Inter-rater Reliability Values Research Articles

Reliability and validity of active and passive pectoralis minor muscle length measures

BackgroundPectoralis minor muscle length is believed to play an important role in shoulder pain and dysfunction. Current clinical procedures for assessing pectoralis minor muscle length may not provide the most useful information for clinical decision making. ObjectiveTo establish the reliability and construct validity of a novel technique to measure pectoralis minor muscle length under actively and passively lengthened conditions. DesignCross-sectional repeated measures. MethodsThirty-four healthy adults (age: 23.9, SD=1.6 years; 18 females) participated in this study. Pectoralis minor muscle length was measured on the dominant arm in three length conditions: resting, actively lengthened, and passively lengthened. Based upon availability, two raters, out of a pool of five, used a caliper to measure the distance between the coracoid process and the 4th rib. The average of two pectoralis minor muscle length measures was used for all muscle length conditions and analyses. Intraclass correlation coefficients determined intra-and inter-rater reliability, and measurement error was determined via standard error of measurement and minimal detectable change. Construct validity was assessed by ANOVA to determine differences in muscle length across the three conditions. ResultsOur intra- and inter-rater reliability values across all three conditions ranged from 0.84 to 0.92 and from 0.80 to 0.90, respectively. Significant differences (p<0.001) in muscle length were found among all three conditions: rest-active (3.66; SD=1.36cm), rest-passive (4.72, SD=1.41cm), and active-passive (1.06, SD=0.47cm). ConclusionsThe techniques described in this study for measuring pectoralis minor muscle length under resting and actively and passively lengthened conditions have acceptable reliability for clinical decision making.

The scapular dyskinesis test: Reliability, agreement, and predictive value in patients with subacromial impingement syndrome

Study DesignProspective cohort. IntroductionAssessment of scapular dysfunction is considered important in the clinical evaluation and treatment of patients with symptoms of subacromial impingement. However, sparse research has been conducted into the reliability and predictive value of clinical tests with which to identify scapular dyskinesis. Purpose of the StudyTo evaluate intrarater and interrater reliability and predictive value of the Scapular Dyskinesis Test (SDT) in patients with subacromial impingement syndrome. MethodsForty-five patients with subacromial impingement syndrome were included. The presence of scapular dyskinesis was classified by 2 raters using the SDT. Intrarater and interrater reliabilities were examined and compared. Patients with and without scapular dyskinesis were compared in terms of Oxford Shoulder Score and EQ-5D-5L scores at baseline and 3 months, as well rating of overall improvement in shoulder condition. ResultsSDT could not be performed in 5 patients, leaving 40 patients for further analysis. Kappa with squared weights was 0.64 for rater A and 0.86 for rater B; the intrarater agreement was 88% for A and 96% for B. For interrater comparison, the Kappa value was 0.59 and agreement 86%. No statically significant differences in Oxford Shoulder Score and EQ-5D-5L baseline and change scores or overall improvement in shoulder condition at 3 months were observed between patients with or without scapular dyskinesis. ConclusionsIntrarater and interrater reliability and agreement of the SDT were determined. The findings that functional impairment and outcomes did not differ between patients with or without the presences of scapular dyskinesis may question the clinical value of the SDT in patients with subacromial impingement syndrome. Level of Evidence1b.

Test-Retest and Interrater Reliability of Core Muscular Endurance Tests Used for Injury Risk Screening

There is an absence of literature pertaining to the reliability of core muscular endurance tests. The purpose of this study was to assess the test-retest and interrater reliability of four core muscular endurance tests. Participants were physically active, college students. Data were gathered during three trials for each core test. Participants were timed by two test administrators (raters) until the participant could no longer hold the test position. Test-retest reliability values ranged from 0.57–0.85 for all three trials, and from 0.80–0.89 for the latter two trials. Interrater reliability values ranged from 0.99–1.00 for all three trials of all four tests. Although the participants were not athletes, we were able to demonstrate good test-retest and interrater reliability for the core muscular endurance tests assessed.

