RELIABILITY OF THE SITTING HAND PRESS-UP TEST FOR IDENTIFYING AND QUANTIFYING THE LEVEL OF SCAPULAR MEDIAL BORDER POSTERIOR DISPLACEMENT IN OVERHEAD ATHLETES

Background:

The lack of proper scapular kinematics can limit the function of the entire shoulder complex.^1,3 Many forms of scapular dyskinesis have been proposed along with tests to measure for the position and motion associated with those positional and movement faults (2,4-6). While scapular internal rotation has been listed among the forms of scapular dyskinesis there has not been a reliable test documented in the literature that examines this motion. The purpose of this study was to determine whether an innovative scapular medial border posterior displacement measurement device has adequate inter-rater and intra-rater reliability when used at rest and during the sitting hand press up test.

Methods:

16 male Division III baseball players free of upper limb injury for the previous 12 months participated in the study. Posterior scapular displacement measures were taken on each subject in a resting static posture and while performing a sitting hand press up test. Subjects were tested twice within 24 hours by two separate examiners. Intraclass correlation coefficients (ICC) were calculated to determine intra-rater and inter-rater reliability.

Results:

The intra-rater reliability for rater 1 was .97 (95% confidence interval [CI]= .91-.98), for the rest position and .95 (95% CI= .86-.98) for the sitting hand press-up position. Intra-rater reliability for rater 2 was .99 (95% CI= .97-.99) for the rest position and .98 (95% CI=. 95-.99) for the sitting hand press-up position. The ICCs for inter-rater reliability of the scapular medial border posterior displacement measurement in at the rest position and the sitting hand press-up position were .89 (95% CI= .81-.96) and .89 (95% CI= .80-.96) respectively.

Conclusions:

The findings of this study indicate that the measurement of medial border posterior displacement using this device demonstrates good to excellent inter-rater and intra-rater reliability.     

Scapular positioning in patients with shoulder pain: a study examining the reliability and clinical importance of 3 clinical tests

Nijs J, Roussel N, Vermuelen K, Souvereyns G. Scapular positioning in patients with shoulder pain: a study examining the reliability and clinical importance of 3 clinical tests.

Objective

To examine the interobserver reliability, internal consistency, and clinical importance of 3 clinical tests for the assessment of scapular positioning in patients with shoulder pain.

Design

Prospective repeated-measures design.

Setting

Private practices for physical therapy and hospital outpatient physical therapy divisions.

Participants

Twenty-nine patients with shoulder pain who were diagnosed by a physician as having a shoulder disorder.

Interventions

Not applicable.

Main Outcome Measures

Study participants filled in a visual analog scale for pain and the Shoulder Disability Questionnaire. Next, 2 assessors performed the following tests: measurement of the distance between the posterior border of the acromion and the table, measurement of the distance from the medial scapular border to the fourth thoracic spinous processes, and the lateral scapular slide test.

Results

The interobserver reliability coefficients were greater than .88 (intraclass correlation coefficients) for the measurement of the distance between the posterior border of the acromion and the table, were greater than .50 for the measurement of the distance from the medial scapular border to the fourth thoracic spinous processes, and were greater than .70 for the lateral scapular slide test. The Cronbach α coefficient for internal consistency for all tests was .88. No associations between the outcome of the tests and self-reported pain severity or disability were found.

Conclusions

These data provide evidence favoring the interobserver reliability of 2 of 3 tests for the assessment of scapular positioning in patients with shoulder pain. The clinical importance of the tests’ outcomes, however, is questionable.     

A NOVEL TECHNIQUE FOR DETERMINING SCAPULOHUMERAL TRANSLATION: A CASE-CONTROL AND INTER-RATER RELIABILITY STUDY

Background:

Alterations in scapular and glenohumeral kinematics in patients with shoulder dysfunction have been recognized by this studies authors'' and described in multiple other studies available in the literature. A reliability study was developed to assess a new technique for measuring scapulohumeral kinematics. Previous scapular position measuring techniques may require expensive equipment which decreases clinical utility. Other techniques require identification of multiple anatomic landmarks that may decrease accuracy, precision, and reliability.

