Goniometric reliability in a clinical setting. Shoulder measurements

The purpose of this study was to examine the intratester and intertester reliabilities for clinical goniometric measurements of shoulder passive range of motion (PROM) using two different sizes of universal goniometers. Patients were measured without controlling therapist goniometric placement technique or patient position during measurements. Repeated PROM measurements of shoulder flexion, extension, abduction, shoulder horizontal abduction, horizontal adduction, lateral (external) rotation, and medial (internal) rotation were taken of two groups of 50 subjects each. The intratester intraclass correlation coefficients (ICCs) for all motions ranged from .87 to .99. The ICCs for the intertester reliability of PROM measurements of horizontal abduction, horizontal adduction, extension, and medial rotation ranged from .26 to .55. The intertester ICCs for PROM measurements of flexion, abduction, and lateral rotation ranged from .84 to .90. Goniometric PROM measurements for the shoulder appear to be highly reliable when taken by the same physical therapist, regardless of the size of the goniometer used. The degree of intertester reliability for these measurements appears to be range-of-motion specific.     

Goniometric reliability in a clinical setting. Elbow and knee measurements

Reliability of goniometric measurements has been examined only under standardized conditions and usually with healthy subjects. The purpose of this study was to assess goniometric reliability in a clinical setting. The reliability of goniometric measurements of passive elbow and knee positions was assessed using patients as subjects. The effect of using the means of repeated measurements and the interdevice reliability of three common goniometers were also examined. Results showed that intratester reliability for flexion and extension of the knee and the elbow joints was high (r = .91 to .99). Intertester reliability was also high (r = .88 to .97) for these measurements except for measurements of knee extension (r = .63 to .70). Although previous investigators have suggested that using the means of multiple measurements improves reliability, our data indicate that this procedure never improves the correlation coefficient more than .12. The reliability was similar for all three devices. The results of this study indicate that for the knee and elbow joints, goniometric measurements performed in a clinical setting can be highly reliable. The method described in this study provides a simple protocol that can be used clinically to investigate goniometric reliability.     

老年人膝关节和踝关节位置觉的重测信度

背景：目前国内外关节位置觉的研究主要以青年人为对象,而老年人在不同角度关节位置重现的重测信度研究比较缺乏。目的：观察老年人膝关节和踝关节在不同角度关节复位测试的重测信度。方法：在Biodex system 3等速系统上用被动复位测试法测试28名健康老年人的膝、踝关节本体感觉,以被动复位绝对误差角度作为个体位置觉能力优劣的代表。重测信度评价指标为组内相关系数（ICC）。结果与结论：左右两侧膝关节位置觉测试在不同角度都具有良好的重测信度,ICC值为0.851～0.973;左右两侧踝关节位置觉测试在跖屈与背伸位具有中等以上的重测信度,ICC值为0.742～0.964;左侧踝关节复位的绝对误差角度小于右侧踝关节（P〈0.05）,且左侧（ICC为0.870～0.964）踝关节重测的相关系数高于右侧（ICC为0.742～0.944）。提示老年人膝关节和踝关节位置觉重测的相关性良好,并且左侧踝关节的相关性高于右侧。     

老年人膝关节和踝关节位置觉的重测信度

背景:目前国内外关节位置觉的研究主要以青年人为对象,而老年人在不同角度关节位置重现的重测信度研究比较缺乏.目的:观察老年人膝关节和踝关节在不同角度关节复位测试的重测信度.方法:在Biodex system 3等速系统上用被动复位测试法测试28名健康老年人的膝、踝关节本体感觉,以被动复位绝对误差角度作为个体位置觉能力优劣的代表.重测信度评价指标为组内相关系数(ICC).结果与结论:左右两侧膝关节位置觉测试在不同角度都具有良好的重测信度,ICC值为0.851~0.973;左右两侧踝关节位置觉测试在跖屈与背伸位具有中等以上的重测信度,ICC值为0.742~0.964;左侧踝关节复位的绝对误差角度小于右侧踝关节(P < 0.05),且左侧(ICC为0.870~0.964)踝关节重测的相关系数高于右侧(ICC为0.742~0.944).提示老年人膝关节和踝关节位置觉重测的相关性良好,并且左侧踝关节的相关性高于右侧.     