Development and validation of the Bush-Francis Catatonia Rating Scale - Brazilian version.

This article aims to describe the adaptation and translation process of the Bush-Francis Catatonia Rating Scale (BFCRS) and its reduced version, the Bush-Francis Catatonia Screening Instrument (BFCSI) for Brazilian Portuguese, as well as its validation. Semantic equivalence processes included four steps: translation, back translation, evaluation of semantic equivalence and a pilot-study. Validation consisted of simultaneous applications of the instrument in Portuguese by two examiners in 30 catatonic and 30 non-catatonic patients. Total scores averaged 20.07 for the complete scale and 7.80 for its reduced version among catatonic patients, compared with 0.47 and 0.20 among non-catatonic patients, respectively. Overall values of inter-rater reliability of the instruments were 0.97 for the BFCSI and 0.96 for the BFCRS. The scale's version in Portuguese proved to be valid and was able to distinguish between catatonic and non-catatonic patients. It was also reliable, with inter-evaluator reliability indexes as high as those of the original instrument.

The Inter-Rater Reliability of the Observation Instrument for Assessing Pain in Elderly With Dementia: An Investigation in the Long-Term Care Setting.

The Observation Instrument for Assessing Pain in Elderly With Dementia (BISAD) was developed in Germany. The instrument demonstrated high inter-rater reliability values for the original French version. So far, there are no results to that effect in the Austrian long-term care setting available. The objective of this study was to investigate agreement and inter-rater reliability of BISAD in residents with dementia. A quantitative multicenter-descriptive cross-sectional design with a convenience sample of 71 residents. Analysis of all eight items demonstrated fair to moderate concordance. Absolute agreement of the total value was 25.32%. Subtotals of the observation before mobilization was 52.11%, and during mobilization 32.39%. The reliability analysis shows that the items are less reliable. Currently, BISAD does not make a reliable contribution to clinical decision making in the tested setting.

Interrater Reliability and Age-Based Normative Values for Radiographic Indices of the Ankle Syndesmosis in Children.

Background:While recent research has investigated the normative values, discriminative capacity, and interrater reliability of radiographic indices for the evaluation of the syndesmosis in adults, no such data exist for children. The purposes of the present study were (1) to determine the interrater reliability of common radiographic measures of syndesmosis and deltoid ligament competency in children and (2) to establish age-based normative values.Methods:A consecutive series of patient radiographs from a Level-I pediatric trauma center were identified and were used to create an age and sex-balanced cohort of 282 patients. Subjects between 2 and 17 years of age were randomly selected from a pool of patients who had a complete 3-view (anteroposterior, lateral, and mortise) radiographic ankle series and a final diagnosis without osseous or ligamentous injury. Eight age and sex-balanced groups were created for analysis. Three independent raters evaluated all radiographs and recorded radiographic indices that are commonly used for the evaluation of ankle trauma: width of medial clear space, width of superior clear space, tibiofibular clear space, tibiofibular overlap, and medial clear space/superior clear space ratio. Interrater reliability was calculated with use of the intraclass correlation coefficient (ICC); means and standard deviations were used to report age-group normative values.Results:Two hundred and eighty-two patients (mean age [and standard deviation], 9.6 ± 4.6 years) were analyzed. The superior clear space and tibiofibular overlap demonstrated excellent interrater reliability (ICC = 0.915 and 0.964, respectively), the medial clear space and tibiofibular clear space demonstrated substantial agreement (ICC = 0.656 and 0.635, respectively), and the medial clear space/superior clear space ratio demonstrated moderate agreement (ICC = 0.418). The medial clear space could not be reliably measured until the age of 8 years because of insufficient ossification of the medial malleolus. Tibiofibular overlap demonstrated a linear increase over time, ranging from −1.4 mm in 2 and 3-year-old patients to 6.7 mm in 16 and 17-year-old patients (R2 = 0.995). Normative values varied by age and sex.Conclusions:The medial clear space and medial clear space/superior clear space ratio could not be reliably assessed for children under 8 years of age and were thus characterized by suboptimal interrater reliability. Tibiofibular overlap had excellent interrater agreement, changed predictably with skeletal growth, and may be useful for future research as well as the clinical assessment of pediatric ankle injuries to guide clinical decision-making.Level of Evidence:Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Сравнительная характеристика рентгенологических классификаций последствий септического коксита у детей