Methods:

A sample of asymptomatic controls and symptomatic study subjects were recruited. Each subject had markers placed on each acromion and stood at a standardized distance in front of a light. The shadow projected from the acromial marker onto a standardized, data collection board was measured during the resting, flexion, and scaption positions for bilateral shoulders. The horizontal and vertical translations of the shadows were measured compared to the resting point for both flexion and scaption.

Results:

The scapula translated superiorly and medially during both flexion and scaption movements in all subjects and controls. There was good inter-rater reliability for measuring scapular translation with scaption (ICC= 0.81) and moderate reliability for measuring scapular translation with flexion (ICC = 0.62). There was increased superior and medial scapular translation in the subjects with flexion (p= 0.004 and p=0.002) and scaption (p= 0.01 and p=0.007) in the symptomatic shoulder compared to the asymptomatic shoulder. Superior scapular translation with flexion (p=0.0003) and scaption (p=0.006) and medial scapular translation with flexion (p<0.0001) and scaption (p<0.0001) was greater in the symptomatic subjects compared to controls.

Conclusions:

The scapula translates both superiorly and medially with flexion and scaption in asymptomatic and symptomatic subjects. After shoulder surgery, patients have increased superior and medial translation of the scapula compared to 1) their asymptomatic shoulder and 2) an asymptomatic control group. The current technique has good inter-rater reliability (ICC=0.81) when measuring scaption and moderate reliability when measuring flexion (ICC=0.62).

Level of Evidence:

III Diagnostic Case-Control Study     

Intraobserver reliability of angular and linear measurements of scapular position in subjects with and without symptoms

Lewis JS, Valentine RE. Intraobserver reliability of angular and linear measurements of scapular position in subjects with and without symptoms.

Objective

To assess intraobserver reliability of angular and linear clinical measurements of scapular position.

Design

Test-retest analyses.

Setting

Outpatient department in National Health Service teaching hospital in the United Kingdom.

Participants

Subjects (n=45) without symptoms (21 men, 24 women; age range, 23-56y) and 45 subjects (22 men, 23 women; age range, 19-84y) with shoulder symptoms (defined as pain in the C5-6 dermatome reproduced by shoulder movement and not reproduced with cervical movement).

Interventions

Not applicable.

Main Outcome Measures

Intraclass correlation coefficient (ICC) models 2,1 and 2,3, 95% confidence intervals (CIs), and SE of measurements for 68% confidence and 2 SEs of measurement (for the 95% CI) for the bilateral angular measurements of scapular rotation and tilt, and the bilateral linear measurements of lateral scapular displacement (protraction) and vertical displacement (elevation).

Results

For subjects without symptoms, ICC_2,3 results ranged from .75 to .98. The 2 SE results for the angular movements ranged from 1.8° to 2.4° and from 0.4 to 1.0cm for the direct linear measurements. Subjects with symptoms: ICC_2,3 results ranged from .61 to .98. The 2 SE results for the angular movements ranged from 1.4° to 2° and from 0.6 to 1cm for the direct linear measurements.

Conclusions

Repeated-measure (ICC_2,3) results were more reliable than single-measure (ICC_2,1) results. Very good to excellent intraobserver reliability was demonstrated for the angular and linear measurements of interest in both shoulders of subjects with and without symptoms. The 2 SE results provide guidance about the error associated with the individual measurements and will assist the clinician determining whether a change in the static position of the scapula has occurred as a result of intervention or over time. (National Research Register identifier N0060148286.)     

