-structured interviews, and expert consultation. Further development and assessment of the CUQOL were performed using Classic Test Theory and Rasch analysis. Results The CUQOL version 1.0 was constructed with 28 items in five dimensions. The five subscales satisfied the requirements of unidimensionality, local independence, and threshold ordering. Cronbach’s α coefficient for overall and each scale of the CUQOL 1.0 ranged from 0.75 to 0.94, with test-retest intraclass correlation ranging from 0.95 to 0.99. The CUQOL 1.0 has satisfactory convergent validity (r = 0.41–0.82), reasonable known group validity (p < .05), and good responsiveness (p < .05). Conclusions The CUQOL 1.0 is reliable and vaild for evaluating the QOL of patients with chronic uveitis.

Validity and reliability of adapted Bengali version of self-assessment questionnaire to assess Prakriti

Background: The constitutional type of a human being, the Prakriti, depends on the relativity of three Doshas – Kapha, Pitta, and Vata. Assessment of Prakriti requires expertise in inspection, palpation, and interview. There are self-administered questionnaires in English that can assess the Prakriti.&#x0D; Aim: We aimed to adapt an English questionnaire - “self-assessment questionnaire to assess Prakriti” in Bangla and test its validity and reliability in the assessment of Prakriti.&#x0D; Methods: We adapted the questionnaire in Bangla by forward and backward translation. We conducted a pre-test and interview with 36 research participants. An Ayurveda physician assessed the Prakriti by the traditional method. The validity was tested by comparing the expert-assessed and questionnaire-assed Prakriti. The internal consistency was tested by Chronbach’s alpha and reliability by Intra-class correlation coefficient (ICC).&#x0D; Results: A total of 36 (men 21, women 15) research participants of mean age 36.01± 3.44 participated in the pre-test, interview, and retest. Adapted Bangla “self-assessment questionnaire to assess Prakriti” is found to be valid for the assessment of Prakriti. It is reliable in terms of internal consistency (Chronbach’s alpha 0.64, 0.76, and 0.81 for Kapha, Pitta, and Vata, respectively) and repeatability (test-retest ICC 0.88, 0.91, and 0.79 for Kapha, Pitta, and Vata, respectively).&#x0D; Conclusion: A Bangla questionnaire for self-assessment of Prakriti has been adapted. The questionnaire was found to be valid and reliable. This questionnaire may be used for the assessment of Prakriti of Bangla-speaking people in any mass survey, research, or healthcare settings of Ayurveda for a quick assessment of Prakriti.

Professional socialization of hospital nurses: A scale development and validation study

BackgroundTools currently available to measure professional socialization are outdated or could not reflect various properties of professional socialization of nurses. Thus, the objective of this study was to develop and validate a professional socialization measurement instrument for hospital nurses.MethodsFifty-two items were initially extracted from literature reviews and in-depth interviews with 32 nurses. After content validity testing, 48 items remained. They were used to survey 881 hospital nurses in Korea in the testing phase for construct validity and reliability.Results: Four factors (21 items) were extracted: ethical practice and reflection, perception of respect and recognition, clinical competency based on leadership, and desires and motivation for professional development. These factors demonstrated good construct validity and reliability. Correlation coefficients of professional socialization with professional value, compassion satisfaction, secondary traumatic stress, and burden were 0.58 (p < 0.001), 0.70 (p < 0.001), − 0.08 (p = 0.014), and − 0.56 (p < 0.001), respectively. Reliability had a Cronbach’s alpha of 0.95. Test-retest reliability intraclass correlation coefficient was 0.90.ConclusionsThe four professional socialization scale factors in this study reflected attributes of knowledge, skills, values, and professional roles. Professional socialization of nurses can be continuously developed by emphasizing elements of the professional socialization scale in nursing education programs. Nursing managers should help nurses go through the professional socialization process. The professional socialization scale will serve as a tool for developing careers of hospital nurses.

