Interrater and intrarater reliability of the Assisting Hand Assessment.

OBJECTIVE: The aim of this study was to evaluate interrater and intrarater reliability for the Assisting Hand Assessment. METHOD: For interrater reliability, two designs were used: 2 occupational therapists rated the same 18 children, and 20 occupational therapists rated the same 8 children. For intrarater reliability, 20 raters each rated one child twice. Both English and Swedish versions of the instrument were used. Intraclass correlation coefficients (ICCs) and standard error of measurement (SEM) were calculated. RESULTS: ICCs for the sum score for the interrater were 0.98 (two raters) and 0.97 (20 raters) and for the intrarater 0.99. SEM was 1.5 for interrater and 1.2 for the intrarater study, which gave an error interval of +/-3 raw scores for interrater and +/- 2.4 raw scores for intrarater. CONCLUSION: This study shows excellent interrater and intrarater reliability for sum scores.     

Reliability and validity of the Shaw gait assessment tool for temporospatial gait assessment in people with hemiparesis

Reid S, Held JM, Lawrence S. Reliability and validity of the Shaw gait assessment tool for temporospatial gait assessment in people with hemiparesis.

Objective

To assess the intra-/interrater reliability and the validity of the free web-based Shaw Gait Assessment Tool (with visual and numerical output) for assessing speed, cadence, step length, and limb advance time in people with hemiplegic gait.

Design

Intra-/interrater reliability and concurrent validity with 2 raters using the Shaw Gait Assessment Tool and 1 rater using a multimemory stopwatch.

Setting

Busy outpatient rehabilitation gym at a tertiary care medical center.

Participants

Convenience sample of adults with hemiplegic gait after cerebrovascular accident or traumatic brain injury.

Interventions

Not applicable.

Main Outcome Measures

Intraclass correlation coefficients (ICCs) and Pearson product-moment correlation coefficients.

Results

ICCs for intrarater reliability ranged from 0.94 (95% CI, 0.88–0.97) to 0.98 (95% CI, 0.96–0.99), (P<.001), and for interrater reliability from 0.95 (95% CI, 0.88–0.98) to 0.99 (95% CI, 0.99–0.99), (P<.001). The Shaw Gait Assessment Tool correlated with the stopwatch for all measured gait parameters with Pearson product-moment correlation coefficients (range, r=0.95 to r= 0.99, P<.001).

Conclusions

The Shaw Gait Assessment Tool is a free, easy-to-use tool that gives reliable and valid results for 4 temporospatial parameters of hemiplegic gait.     

The intra- and interrater reliability of hip muscle strength assessments using a handheld versus a portable dynamometer anchoring station

OBJECTIVE: To compare the inter- and intrarater reliability of a portable dynamometer anchoring station (DAS) to a handheld dynamometer (HHD). DESIGN: Repeated-measures design. SETTING: Human performance and movement analysis laboratory. PARTICIPANTS: Fifteen healthy participants, ages 23 to 44 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three consecutive measures of peak bilateral isometric strength were obtained for hip abduction, extension, and flexion by 2 investigators by using the DAS and the HHD after a 1-hour rest period. This testing scenario was repeated 1 week later. Intraclass correlation coefficients (ICCs) were used to determine reliability. RESULTS: Interrater ICCs of average peak strength ranged from.84 to.92 (hip flexors),.69 to.88 (hip abductors), and.56 to.80 (hip extensors). Intrarater ICCs ranged from.59 to.89 for tester A and from.72 to.89 for tester B using the DAS, and from.67 to.81 for the HHD across muscle groups. CONCLUSIONS: The DAS showed good intrarater reliability for hip flexion and abduction, whereas the HHD demonstrated higher reliability for hip extension. The results support the use of dynamometers that are quick and reliable and that reduce tester bias during hip strength assessment.     

Assessing the reliability of measurements from the Krusen limb load monitor to analyze temporal and loading characteristics of normal gait

This study assessed the reliability of measurements made by four physical therapists on healthy subject gait data recorded from the Krusen limb load monitor. The five components of step (stance time, time up, time to second peak, and force at the first and second peaks) were analyzed. Six components contributing to gait (ambulation time; velocity; cadence; average swing phase duration, left lower extremity; average swing phase duration, right lower extremity; and ratio of unilateral weight bearing, right lower extremity to left lower extremity) were also analyzed. Intraclass correlation coefficients for the five step components and the gait measures of ambulation time, velocity, and cadence showed high measurement reliability. The other measures of gait showed low intraclass correlation coefficients. The limb load monitor can, therefore, be used by clinicians to measure the five step components and three gait measures (ambulation time, velocity, and cadence) with high measurement reliability.     