Comparative study of cardiac troponin I and T measurements in a routine extra-cardiological clinical setting.

This study compared troponin I (cTnI) to troponin T (cTnT) in a population admitted to General Medicine Divisions in whom acute myocardial infarction (AMI) was suspected; 98 consecutive patients were included. Diagnoses were made without knowledge of troponin results: 51 patients had AMI, and 47 (including 8 with unstable angina) had no AMI. Patients were considered to be troponin positive if the marker concentration was >99th percentile value of the reference population. Both troponins were associated with an almost absolute sensitivity for AMI (100% for cTnI and 98.0% for cTnT), while the specificity was marginally higher for cTnI (78.7% vs. 68.1%). Increased cTnI and/or cTnT were observed in 15 patients out of 39 without acute coronary syndromes. Simultaneous positivity was seen in 8 patients with severe disorders and complications. Discordances were more frequent in favor of increased cTnT (n = 5) than the opposite (n = 2), even if this difference did not achieve statistical significance. cTnI and cTnT detected AMI with comparable efficiency. Cases without coronary syndrome positively concordant for troponins confirmed the ability of these biomarkers to detect myocardial injury undetectable by conventional diagnostic approaches.     

踝关节位置觉和肌肉力觉的重测信度

背景:目前对于踝关节矢状面内本体感觉的研究较为缺乏,踝关节本体感觉的测试没有统一的标准.目的:分析踝关节矢状面内运动位置觉和力觉的重测信度.方法:踝关节位置觉采用对踝关节跖屈5°的被动定位被动复位能力进行测试,肌肉力觉采用受试者踝关节对跖屈肌群25%最大等长峰值力矩值的复制能力进行测试;运用组内相关系数和测量的标准误来判断位置觉和力觉重复测量结果的一致性程度.结果与结论:用来衡量关节位置觉和肌肉力觉的可变误差和绝对误差的组内相关系数均大于0.75,而且测量的标准误相对较小.常数误差的组内相关系数均小于0.75,而且测量的标准误相对较大.提示用来衡量位置觉和力觉的常数误差重测信度较差,用来衡量位置觉和力觉的可变误差和绝对误差重测信度较好.     

Total joint arthroplasty. The ankle.

When conservative measures fail to relieve significant disability due to ankle joint disease, the only surgical method of treatment has been arthrodesis. Because of less than ideal results and other long-term problems with ankle arthrodesis, and after numerous investigation to characterize the ankle mechanically, we developed a prosthetic ankle joint replacement. The Mayo total ankle replacement is a metal-on-polyethylene, congruent, constrained prosthesis. Analysis of 94 patients (102 ankle prostheses) revealed good clinical results in patients with rheumatoid arthritis and in older persons with posttraumatic degenerative disease. Younger, more active patients in the latter category had more disappointing results. Further design development is under way to improve range-of-motion characteristics, decrease constraint forces, and improve bone fixation of the prosthetic components.     

Methods for taking subtalar joint measurements. A clinical report

Physical therapists frequently evaluate the lower extremity, and this evaluation often includes measuring the subtalar joint neutral (STJN) position and subtalar joint (STJ) passive range of motion (PROM). This report critically reviews methods used to measure STJN position and STJ PROM. Standardized methods for taking these measurements, which have been clinically tested and appear to be theoretically sound, are presented. Although these methods are based on anatomical considerations, their reliability is less than optimal. However, these are the only methods of measuring STJN position and STJ PROM that have been tested adequately for reliability.     

Design and validation of an instrument package designed to increase the reliability of ankle range of motion measurements.

OBJECTIVE: To validate a novel device termed the equinometer, which is designed to accurately measure ankle dorsiflexion. DESIGN: Test retest reliability analysis using serial measurements of dorsiflexion endpoint in a group of normal individuals. SETTING: Motion analysis laboratory. PARTICIPANTS: Ten healthy individuals. PRIMARY OUTCOME MEASURE: The mean and standard deviation of the absolute difference in dorsiflexion endpoint for the group. RESULTS: The mean absolute change in dorsiflexion endpoint for the group was 0.45 degrees with a standard deviation of 0.43 degrees. CONCLUSIONS: With the use of the device described, the mean change in dorsiflexion endpoint was well within acceptable clinical limits. The reliability of measurements obtained with the equinometer exceeds that which has been published with other techniques and devices.     