Translation, transcultural adaptation, and validation of the Serbian version of the PSS-QoL questionnaire: A pilot research

Background/Aim. The assessment of health-related quality of life (HRQoL) is fundamental for a better understanding of the effect of a disease on different aspects of a patient?s daily functioning and the efficacy of the treatment modalities. Primary Sj?gren?s Syndrome (SS) Quality of Life Questionnaire (PSS-QoL) is the first disease-specific instrument for evaluating HRQoL in patients with primary SS. The aim of this study was to formally translate the PSS-QoL questionnaire from English to Serbian, assess its psychometric properties, and validate it for use in the Serbian population. Methods. The research was designed as a pilot study and included 30 participants. Internal consistency was determined by calculating Cronbach?s alpha coefficient. The construct validity of the questionnaire was estimated by the correlation of its overall result with the patients? EuroQoL- 5D, European League Against Rheumatism (EULAR) SS Patient Reported Index, Oral Health Impact Profile-14, and Emotion Regulation Questionnaire scores. Results. There were 29 (96.7%) female participants and one (3.3%) male participant in the research. The average (? standard deviation) score of PSS-QoL was 44.63 ? 12.901 at baseline and 41.70 ? 12.075 at follow-up. Cronbach?s alpha value of the Serbian version of PSS-QoL was 0.922. The test-retest intraclass correlation coefficient was 0.981 (95% confidence interval: 0.436?0.996). Analysis revealed a statistically significant moderate to strong correlation between PSS-QoL scores and EuroQol-5D (rs = -0.696), EULAR SS Patient Reported Index (rs = 0.883), and Oral Health Impact Profile-14 scores (rs = 0.809). Conclusion. Serbian adaptation of the PSS-QoL instrument can be used to evaluate HRQoL of patients with primary SS both in academic re-search and clinical practice as a novel outcome measure.

Validation of Chinese version of a global anesthetic recovery questionnaire: A multicenter observational trial on ObsQoR-11

The obstetric quality of recovery (ObsQoR-11) is considered one of the best patient-reported outcome measures of post-cesarean recovery. However, it has been neither validated in Chinese nor evaluated at >24h after delivery. Parturients from three hospitals (n=279) completed the Chinese ObsQoR-11 at 24h (T1) and 96h (T2) after elective cesarean delivery. Convergent validity was assessed by correlation of Chinese ObsQoR-11 with a 100-mm numerical rating scale (NRS) of general health status; discriminant validity of good recovery (NRS ≥ 70-mm); and construct validity by correlation with influential factors to post-cesarean recovery. The reliability and responsiveness were also assessed. The Chinese ObsQoR-11 correlated moderately with the NRS [T1: r=0.38 (95% confidence interval: 0.28-0.48), p<0.0001; T2: r=0.43 (95% confidence interval: 0.32-0.52), p<0.0001] and discriminated between good and poor recovery [T1: mean (SD) score: 64 (20) vs 49 (17), p<0.0001; T2: median (IQR) score: 81 (66-94) vs. 61 (53-72); p=0.0002]; weakly correlated with gestational age, successful breastfeeding, and operation time. It was reliable (internal consistency: 0.75 (T1) and 0.82 (T2); split-half: 0.77 (T1) and 0.85 (T2); test-retest intraclass correlation coefficient r>0.6 for each item) and responsive (Cohen effect size: 0.88; standardized response mean: 0.81). The Chinese ObsQoR-11may be used for assessing recovery at 24h and 96h after cesarean delivery. However, its' cutoff value for good recovery may be lower than that of other versions.

The osteoarthritis knowledge scale.

Accurate knowledge is central to effective self-care of osteoarthritis (OA). This study aimed to assess the measurement properties of the Osteoarthritis Knowledge Scale (OAKS) with versions for the hip and knee. Participants with hip OA (n=144), knee OA (n=327), and no OA (n=735) were recruited. Rasch analysis was conducted to assess psychometric properties using data from all participants with hip OA and 144 randomly selected participants with either knee OA or no OA. Test-retest reliability and measurement error were estimated among those with hip (n=51) and knee (n=142) OA. Four items from the draft scales were deleted following Rasch analysis. The final 11-item OAKS was unidimensional. Item functioning was not affected by gender, age, educational level, or scale version (hip or knee). Person separation index was 0.75. Test-retest intraclass correlation coefficient was 0.81 (95% CI 0.74, 0.86; hip version 0.66 [0.47, 0.79]; knee version 0.85 (0.79, 0.90)). Smallest detectable change was 9 points (scale range 11-55; hip OA version 11 points; knee OA version 8 points). The OAKS is a psychometrically adequate, unidimensional measure of important OA knowledge that can be used in populations with and without hip and knee OA. Caution is needed when using with populations with only hip OA as test-retest reliability of the hip version did not surpass the acceptable range.