The wheelchair circuit: reliability of a test to assess mobility in persons with spinal cord injuries

OBJECTIVE: To assess the reliability of a 9-task wheelchair circuit. DESIGN: Three test trials per subject were conducted by 2 raters. Inter- and intrarater reliability were examined. SETTING: Eight rehabilitation centers in the Netherlands. PARTICIPANTS: Convenience sample of 27 patients (age, >or=18 y) with spinal cord injury (SCI), all of whom were in the final stage of their inpatient rehabilitation. INTERVENTION: A wheelchair circuit was developed to assess mobility in subjects with SCI. The circuit consisted of 9 tasks: figure-of-8 shape, doorstep crossing, mounting a platform, sprint, walking, driving up treadmill slopes of 3% and 6%, wheelchair driving and transfer. MAIN OUTCOME MEASURE: Task feasibility, task performance time, and peak heart rates. RESULTS: The number of tasks that subjects could perform varied from 3 to 9. Feasibility intrarater reliability was.98, and the interrater reliability intraclass correlation coefficient (ICC) was.97. Performance time ICCs ranged from.70 to.99 (mean,.88) for intrarater reliability and from.76 to.98 (mean,.92) for interrater reliability. Heart rate ICCs ranged from.64 to.96 (mean,.81) for intrarater reliability and from.82 to.99 (mean,.89) for interrater reliability. CONCLUSIONS: The reliability of the wheelchair circuit was good. More research is needed to assess test validity and responsiveness.     

Comparison of the 2-, 6-, and 12-minute walk tests in patients with stroke

This study assessed inter- and intrarater reliability and sensitivity to change of the 2-, 6-, and 12-minute walk tests following stroke. A convenience sample of patients enrolled in an inpatient stroke rehabilitation program participated in the standardization protocol. The 2-, 6-, and 12-minute walk tests were performed and inter- and intrarater reliability and responsiveness to change assessed. The interrater intraclass correlation coefficients (ICCs) for the 2-, 6-, and 12-minute walk tests were, respectively, 0.85, 0.78, and 0.68 (p < 0.0007 for each). The intrarater ICCs were 0.85, 0.74, and 0.71 (p < 0.0003 for each). Responsiveness to change as measured by standardized response mean (SRM) scores was, respectively, 1.34, 1.52, and 1.90 (F = 24.24, p < 0.001). Pearson correlations for the 2-, 6-, and 12-minute walk tests by the same rater on the same day were 2 versus 6 minutes, r = 0.997; 2 versus 12 minutes, r = 0.993; and 6 versus 12 minutes, r = 0.994 (p < 0.0001 for each). The 2-, 6-, and 12-minute walk tests show acceptable inter- and intrarater reliability and high intertest correlations when they are used for the assessment of walking following stroke. The SRM statistic indicates that the 12-minute walk test is the most responsive to change.     

Reliability of stationary dynamometer muscle strength testing in community-dwelling older adults

OBJECTIVES: To determine the 1-week test-retest reliability of stationary dynamometer scores in the measurement of muscle strength in older adults and to determine the reliability of composite scores obtained by combining right and left lower limb strength scores for each muscle group. DESIGN: In separate sessions, 1 therapist performed repeated measurements of muscle force production. SETTING: Outpatient physical therapy clinic of a large teaching hospital. PARTICIPANTS: A convenience sample of 25 volunteers aged 70 to 87 years residing independently in the community and who did not have significant health problems. INTERVENTION: On 2 separate occasions, 1 week apart, bilateral isometric force measurements were obtained for the flexor and extensor muscle groups of the ankle, knee, and hip joints. MAIN OUTCOME MEASURES: For test-retest reliability of individual and composite scores, the intraclass correlation coefficients (ICCs) and 90% confidence intervals were determined. RESULTS: The mean scores for ankle dorsiflexion, knee flexion and extension, and hip flexion exhibited excellent reliability with ICCs ranging from.90 to.76 for the individual lower limb scores and.91 to.84 for the composite scores. Scores for the remaining muscle groups exhibited good reliability with ICCs ranging from.74 to.71 for the composite scores. CONCLUSION: The stationary dynamometer is a reliable tool to use in determining lower limb muscle force production in elderly adults.     