Introduction Septic coxitis is sustained in the early childhood and has a devastating effect on the musculoskeletal system. Systematization of the acquired defects and deformities is of great importance for treatment planning and outcome prediction. A radiographic classification based on the features of the deformities in the proximal femur and acetabulum as well as on their mutual orientation was proposed at the Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics. Purpose To study the reliability of the mentioned classification and to compare it with other classifications. Material and Methods Six orthopedic surgeons divided into two groups according to their specialization evaluated 23 X-rays of the hips using the classification systems of I.H. Choi, O.A. Sokolovsky, Е. Forlin, and RISC for RTO. Two orthopedic surgeons re-evaluated them two weeks later. Intra-rater and inter-rater agreement was determined using kappa value calculations. Results The number of inter-rater and intra-rater consensus depended on the specialization of experts, and it was higher in the first group. The highest proportion of the coincidences of three expert conclusions was observed when the classification systems of Forlin and RISC for RTO were used. The values of intra-rater and inter-rater reliability of the RISC for RTO classification were 0.542-0.641 and 0.436-0.738. Conclusion Taking into account a sufficient level of reliability, the RISC RTO classification can be used as a working system by planning surgical treatment and for prediction of its outcome in children with consequences of septic coxitis.

Absolute and Relative Reliability of the Timed 'Up & Go' Test and '30second Chair-Stand' Test in Hospitalised Patients with Stroke.

ObjectiveThe timed ‘Up & Go’ test and ‘30second Chair-Stand’ test are simple clinical outcome measures widely used to assess functional performance. The reliability of both tests in hospitalised stroke patients is unknown. The purpose was to investigate the relative and absolute reliability of both tests in patients admitted to an acute stroke unit.MethodsSixty-two patients (men, n = 41) attended two test sessions separated by a one hours rest. Intraclass correlation coefficients (ICC2,1) were calculated to assess relative reliability. Absolute reliability was expressed as Standard Error of Measurement (with 95% certainty—SEM95) and Smallest Real Difference (SRD) and as percentage of their respective means if heteroscedasticity was observed in Bland Altman plots (SEM95% and SRD%).ResultsICC values for interrater reliability were 0.97 and 0.99 for the timed ‘Up & Go’ test and 0.88 and 0.94 for ‘30second Chair-Stand’ test, respectively. ICC values for intrarater reliability were 0.95 and 0.96 for the timed ‘Up & Go’ test and 0.87 and 0.91 for ‘30second Chair-Stand’ test, respectively. Heteroscedasticity was observed in the timed ‘Up & Go’ test. Interrater SEM95% ranged from 9.8% to 14.2% with corresponding SRD% of 13.9–20.1%. Intrarater SEM95% ranged from 15.8% to 18.7% with corresponding SRD% of 22.3–26.5%. For ‘30second Chair-Stand’ test interrater SEM95 ranged between 1.5 and 1.9 repetitions with corresponding SRD of 2 and 3 and intrarater SEM95 ranged between 1.8 and 2.0 repetitions with corresponding SRD values of 3.ConclusionExcellent reliability was observed for the timed ‘Up & Go’ test and the ‘30second Chair-Stand’ test in hospitalised stroke patients. The thresholds to detect a real change in performance were 18.7% for the timed ‘Up & Go’ test and 2.0 repetitions for the ‘30second Chair-Stand’ in groups of patients and 26.5% and 3 repetitions in individual patients, respectively.

Study on the Interrater Reliability of an OSPE (Objective Structured Practical Examination) - Subject to the Evaluation Mode in the Phantom Course of Operative Dentistry.