A novel physical functioning test to complement subjective questionnaires in chronic low back pain assessments

BACKGROUND CONTEXTLifting disability commonly affects patients with chronic low back pain (CLBP) and may not correlate with the existing lifting-related physical assessment tests, such as the loaded forward reach (LFR) test. PURPOSEThe Lift and Place (LAP) test was developed to assess lifting disability in CLBP based on known risk factors. The LAP test was compared with established physical assessment test, including the LFR test and self-reported disability questionnaires. STUDY DESIGN/SETTINGThis cross-sectional study measured self-reported disability questionnaires along with LAP and other physical assessment test results PATIENT SAMPLEEighty three CLBP and 82 asymptomatic participants aged 18 to 55 with normal BMI according to WHO classification. OUTCOME MEASURESOswestry disability index (ODI), Roland–Morris disability questionnaire (RMDQ), Numerical Pain Rating Scale, Trunk Extensor Endurance test, 5 Repetition Sit-To-Stand test, LAP and LFR test. METHODSPhysical assessment test scores were compared between the two groups. The correlation of assessment test scores with ODI and RMDQ in patients with CLBP was calculated. Receiver operating characteristic (ROC) curve analysis was performed to calculate the area under the curve (AUC) of each assessment tests. Assessment tests, ODI, and RMDQ were measured twice for CLBP patients on separate days to calculate the test-retest intraclass correlation (ICC) reliability. Two researchers scored the assessment tests independently to calculate the inter-rater ICC. RESULTSPatients with CLBP were slower in the LAP test (CLBP vs asymptomatic: 21.6±4.9 s vs 18.6±3.6 s) and had shorter reach in the LFR test (CLBP vs asymptomatic: 33.6±6.0 cm vs 36.3±6.6 cm). The LAP was correlated with both ODI (r=0.418) and RMDQ (r=0.390), while the LFR was not. In the ROC analysis, the LAP and LFR bore AUCs of 0.685 and 0.379, respectively. Their test-retest ICCs were 0.913 and 0.858, and their inter-rater ICCs were 0.997 and 0.969, respectively. CONCLUSIONSThe LAP test demonstrated higher reliability and significant correlation with the ODI and RMDQ, indicating its potential as performance assessment for lifting disability in CLBP. Further studies should investigate the use of LAP and other physical assessments for rapid CLBP screening.

Development and psychometric evaluation of the High-Risk Pregnancy Well-Being Index in Mashhad: a methodological study

BackgroundAssessment of well-being in high-risk pregnancy (HRP) is the key to achieve positive maternal and fetal outcomes. Although there are a wide range of instruments for well-being assessment, none of them is comprehensive for well-being assessment in HRP. The present study aimed at the development and psychometric evaluation of the High-Risk Pregnancy Well-Being Index (HRPWBI).MethodsThis methodological study was conducted using the Waltz’s four-step method. The dimensions of well-being in HRP were determined based on a conceptual model and the blueprint and the item pool of HRPWBI were developed. Then, the face and the content validity were assessed and item analysis was performed. Construct validity was also assessed through exploratory factor analysis with principal component analysis on the data obtained from 376 women with HRP in Mashhad, Iran. Finally, internal consistency, test–retest stability, sensitivity, and interpretability of HRPWBI were assessed.ResultsThe scale- content validity index (SCVI) of HRPWBI was 0.91. In factor analysis, 33 items were loaded on seven factors which explained 53.77% of the total variance. Internal consistency, relative stability, absolute stability, sensitivity, and interpretability of HRPWBI were confirmed with a Cronbach’s alpha of 0.84, a test–retest intraclass correlation coefficient of 0.97, a standard error of measurement of 0.92, a minimal detectable change of 8.09, and a minimal important change of 2.92, respectively.ConclusionHRPWBI is a valid and reliable instrument for well-being assessment among women with HRP. It can be used to assess well-being and the effects of well-being improvement interventions on well-being among women with HRP.

Fatigue following type 2 diabetes: Psychometric testing of the Indonesian version of the multidimensional fatigue Inventory-20 and unmet fatigue-related needs.

