Female Adolescent Soccer Players Utilize Different Neuromuscular Strategies Between Limbs During the Propulsion Phase of a Lateral Vertical Jump

BackgroundMultiplanar dynamic stability is an important unilateral function in soccer performance but has been scarcely examined in female soccer players. The lateral vertical jump task assesses unilateral functional performance, and energy generation contribution examines how each joint (hip, knee, ankle) contributes to the vertical component of the vertical jump phase to measure inter- and intra-limb differences.PurposeTo examine dominant versus non-dominant limb performance using energy generation contribution of the hip, knee, and ankle during the vertical jump component of the lateral vertical jump.Study DesignCross-sectional observational study.MethodsSeventeen healthy, adolescent female soccer players (age 13.4±1.7 years; height 160.6±6.0 cm; mass 53.1±8.2 kg) participated. Quadriceps strength was measured via isokinetic dynamometry. Energy generation contribution (measured from maximal knee flexion to toe off) and vertical jump height were measured during the vertical component of the lateral vertical jump.ResultsThere was no significant difference between limbs for quadriceps strength (p=0.64), jump height (p=0.59), or ankle energy generation contribution (p=0.38). Energy generation contribution was significantly greater in the dominant hip (dominant 29.7±8.6%, non-dominant 18.4±6.3%, p<0.001) and non-dominant knee (dominant 22.8±6.8%, non-dominant 36.2±8.5%, p<0.001).ConclusionHigh demand on coordination and motor control during the lateral vertical jump and inherent limb dominance may explain different intra-limb strategies for task performance despite jump height symmetry. Non-dominant affinity for stability and dominant compensatory performance may neutralize potential asymmetries. Implications for symmetry in observable outcomes such as jump height must consider underlying internal asymmetries.Levels of Evidence3BClinical RelevanceSymmetrical findings on functional tasks have underlying internal asymmetries observed here in female adolescent soccer players. The lateral vertical jump may highlight these internal asymmetries (hip- versus knee-dominant movement strategies) due to the high coordinative demand to perform the task. Clinicians should be cognizant of underlying, potentially inherent, asymmetries even when observing functional symmetry in a task.What is known about the subjectFemale adolescent soccer players are a high-risk cohort for sustaining anterior cruciate ligament injuries. Limb dominance may play a role in the performance of functional tasks, and limb dominance in soccer players is quite specialized: the dominant limb is the preferred kicking limb, while the non-dominant limb is the preferred stabilizing limb (plant leg). Functional performance in female soccer players has been studied in kicking, dribbling, sprinting, change of direction, and jumping – however, these tasks were measured independent of limb dominance. It remains to be seen how unilateral functional tasks may be affected by limb dominance in female adolescent soccer players.What this study adds to existing knowledgeThis study provides data on functional performance relative to limb dominance in female adolescent soccer players, and captures the lateral vertical jump task in both inter- and intra-limb measures. This highlights that intra-limb strategies to perform a coordinated motor task may be different between limbs, herein attributed to limb dominance. Even if gross motor outputs between limbs are symmetrical (i.e. jump height), the underlying movement strategies to achieve that output may be different (hip- versus knee-dominant movement strategies). These findings are important to research on functional performance measures related to attaining between-limb symmetry, as measures of energy generation contribution open the door for a more thorough understanding of joint-by-joint intra-limb contributions during a functional task.     

The Intra- and Inter-rater Reliability of an Arm Care Screening Tool in High School Baseball Coaches