Introduction: The aim of the study presented here was to evaluate the reliability of an OSPE end-of-semester exam in the phantom course for operative dentistry in Frankfurt am Main taking into consideration different modes of evaluation (examiner’s checklist versus instructor’s manual) and number of examiners (three versus four).Methods: In an historic, monocentric, comparative study, two different methods of evaluation were examined in a real end-of-semester setting held in OSPE form (Group I: exclusive use of an examiner’s checklist versus Group II: use of an examiner’s checklist including an instructor’s manual). For the analysis of interrater reliability, the generalisability theory was applied that contains a generalisation of the concept of internal consistency (Cronbach’s alpha). Results: The results show that the exclusive use of the examiner’s checklist led to higher interrater reliability values than the in-depth instructor’s manual used in addition to the list.Conclusion: In summary it can be said that the examiner’s checklists used in the present study, without the instructor’s manual, resulted in the highest interrater reliability in combination with three evaluators within the context of the completed OSPE.

Ankle dorsiflexion: what is normal? Development of a decision pathway for diagnosing impaired ankle dorsiflexion and M. gastrocnemius tightness.

Impaired ankle dorsiflexion (ADF) is known to increase forefoot pressure, which is associated to various pathologies affecting the foot and ankle. M. gastrocnemius tightness (MGT) is its most common cause. Up to date we are missing a standardized examination procedure, norm values, and a valid decision pathway to diagnose impaired ADF and MGT. The aim of this study was to define norm values for ADF using a standardized examination procedure. These were used to define a decision pathway to diagnose impaired ADF and MGT. 64 young, asymptomatic subjects were examined. Based on a standardized examination procedure, bilateral ADF, both with the knee extended and flexed, non-weight bearing and weight bearing, was assessed by three investigators. Inter-rater test reliability and norm values for ADF were calculated. Side differences were analyzed. ADF differences between the knee extended and flexed were calculated. The standardized examination procedure revealed high ICC values (0.876-0.915). ADF values with the knee extended for the left/right limb were 22.7°±5.9° [95% CI 21.2°-24.3°]/23.4°±6.5° [95% CI 21.7°-25.1°] non-weight bearing and 33.3°±5.5° [95% CI 31.9°-34.7°]/33.6°±5.6° [95% CI 32.1°-35.0°] weight bearing. Physiological side differences with the knee extended were <6° (95% CI). Knee flexion resulted in an approximate ADF increase of 10°. Based on an extensive systematic approach, physiological values for ADF were assessed in a large asymptomatic population. This allowed the definition ofa decision pathway to diagnose impaired ADF and MGT. Patients presenting with pathologies associated with impaired ADF should be examined according to the herein presented examination protocol. This systematic approach provides a consistent definition of impaired ADF and MGT, which is the prerequisite to study the effectiveness of treatment strategies for MGT.

Reliability of a Qualitative Video Analysis for Running.