功能性步态评价应用于帕金森病患者的信度分析

目的:验证功能性步态评价(FGA)在帕金森病(PD)患者中的组间信度、重测信度、内部一致性及分半信度,为临床提供评价工具.方法:121例住院帕金森病患者(平均年龄61.9岁)入选.两名评价者同时评定PD患者的FGA表现,进行组间信度分析.评价过程同时记录为视频资料,4周后其中一名评定者对视频资料进行二次评价,进行重测信度分析.内部一致性信度采用克朗巴赫α系数来评价.分半信度:将FGA各单项以奇数项、偶数项分为两半,计算其分半信度.结果:FGA总分的组间信度和重测信度均为0.99,各单项组间信度波动于0.49-0.98之间,重测信度波动于0.91-0.99之间.FGA内部一致性Cronbach α为0.94,分半信度为0.97.结论:FGA用于评价PD患者的平衡及步态障碍,其组间信度、重测信度、内部一致性及分半信度极佳.     

Inter- and intrarater reliability of a back range of motion instrument

OBJECTIVE: To examine the interrater and intrarater reliability of a back range of motion (BROM) instrument when measuring lumbar spine active planar motions and pelvic inclination. DESIGN: Single-group repeated measures for inter- and intrarater reliability. SETTING: Academic institution. PARTICIPANTS: Ninety-one participants (61 women, 30 men; mean age, 28 y) without a current complaint of low back pain volunteered. INTERVENTION: Two examiners measured pelvic inclination and all lumbar motions by using the BROM device. Subjects alternated between examiners for 4 complete trials; examiners remained blinded to the measurements. MAIN OUTCOME MEASURES: Intraclass correlation coefficients (ICCs) were used to determine intrarater and interrater reliability. Regression analysis was performed to determine the role palpation played in sagittal plane measurement error. RESULTS: Intrarater reliability for side bending was good (ICC range, .85-.83), lumbar forward flexion and pelvic inclination was good to fair (ICC range, .84-.79), and extension and rotation was fair to poor (ICC range, .76-.58). Interrater reliability was fair to poor for all lumbar motions and for pelvic inclination (ICC range, .79-.55). Less than 2% of the variation in sagittal plane measurements was explained by consistency of palpation for device placement. CONCLUSIONS: The BROM provides a reliable means of measuring lumbar forward flexion, side bending, and pelvic inclination when performed by the same examiner in asymptomatic subjects.     

The reliability and concurrent validity of scapular plane shoulder elevation measurements using a digital inclinometer and goniometer

This study investigated the reliability and concurrent validity of active shoulder elevation in the scapular plane (scaption) using a digital inclinometer and goniometer. Two investigators used a goniometer and digital inclinometer to measure scaption on 30 asymptomatic participants in a blinded repeated measures design. Good reliability was present with intraclass correlation coefficients (ICCs) for intrarater reliability of goniometry?=?0.87, intrarater digital inclinometry?=?0.88, interrater goniometry?=?0.92, and interrater digital inclinometry?=?0.89. The minimal detectable change (MDC₉₅) for the interrater analysis indicated that a change equal to or greater than 8 degrees for goniometry and 9 degrees for inclinometry is required to be 95% certain that the change is not due to intertrial variability or measurement error. The concurrent validity between goniometry and digital inclinometry was excellent with an ICC value of 0.94 for both raters. The 95% limits of agreement suggest that the difference between these two measurement instruments can be expected to vary by up to ±11 degrees. The results support the interchangeable use of goniometry and digital inclinometer for measuring scaption. Clinicians and researchers should consider the MDC values presented when interpreting change during subsequent measurement sessions.     