BackgroundPreseason movement screening can identify modifiable risk factors, deterioration of function, and potential for injury in baseball players. Limited resources and time intensive testing procedures prevent high school coaches from accurately performing frequent movement screens on their players.PurposeTo establish the intra-rater and inter-rater reliability of a novel arm care screening tool based on the concepts of the Functional Movement Screen (FMS™) and Selective Functional Movement Assessment (SFMA™) in high school coaches.Study DesignMethodological intra- and inter-rater reliability studyMethodsThirty-one male high school baseball players (15.9 years ± 1.06) were independently scored on the Arm Care Screen (ACS) by three examiners (two coaches, one physical therapist) in real-time and again seven days later by reviewing video recordings of each players’ initial screening performance. Results from each examiner were compared within and between raters using Cohen’s kappa and percent absolute agreement.ResultsSubstantial to excellent intra-rater and inter-rater reliability were established among all raters for each component of the ACS. The mean Cohen’s kappa coefficient for intra-rater reliability was 0.76 (95% confidence interval, 0.54-0.95) and percent absolute agreement ranged from 0.82-0.94 among all raters. Inter-rater reliability demonstrated a mean Cohen’s kappa value of 0.89 (95% confidence interval, 0.77-0.99) while percent absolute agreement between raters ranged from 0.81-1.00. Intra- and inter-rater reliability did not differ between raters with various movement screening experience (p>0.05).ConclusionsHigh school baseball coaches with limited experience screening movement can reliably score all three components of the ACS in less than three minutes with minimal training.Level of EvidenceLevel 3, Reliability study     

The Relationship between Landing Error Scoring System Performance and Injury in Female Collegiate Athletes

BackgroundThe Landing Error Scoring System (LESS) is a standardized tool used to identify aberrant biomechanical movement patterns during a jump-landing task. Prior authors have examined the value of the LESS in identifying ACL injury risk in athletic populations. Yet, no study has evaluated the association between LESS performance and incidence of any type of lower extremity injury in female collegiate athletes across multiple sports.PurposeThe purpose of this study was to examine the association between LESS performance as measured with a markerless motion-capture system and lower extremity injury in female collegiate athletes.Study DesignProspective cohort study.MethodsOne hundred and ten DI female collegiate athletes (basketball, n=12; field hockey, n=17; gymnastics, n=14; lacrosse, n=27; softball, n=23; volleyball, n=17) completed a jump-landing test prior to the start of their sport seasons. The LESS was automatically scored using a Microsoft Kinect sensor and Athletic Movement Assessment software (PhysiMax®). Participants were tracked throughout one competitive season for incidence of time-loss lower extremity injury. A Receiver Operating Characteristic curve determined the optimal cutpoint for the total LESS score for predicting injury. Pearson’s Chi squared statistics examined the association between injury and LESS total scores >5. The Fisher exact test evaluated group differences for the frequency of receiving an error on individual LESS test items.ResultsFemale collegiate athletes with LESS scores >5 were not more likely to be injured than those with scores ≤5 (χ2=2.53, p=0.111). The relative risk of injury to this group was 1.78 (95% CI=0.86, 3.68) while the odds ratio was 2.10 (95% CI=0.83, 5.27). The uninjured group was more likely to receive an error on lateral trunk flexion at initial contact than the injured group (p=0.023).ConclusionThe LESS total score was not associated with an increased odds of lower extremity injury in this cohort of female collegiate athletes. Future studies to examine the association between individual LESS item scores and injury are warranted.Level of Evidence1b.     

Monitoring training status using novel submaximal test

While measures of asymmetry may provide a means of identifying individuals predisposed to injury, normative asymmetry values for challenging sport specific movements in elite athletes are currently lacking in the literature. In addition, previous studies have typically investigated symmetry using discrete point analyses alone. This study examined biomechanical symmetry in elite rugby union players using both discrete point and continuous data analysis techniques. Twenty elite injury free international rugby union players (mean ± SD: age 20.4 ± 1.0 years; height 1.86 ± 0.08 m; mass 98.4 ± 9.9 kg) underwent biomechanical assessment. A single leg drop landing, a single leg hurdle hop, and a running cut were analysed. Peak joint angles and moments were examined in the discrete point analysis while analysis of characterising phases (ACP) techniques were used to examine the continuous data. Dominant side was compared to non-dominant side using dependent t-tests for normally distributed data or Wilcoxon signed-rank test for non-normally distributed data. The significance level was set at α = 0.05. The majority of variables were found to be symmetrical with a total of 57/60 variables displaying symmetry in the discrete point analysis and 55/60 in the ACP. The five variables that were found to be asymmetrical were hip abductor moment in the drop landing (p = 0.02), pelvis lift/drop in the drop landing (p = 0.04) and hurdle hop (p = 0.02), ankle internal rotation moment in the cut (p = 0.04) and ankle dorsiflexion angle also in the cut (p = 0.01). The ACP identified two additional asymmetries not identified in the discrete point analysis. Elite injury free rugby union players tended to exhibit bi-lateral symmetry across a range of biomechanical variables in a drop landing, hurdle hop and cut. This study provides useful normative values for inter-limb symmetry in these movement tests. When examining symmetry it is recommended to incorporate continuous data analysis techniques rather than a discrete point analysis alone; a discrete point analysis was unable to detect two of the five asymmetries identified.     