EVALUATING CHANGE IN CLINICAL STATUS: RELIABILITY AND MEASURES OF AGREEMENT FOR THE ASSESSMENT OF GLENOHUMERAL RANGE OF MOTION

Objectives:

To evaluate intra-rater and inter-rater reliability and measurement error in glenohumeral range of motion (ROM) measurements using a standard goniometer.

Study design:

17 adult subjects with and without shoulder pathology were evaluated for active and passive range of motion. Fifteen shoulder motions were assessed by two raters to determine reliability. The intra-class correlation coefficients (ICC) were calculated and examined to determine if reliability of ICC ≥ 0.70 existed. The standard error of measurement (SEM) and the minimal clinical difference (MCD) were also calculated.

Results:

Thxe criterion reliability was achieved in both groups for intra-rater reliability of standing AROM abduction; supine AROM and PROM abduction, flexion, external rotation at 0° abduction; and for inter-rater reliability of supine AROM and PROM abduction, external rotation at 0° abduction. The SEM ranged from 4°-7° for intra-rater and 6°-9° for inter-rater agreement on movements that achieved the criterion reliability. The MCD ranged from 11°-16° for a single evaluator and 14°-24° for two evaluators.

Conclusions:

Assessment of AROM and PROM in supine achieves superior reliability. The use of either a single or multiple raters affects the number of movements that achieved clinically meaningful reliability. Some movements consistently did not achieve the criterion and may not be the best movements to monitor treatment outcome.     

Intra-rater and inter-rater reliabilities of real-time acceleration gait analysis system

Purpose: The purposes of this study were to construct a real-time acceleration gait analysis system equipped with software to analyse real-time trunk acceleration during walking and to examine the intra-rater and inter-rater reliabilities of the this system. Methods: This system has been comprised of an accelerometer, an acceleration amplifier, a transmitter, two foot switches, a receiver and a personal computer installed with the real-time acceleration analysis software. The acceleration signals received were analysed using the real-time acceleration analysis software, and gait parameters were calculated. The subjects were 20 healthy individuals and two raters. The intra-rater and inter-rater reliabilities of the measurement results obtained from this system were examined by performing intraclass correlation coefficients (ICC) and Bland–Altman analysis. Results: The intra-rater and inter-rater ICCs ranged from 0.61 to 0.92 in any gait parameters. In the Bland–Altman analysis, neither fixed nor proportional bias was found in any of the gait parameters. Conclusions: From the ICC and Bland–Altman analysis results, the gait measurement using this system clearly demonstrates that the intra-rater and inter-rater measurements had good reproducibility. Owing to this system, we can improve the clinical efficiency of gait analysis and gait training for physiotherapy.

• Implication for Rehabilitation

• This study focused on the advantage of a gait analysis method using an accelerometer and constructed a gait analysis system that calculates real-time gait parameters from trunk acceleration measurements during walking. The gait analysis using this system has good intra-rater and inter-rater reliabilities, and using this system can improve the clinical efficiency of gait analysis and gait training.

     

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-rater and Inter-rater Reliability of Mandibular Range of Motion Measures Considering a Neutral Craniocervical Position

[Purpose] The aim of this study was to determine the inter-rater and intra-rater reliability of the mandibular range of motion (ROM) considering the neutral craniocervical position when performing the measurements. [Subjects and Methods] The sample consisted of 50 asymptomatic subjects. Two raters measured four mandibular ROMs (maximal mouth opening (MMO), laterals, and protrusion) using the craniomandibular scale. Subjects alternated between raters, receiving two complete trials per day, two days apart. Intra- and inter-rater reliability was determined using intra-class correlation coefficients (ICCs). Bland-Altman analysis was used to assess reliability, bias, and variability. Finally, the standard error of measurement (SEM) and minimal detectable change (MDC) were analyzed to measure responsiveness. [Results] Reliability was good for MMO (inter-rater, ICC= 0.95−0.96; intra-rater, ICC= 0.95−0.96) and for protrusion (inter-rater, ICC= 0.92−0.94; intra-rater, ICC= 0.93−0.96). Reliability was moderate for lateral excursions. The MMO and protrusion SEM ranged from 0.74 to 0.82 mm and from 0.29 to 0.49 mm, while the MDCs ranged from 1.73 to 1.91 mm and from 0.69 to 0.14 mm respectively. The analysis showed no random or systematic error, suggesting that effect learning did not affect reliability. [Conclusion] A standardized protocol for assessment of mandibular ROM in a neutral craniocervical position obtained good inter- and intra-rater reliability for MMO and protrusion and moderate inter- and intra-rater reliability for lateral excursions.Key words: Reliability, Range of motion, Temporomandibular joint     