不同目标力矩时距小腿关节肌肉力觉的重测信度（英文）

背景：目前对于距小腿关节矢状面内肌肉力觉的研究较为缺乏,距小腿关节肌肉力觉的测试没有统一的标准。目的：通过分析不同目标力矩时距小腿关节矢状面内运动肌肉力觉的重测信度,探讨距小腿关节肌肉力觉的测量方法。方法：选取跖屈肌群最大等长峰值力矩值的25%,50%和75%作为距小腿关节肌肉力觉的目标力矩值,测试距小腿关节肌肉对这些目标力矩值的复制能力;运用组内相关系数和测量的标准误来判断肌肉力觉的重复测量结果的一致性程度。结果与结论：结果显示用来衡量关节肌肉力觉的可变误差和绝对误差的组内相关系数均大于0.75,而且测量的标准误相对较小;常数误差的组内相关系数均小于0.75,而且测量的标准误相对较大。在目标力矩较小时,用来衡量肌肉力觉的可变误差和绝对误差重测信度较好。     

不同目标力矩时距小腿关节肌肉力觉的重测信度(英文)

背景:目前对于距小腿关节矢状面内肌肉力觉的研究较为缺乏,距小腿关节肌肉力觉的测试没有统一的标准。目的:通过分析不同目标力矩时距小腿关节矢状面内运动肌肉力觉的重测信度,探讨距小腿关节肌肉力觉的测量方法。方法:选取跖屈肌群最大等长峰值力矩值的25%,50%和75%作为距小腿关节肌肉力觉的目标力矩值,测试距小腿关节肌肉对这些目标力矩值的复制能力;运用组内相关系数和测量的标准误来判断肌肉力觉的重复测量结果的一致性程度。结果与结论:结果显示用来衡量关节肌肉力觉的可变误差和绝对误差的组内相关系数均大于0.75,而且测量的标准误相对较小;常数误差的组内相关系数均小于0.75,而且测量的标准误相对较大。在目标力矩较小时,用来衡量肌肉力觉的可变误差和绝对误差重测信度较好。     

Medication administration evaluation and feedback tool: Inter-rater reliability in the clinical setting

AimsThis study assessed the inter-rater reliability, acceptability and usability of the Medication Administration Evaluation and Feedback Tool for nurses in the clinical setting.BackgroundMedication administration is a complex nursing task requiring multiple steps to ensure safe and accurate delivery of medications to patients. Currently, registered nurses are not routinely provided the opportunity for regular review of their practice. The Medication Administration Evaluation and Feedback Tool has been previously validated in the simulated environment.MethodsFour nurse observers were trained to use the tool. Thirty nurses participated to be observed in the clinical setting. Each nurse was assessed simultaneously by two observers. Inter-rater reliability was assessed using Fleiss’ Kappa coefficient. A postobservation survey was conducted to assess user acceptability. The Guideline for Reporting Reliability and Agreement Studies Enhancing the Quality and Transparency of Health Research was used.ResultsThe observed agreement between observers using the Medication Administration Evaluation and Feedback Tool in clinical practice was 0.90 and Fleiss’ kappa coefficient was 0.77 demonstrating excellent agreement and inter-rater reliability. Both nurses and observers reported the tool was useful and practical for use in evaluating medication administration practice in the clinical environment.ConclusionsInter-rater reliability testing of the Medication Administration Evaluation and Feedback Tool in the clinical environment demonstrated it is a reliable and valid tool when used by different observers. Both nurses and observers found using the tool a positive and useful experience when evaluating medication administration practice.     

Integration of technology in a clinical research setting.

The use of wireless technology to collect and retrieve relevant patient data has been in use on many nursing units for the past decade. The technology continues to advance as it relates to patient data collection devices. The utilization of computers (in the form of a wireless tablet) is used in the General Clinical Research Unit (GCRC) at Howard University Hospital. The wireless technology is used for the compilation and retrieval of pertinent research data.     