Reliability of postural measures in elite badminton players using Posture Pro 8

The Posture Pro software is used for photogrammetry assessment of posture and has been commercially available for several years. Along with symmetry-related measures, a Posture Number® is calculated to reflect the sum of postural deviations. Our aim was to investigate the intra- and inter-rater reliability of measures extracted using the Posture Pro 8 software without using reference markers on subjects. Four raters assessed the standing posture of 40 badminton players (20 males, 20 females) from anterior, lateral, and posterior photographs. Thirty-three postural measures were extracted using visual landmarks as guide. Reliability was quantified using intra-class correlation coefficient (ICC) and typical error of measurement (TEM). Overall, the intra-rater reliability was considered good to excellent for nearly all measures. However, only two measures had excellent inter-rater reliability, with 13 and 18 measures exhibiting good and fair inter-rater reliability, respectively. Posture Pro specific measures (n = 9) exhibited good-to-excellent intra-rater and fair-to-excellent inter-rater reliability, with small-to-moderate and small-to-large TEM, respectively. Overall, the Posture Pro 8 software can be considered a reliable tool for assessing a range of posture-relevant measures from photographs, particularly when performed by the same examiner. The Posture Number® demonstrated generally acceptable intra- and inter-rater reliability. Nonetheless, investigations on the validity, sensitivity, and interpretation of this measure are essential to confirm its clinical relevance.     

Translation,reliability, and clinical utility of the Melbourne Assessment 2

Objective: The aims were to (i) provide a German translation of the Melbourne Assessment 2 (MA2), a quantitative test to measure unilateral upper limb function in children with neurological disabilities and (ii) to evaluate its reliability and aspects of clinical utility.

Methods: After its translation into German and approval of the back translation by the original authors, the MA2 was performed and videotaped twice with 30 children with neuromotor disorders. For each participant, two raters scored the video of the first test for inter-rater reliability. To determine test–retest reliability, one rater additionally scored the video of the second test while the other rater repeated the scoring of the first video to evaluate intra-rater reliability. Time needed for rater training, test administration, and scoring was recorded.

Results: The four subscale scores showed excellent intra-, inter-rater, and test–retest reliability with intraclass correlation coefficients of 0.90–1.00 (95%-confidence intervals 0.78–1.00). Score items revealed substantial to almost perfect intra-rater reliability (weighted kappa k_w?=?0.66–1.00) for the more affected side. Score item inter-rater and test–retest reliability of the same extremity were, with one exception, moderate to almost perfect (k_w?=?0.42–0.97; k_w?=?0.40–0.89). Furthermore, the MA2 was feasible and acceptable for patients and clinicians.

Conclusions: The MA2 showed excellent subscale and moderate to almost perfect score item reliability.

• Implications for Rehabilitation

• There is a lack of high-quality studies about psychometric properties of upper limb measurement tools in the neuropediatric population.

• The Melbourne Assessment 2 is a promising tool for reliable measurement of unilateral upper limb movement quality in the neuropediatric population.

• The Melbourne Assessment 2 is acceptable and practicable to therapists and patients for routine use in clinical care.

     

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 in Mandibular Movement Evaluation Using Photogrammetry in Patients With Temporomandibular Disorders