Study Design Reliability study. Background Video analysis of running gait is frequently performed in orthopaedic and sports medicine practices to assess biomechanical factors that may contribute to injury. However, the reliability of a whole-body assessment has not been determined. Objective To determine the intrarater and interrater reliability of the qualitative assessment of specific running kinematics from a 2-dimensional video. Methods Running-gait analysis was performed on videos recorded from 15 individuals (8 male, 7 female) running at a self-selected pace (3.17 ± 0.40 m/s, 8:28 ± 1:04 min/mi) using a high-speed camera (120 frames per second). These videos were independently rated on 2 occasions by 3 experienced physical therapists using a standardized qualitative assessment. Fifteen sagittal and frontal plane kinematic variables were rated on a 3- or 5-point categorical scale at specific events of the gait cycle, including initial contact (n = 3) and midstance (n = 9), or across the full gait cycle (n = 3). The video frame number corresponding to each gait event was also recorded. Intrarater and interrater reliability values were calculated for gait-event detection (intraclass correlation coefficient [ICC] and standard error of measurement [SEM]) and the individual kinematic variables (weighted kappa [κw]). Results Gait-event detection was highly reproducible within raters (ICC = 0.94-1.00; SEM, 0.3-1.0 frames) and between raters (ICC = 0.77-1.00; SEM, 0.4-1.9 frames). Eleven of the 15 kinematic variables demonstrated substantial (κw = 0.60-0.799) or excellent (κw>0.80) intrarater agreement, with the exception of foot-to-center-of-mass position (κw = 0.59), forefoot position (κw = 0.58), ankle dorsiflexion at midstance (κw = 0.49), and center-of-mass vertical excursion (κw = 0.36). Interrater agreement for the kinematic measures varied more widely (κw = 0.00-0.85), with 5 variables showing substantial or excellent reliability. Conclusion The qualitative assessment of specific kinematic measures during running can be reliably performed with the use of a high-speed video camera. Detection of specific gait events was highly reproducible, as were common kinematic variables such as rearfoot position, foot-strike pattern, tibial inclination angle, knee flexion angle, and forward trunk lean. Other variables should be used with caution. J Orthop Sports Phys Ther 2016;46(7):556-561. Epub 6 Jun 2016. doi:10.2519/jospt.2016.6280.

Reliability of Thickness Measurements of the Abductor Hallucis Muscle Using the Spring Gauge Technique in Hallux Valgus Subjects: An Ultrasonographic Study

Purpose: The purpose of this study was to determine the intraand inter-rater reliability of muscle thickness (MT) measurements of the abductor hallucis (AbdH) in subjects with hallux valgus (HV), using ultrasonography performed at different inward pressures of approximately 0.5 kg, 1.0 kg, 1.5 kg, and 2.0 kg, with no pressure control. Methods: Thirty-two subjects with HV were recruited. The thicknesses of both sides of the AbdH were measured randomly by two different examiners for assessment of the intraand inter-rater reliability. The measurement values were analyzed using the intra-class correlation coefficient (ICC) with a 95% confidence interval (CI). ICC (2,1) was used to determine the inter-rater reliability of MT measurements of the AbdH, while ICC (3,1) was used to assess the intra-rater reliability. Results: The results showed higher ICC values for intra-rater reliability compared to inter-rater reliability, and the value for inter-rater reliability with no pressure control (ICC=0.74 [95%CI=0.53-0.87]) was smaller compared to pressures of 0.5 kg, 1.0 kg, 1.5 kg, and 2.0 kg. Other inward pressures for intraand inter-rater reliability also showed excellent values (ICC=0.86-0.96). Conclusion: The findings showed that maintaining consistent inward pressure is essential for reliable results in measurement of the MT of the AbdH by different examiners in a clinical setting.

The Structured Interview of Family Assessment Risk: Convergent Validity, Inter-rater Reliability and Structural Relations

The quality of parenting, composition and socio-economic status are family risk or protective factors on juvenile delinquency, however, there is not an instrument to help psychologists and social workers to specifically assess the adolescent offender’s family. This study set out to accomplish an additional validation study of the structured interview of family assessment risk (SIFAR), a structured professional judgment tool for the assessment of family risk and protective factors of juvenile delinquents. The statistical analyses included inter-rater reliability, convergent validity with YLS/CMI, the Partial Least Squares approach to structural equation modeling and receiving operator characteristics (ROC) analysis. A sample of 130 male adolescent delinquents detained in Portuguese forensic facilities and their parents, were paired analyzed. The YLS/CMI was used to analyze the convergent validity with SIFAR. SIFAR shows a strong correlation with the YLS/CMI family context, moderate to high values of inter-rater reliability; SIFAR factors show that they are predictive determinants of the Moderate Four risk factors. ROC analysis shows adequate accuracy power. The findings show that SIFAR it is useful as an additional assessment tool for structured risk assessment instruments since it allows understanding the vulnerabilities and strengths of the delinquent’s family.

