A Screening Tool for Patients With Lumbar Instability: A Content Validity and Rater Reliability of Thai Version

ObjectiveLumbar instability is a condition that has been extensively reported in its prevalence and its effect on patients. To date, however, a clinical screening tool for this condition has not been developed for use in Thailand. The objectives of this study were to translate and test the content validity and rater reliability of a screening tool for evaluating Thai patients with lumbar instability.MethodsThe investigators selected the lumbar instability questionnaire from an original English version. Elements of the tool comprised the dominant subjective findings reported by this clinical population. The screening tool was translated into the Thai language following a process of cross-cultural adaptation. The index of item-objective congruence (IOC) was checked for content validity by 5 independent experts. Seventy-five Thai patients with chronic nonspecific low back pain were asked to report their symptoms. The interview procedure using the tool was conducted by expert and novice physical therapists, which informed the intraclass correlation coefficient (ICC) for inter- and intrarater reliability.ResultsThe IOC was 0.95. The interrater ICC between expert and novice physical therapists was 0.92 (95% CI = 0.88-0.95). The intrarater ICC of novice physical therapist was 0.91 (95% CI = 0.86-0.94).ConclusionThe Thai version of the screening tool for patients with lumbar instability achieved excellent content validity and interrater and intrarater reliability. This screening tool is recommended for use with Thai patients with low back pain to identify the subpopulation with lumbar instability.     

Intrasession and interrater reliability of rehabilitative ultrasound imaging measures of the deep neck flexors: A pilot study

The purpose of this investigation was to examine the intrasession and interrater reliability of rehabilitative ultrasound imaging (RUSI) to measure the deep neck flexors (DNF). Two investigators traced the DNF muscle borders in eight female subjects aged 33?±?11.2 years. Of the eight subjects, five subjects reported a greater than 6-month history of neck pain, and three subjects were asymptomatic healthy controls. Cross-sectional area (CSA) (cm(2)) of right and left muscle groups were calculated. The intraclass correlation coefficients (ICC) for CSA measures were 0.67 (95% CI: 0.27-0.87) for rater 1 with a standard error of measurement (SEM) of 0.06?cm(2); 0.87 (95% CI: 0.65-0.96) for rater 2 with an SEM of 0.09?cm(2); and 0.68 (95% CI: 0.44-0.87) for interrater reliability between rater 1 and rater 2 with an SEM of 0.11?cm(2). The mean difference between CSA (cm(2)) measures were 0.00?±?0.10?cm(2) for rater 1 and 0.09?±?0.13?cm(2) for rater 2. The mean differences for CSA were 0.04?±?0.12?cm(2). This pilot investigation suggests that RUSI could be used to reliably assess the size of the deep neck flexors.     

Comparative Pitching Biomechanics Among Adolescent Baseball Athletes: Are There Fundamental Differences Between Pitchers and Non-pitchers?

BackgroundApproximately 25% of youth baseball players pitch, with most young athletes predominately playing multiple positions. While some youth baseball players may primarily pitch, other players may only pitch on occasion, potentially creating a pitching skill level discrepancy. Understanding potential kinematic and kinetic differences between pitching and non-pitching baseball players can inform injury risk reduction strategies for amateur athletes.Purpose/HypothesisTo analyze differences in pitching biomechanics for fastballs, breaking balls, and change-ups in adolescent youth baseball players that identify as pitchers and non-pitchers.Study DesignRetrospective cross-sectional studyMethodsBaseball players were designated as pitchers or non-pitchers, who then threw fastballs (FB), breaking balls (BB), and change-ups (CH) during a biomechanical assessment. T-tests, Mann-Whitney U tests, and ANOVAs with Bonferroni correction, and effect sizes (ES) were performed.ResultsSixty baseball players (pitchers = 40; non-pitchers = 20; Age: 15.0 (1.1); Left-handed: 15%; Height 1.77 (0.09) m; Weight: 70.0 (12.5) kg) threw 495 pitches (FB: 177, BB: 155, CH: 163) for analysis. Pitchers threw 2 m/s faster and produced greater trunk rotation velocity (ES: 0.71 (95% CI: 0.39, 1.30, p<0.0001) than non-pitchers. Furthermore, pitchers demonstrated greater ground reaction force for FB compared to CH (ES: 0.48 (95% CI: 0.01, 0.94), p<0.0001). No other biomechanical differences were observed between pitchers and non-pitchers or between pitch types.ConclusionDespite throwing at greater velocity for all pitch types, baseball players that identify primarily as pitchers had overall similar kinematics and kinetics in comparison to baseball players that primarily identify as non-pitchers. Self-identified pitching baseball athletes have improved force transfer strategies for ball propulsion, utilizing different force production and attenuation strategies across different pitch types when compared to non-pitchers. Coaches should consider that novice pitchers may potentially have dissimilar trunk and ground reaction strategies in comparison to primary pitchers when designing appropriate pitch loading and recovery strategies.Level of Evidence3     