ObjectiveThe purpose of this study was to propose a quantitative evaluation for mandibular opening–closing movement asymmetries and to verify the intraexaminer and interexaminer reliability using photogrammetry in individuals with and without myogenic temporomandibular disorders.MethodsForty-nine female participants between ages 18 and 40 were enrolled in this study. They were assigned to 2 different groups: a temporomandibular disorder group, (n = 25; 28.1 ± 3.6 years) and an asymptomatic group (n = 24; 25.6 ± 5.1 years). Data were collected through photogrammetry using Corel Draw X3 software (Corel Corp, Ottawa, Ontario, Canada) for angle measurements. Reliability analysis was done on the total sample, and the photographs were obtained by a singular examiner on 2 occasions (intraexaminer) 1 month apart and from measurement made by another examiner (interexaminer) on different days. The intraclass correlation coefficient (ICC) was applied with a significance level of 5%.ResultsThe photogrammetry had excellent intrarater and inter-rater reliability for the evaluation of opening and closing movements of the jaw (intrarater: opening ICC = 0.99; closing ICC = 0.98; inter-rater: opening ICC = 0.89 and closing ICC = 0.82). Photogrammetry also demonstrated excellent intra- and inter-rater reliability in the evaluation of head posture (intra-rater: head deviation ICC = 0.96; head position ICC = 0.75; inter-rater: head deviation ICC = 0.98; head position ICC = 0.98).ConclusionUnder these experimental conditions, most angular values presented excellent intra- and interexaminer reliability.     

Intrarater Reliability of Neck Strength Measurement of Rugby Union Players Using a Handheld Dynamometer

Objective

The purpose of this study was to investigate the isometric neck strength profiles of rugby union players and to assess the intrarater reliability of isometric neck strength measurement using a handheld dynamometer.

Methods

Twenty-five male, academy-level, rugby union players (forwards [n = 16], backs [n = 9]) were tested on 2 occasions during a training week 2 days apart. Isometric strength of the neck musculature was tested using a handheld dynamometer, for flexion (F), extension (E), left side flexion (LSF), and right side flexion (RSF). The average of 3 trials for each test position was used for statistical analysis. The following isometric neck strength values were obtained: F, E, F:E, LSF, RSF, LSF:RSF, and total isometric strength.

Results

Intrarater reliability intraclass correlation coefficients ranged from 0.80 to 0.92 (intraclass correlation coefficient values: F, 0.85; E, 0.85; F:E, 0.85; LSF, 0.80; RSF, 0.85; LSF:RSF, 0.91; total isometric strength, 0.92), thus indicating excellent reliability in all instances. Forwards recorded significantly greater E scores compared with backs (637.10 ± 75.15 N vs 537.87 ± 82.25 N). Forwards also recoded significantly greater total isometric neck strength scores (2151.96 ± 231.11 N vs 1814.21 ± 211.26 N).

Conclusion

The results of this study provide isometric neck strength values for the forward and back units in the rugby union and indicate that a handheld dynamometer may be a reliable tool for assessing isometric neck strength in this population.     

Inter-rater reliability of the Johns Hopkins Highest Level of Mobility Scale (JH-HLM) in the intensive care unit

BackgroundThe Johns Hopkins Highest Level of Mobility (JH-HLM) scale is used to document the observed mobility of hospitalized patients, including those patients in the intensive care unit (ICU) setting.ObjectiveTo evaluate the inter-rater reliability of the JH-HLM, completed by physical therapists, across medical, surgical, and neurological adult ICUs at a single large academic hospital.MethodsThe JH-HLM is an ordinal scale for documenting a patient’s highest observed level of activity, ranging from lying in bed (score = 1) to ambulating >250 feet (score = 8). Eighty-one rehabilitation sessions were conducted by eight physical therapists, with 1 of 2 reference physical therapist rater simultaneously observing the session and independently scoring the JH-HLM. The intraclass correlation coefficient was used to determine the inter-rater reliability.ResultsA total of 77 (95%) of 81 assessments had perfect agreement. The overall intraclass correlation coefficient for inter-rater reliability was 0.98 (95% confidence interval: 0.96, 0.99), with similar scores in the medical, surgical, and neurological ICUs. A Bland–Altman plot revealed a mean difference in JH-HLM scoring of 0 (limits of agreement: ?0.54 to 0.61).ConclusionThe JH-HLM has excellent inter-rater reliability as part of routine physical therapy practice, across different types of adult ICUs.     