Perioral wrinkles are associated with female gender, aging, and smoking: Development of a gender-specific photonumeric scale

Perioral wrinkling is commonly reported among older adults, but its objective evaluation and causes remain poorly understood. We sought to develop a photonumeric scale for perioral wrinkling and to elucidate contributory lifestyle factors. In this cross-sectional study, we recruited participants for facial photographs and a survey. A gender-specific photonumeric scale for perioral wrinkling was developed and used by 3 graders to evaluate participant photographs. Scores and survey responses were used to create a multiple regression model to predict perioral wrinkling. In all, 143 participants aged 21 to 91 years were enrolled. Intraclass correlation coefficient values for interrater and intrarater reliability were high (>0.8) across 2 trials and 3 graders. A multiple regression model for prediction of perioral wrinkling severity included age, gender, and years of smoking as variables. The study was limited by sample size and a predominantly Caucasian study population. We created a photonumeric scale that accounts for gender differences in perioral wrinkling and highlighted contributory variables to photoaging in this anatomical location.

Dynamometry for the measurement of grip, pinch, and trunk muscles strength in subjects with subacute stroke: reliability and different number of trials.

ABSTRACTBackgroundMuscle strength is usually measured in individuals with stroke with Portable dynamometers (gold standard). However, no studies have investigated the reliability, the standard error of measurement (SEM) and the minimal detectable difference (MDD95%) of the dynamometry for the measurement of hand grip, pinch grip and trunk strength in subjects with subacute stroke.Objective1) To investigate the intra and inter-rater reliability, the SEM and the MDD95% of the portable dynamometers for the measurement of grip, pinch and trunk strength in subjects with subacute stroke, and 2) to verify whether the use of different number of trials (first trial and the average of the first two and three trials) affected the results.Method32 subjects with subacute stroke (time since stroke onset: 3.6 months, SD=0.66 months) were evaluated. Hand grip, 3 pinch grips (i.e. pulp-to-pulp/palmar/lateral) and 4 trunk muscles (i.e. flexors, extensors, lateral flexors and rotators) strength were bilaterally assessed (except trunk flexors/extensors) with portable dynamometry by two independent examiners over two sessions (1-2 weeks apart). One-way ANOVAs and intraclass correlation coefficients (ICC2,k) were used for analysis (α=0.05). SEM and MDD95% were also calculated.ResultsFor all muscular groups and sources of outcome values, including one trial, after familiarization, similar results were found (0.01≤F≤0.08; 0.92≤p≤0.99) with significant and adequate values of intra-rater (0.64≤ICC≤0.99; 0.23≤95%CI≤0.99) and inter-rater (0.66≤ICC≤0.99; 0.25≤95%CI≤0.99) reliability. SEM and MDD95% were considered low (0.39≤EPM≤2.21 Kg; 0.96≤MMD95%≤6.12 Kg) for all outcome scores.ConclusionOnly one trial, following familiarization, demonstrated adequate intra-rater and inter-rater reliability of the portable dynamometers for the measurement of hand grip, pinch grip and trunk strength in subjects with subacute stroke.

Reliability and validity of a tool to assess airway management skills in anesthesia trainees.

Background and Aims:Gaining expertise in procedural skills is essential for achieving clinical competence during anesthesia training. Supervisors have the important responsibility of deciding when the trainee can be allowed to perform various procedures without direct supervision while ensuring patient safety. This requires robust and reliable assessment techniques. Airway management with bag-mask ventilation and tracheal intubation are routinely performed by anesthesia trainees at induction of anesthesia and to save lives during a cardiorespiratory arrest. The purpose of this study was to evaluate the construct validity, and inter-rater and test-retest reliability of a tool designed to assess competence in bag-mask ventilation followed by tracheal intubation in anesthesia trainees.Material and Methods:Informed consent was obtained from all participants. Tracheal intubation and bag-mask ventilation skills in 10 junior and 10 senior anesthesia trainees were assessed by two investigators on two occasions at a 3-4 weeks interval, using a procedure-specific assessment tool.Results:Average kappa value for inter-rater reliability was 0.91 and 0.99 for the first and second assessments, respectively, with an average agreement of 95%. The average agreement for test-retest reliability was 82% with a kappa value of 0.39. Senior trainees obtained higher scores compared to junior trainees in all areas of assessment, with a significant difference for patient positioning, preoxygenation, and laryngoscopy technique, depicting good construct validity.Conclusion:The tool designed to assess bag-mask ventilation and tracheal intubation skills in anesthesia trainees demonstrated excellent inter-rater reliability, fair test-retest reliability, and good construct validity. The authors recommend its use for formative and summative assessment of junior anesthesia trainees.