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.     

Inter-rater reliability of formally trained and self-trained raters using the Edmonton Functional Assessment Tool

The primary objective of this study was to determine the inter-rater reliability of the revised version of the Edmonton Functional Assessment Tool (EFAT-2). A second objective was to determine whether both formally trained and self-trained therapists had an acceptable level of inter-rater reliability. The EFAT-2 was administered to consenting palliative care patients by one of two independent physical therapist rater pairs; one pair self-trained (R1, R2) and the other formally trained (R3, R4). The intraclass correlation [ICC (1,1)] for R1, R2 was 0.97 [95% confidence interval (CI) 0.94-0.99] and for R3, R4 was 0.95 (95% CI 0.90-0.98). The standard error of measurement was 1.09 and 1.44, respectively. The Kappa statistic for the rater pairs on individual EFAT items ranged from 0.17 to 0.96. The results suggest that both formally trained and self-trained therapists obtain an acceptable level of inter-rater reliability when using the EFAT-2.     

Reliability of the Expanded Cutting Alignment Scoring Tool (E-CAST) to Assess Trunk and Limb Alignment During a 45-Degree Side-Step Cut

BackgroundCurrent clinical screening tools assessing risky movements during cutting maneuvers do not adequately address sagittal plane foot and ankle evaluations. The Cutting Alignment Scoring Tool (CAST) is reliable in evaluating frontal plane trunk and lower extremity alignment during a 45-degree side-step cut. The Expanded Cutting Alignment Scoring Tool (E-CAST) includes two new sagittal plane variables, knee flexion and ankle plantarflexion angle.Hypothesis/PurposeTo assess the inter-and intra-rater reliability of the E-CAST to evaluate trunk and lower extremity alignment during a 45-degree side-step cut.Study DesignRepeated MeasuresMethodsParticipants included 25 healthy females (13.8 ± 1.4 years) regularly participating in cutting or pivoting sports. Participants were recorded performing a side-step cut in frontal and sagittal planes. One trial was randomly selected for analysis. Two physical therapists independently scored each video using the E-CAST on two separate occasions, with randomization and a two-week wash-out between rounds. Observed movement variables were awarded a score of “1”, with higher scores representing poorer technique. Intraclass correlation coefficients (ICC) and 95% confident intervals (95% CI) were calculated for the total score, and a kappa coefficient (k) was calculated for each variable.ResultsThe cumulative intra-rater reliability was good (ICC=0.78, 95% CI 0.59-0.96) and the cumulative inter-rater reliability was moderate (ICC=0.71, 95% CI 0.50-0.91). Intra-rater kappa coefficients ranged from moderate to excellent for all variables (k= 0.50-0.84) and inter-rater kappa coefficients ranged from slight to excellent for all variables (k=0.20-0.90).ConclusionThe addition of two sagittal plane variables resulted in lower inter-rater ICC compared to the CAST (ICC= 0.81, 95% CI 0.64-0.91). The E-CAST is a reliable tool to evaluate trunk and LE alignment during a 45-degree side-step cut, with good intra-rater and moderate inter-rater reliability.Level of EvidenceLevel 2, Diagnosis     

Reliability and minimal detectable change of thoracoabdominal mobility measurements using photogrammetry