Reliability and Validity of the Functional Movement Screen™ with a Modified Scoring System for Young Adults with Low Back Pain

BackgroundLow back pain (LBP) is one of the most common complaints in individuals who seek medical care and is a leading cause of movement impairments. The Functional Movement Screen (FMS™) was developed to evaluate neuromuscular impairments during movement. However, the reliability and validity of the FMS™ have not yet been established for the LBP population because of a limitation of its original scoring system.PurposeThe purposes of this study were to determine the reliability and validity of the FMS™ with a modified scoring system in young adults with and without LBP. The FMS™ scores were modified by assigning a zero score only when there was an increase in LBP during the FMS™, not simply for the presence of pain, as in the original FMS™ scoring system.Study DesignReliability and validity study.MethodsTwenty-two participants with LBP (8 males and 14 females, 26.7 ± 4.68 years old) and 22 age- and gender-matched participants without LBP (26.64 ± 4.20 years old) completed the study. Each participant performed the FMS™ once while being scored simultaneously and independently by two investigators. In addition, each participant’s FMS™ performance was video-recorded and then was scored by another two investigators separately. The video-recorded performance also was scored twice six weeks apart by the same investigator to determine intra-rater reliability.ResultsThe results showed excellent inter-rater and intra-rater reliability of the FMS™ composite score with intraclass correlation coefficients ranging from 0.93 to 0.99 for both groups. In addition, the LBP group scored significantly lower than the group without LBP (p = 0.008).ConclusionsThe results indicate that the FMS™ is able to distinguish between individuals with and without LBP, and that it could be a useful test for clinicians to quantify movement quality and to assess movement restrictions in individuals with LBP.Levels of Evidence2b.     

Reliability and Validity of the Y-balance Test in Young Adults with Chronic Low Back Pain

BackgroundIndividuals with chronic low back pain (CLBP) may demonstrate reduced ability to perform dynamic tasks due to fear of additional pain and injury in response to the movement. The Y-balance test (YBT) is a functional and inexpensive test used with various populations. However, the reliability and validity of the YBT used for assessing dynamic balance in young adults with CLBP have not yet been examined.PurposeTo determine the inter-rater reliability of the YBT and to compare dynamic balance between young adults with CLBP and an asymptomatic group.Study DesignReliability and validity study.MethodsFifteen individuals with CLBP (≥ 12 weeks) and 15 age- and gender-matched asymptomatic adults completed the study. Each group consisted of 6 males and 9 females who were 21-38 years of age (27.47 ± 5.0 years). The YBT was used to measure participant’s dynamic balance in the anterior (ANT), posteromedial (PM) and posterolateral (PL) reach directions. The scores for each participant were independently determined and recorded to the nearest centimeter by two raters. Both the YBT reach distances and composite scores were collected from the dominant leg of asymptomatic individuals and the involved side of participants with CLBP and were used for statistical analysis.ResultsThe YBT demonstrated excellent inter-rater reliability, with intraclass correlation coefficients ranging from 0.99 to 1.0 for the YBT scores of both asymptomatic and CLBP groups. The CLBP group had lower scores than those of the asymptomatic group in the reach distances of the ANT (p = 0.023), PM (p < 0.001), and PL (p = 0.001) directions, and the composite scores (p < 0.001).ConclusionsThe results demonstrated excellent inter-rater reliability and validity of the YBT for assessing dynamic balance in the CLBP population. The YBT may be a useful tool for clinicians to assess dynamic balance deficits in patients with CLBP.Level of Evidence2b.     

Intrarater and interrater reliability of the modified Thomas Test

IntroductionThe modified Thomas Test (MTT) is a method of assessing flexibility of the iliopsoas, rectus femoris and tensor fascia Latae. The aim of this study is to identify the intra and inter-rater reliability of the pass/fail scoring for the Modified Thomas Test (MTT) using digital photographs.MethodsSix raters varying between 1 and 13years of clinical experience were used to review digital photographs of 20 semi-professional rugby players performing the /MTT. Raters were asked to score each muscle of the MTT either with 0 (fail) or 1 (pass). Digital photographs were allocated in a randomized order. Each rater reviewed each photograph three times at two week intervals.ResultsCronbach's alpha (Cα) revealed a mean result of high reliability for both iliopsoas (Cα = 0.95) and rectus femoris (Cα = 1.00) flexibility. TFL flexibility values ranged from 0.64 to 0.95, demonstrating some inconsistencies within some of the 6 raters. Fleiss kappa (Fк) revealed a high mean reliability result across the 3 testing sessions for both iliopsoas (Fк = 0.78) and rectus femoris (Fк = 0.80) flexibility, along with a moderate reliability mean result for TFL (Fк = 0.56).ConclusionHigh intra and inter rater reliability was found for iliopsoas and rectus femoris flexibility with those for TFL found to be moderately reliable.     