Reliability of different methodologies of infrared image analysis of myofascial trigger points in the upper trapezius muscle

BACKGROUND:

Infrared thermography is recognized as a viable method for evaluation of subjects with myofascial pain.

OBJECTIVE:

The aim of the present study was to assess the intra- and inter-rater reliability of infrared image analysis of myofascial trigger points in the upper trapezius muscle.

METHOD:

A reliability study was conducted with 24 volunteers of both genders (23 females) between 18 and 30 years of age (22.12±2.54), all having cervical pain and presence of active myofascial trigger point in the upper trapezius muscle. Two trained examiners performed analysis of point, line, and area of the infrared images at two different periods with a 1-week interval. The intra-class correlation coefficient (ICC_2,1) was used to assess the intra- and inter-rater reliability.

RESULTS:

With regard to the intra-rater reliability, ICC values were between 0.591 and 0.993, with temperatures between 0.13 and 1.57 °C for values of standard error of measurement (SEM) and between 0.36 and 4.35 °C for the minimal detectable change (MDC). For the inter-rater reliability, ICC ranged from 0.615 to 0.918, with temperatures between 0.43 and 1.22 °C for the SEM and between 1.19 and 3.38 °C for the MDC.

CONCLUSION:

The methods of infrared image analyses of myofascial trigger points in the upper trapezius muscle employed in the present study are suitable for clinical and research practices.     

The Sport Injury Rehabilitation Adherence Scale: a reliable scale for use in clinical physiotherapy

Objective

To evaluate, through two studies, the factor structure, inter-rater agreement, and test-retest and inter-rater reliability of the Sport Injury Rehabilitation Adherence Scale (SIRAS).

Design

Repeated measures design in both Study 1 (video evaluation) and Study 2 (clinical evaluation).

Setting

University department (Study 1) and outpatient physiotherapy department (Study 2).

Participants

Sixty physiotherapists and physiotherapy students in Study 1 and 45 patients undergoing physiotherapy treatment for a musculoskeletal injury in Study 2.

Intervention

In Study 1, participants rated the adherence of a simulated videotaped patient demonstrating high, moderate and low adherence during rehabilitation. In Study 2, two physiotherapists rated the adherence of patients at two consecutive rehabilitation sessions.

Main outcome measure

The SIRAS.

Results

In Study 1, principal components analysis confirmed a single factor for the SIRAS, and inter-rater agreement values ranged from 0.87 to 0.93. In Study 2, inter-rater and test-retest reliability coefficients ranged from 0.76 [95% confidence interval (CI) 0.54 to 0.83] to 0.89 (95% CI 0.79 to 0.95), and from 0.63 (95% CI 0.36-0.82) to 0.76 (95% CI 0.55-0.88), respectively.

Conclusion

The SIRAS is a reliable measure with high inter-rater agreement when used to evaluate clinic-based adherence to physiotherapy rehabilitation for musculoskeletal injury.     

Assessment of undergraduate physiotherapist clinical performance: investigation of educator inter-rater reliability

Objectives

To investigate the inter-rater reliability of physiotherapy educators in awarding clinical placement marks to undergraduate students using a standardised clinical placement assessment form.

Design

Inter-rater reliability study performed over five undergraduate physiotherapy clinical placements.