The knowledge about measurement errors of the measuring tool is important before its use, as clinical decisions are going to be made based on its results. Here we investigate intrarater and interrater reliability and the minimal detectable change (MDC) of thoracoabdominal mobility measurements using photogrammetry, considering novice and experienced raters. Thoracoabdominal mobility of 17 healthy participants was assessed; photographs during apnea in maximal inspiration and expiration were used to calculate latero-lateral and anteroposterior diameters of the thorax (at axillary and xiphoid level) and abdomen. One novice and one experienced rater measured the same photographs three times. We found good reliability for the experienced rater (average Intraclass Correlation Coefficient (ICC): 0.98; average MDC: 0.3) and for interrater comparison (average ICC: 0.97; average MDC: 0.35) for all measures, with poorer results for latero-lateral mobility of abdomen. The novice rater presented moderate reliability for latero-lateral mobility of the thorax at axillary level and abdomen (ICC: 0.52 and 0.61; MDC: 1.42 and 2.05, respectively) and good reliability for the other measures (average ICC: 0.81; average MDC: 1.52). The photogrammetric analysis of thoracoabdominal mobility presented itself as a reliable method when used by an experienced professional. However, considering that the measurement of latero-lateral mobility is more subjected to errors, it should be used with caution. The MDC presented should be taken into account as a threshold to be certain that the measure is not under the measurement error due to rater variability.     

Translation and cross-cultural adaptation of the Charcot-Marie-Tooth disease Pediatric Scale to Brazilian Portuguese and determination of its measurement properties

BackgroundThe Charcot-Marie-Tooth disease Pediatric Scale (CMTPedS) has been used to measure aspects of disability in children with all types of Charcot-Marie-Tooth disease (CMT).ObjectiveTo translate and cross-culturally adapt the CMTPedS into Brazilian–Portuguese and determine its reliability and validity.MethodsThe translation and cross-cultural adaptation followed international guidelines recommendations. Twenty individuals with CMT were assessed. Two examiners assessed the participants for inter-rater reliability. Face validity was assessed by eight physical therapists that judged the relevance of each test item. The Bland-Altman analysis (bias) and standard error of measurement (SEM) complemented the analysis. Furthermore, intraclass correlation coefficients (ICC), weighted kappa (k), and internal consistency (Cronbach’s alpha) was determined.ResultsThe CMTPedS was successfully translated and cross-culturally adapted. Twenty children/youth were enrolled in the study. Of these, the majority (55%) were girls with a mean age of 13.9 (range: from 6 to 18) years. Regarding face validity, the CMTPedS-Br showed relevant items for assessing children and youth with CMT. The ICC for the total score showed excellent reliability (ICC_2.1 = 0.93, 95% CI = 0.84, 0.97). The most reliable items were grip, dorsiflexion and plantar flexion strength while the least reliable items were pinprick, vibration, and gait. The internal consistency was excellent (α = 0.96, 95% CI = 0.91, 0.99) and the agreement showed small variability (bias = 0.15, 95% CI= -4.28, 4.60).ConclusionThe CMTPedS-Br showed adequate reliability and face validity to measure disability in individuals with CMT. This tool will allow Brazil to be part of multicentered studies on such a rare but debilitating condition.     

Modified Rivermead Mobility Index: a reliable measure in people within 14 days post-stroke

Abstract

Purpose: The reliability of the Modified Rivermead Mobility Index (MRMI) has not previously been investigated in the very early post-stroke phase. The aim of the study was to evaluate inter-rater and intra-rater reliability and internal consistency in patients, 1–14?d post-stroke. Method: A cohort study with repeated measures within 24?h, on 37 patients, 1–14?d post-stroke was conducted. Inter-rater (two raters) and intra-rater (one rater) reliability was analyzed using weighted kappa (κ) statistics and internal consistency with Cronbach’s alpha and intra-class correlation (ICC), 3.k. Results: Inter-rater and intra-rater reliability was excellent (ICC coefficient 0.97 and 0.99) for MRMI summary score. Intra-rater exact agreement for separate items was between 77% and 97%; κ between 0.81 and 0.96. Inter-rater exact agreement for separate items was between 68% and 92%; κ 0.59–0.87. The internal consistency was high (α 0.96; ICC 3.k 0.99). Conclusion: The MRMI is a reliable measure of physical mobility in the early post-stroke phase.     