The reliability and concurrent validity of scapular plane shoulder elevation measurements using a digital inclinometer and goniometer

This study investigated the reliability and concurrent validity of active shoulder elevation in the scapular plane (scaption) using a digital inclinometer and goniometer. Two investigators used a goniometer and digital inclinometer to measure scaption on 30 asymptomatic participants in a blinded repeated measures design. Good reliability was present with intraclass correlation coefficients (ICCs) for intrarater reliability of goniometry?=?0.87, intrarater digital inclinometry?=?0.88, interrater goniometry?=?0.92, and interrater digital inclinometry?=?0.89. The minimal detectable change (MDC95) for the interrater analysis indicated that a change equal to or greater than 8 degrees for goniometry and 9 degrees for inclinometry is required to be 95% certain that the change is not due to intertrial variability or measurement error. The concurrent validity between goniometry and digital inclinometry was excellent with an ICC value of 0.94 for both raters. The 95% limits of agreement suggest that the difference between these two measurement instruments can be expected to vary by up to ±11 degrees. The results support the interchangeable use of goniometry and digital inclinometer for measuring scaption. Clinicians and researchers should consider the MDC values presented when interpreting change during subsequent measurement sessions.     

Reliability and concurrent criterion validity of a novel technique for analyzing hip kinematics during running

Abstract

Excessive frontal plane hip kinematics during running has been associated with numerous running pathologies. Traditionally, assessment of hip kinematics during running required expensive and complex equipment and procedures making objective running assessment difficult for practicing clinicians. The aim of this study was to establish the reliability and validity of a novel technique designed for clinicians that allows for objective assessment of frontal plane hip kinematics during running. Hip angles and excursions were measured using videos and jpeg images of 10 subjects (five males and five females) running. A 2-D motion analysis system and computer algorithm served as reference measures. Six raters (three licensed physical therapists and three student physical therapists) took measures on two instances. Reliability was examined using intraclass correlation coefficients (ICC). Validity was investigated with ICCs, 95% limits of agreement (LA), and mean absolute differences (MAD) by comparing each rater's 2-trial average to the criterion reference values. The ICCs for interrater and intrarater reliability for angle and excursion measures ranged from 0.82 to 0.99. The validity ICCs of all measures ranged from 0.89 to 0.99 with acceptable LA. The MAD ranged from 0.5°–1.5°. These results indicate that this novel technique is reliable and valid for measuring hip kinematics compared to the reference measures making it suitable for broad-based clinical use.     

Inter- and intrarater reliability of the Modified Modified Ashworth Scale in patients with knee extensor poststroke spasticity

Muscle spasticity is a common motor disorder following upper motor neuron syndrome. A reliable and valid clinical tool is essential to document the effect of therapeutic interventions aimed to improve function by reducing spasticity. The Modified Ashworth Scale (MAS) is the most widely used and accepted clinical scale of spasticity. The MAS has been recently modified. The aim of this investigation was to determine the interrater and intrarater reliability of clinical test of knee extensor post-stroke spasticity graded on a Modified Modified Ashworth Scale (MMAS). Two raters scored the muscle spasticity of 15 patients with ischaemic stroke. For the inter- and intrarater reliability, two raters agreed on 80.1% and 86.6%, respectively. The Kappa values were good (kappa=0.72, SE=0.14, p<0.001) between raters and very good (kappa=0.82, SE=0.12, p<0.001) within one rater. The values of Kendall tau-b correlation were acceptable for clinical use with 0.87 (SE=0.06, p<0.001) between raters and 0.92 (SE=0.05, p<0.001) within one rater. The MMAS demonstrated reliable measurements for a single rater and between raters for measuring knee extensor post-stroke spasticity. The results encourage further study on the reliability and the validity of the scale.     

Influence of Standardized Procedures on the Reliability of Hip Clinical Assessment