Setting

Five clinical sites associated with a BSc undergraduate physiotherapy programme.

Participants

Second and final year physiotherapy students who were on clinical placements (n = 86 paired assessments). Two physiotherapy educators (a practice tutor and a practice educator), equally involved in supervising the students over the placement period, marked each student blindly at the end of the placement.

Outcome measure

Marking was performed using a standardised clinical placement assessment form and guidelines. This form was developed by physiotherapy educators, and utilised previously published work in the area.

Results

Eighty-six paired assessment marks were analysed. Practice educators and practice tutors agreed on grades on 74% of occasions. The mean difference in marks (maximum of 100) between educators was −0.5 (95% confidence interval −1.1 to 0.2), and using the limits of agreement method, the results suggested that where two raters mark a student at the end of a clinical placement, the raters will be within 6.2 marks of each other on 95% of occasions. The intraclass correlation coefficient (ICC) for the overall mark was 0.84, indicating almost perfect agreement. Subsections of the form also had substantial agreement (patient management ICC, 0.75; professional development ICC, 0.75; organisation and management ICC, 0.81).

Conclusion

Physiotherapy educators demonstrated a high level of reliability in the assessment and marking of undergraduate physiotherapy student performance using a standardised clinical assessment form. This was evident over several sites and specialities.     

Inter-rater reliability study of the modified Oxford Grading Scale and the Peritron manometer

Objective

To evaluate the inter-rater reliability of the modified Oxford Grading Scale and the Peritron manometer.

Design

All participants were evaluated twice, first by one examiner and 30 days later by a second examiner. Measurements of vaginal squeeze pressure were compared with the results from the palpation test.

Participants

Nineteen women with a mean age of 23.7 years (range 21 to 28 years).

Results

Inter-rater reliability for vaginal palpation was fair (κ = 0.33, 95% confidence interval 0.09 to 0.57). Using the Peritron manometer, the difference between examiners was less than 10 cmH₂O in 11 of the 19 (58%) cases. The palpation test did not differentiate between weak, moderate, good and strong muscle contractions. This study found fair inter-rater reliability for the modified Oxford Grading Scale and moderate inter-rater reliability for the Peritron manometer.

Conclusions

The inter-rater reliability of vaginal squeeze pressure measurement using the Peritron manometer is acceptable and can be used in re-evaluations performed by different examiners in clinical practice. However, for research purposes, the ideal situation would be for a single examiner to assess and re-assess the subject. Vaginal palpation is important in the clinical assessment of correctness of a pelvic floor muscle contraction, but this study does not support the use of the modified Oxford Grading Scale as a reliable and valid method to measure and differentiate pelvic floor muscle strength.     

The Effects of Scapulothoracic Bursa Injections in Patients With Scapular Pain: A Pilot Study

Chang WH, Im SH, Ryu JA, Lee SC, Kim JS. The effects of scapulothoracic bursa injections in patients with scapular pain: a pilot study.

Objective

To assess the effects of steroid plus hyaluronate injections for scapulothoracic bursitis in patients with scapular pain.

Design

Prospective open-label unicenter trial with a 3-month follow-up.

Setting

University rehabilitation hospital.

Participants

Twenty-two cases of suspected scapulothoracic bursitis.

Intervention

Injections into scapulothoracic bursa were performed with steroid plus hyaluronate. Injections were administered once a week for 3 weeks.

Main Outcome Measures

Visual analog scale (VAS), Rubin scale, adverse events, and injection-associated complications.

Results

Mean outcome scores at 3-month follow-up visits showed significant improvements versus baseline (mean VAS increased from 7.8 to 2.2) (P<.05). Furthermore, mean VAS scores at 1, 2, and 3 weeks after treatment commencement showed significant improvements versus baseline (P<.05). No serious complication occurred during the study.