Adaptation and evaluation of a child-friendly patient reported outcome measure for use in Australia

BackgroundUse of Patient Reported Outcomes (PROs) to assess symptoms in children are not routinely used in clinical practice, yet children with complex conditions experience a significant number of symptoms.AimTo adapt and evaluate the Symptom Screening in Pediatrics Tool (SSPedi), a PRO measure developed in Canada for use with Australian children.MethodsSSPedi wording was adapted and item relevance assessed by an expert clinical group (N = 7) resulting in the Australian version (SSPedi-Aus). Cognitive interviewing with children with cancer (N = 10, 8–18 years) established understanding and difficulty with completing. A second group of child-parent dyads (N = 30) were recruited to evaluate psychometric properties (content validity, test-retest reliability, and parent-proxy) measured with Intraclass Correlation Coefficients (ICC) with 95% Confidence Intervals (CI). Acceptability and usefulness of SSPedi-Aus were also assessed.FindingsConstruct validity was confirmed across all items by 30 children. Child test-retest achieved excellent concordance (ICC 0.98, 95% CI 0.91 to 0.99). Symptoms causing the most distress as reported by children were different to those identified by parents. Although children and parents returned a similar mean total score (13.43 vs. 13.80), there was weak overall interrater reliability (ICC 0.37, 95% CI ?0.26 to 0.70, p = 0.12).ConclusionChildren are distressed by symptoms that may not be identified by parents or reported to clinicians, yet these symptoms are amendable to intervention. The SSPedi-Aus is useful to assess the level of distress caused by symptoms in children.     

Interrater reliability of pediatric point-of-care lung ultrasound findings

ObjectiveWe sought to assess interrater reliability (IRR) of lung point-of-care ultrasound (POCUS) findings among pediatric patients with suspected pneumonia.MethodsA convenience sample of patients between the ages of 6 months and 18 years with a clinical suspicion of pneumonia had a lung ultrasound performed by a POCUS-credentialed emergency medicine physician with subsequent expert review. Each lung zone was assessed as either normal or abnormal, and specific ultrasound findings were recorded. IRR was assessed by intraclass correlation coefficient (ICC) and kappa statistics.ResultsSeventy-one patients, with a total of 852 lung zones imaged, were included. The sonographer assessment of normal versus abnormal, across each of the zones, demonstrated moderate agreement with ICC 0.46 (95% CI: 0.41, 0.52) and kappa 0.56. Right-sided zones demonstrated moderate agreement [0.43 (CI 0.35, 0.51)] while left-sided zones, specifically left-sided anterior zones, showed only fair agreement [0.36 (0.28, 0.44)]. IRR varied between specific findings: ICC for B-lines 0.52 (95% CI: 0.46, 0.57), pleural effusion 0.40 (0.34, 0.45), consolidation 0.39 (0.33, 0.44), subpleural consolidation 0.31 (0.25, 0.37), and pleural line irregularity 0.16 (0.10, 0.23). A composite indicator of typical pneumonia findings (consolidation, B-lines, and pleural effusion) demonstrated moderate [ICC 0.52 (0.46, 0.57)] reliability.ConclusionsWe found moderate interrater reliability of lung POCUS findings for the assessment of pediatric patients with suspected pneumonia. B-lines had the highest reliability. Further assessment of lung POCUS is necessary to guide proper training and optimal scanning techniques to ensure adequate reliability of ultrasound findings in the assessment of pediatric pneumonia.     

The Orpington Prognostic Scale for patients with stroke: Reliability and pilot predictive data for discharge destination and therapeutic services

Purpose.?To determine the inter-rater and test-retest reliability of the Orpington Prognostic Scale (OPS) in patients with stroke. Pilot data were gathered to evaluate its predictive validity for discharge destination and therapeutic services required on discharge.

Method.?Ninety-four consecutive patients, admitted to hospital due to stroke participated. Pairs of physiotherapists (PT) and occupational therapists (OT) assessed patients using the OPS on days 7 and 14 post stroke. For inter-rater reliability, one rater performed the OPS while the other observed, each scoring the scale independently. For test-retest reliability, two different raters tested the subjects separately within the same day. Data were gathered on the discharge destination and the number of follow-up services prescribed.