Intra-rater and inter-rater reliability of Surgimap Spine software for measuring spinal postural angles from digital photographs

An accurate noninvasive measurement of spinal angles is crucial for detecting postural problems and for assessing therapeutic intervention for students in school. This study was conducted to evaluate the intra-rater and inter-rater reliability of Surgimap Spine software for measuring spinal postural angles from digital photos of adolescents in schools. Twenty-two adolescent students of both sexes (10 boys and 12 girls) participated in this reliability study. The researcher took four photographs of each adolescent from different standing views; at intra-rater analysis, one rater analyzed the four photos at three different time, whereas at inter-rater analysis three raters analyzed them once. Reliability was quantified with intraclass correlation coefficient (ICC), repeated measurement analysis (RMA), and standard of measurement error (SEM). Intra-rater reliability of all spinal postural angles [head tilt, shoulder tilt, pelvic tilt from anterior view, scapular tilt, gaze angle, craniovertebral angle, trunk angle, lumbar angle, pelvic tilt from lateral view, and sway angle for right and left sides] showed excellent results, with ICC above 0.9, whereas ICC for pelvic tilt from the posterior view (0.813) was very good. SEM ranged from 0.28 to 1.5° and RMA showed no statistical difference between measurements of the same rater. ICC values for inter-rater reliability of all spinal postural angles ranged from 0.836 to 0.992. SEM ranged from 0.3 to 1.63° and RMA showed no statistical difference in measurements between different raters. Surgimap Spine software is a reliable method for measuring spinal postural angles of adolescents from different views in standing position from digital photographs.

Relation between observed locomotion traits and locomotion score in dairy cows

Lameness is still an important problem in modern dairy farming. Human observation of locomotion, by looking at different traits in one go, is used in practice to assess locomotion. The objectives of this article were to determine which individual locomotion traits are most related to locomotion scores in dairy cows, and whether experienced raters are capable of scoring these individual traits consistently. Locomotion and 5 individual locomotion traits (arched back, asymmetric gait, head bobbing, reluctance to bear weight, and tracking up) were scored independently on a 5-level scale for 58 videos of different cows. Videos were shown to 10 experienced raters in 2 different scoring sessions. Relations between locomotion score and traits were estimated by 3 logistic regression models aiming to calculate the size of the fixed effects on the probability of scoring a cow in 1 of the 5 levels of the scale (model 1) and the probability of classifying a cow as lame (locomotion score ≥3; model 2) or as severely lame (locomotion score ≥4; model 3). Fixed effects were rater, session, traits, and interactions among fixed effects. Odds ratios were calculated to estimate the relative probability to classify a cow as lame when an altered (trait score ≥3) or severely altered trait (trait score ≥4) was present. Overall intrarater and interrater reliability and agreement were calculated as weighted kappa coefficient (κw) and percentage of agreement, respectively. Specific intrarater and interrater agreement for individual levels within a 5-level scale were calculated. All traits were significantly related to the locomotion score when scored with a 5-level scale and when classified as (severely) lame or nonlame. Odds ratios for altered and severely altered traits were 10.8 and 14.5 for reluctance to bear weight, 6.5 and 7.2 for asymmetric gait, and 4.8 and 3.2 for arched back, respectively. Raters showed substantial variation in reliability and agreement values when scoring traits. The acceptance threshold for overall intrarater reliability (κw ≥0.60) was exceeded by locomotion scoring and all traits. Overall interrater reliability values ranged from κw=0.53 for tracking up to κw=0.61 for reluctance to bear weight. Intrarater and interrater agreement were below the acceptance threshold (percentage of agreement <75%). Most traits tended to have lower specific intrarater and interrater agreement in level 3 and 5 of the scale. In conclusion, raters had difficulties in scoring locomotion traits consistently, especially slight alterations were difficult to detect by experienced raters. Yet, the locomotion traits reluctance to bear weight, asymmetric gait, and arched back had the strongest relation with the locomotion score. These traits should have priority in locomotion-scoring-system guidelines and are the best to be used for the development of automated locomotion scoring systems.