Absolute reliability of shoulder joint horizontal adductor muscle strength measurements using a handheld dynamometer

[Purpose] The aim of this study was to verify the absolute reliability of shoulder joint horizontal adductor muscle strength measurements using a handheld dynamometer (HHD). [Subjects and Methods] The subjects were 33 healthy college students. The measurements were made three times with the HHD fixed using a belt (BFHHD) or with the examiner’s hand (conventional method; HFHHD). The absolute reliability of measurements was verified using Bland-Altman analysis, both in the all subjects group and a group of subjects showing measurements less than a fixed limit of 30 kgf. [Results] In the <30 kgf group, a systematic bias was not observed, and BFHHD values were greater than HFHHD values. BFHHD values in the all subjects group showed a systematic bias; the 3rd measurement value was less than the maximum value obtained during the 1st and 2nd measurements. [Conclusion] For obtaining an acceptable value during clinical measurements of horizontal adductor muscle strength, single measurements obtained using an HFHHD in the case of a <30 kgf group and the maximum value of two measurements obtained using a BFHHD are reliable.Key words: Absolute reliability, Handheld dynamometer, Shoulder joint horizontal adduction strength     

Intertester reliability for selected clinical tests of the sacroiliac joint

The purpose of this study was to examine the intertester reliability of 13 tests for sacroiliac joint (SIJ) dysfunction. Eight therapists examined 17 patients in two clinical settings. In each case, two therapists independently examined the patients and obtained results on all 13 of the SIJ tests. Patients with lumbosacral pain and unilateral lower extremity symptoms of a duration less than one year were examined. All the therapists had specialized in orthopedic physical therapy and had been trained in SIJ examination. Reliability was poor; 11 of the 13 tests resulted in less than 70% agreement. The two tests that relied solely on subjective patient response and imparted no information on SIJ position or mobility were within a range of 70% to 90% agreement. Our findings suggest the necessity of reviewing examination methods for the SIJ and improving reliability of clinical testing of this joint.     

The reliability of clinical measurements designed to quantify shoulder mobility

Abstract

Background: The assessment of shoulder mobility is an integral component of the physical therapy examination. Recognizing a mobility loss may assist the physical therapist in making a differential diagnosis, measuring improvement or deterioration, determining functional impairment, and planning interventions. Reliable measurement instruments and procedures are therefore essential to both the clinician and researcher desiring to objectively monitor disease progression, outcomes, and mobility impairments.

Objectives: The purpose of this review is to summarize the literature on the reliability and concurrent validity of clinical measurements used to quantify osteokinematic mobility of the shoulder.

Major findings: The reliability of shoulder mobility measurements is highly variable with no consistent advantage of instrumentation or procedures. Inclinometric measurement reliability coefficients ranged from 0·11 to 0·99, with goniometry ?0·22 to 0·99 and visual inspection 0·18 to 0·98. Reliability was independent of symptom state and measurement approach (passive versus active), although there was a trend for intrarater reproducibility exceeding interrater. Extension, horizontal abduction, and adduction measurements were limited to one investigation which utilized passive goniometric measurements. Research investigating the concurrent validity of instruments and procedures was limited, although favorable when comparing small versus large goniometers and goniometry to a digital level.

Conclusions: A consensus for choosing instruments and/or procedures was not conclusive based on comparable reliability reports and ranges. Instruments used to quantify shoulder mobility cannot be used interchangeably with confidence given the paucity of concurrent validity reports. Clinicians should recognize both the merits and limitations of the instruments and procedures that they incorporate into practice.     

Reliability of goniometric measurements and visual estimates of knee range of motion obtained in a clinical setting

The purpose of this study was to examine the intratester and intertester reliability for goniometric measurements of knee flexion and extension passive range of motion (PROM). In addition, parallel-forms reliability for PROM measurements of the knee obtained by use of a goniometer and by visual estimation was examined. The intertester reliability for visual estimates of the PROM of the knee was also examined. Repeated measurements were obtained on 43 patients in a clinical setting. The intraclass correlation coefficients (ICCs) for intratester reliability of measurements obtained with a goniometer were .99 for flexion and .98 for extension. Intertester reliability for measurements obtained with a goniometer was .90 for flexion and .86 for extension. The ICCs for parallel-forms reliability for measurements obtained with a goniometer and by visual estimation ranged from .82 to .94. The intertester reliability for measurements obtained by visual estimation was .83 for flexion and .82 for extension. Results suggest clinicians should use a goniometer to take repeated PROM measurements of a patient's knee to minimize the error associated with these measurements.