Results.?The inter-rater reliability as measured by the intraclass correlation coefficient (ICC) was 0.99 (95% CI 0.97 – 0.99). For test-retest reliability, the ICC was 0.95 (95% CI 0.90 – 0.98). The accuracy for predicting discharge to home using OPS ? 5.0 was 65% (95% CI 0.52 – 0.76). OPS scores were not related to number of follow-up services prescribed.

Conclusions.?Despite high inter-rater and test-retest reliability, the OPS has limited predictive accuracy for discharge destination and is a poor predictor of follow-up services.     

Intra- and Interrater Reliability of Remote Assessment of Transfers by Wheelchair Users Using the Transfer Assessment Instrument (Version 4.0)

ObjectiveTo evaluate the reliability, standard error of measurement, minimum detectable change, and item-level consistency of the Transfer Assessment Instrument (TAI) version 4.0 when used to evaluate transfer quality remotely.DesignParticipants transferred from their wheelchair to a mat table (transfer 1), repeated this after a 10-minute delay to assess intrarater reliability (transfer 2), and repeated this 1-2 days later to assess test-retest reliability (transfer 3). Each transfer was scored in person by 4 raters and asynchronously by a remote clinician rater.Setting2017 National Veterans Wheelchair Games.ParticipantsConvenience sample of 44 full-time wheelchair users (N=44).InterventionsNot applicable.Main Outcome MeasuresTAI total score, subscores (wheelchair setup, body setup, flight/landing), and item scores (15 items).ResultsModerate to excellent reliability was found when scoring remotely for TAI total and subscores for intrarater (intraclass correlation coefficient (ICC(3,1)=0.687-0.854), test-retest (ICC(3,1)=0.695-0.836), and interrater reliability (ICC(3,5)=0.746-0.962). Remote rater total score and flight/landing subscore were greater (indicating higher transfer quality) compared to the average in-person raters (P=.021 and P=.005, respectively). There were no differences between transfers 1-3 in remote rater scores. Item-level percentage agreement between the remote rater and in-person exceeded the 75% cutoff for clinical utility for all items.ConclusionsThe TAI is a reliable outcome measure for assessing transfer technique remotely.     

A Comparison of Pitching Biomechanics and Sport Specialization in High School Pitchers

BackgroundThe prevalence of sport specialization in high school athletes continues to rise, particularly among baseball players. Previous research has focused on the incidence of injury among specialized and non-specialized athletes but has yet to examine the level of sport specialization and pitching biomechanics.Hypotheses/PurposeThe purpose of this study was to investigate differences in pitching volume and biomechanics between low-, moderate-, and high-level specialized baseball pitchers. It was hypothesized that high-level specialized pitchers would have the most pitching volume within the current and previous years while low-level specialized pitchers would exhibit the least amount. The second hypothesis states that kinematics and kinetics commonly associated with performance and injury risk would differ between low-, moderate-, and high-level specialized pitchers.Study DesignCase-Control StudyMethodsThirty-six high school baseball pitchers completed a custom sport specialization questionnaire before participating in a three-dimensional pitching motion analysis. Sport specialization was based off current guidelines and categorized as low-, moderate-, and high-level specialized based upon self-reported outcomes. Pitchers then threw ≈10 fastballs from a mound engineered to professional specifications. Data averaged across fastballs was used for biomechanics variables. Key pitching biomechanical and pitching volume variables were compared between low-, moderate-, and high-level specialized pitchers.ResultsHigh-level specialized pitchers were older (p = 0.003), had larger body mass (p = 0.05) and BMI (p = 0.045), and threw faster (p = 0.01) compared to low-level specialized pitchers. Pitching volume and pitching biomechanics were similar across groups.ConclusionsPitching biomechanics were similar across groups, although high-level specialized pitchers threw with significantly higher throwing velocity compared to low-level pitchers. The low amount of pitching volume throughout the season may be responsible for the lack of additional observed differences. Further research should examine the relationship between pitching biomechanics, upper extremity strength and flexibility, and sport specialization.Level of EvidenceLevel III     

Interrater reliability of the Physical Ability Scale for patients after stroke: A pilot study