Patients with type 2 diabetes mellitus (T2DM) often experience fatigue. The Multidimensional Fatigue Inventory (MFI-20) is a valid tool for evaluating fatigue; however, its psychometric properties have not been examined in Indonesian-speaking patients with T2DM. This study assessed the psychometric properties of the Indonesian version of the Multidimensional Fatigue Inventory-20 (IMFI-20) in patients with T2DM and investigated fatigue in a health-care setting. A cross-sectional design was adopted. Two hundred patients with T2DM were interviewed in clinics. Five self-structured measures were used to assess the frequency and duration of fatigue and the health-care utilization of patients with fatigue. Cronbach's alpha and intraclass correlation (ICC) were used to evaluate the internal consistency and test-retest reliability of the Indonesian version of the MFI-20 (IMFI-20). The criterion, convergent, and known-group validity of the IMFI-20 were also examined, and its underlying structure was determined using explanatory factor analysis. The STROBE checklist was used. The results revealed that approximately half of the patients experienced fatigue. Among those with fatigue, 62% reported that their fatigue was rarely or never treated by their physicians. The IMFI-20 exhibited satisfactory model fit, excellent internal consistency (Cronbach's alpha of 0.92), and test-retest ICC of 0.93. The IMFI-20 was significantly associated with the Functional Assessment of Chronic Illness Therapy-Fatigue, Beck Depression Inventory-Second Edition, and Pittsburgh Sleep Quality Index (r = 0.705, 0.670, and 0.581, respectively). The IMFI-20 exhibited known-group validity for unfavorable sleep quality and HbA1C ≥ 6.5%. Our findings suggest that patients with T2DM who experience fatigue are often overlooked by health-care providers, and that the IMFI-20, which exhibits excellent psychometric properties, can be adopted by studies that use fatigue as an endpoint in Indonesian-speaking populations.

Comparison of New Spirometry Measures to Diagnose COPD.

COPD is diagnosed by using FEV1/FVC, which has limitations as a diagnostic test. We assessed the validity of several measures derived from the expiratory phase of the flow-volume curve obtained from spirometry to diagnose COPD: the slopes that correspond to the volume expired after the 50% and 75% of the FVC, the slope formed between the peak expiratory flow (PEF) and the FVC, and the area under the expiratory flow/volume curve. We conducted a cross-sectional diagnostic test study in 765 consecutive subjects referred for spirometry because of respiratory symptoms. We compared the reproducibility and accuracy of the proposed measures against post-bronchodilator FEV1/FVC < 0.70. We also evaluated the proportion of respiratory symptoms for the FEV1/FVC, FEV1 per FEV in the first 6 s (FEV6), and the PEF slope. The subjects had a mean age of 65.8 y, 57% were women, and 35% had COPD. The test-retest intraclass correlation coefficient values were 0.89, 0.85, and 0.83 for FEV1/FVC, FEV1/FEV6, and the PEF slope, respectively. The area under the curve values were 0.93 (expiratory flow/volume), 0.96 (potential expiratory flow/volume), 0.97 (potential expiratory flow/volume at 75% of FVC), and 0.82 (potential expiratory flow/volume at 50% of FVC). The area under the receiver operating characteristic curve was 0.99 for FEV1/FEV6, 0.99 for the slope at 50% of the FVC, and 0.98 for the PEF slope. The FEV1/FEV6, PEF slope, and 50% FVC slopes had similar diagnostic performances compared with FEV1/FVC.

Psychometric evaluation of the Pain Assessment in Advanced Dementia scale in an acute general hospital setting.

People with dementia are at risk of unplanned hospital admissions and commonly have painful conditions. Identifying pain is challenging and may lead to undertreatment. The psychometric properties of the Pain Assessment in Advanced Dementia (PAINAD) scale, in medical inpatients with dementia have not been evaluated. A secondary data analysis from a longitudinal study of 230 people with dementia admitted to two acute general hospitals in London, UK. Internal consistency, inter-rater reliability, test-retest reliability, concurrent validity, construct validity and discriminant validity of PAINAD were tested at rest and in movement. This predominantly female (65.7%) sample had a mean age of 87.2 (Standard Deviation; SD=5.92) years. Inter-rater reliability showed an intra-class correlation (ICC) of 0.92 at rest and 0.98 in movement, test-retest reliability ICC was 0.54 at rest and 0.66 in movement. Internal consistency was 0.76 at rest and 0.80 in movement (Cronbach's α). Concurrent validity was weak between PAINAD and a self-rating level of pain (Kendall's Tau; τ=0.29; p>0.001). There was no correlation between PAINAD and a measure of behavioural and psychological symptoms of dementia, suggesting no evidence of convergent validity. PAINAD scores were higher during movement than rest, providing evidence of discriminant validity (z=-8.01, p<0.001). We found good inter-rater reliability and internal consistency. The test-retest reliability was modest. This study raises concerns about the validity of the PAINAD in general acute hospitals. This provides an insight into pain assessment in general acute hospitals which may inform further refinements of the PAINAD.