ObjectiveThis study evaluated a standardized and personalized approach to verify the effects of conditions on intrarater and interrater reliability, standard error of measurement, and minimal detectable difference for provocative tests and range-of-motion (ROM) tests used in hip pain assessment: flexion-adduction-internal rotation (FADIR), flexion-abduction-external rotation-extension (FABER), and hip internal rotation with 90° of hip flexion (hip IR).MethodsNineteen participants (mean [± SD] age = 24 ± 2 years; 10 women and 9 men) without lower limb or back pain were recruited. Three raters evaluated each participant during 2 testing sessions, 1 day apart. Raters performed the 3 tests in 4 conditions: classic (C), controlled pressure duration (CPD), subject-specific position (SSP), and mixed (M = CPD + SSP).ResultsFor intrarater reliability, the CPD condition showed the highest intraclass correlation coefficients (ICCs; mean and 95% confidence interval [CI]) for hip IR_ROM (0.83; 95% CI, 0.53-0.94) and FADIR_ROM (0.75; 95% CI, 0.60-0.89). The SSP condition showed the highest ICCs for FABER_height (0.71; 95% CI, 0.42-0.87) and FABER_ROM (0.62; 95% CI, 0.27-0.83). Concerning interrater reliability, the classic condition presented the highest ICCs for FABER variables (height: 0.54; 95% CI, 0.28-0.76; ROM: 0.58; 95% CI, 0.32-0.79) and hip IR ROM (0.72; 95% CI, 0.51-0.87). The CPD condition showed the highest ICC for FADIR_ROM (0.57; 95% CI, 0.32-0.78).ConclusionIn the conditions of this study, CPD showed the highest ICCs for hip IR_ROM and FADIR_ROM, and SSP showed the highest ICCs for FABER_height and FABER_ROM.     

Reliability of Different Clinical Techniques for Assessing Foot Posture

ObjectiveThe aim was to determine the interrater and intrarater reliability of navicular drop (NDP), navicular drift (NDT), and the Foot Posture Index-6 (FPI-6), and test–retest reliability of the static arch index (SAI) and dynamic arch index (DAI).MethodsSixty healthy individuals were assessed for intrarater and test–retest reliability. From 60 participants, 30 individuals were assessed for interrater reliability. A digital caliper was used to measure NDP and NDT. Electronic pedography was used to calculate SAI and DAI. The FPI-6 was also performed. All assessments were performed on the dominant foot. The NDP, NDT, SAI, and DAI were repeated 3 times. The NDP and NDT were analyzed separately using both first measurement and the average, but the SAI and DAI were analyzed using only the average. The NDP, NDT, and FPI-6 were conducted by 2 raters to determine interrater reliability and were repeated by a single rater after 5 days from initial assessment to determine intrarater reliability. The SAI and DAI were also repeated after 5 days to determine test–retest reliability.ResultsIntrarater intraclass correlation coefficients (ICCs) were 0.934 and 0.970 for NDP, 0.724 and 0.850 for NDT, and 0.945 for FPI. Interrater ICCs were 0.712 and 0.811 for NDP, 0.592 and 0.797 for NDT, and 0.575 for FPI. Test–retest ICCs of the SAI and DAI were 0.850 and 0.876, respectively.ConclusionNavicular drop is relatively more reliable than other traditional techniques. Also, the FPI-6 has excellent intrarater reliability, but only moderate interrater reliability. The results can provide clinicians and researchers with a reliable way to implement foot posture assessment.     

Alberta infant motor scale: reliability and validity when used on preterm infants in Taiwan

BACKGROUND AND PURPOSE: The goal of this study was to examine the reliability and validity of measurements obtained with the Alberta Infant Motor Scale (AIMS) for evaluation of preterm infants in Taiwan. SUBJECTS: Two independent groups of preterm infants were used to investigate the reliability (n=45) and validity (n=41) for the AIMS. METHODS: In the reliability study, the AIMS was administered to the infants by a physical therapist, and infant performance was videotaped. The performance was then rescored by the same therapist and by 2 other therapists to examine the intrarater and interrater reliability. In the validity study, the AIMS and the Bayley Motor Scale were administered to the infants at 6 and 12 months of age to examine criterion-related validity. RESULTS: Intraclass correlation coefficients (ICCs) for intrarater and interrater reliability of measurements obtained with the AIMS were high (ICC=.97-.99). The AIMS scores correlated with the Bayley Motor Scale scores at 6 and 12 months (r=.78 and.90), although the AIMS scores at 6 months were only moderately predictive of the motor function at 12 months (r=.56). CONCLUSION AND DISCUSSION: The results suggest that measurements obtained with the AIMS have acceptable reliability and concurrent validity but limited predictive value for evaluating preterm Taiwanese infants.     