This study aimed to evaluate the interrater reliability of the Physical Ability Scale (PAS) and secondly to test the statistical methods to analyse the scoring. Williamson () stated that the PAS measures the degree of compatibility of the trunk with gravity and the supporting surface through investigation of limb, head, and posture in five different positions, each with six levels of ability. Four experienced physiotherapists observed a video of 10 inpatients from a general hospital stroke unit being assessed with the PAS up to 5 months after a stroke. The intraclass coefficient (ICC) for the total scores was 0.7 (95% CI 0.35–0.91) with the highest individual position scores in standing 0.86 (95% CI 0.68–0.96) and long sitting 0.74 (95% CI 0.46–0.92). The ICC for the levels of ability indicated good agreement in standing 0.79 (95% CI 0.55–0.93) and long sitting 0.77 (95% CI 0.52–0.93). Kappa values for each body part yielded the highest values in long sitting (0.62) and standing (0.56). Interrater reliability is variable, with the greatest level of agreement in long sitting and standing but with poor to fair agreement in sitting, prone, and supine. The study has also shown that the scoring can be analysed to yield meaningful repeatable results. Further investigation is needed to examine validity and reliability with a larger sample of diverse ability, therapists with varying clinical experience, and with direct observation of the assessment.     

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.     

Intra- and interrater reliability of the Ergo-Kit functional capacity evaluation method in adults without musculoskeletal complaints

OBJECTIVE: To evaluate the intra- and interrater reliability of tests from the Ergo-Kit (EK) functional capacity evaluation method in adults without musculoskeletal complaints. DESIGN: Within-subjects design. SETTING: Academic medical center in The Netherlands. PARTICIPANTS: Twenty-seven subjects without musculoskeletal complaints (15 men, 12 women). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Seven EK tests (2 isometric, 3 dynamic lifting, 2 manipulation tests) were each assessed 3 times (over 4 days), twice by 1 rater (R1) and once by another rater (R2). Intrarater reliability was calculated using the EK test scores assessed by R1. Interrater reliability was calculated using the EK test scores assessed by both raters. Counterbalancing the rater order made possible the calculation of 2 interrater reliability levels (at time intervals of 4 and 8d). All reliability levels were expressed as intraclass correlation coefficients (ICCs). RESULTS: Intrarater and interrater reliability (8-d time interval) was high (ICC, >.80) for the isometric lifting tests, moderate (ICC range, .50-.80) for the dynamic lifting tests, and low (ICC, <.50) for the manipulation tests. The interrater reliability of the isometric and dynamic lifting tests (4-d time interval) was high (ICC, >.80), and it was moderate (ICC range, .50-.80) for both manipulation tests. CONCLUSIONS: The isometric and dynamic lifting tests of the EK have a moderate to high level of reliability; the manipulation tests have a low level of reliability.     

Pressure ulcer risk assessment in critical care: Interrater reliability and validity studies of the Braden and Waterlow scales and subjective ratings in two intensive care units

Background

The application of standardized pressure ulcer risk assessment scales is recommended in clinical practice.

Objectives

The aims of this study were to compare the interrater reliabilities of the Braden and Waterlow scores and subjective pressure ulcer risk assessment and to determine the construct validity of these three assessment approaches.

Design

Observational.

Settings

Two intensive care units of a large University Hospital in Germany.

Participants

21 and 24 patients were assessed by 53 nurses. Patients’ mean age was 69.7 (SD 8.3) and 67.2 (SD 11.3).

Methods

Two interrater reliability studies were conducted. Samples of patients were assessed independently by a sample of three nurses. A 10-cm visual analogue scale was applied to measure subjective pressure ulcer risk rating. Intraclass correlation coefficients (ICC) and standard errors of measurement (SEM) were used to determine interrater reliability and agreement of the item and sum scores. Pearson product moment correlation coefficients (r) were used to indicate the degree and direction of the relationships between the measures.