A Preliminary Quantitative Comparison of Vibratory Amplitude Using Rigid and Flexible Stroboscopic Assessment

The purpose of this study was to establish preliminary, quantitative data on amplitude of vibration during stroboscopic assessment in healthy speakers with normal voice characteristics. Amplitude of vocal fold vibration is a core physiological parameter used in diagnosing voice disorders, yet quantitative data are lacking to guide the determination of what constitutes normal vibratory amplitude. Eleven participants were assessed during sustained vowel production using rigid and flexible endoscopy with stroboscopy. Still images were extracted from digital recordings of a sustained /i/ produced at a comfortable pitch and loudness, with F0 controlled so that levels were within ±15% of each participant's comfortable mean level as determined from connected speech. Glottal width (GW), true vocal fold (TVF) length, and TVF width were measured from still frames representing the maximum open phase of the vibratory cycle. To control for anatomic and magnification differences across participants, GW was normalized to TVF length. GW as a ratio of TVF width was also computed for comparison with prior studies. Mean values and standard deviations were computed for the normalized measures. Paired t tests showed no significant differences between rigid and flexible endoscopy methods. Interrater and intrarater reliability values for raw measurements were found to be high (0.89-0.99). These preliminary quantitative data may be helpful in determining normality or abnormality of vocal fold vibration. Results indicate that quantified amplitude of vibration is similar between endoscopic methods, a clinically relevant finding for individuals performing and interpreting stroboscopic assessments.

Prediction of patency capsule retention in known Crohn's disease patients by using magnetic resonance imaging

Evaluation of small-bowel patency is recommended before swallowing video capsule endoscopy to prevent capsule retention. This study aimed to evaluate the ability of magnetic resonance enterography (MRE) to predict patency capsule (PC) retention in patients with Crohn's disease and to identify the most predictive imaging features for retention. Fifty-seven patients prospectively underwent MRE and PC. Two radiologists predicted PC retention. Interrater reliability was determined by using Cohen's κ coefficient. The sensitivity, specificity, and positive and negative predictive values were calculated for the predictions. Evaluation of the imaging features was done using the t test and receiver-operating characteristics; t-tests were also performed on the clinical parameters. The κ value for interrater reliability was 0.58. The sensitivity, specificity, PPV, and NPV for the predictions by the 2 radiologists were 92.3%, 59%, 40%, 96.3%, and 100%, 52.3%, 38.2%, 100%, respectively. The maximal stricture length (9.7 ± 3.66 cm vs 7.0 ± 3.08 cm, P = .04) and the number of prestenotic dilations (1.9 ± 1.07 vs 1.0 ± 1.38, P = .03) were associated with PC retention. The area under the receiver-operating characteristic curves was 0.69 for the maximal stricture length and 0.751 for the number of prestenotic dilations. The phenotype of the disease was the only clinical parameter significantly correlated with PC retention. MRE has a high NPV and sensitivity for PC retention. When capsule retention is suggested by MRE, PC should be performed before the video capsule endoscopy examination. The maximal stricture length and the number of prestenotic dilations were found to be the most predictive imaging features for PC retention.