Validation of a new scoring approach of a child dietary questionnaire for use in early childhood among low-income, Latino populations

BackgroundMeasuring diet quality in early childhood requires time-intensive and costly measurements (e.g., 24-hour diet recall) that are especially burdensome for low-income, minority populations. This study aimed to validate a new method for calculating overall diet quality among low-income, Latino preschoolers.MethodsThis study was an observational study using data from a randomized controlled trial. Participants included parents of Latino preschoolers who reported child diet quality at baseline, 4-month, 7-month, 12-month, and 13-month follow-up. At each timepoint parents responded to a 28-item child dietary questionnaire (CDQ), based on the National Health and Nutrition Examination Survey (NHANES) dietary module, which generated the number of times/day that a child ate each of 28 foods in the past month. These 28 items were then used to create a total standardized child diet quality index (possible range 0-100), using a percent of maximum method. Parents were asked to complete three 24-hour diet recalls at the 13-month follow-up, from which the 2015 Healthy Eating Index (HEI) was derived. Construct validity was evaluated by Spearman’s rank correlations between the new child diet quality index and the 2015 HEI at the 13-month follow-up. Test-retest reliability was assessed by intraclass correlation coefficients (ICC) for sequential pairs of time points.ResultsAmong 71 eligible parent-child pairs, mean child age was 4.2 (SD = 0.8) years, 50.7% of children were female, and mean child body mass index (BMI) was 17.8 (SD = 2.0) kg/m2. Mean Child Diet Quality Index was 45.2 (SD = 3.2) and mean HEI was 68.4 (SD = 10.5). Child Diet Quality Index and HEI total scores were significantly correlated (r = 0.37; p = 0.001). Test-retest ICCs were statistically significant between all sequential pairs of time points.ConclusionThe new approach for calculating a measure of overall diet quality from the previously-validated 28-item dietary questionnaire demonstrated modest construct validity. When time and resources are limited, this new measure of overall diet quality may be an appropriate choice among low-income, Latino preschoolers.Trial RegistrationThis reports presents observational data collected as a part of a clinical trial, which was registered on clinicaltrials.gov prior to participant enrollment (NCT03141151).

Determining the reliable feature change in longitudinal radiomics studies: A methodological approach using the reliable change index.

Determination of reliable change of radiomics feature over time is essential and vital in delta-radiomics, but has not yet been rigorously examined. This study attempts to propose a methodological approach using reliable change index (RCI), a statistical metric to determine the reliability of quantitative biomarker changes by accounting for the baseline measurement standard error, in delta-radiomics. The use of RCI was demonstrated with the MRI data acquired from a group of prostate cancer (PCa) patients treated by 1.5 T MRI-guided radiotherapy (MRgRT). Fifty consecutive PCa patients who underwent five-fractionated MRgRT were retrospectively included, and 1023 radiomics features were extracted from the clinical target volume (CTV) and planning target volume (PTV). The two MRI datasets acquired at the first fraction (MRI11 and MRI21) were used to calculate the baseline feature reliability against image acquisition using intraclass correlation coefficient (ICC). The RCI was constructed based on the baseline feature measurement standard deviation, ICC, and feature value differences at two time points between the fifth (MRI51) and the first fraction MRI (MRI11). The reliable change of features was determined in each patient only if the calculated RCI was over 1.96 or smaller than -1.96. The feature changes between MRI51 and MRI11 were correlated to two patient-reported quality-of-life clinical endpoints of urinary domain summary score (UDSS) and bowel domain summary score (BDSS) in 35 patients using the Spearman correlation test. Only the significant correlations between a feature that was reliably changed in ≥7 patients (20%) by RCI and an endpoint were considered as true significant correlations. The 352 (34.4%) and 386 (37.7%) features among all 1023 features were determined by RCI to be reliably changed in more than five (10%) patients in the CTV and PTV, respectively. Nineteen features were found reliably changed in the CTV and 31 features in the PTV, respectively, in 10 (20%) or more patients. These features were not necessarily associated with significantly different longitudinal feature values (group p-value < 0.05). Most reliably changed features in more than 10 patients had excellent or good baseline test-retest reliability ICC, while none showed poor reliability. The RCI method ruled out the features to be reliably changed when substantial feature measurement bias was presented. After applying the RCI criterion, only four and five true significant correlations were confirmed with UDSS and BDSS in the CTV, respectively, with low true significance correlation rates of 10.8% (4/37) and 17.9% (5/28). No true significant correlations were found in the PTV. The RCI method was proposed for delta-radiomics and demonstrated using PCa MRgRT data. The RCI has advantages over some other statistical metrics commonly used in the previous delta-radiomics studies, and is useful to reliably identify the longitudinal radiomics feature change on an individual basis. This proposed RCI method should be helpful for the development of essential feature selection methodology in delta-radiomics.