Intra- and inter-rater reliability and validity of the Ottawa Sitting Scale: a new tool to characterise sitting balance in acute care patients

Purpose.?We present the new Ottawa Sitting Scale (OSS) developed to characterise sitting balance in the acute care setting with slow to recover patients. We provide intra- and inter-rater reliability measures of the OSS as well as a factor analysis of scale items.

Method.?Seventy-one subjects aged 21–92 years participated in this study. Original scores were compared to scores from videotaped original sessions. Performance on the OSS was compared to performance on the Berg Balance Scale (BBS) and the Physiotherapy Functional Mobility Profile (PFMP).

Results.?The intra-class correlation coefficient (ICC) obtained for intra-rater reliability was excellent at 0.99 with individual item ICCs ranging from 0.746 to 0.997. Similarly, the ICCs for inter-rater reliability were also excellent at 0.96 to 0.98 with individual item ICCs ranging from 0.723 to 0.985. In the factor analysis, two main factors accounted for 77.8% of the total item variance and could be reasonably identified as movement within base of support (BOS) and movement outside BOS. The BBS and the PFMP had floor effects for the subjects with the lowest OSS scores while there was an OSS ceiling effect corresponding to those with BBS scores of approximately 10 or more.

Conclusions.?The OSS discriminates between those subjects with low levels of sitting balance. Further studies will determine responsiveness to change, and compare the OSS with other postural control measures to identify the unique application of the OSS through the stages of recovery and rehabilitation.     

Intra- and inter-rater reliability of ultrasound measures of the anterior cruciate ligament

Diagnostic ultrasound has accurately and reliably been utilized by clinicians to determine ACL morphology at the tibial insertion site, specifically measuring the entire ACL diameter, the anteromedial bundle (AM), and the posterolateral bundle. However, intra- and inter-rater reliability of these measures in a research setting is unknown. The purpose of this study was to determine intra- and inter-rater reliability of ultrasound measures of ACL diameter and AM diameter in researchers with low-to-moderate ultrasound experience. We hypothesized that intra- and inter-rater reliability of ACL and AM diameters would reach acceptable levels, a minimal intraclass correlation (ICC) of 0.6 and a desired ICC of 0.8 with an α of 0.05 and β of 0.20. Fourteen volunteers participated in this study. During the ACL ultrasound measures, participants were seated with their knee flexed to at least 90°. Each rater recorded two images of both the right and left ACL and AM bundles. Next, participants were re-examined by rater one for intra-rater reliability analyses. Two-way random ICCs were conducted for intra-rater (between sessions) and inter-rater reliability for both the full ACL and the AM bundle diameters. Standard errors between sessions for Rater 1’s AM bundle and ACL diameters were less than 0.03 cm. Intra-rater reliability was higher in AM bundles compared to full ACL, 0.76 versus 0.59, respectively. Standard errors between Rater 1 and Rater 2 were less than 0.03 cm. Inter-rater reliability was higher in AM bundles compared to full ACL, 0.71 versus 0.41, respectively. The results of the study indicate researchers with low-to-moderate training with ultrasound measures can locate and measure the ACL, but with greater reliability using the AM.     

Psychometric properties of the scorable self-care evaluation.

OBJECTIVE: The purpose of this study was to examine evidence for the reliability and validity of the Scorable Self-Care Evaluation (SSCE), an 18-item assessment of observed and perceived self-care performance commonly used with persons with psychiatric disabilities. METHOD: As part of a longitudinal study, 70 adults with psychiatric disabilities were administered two cognitive measures, the Wisconsin Card Sorting Test and the Logical Memory subscales of the Weschler Memory Scale, at baseline, and the SSCE at follow-up. After transforming the weighted item scores, intraclass correlation coefficients were used to examine inter-rater reliability and Rasch analysis was used to examine internal consistency of the SSCE. Spearman rank-order correlations were used to examine construct validity. RESULTS: High interrater reliabilities were found for the four subscale scores (ICCs ranging from .96 to 1.00, p < .001) and the total scores (ICC = .98, p < .001) of the SSCE. Rasch analysis indicated that no items misfit; however, some items showed a weak distribution across all possible scores. The SSCE subscale and total scores correlated to varying degrees with the cognitive measures. CONCLUSION: The SSCE has the potential to be a reliable and valid clinical measure, as demonstrated by the results of the current study. However, these results were only achieved using a transformation of the current scoring system for the SSCE, pointing to the need for further revision of the test items and scoring system.     