Inter- and intrarater reliability of the Modified Modified Ashworth Scale in patients with knee extensor poststroke spasticity

Muscle spasticity is a common motor disorder following upper motor neuron syndrome. A reliable and valid clinical tool is essential to document the effect of therapeutic interventions aimed to improve function by reducing spasticity. The Modified Ashworth Scale (MAS) is the most widely used and accepted clinical scale of spasticity. The MAS has been recently modified. The aim of this investigation was to determine the interrater and intrarater reliability of clinical test of knee extensor post-stroke spasticity graded on a Modified Modified Ashworth Scale (MMAS). Two raters scored the muscle spasticity of 15 patients with ischaemic stroke. For the inter- and intrarater reliability, two raters agreed on 80.1% and 86.6%, respectively. The Kappa values were good (κ=0.72, SE=0.14, p<0.001) between raters and very good (κ=0.82, SE=0.12, p<0.001) within one rater. The values of Kendall tau-b correlation were acceptable for clinical use with 0.87 (SE=0.06, p<0.001) between raters and 0.92 (SE=0.05, p<0.001) within one rater. The MMAS demonstrated reliable measurements for a single rater and between raters for measuring knee extensor post-stroke spasticity. The results encourage further study on the reliability and the validity of the scale.     

Interrater and intrarater reliability of the pectoralis minor muscle length measurement in subjects with and without shoulder impingement symptoms

Measuring the pectoralis minor muscle length (PML) is of clinical interest, as a short PML has been associated with a decrease of scapular posterior tilting and shoulder pain. However, as no reliability data are available at present, the objective of this study was to examine the inter- and intrarater reliability of the PML measurement in both subjects with and without shoulder impingement symptoms (SIS). Therefore, two assessors performed the PML measurement (3 times/shoulder) in 25 patients with SIS and 25 pain-free controls. Both assessors were blinded for each other's findings. For reliability testing, intra-class coefficients (ICCs; model 2,1) and standard errors of measurements were calculated. Intrarater reliability analysis resulted with ICCs ranging from 0.87 (Standard error of measurement (SEM) 0.21–0.27%) (symptomatic) to 0.93 (SEM 0.19–0.30%) (asymptomatic) in patients with SIS, representing excellent test-retest agreement. Healthy subjects presented with ICCs ranging from 0.76 (SEM 0.29–0.32%) (dominant side) to 0.87 (SEM 0.21–0.32%) (non-dominant side), representing good test-retest agreement. ICCs and SEMs on the symptomatic and asymptomatic side (0.48 and 0.46%; 0.56 and 0.61%) in SIS patients, and on the two sides (non-dominant; 0.47 and 0.45%, dominant; 0.53 and 0.38% respectively) in healthy subjects showed moderate interrater reliability and low dispersion of the measurement errors. We concluded that the PML measurement has good to excellent intrarater reliability and poor to moderate interrater reliability.     

Validation of the premature infant pain profile in the clinical setting

OBJECTIVE: The Premature Infant Pain Profile (PIPP) is a 7-indicator composite measure developed to assess acute pain in preterm and term neonates. It has been validated in studies using synchronized videotaping of infants undergoing procedures. The purpose of this study was to establish (a) construct validity of the PIPP and (b) inter- and intrarater reliability of the PIPP prospectively in the clinical environment. DESIGN: A randomized, crossover design was used. SETTING: The study was conducted in a Level III outborn neonatal intensive care unit. PARTICIPANTS: A convenience sample of 43 neonates, stratified by gestational age, was studied. INTERVENTIONS: Each infant experienced three separate, randomly ordered events: baseline, a painful event, and a nonpain event. Infants were videotaped and scored at the bedside using the PIPP by the nurse caring for the infant and the clinical nurse specialist who bad expertise in infant pain. The videotapes were later reviewed by two additional experts; one in real time and one using a second-to-second stop frame technique. RESULTS: Repeated-measures analysis of the main effects and interactions yielded a statistically significant main effect for event (pain, nonpain, baseline), thus differentiating pain from nonpain and baseline events (F = 48, p = 0.0001) and establishing construct validity. Interrater reliability analysis of individual event scores of the PIPP yielded reliability coefficients of 0.93-0.96. Intrarater reliability coefficients analysis for individual events were equally high at 0.94-0.98. CONCLUSIONS: This study demonstrates that the PIPP is a pain measure with good construct validity and excellent inter- and intrarater reliability for the assessment of procedural pain of preterm and term infants in clinical settings.