Development and Validation of the First Smart TV-Based Visual Acuity Test: A Prospective Study.

(1) Background: While smartphones are among the primary devices used in telemedical applications, smart TV healthcare apps are not prevalent despite smart TVs' penetrance in home settings. The present study's objective was to develop and validate the first smart TV-based visual acuity (VA) test (Democritus Digital Visual Acuity Test (DDiVAT)) that allows a reliable VA self-assessment. (2) Methods: This is a prospective validation study. DDiVAT introduces several advanced features for reliable VA self-testing; among them: automatic calibration, voice recognition, voice guidance, automatic calculation of VA indexes, and a smart TV-based messaging system. Normal and low vision participants were included in the validation. DDiVAT VA results (VADDiVAT) were compared against the ones from: (a) the gold-standard conventional ETDRS (VAETDRS), and, (b) an independent ophthalmologist who monitored the self-examination testing (VARES). Comparisons were performed by noninferiority test (set at 2.5-letters) and intraclass correlation coefficients (ICCs). DDiVAT's test-retest reliability was assessed within a 15-day time-window. (3) Results: A total of 300 participants (185 and 115 with normal and low vision, respectively) responded to ETDRS and DDiVAT. Mean difference in letters was -0.05 for VAETDRS-VARES, 0.62 for VARES-VADDiVAT, and 0.67 for VAETDRS-VADDiVAT, significantly lower than the 2.5 letter noninferiority margin. ICCs indicated an excellent level of agreement, collectively and for each group (0.922-0.996). All displayed letters in DDiVAT presented a similar difficulty. The overall accuracy of the voice recognition service was 96.01%. ICC for VADDiVAT test-retest was 0.957. (4) Conclusions: The proposed DDiVAT presented non-significant VA differences with the ETDRS, suggesting that it can be used for accurate VA self-assessment in telemedical settings, both for normal and low-vision patients.

Non-REM sleep with hypertonia in Parkinsonian Spectrum Disorders: A pilot investigation

IntroductionFrom an ongoing multicenter effort toward differentiation of Parkinsonian spectrum disorders (PSD) from other types of neurodegenerative disorders, the sleep biomarker non-rapid-eye-movement sleep with hypertonia (NRH) emerged. MethodsThis study included in the PSD group patients with dementia with Lewy bodies/Parkinson disease dementia (DLB/PDD = 16), Parkinson disease (PD = 16), and progressive supranuclear palsy (PSP = 13). The non-PSD group included patients with Alzheimer disease dementia (AD = 24), mild cognitive impairment (MCI = 35), and a control group with normal cognition (CG = 61). In-home, multi-night Sleep Profiler studies were conducted in all participants. Automated algorithms detected NRH, characterized by elevated frontopolar electromyographic power. Between-group differences in NRH were evaluated using Logistic regression, Mann-Whitney U and Chi-squared tests. ResultsNRH was greater in the PSD group compared to non-PSD (13.9 ± 11.0% vs. 3.1 ± 4.7%, P < 0.0001). The threshold NRH≥5% provided the optimal between-group differentiation (AUC = 0.78, P < 0.001). NRH was independently associated with the PSD group after controlling for age, sex, and SSRI/SNRI use (P < 0.0001). The frequencies of abnormal NRH by subgroup were PSP = 92%, DLB/PDD = 81%, PD = 56%, MCI = 26%, AD = 17%, and CG = 16%. The odds of abnormal NRH in each PSD subgroup ranged from 3.7 to 61.2 compared to each non-PSD subgroup. The night-to-night and test-retest intraclass correlations were excellent (0.78 and 0.84, both P < 0.0001). ConclusionsIn this pilot study, NRH appeared to be a novel candidate sleep biomarker for PSD-related neurodegeneration. Future studies in larger cohorts are needed to confirm these findings, understand the etiology of NRH magnitude/duration, and determine whether it is an independent prodromal marker for specific neurodegenerative pathologies.