Results

The interrater reliability for the subjective pressure ulcer risk assessment was ICC(1,1) = 0.51 (95% CI 0.26-0.74) and 0.71 (95% CI 0.53-0.85). Interrater reliability of Braden scale sum scores was ICC(1,1) = 0.72 (95% CI 0.52-0.87) and 0.84 (95% CI 0.72-0.92) and for Waterlow scale sum scores ICC(1,1) = 0.36 (95% CI 0.09-0.63) and 0.51 (95% CI 0.27-0.72). The absolute degree of correlation between the measures ranged from 0.51 to 0.77.

Conclusions

Interrater reliability coefficients indicate a high degree of measurement error inherent in the scores. Compared to subjective risk assessment and the Waterlow scale scores the Braden scale performed best. However, measurement error is too high to draw valid inferences for individuals. Less than 26-59% of variances in scores of one scale were determined by scores of another scale indicating that all three instruments only partly measured the same construct. The use of the Braden-, Waterlow- and Visual Analogue scales for measuring pressure ulcer risk of intensive care unit patients is not recommended.     

INTRA‐ AND INTER‐RATER RELIABILITY OF THE SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENT (SFMA)

Purpose/Background:

The Selective Functional Movement Assessment (SFMA) is a clinical assessment system designed to identify musculoskeletal dysfunction by evaluation of fundamental movements for limitations or symptom provocation. The purpose of this study was to determine the intra‐ and inter‐rater reliability of the ten fundamental movement patterns of the SFMA in a healthy population using the SFMA categorical and criterion checklist scoring tools.

Methods:

35 healthy subjects (22.9 years +/− 1.9) were recorded with two digital video cameras (1‐frontal view/1‐sagittal view) while they performed the ten fundamental movements patterns that comprise the SFMA. Evaluators with varying experience with the SFMA (rater A, > 100 hours; rater B, 25 hours; and rater C, 16 hours) and not present at the initial data collection evaluated each video using categorical and criterion checklist scoring tools. Evaluators repeated this process at least one week later. The evaluators'' composite results were compared between and within raters using the kappa coefficient and ICC''s for categorical scoring and criterion checklist scoring, respectively.

Results

Substantial to almost perfect intra‐rater reliability of the SFMA (kappa, % agreement) was observed for all raters using the categorical scoring tool (rater A: .83, .91; rater B: .78, .88; and rater C: .72, .85). The criterion checklist scoring tool yielded intra‐rater ICCs (3,1; 95% confidence interval) ranging from good to poor with rater A demonstrating the highest reliability (ICC [SEM]) (.52 [2.36]) and rater C the lowest reliability (.26 [3.42]). Inter‐rater reliability of the categorical scoring tool was slight to substantial (.41‐.61, .69‐.79) while the criterion checklist tool (ICC 2,1) demonstrated unacceptable inter‐rater reliability when assessed in all raters together (.43 [2.7]).

Conclusions

As hypothesized, intra‐and inter‐rater reliability of categorical scoring and criterion checklist scoring of the ten fundamental movements of the SFMA was higher in raters with greater experience.     

The Orpington Prognostic Scale for patients with stroke: reliability and pilot predictive data for discharge destination and therapeutic services

PURPOSE: To determine the inter-rater and test-retest reliability of the Orpington Prognostic Scale (OPS) in patients with stroke. Pilot data were gathered to evaluate its predictive validity for discharge destination and therapeutic services required on discharge.METHOD: Ninety-four consecutive patients, admitted to hospital due to stroke participated. Pairs of physiotherapists (PT) and occupational therapists (OT) assessed patients using the OPS on days 7 and 14 post stroke. For inter-rater reliability, one rater performed the OPS while the other observed, each scoring the scale independently. For test-retest reliability, two different raters tested the subjects separately within the same day. Data were gathered on the discharge destination and the number of follow-up services prescribed.RESULTS: The inter-rater reliability as measured by the intraclass correlation coefficient (ICC) was 0.99 (95% CI 0.97 - 0.99). For test-retest reliability, the ICC was 0.95 (95% CI 0.90 - 0.98). The accuracy for predicting discharge to home using OPS 5.0 was 65% (95% CI 0.52 - 0.76). OPS scores were not related to number of follow-up services prescribed.CONCLUSIONS: Despite high inter-rater and test-retest reliability, the OPS has limited predictive accuracy for discharge destination and is a poor predictor of follow-up services.