Assessing Electronic Note Quality Using the Physician Documentation Quality Instrument (PDQI-9)

Objective

To refine the Physician Documentation Quality Instrument (PDQI) and test the validity and reliability of the 9-item version (PDQI-9).

Methods

Three sets each of admission notes, progress notes and discharge summaries were evaluated by two groups of physicians using the PDQI-9 and an overall general assessment: one gold standard group consisting of program or assistant program directors (n = 7), and the other of attending physicians or chief residents (n = 24). The main measures were criterion-related validity (correlation coefficients between Total PDQI-9 scores and 1-item General Impression scores for each note), discriminant validity (comparison of PDQI-9 scores on notes rated as best and worst using 1-item General Impression score), internal consistency reliability (Cronbach’s alpha), and inter-rater reliability (intraclass correlation coefficient (ICC)).

Results

The results were criterion-related validity (r = –0.678 to 0.856), discriminant validity (best versus worst note, t = 9.3, p = 0.003), internal consistency reliability (Cronbach’s alphas = 0.87–0.94), and inter-rater reliability (ICC = 0.83, CI = 0.72–0.91).

Conclusion

The results support the criterion-related and discriminant validity, internal consistency reliability, and inter-rater reliability of the PDQI-9 for rating the quality of electronic physician notes. Tools for assessing note redundancy are required to complement use of PDQI-9. Trials of the PDQI-9 at other institutions, of different size, using different EHRs, and incorporating additional physician specialties and notes of other healthcare providers are needed to confirm its generalizability.     

Comparison between the reliability levels of manual palpation and pressure pain threshold in children who reported orofacial pain

The aim of this study was to compare the intra- and inter-rater reliability of pressure pain threshold (PPT) and manual palpation (MP) of orofacial structures in symptomatic and symptom-free children for temporomandibular disorders (TMD). Fourteen children reporting pain in masticatory muscles or the temporomandibular joint and 16 symptom-free children were randomly assessed on three different occasions: by rater-1 in the first and third session and by rater-2 in the second session. The trained raters applied algometry and MP as recommended by the Research Diagnostic Criteria for TMD. Intraclass correlation coefficients and the Kappa statistic were used to assess the levels of reliability of PPT and MP, respectively. Excellent intra- and inter-rater reliability levels were observed for PPT values at most of the examined sites for symptom-free children and excellent and moderate reliability levels for children reporting pain. For MP, moderate and poor intra-rater and inter-rater reliability levels were observed for most sites in both groups. Algometry showed higher reliability levels for both groups of children and is recommended for pain assessment in children in association with MP.     

Reliability of Muscle Quantity and Quality Measured With Extended-Field-of-View Ultrasound at Nine Body Sites

ObjectiveMeasuring muscle quantity and quality is very important because the loss of muscle quantity and quality is associated with several adverse effects specifically in older people. Ultrasound is a method widely used to measure muscle quantity and quality. One problem with ultrasound is its limited field of view, which makes it impossible to measure the muscle quantity and quality of certain muscles. In this study, we aimed to evaluate the intra- and inter-rater reliability of extended-field-of-view (EFOV) ultrasound for the measurement of muscle quantity and quality in nine muscles of the limbs and trunk.MethodsTwo examiners took two ultrasound EFOV images with a linear probe from each of the muscle sites. The intraclass correlation coefficient (ICC) was used, and the standard error of measurement and coefficient of variation were calculated.ResultsIntra-rater reliability was good to excellent (ICC = 0.2–1.00) for all muscle measurements. The inter-rater reliability for most of the muscle measurements was good to excellent (ICC = 0.82–0.98). Inter-rater reliability was moderate (0.58–0.72) for some muscle quantity measurements of the tibialis anterior, gastrocnemius, rectus femoris, biceps femoris and triceps brachii muscles.ConclusionMuscle quantity and quality can be measured reliably using EFOV US.