Reliability and Validity of Patient-Reported Outcome Measures for Ankle Instability in Hebrew.

BackgroundThe International Ankle Consortium has recommended several instruments for assessing and diagnosing chronic ankle instability. These include the Ankle Instability Instrument (AII), Cumberland Ankle Instability Tool (CAIT), Identification of Functional Ankle Instability (IdFAI), and Foot and Ankle Ability Measure (FAAM). This study aimed to translate, culturally adapt, and assess the reliability, validity, discriminative power, and classification agreement of the Hebrew online versions of the AII, CAIT, IdFAI, and FAAM.Material/MethodsAfter translation and cross-cultural adaptation of the questionnaires, we recruited 87 participants with self-reported ankle disorders to evaluate the psychometric properties of the questionnaires. To evaluate each questionnaire’s discriminative power, we recruited 75 healthy participants. Reliability was assessed by calculating internal consistency (Cronbach’s alphas) and test-retest intraclass correlation coefficients. Convergent and divergent validity were assessed by Spearman’s correlation between each instrument and the Short-Form-12 (SF-12) score for physical and mental components, respectively.ResultsAll instruments had acceptable internal consistency (α>0.7) and good test-retest reliability (ICC2,1>0.8), except for the IdFAI (ICC2,1=0.73). All instruments had moderate convergent validity (ρ>0.4 with SF-12 physical component) except for AII (ρ=0.36). No instrument was correlated with the SF-12 mental component score (good divergent validity, ρ<0.3). All instruments had excellent discriminative power (area under the receiver operator characteristic curve >0.9). Strong correlations were found between all instruments.ConclusionsThe Hebrew online versions of the AII, CAIT, IdFAI, and FAAM are valid, consistent, and reliable and may be used in research or clinical settings.

Novel Physical Functioning Test To Complement Subjective Questionnaires In Chronic Low Back Pain Assessments

The gold standard for Chronic Low Back Pain (CLBP) evaluation uses self-reported Patient Reported Outcome Measures (PROMs), with Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI) and Roland Morris Disability Questionnaire (RMDQ) as the most common outcome. Physical Functioning Tests (PFTs) was proposed as a complementary objective outcome measure with no consensus on implementation. PURPOSE: Assess the feasibility of established PFTs that includes Sorensen Test (ST), 5 Repetition Sit-to-stand (5R-STS), Loaded Forward Reach (LFR) for CLBP assessment. Novel Proposed Lift and Place (PLAP) developed based on existing workplace guideline and known risk factors, compared with established PFTs. METHODS: Men and women aged 19 to 55 with and without CLBP would have their PROM and PFT measured. Statistical analysis tests the difference in PFT score between CLBP participant and control, and correlation of PROM and PFT score in CLBP participants, Receiver Operating Characteristic (ROC) curve analysis was done to calculate Area Under the Curve (AUC) of each PFT. CLBP participants’ PROMs and PFTs were measured on separate days to calculate test-retest IntraClass Correlation (ICC) reliability. RESULTS: 83 CLBP participants (32 men and 51 women, mean age: 30.2) and 82 control participants (40 men and 42 women, mean age: 27.4) were recruited. CLBP group (mean 88.1 ± 49.5 s) had less endurance than control (mean 114.1 ± 44.5 s) in ST. CLBP group (mean 8.0 ± 1.8 s) was slower than control (mean 6.8 ± 1.4 s) in 5R-STS. CLBP group (mean 33.6 ± 6.0 cm) had shorter reach than control (mean 36.3 ± 6.6 cm) in LFR. CLBP group (mean 21.6 ± 4.9 s) was slower than control (mean 18.6 ± 3.6 s) in PLAP. 5R-STS was correlated with ODI, r = .506 and RMDQ, r = .341. PLAP was correlated with ODI, r = 0.418, and RMDQ, r = .390. 5R-STS had AUC = .743 and PLAP had AUC = .685 on ROC analysis. All PFT had test-retest ICC > .8, with ST ICC = .925, 5R-STS ICC = .869, LFR ICC = .858 and PLAP ICC = .913. CONCLUSIONS: 5R-STS and PLAP demonstrated weak to moderate correlation with established PROMS and high reliability and can be consider as objective measurement in future CLBP intervention studies to complement subjective PROMS. Further studies can investigate usage of 5R-STS, PLAP and other PFT for quick screening of CLBP disability.