Conclusions

Scapulothoracic bursitis should be considered when treating patients with perimarginal scapular pain or subscapular pain. Our findings show that steroid plus hyaluronate injections into the scapulothoracic bursa provide an effective means of treating patients with scapulothoracic bursitis.     

Test-Retest Reliability of Discrete Gait Parameters in Children With Cerebral Palsy

Klejman S, Andrysek J, Dupuis A, Wright V. Test-retest reliability of discrete gait parameters in children with cerebral palsy.

Objectives

To examine the test-retest reliability of discrete gait parameters in children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels I, II, and III; to calculate the measurement error between testing sessions of these parameters in the total sample and within GMFCS subgroups using the standard error of measurement; and to evaluate the minimal detectable change (MDC) to identify discrete gait parameters that are most sensitive to change in children with CP.

Design

Test-retest reliability study.

Setting

Rehabilitation facility with human movement laboratory.

Participants

Ambulatory children with CP (N=28).

Interventions

Not applicable.

Main Outcome Measures

Intraclass correlation coefficients (ICCs), standard error of measurement, and MDC of discrete gait parameters.

Results

Parameters measured in the sagittal plane and temporal-spatial parameters were highly reliable across all GMFCS levels (ICC range, .84-.97), while test-retest reliability in the frontal and transverse planes varied from poor to excellent (ICC range, .46-.91). Using MDC as a guide, hip and pelvis parameters in the transverse and frontal planes were least responsive for GMFCS levels I and III (MDC ranges, 8.3°-18.0° and 2.7°-23.4°, respectively), whereas ankle kinematics were the least responsive for level II (MDC range, 8.2°-11.9°). Reliability was dependent on mobility level, with children in GMFCS level III exhibiting greater test-retest variability overall.

Conclusions

Our findings suggest that select discrete gait parameters measured using computerized gait analysis are reliable and potentially responsive measures of performance and can be used as outcome measures in intervention studies.     

5-Repetition Sit-to-Stand Test in Subjects With Chronic Stroke: Reliability and Validity

Mong Y, Teo TW, Ng SS. 5-repetition sit-to-stand test in subjects with chronic stroke: reliability and validity.

Objectives

To examine the (1) intrarater, interrater, and test-retest reliability of the 5-repetition sit-to-stand test (5-repetition STS test) scores, (2) correlation of 5-repetition STS test scores with lower-limb muscle strength and balance performance, and (3) cut-off scores among the 3 groups of subjects: the young, the healthy elderly, and subjects with stroke.

Design

Cross-sectional study.

Setting

University-based rehabilitation center.

Participants

A convenience sample of 36 subjects: 12 subjects with chronic stroke, 12 healthy elderly subjects, and 12 young subjects.

Interventions

Not applicable.

Main Outcome Measures

5-Repetition STS test time scores; hand-held dynamometer measurements of hip flexors, and knee flexors and extensors; ankle dorsiflexors and plantarflexors muscle strength; Berg Balance Scale (BBS); and limits of stability (LOS) test using dynamic posturography.

Results

Excellent intrarater reliability of intraclass correlation coefficient (ICC) (range, .970-.976), interrater reliability (ICC=.999), and test-retest reliability (ICC range, .989-.999) were found. Five-repetition STS test scores were also found to be significantly associated with the muscle strength of affected and unaffected knee flexors (ρ=-.753 to -.830; P<.00556) of the subjects with stroke. No significant associations were found between 5-repetition STS test and BBS and LOS tests in subjects with stroke. Cut-off scores of 12 seconds were found to be discriminatory between healthy elderly and subjects with stroke at a sensitivity of 83% and specificity of 75%.

Conclusions

The 5-repetition STS test is a reliable measurement tool that correlates with knee flexors muscle strength but not balance ability in subjects with stroke.     

Reliability and responsiveness of a goniometric device for measuring the range of motion in the dart-throwing motion plane

Background: Dart-throwing motion (DTM) is an important component of wrist function and, consequently, has the potential to become an evaluation tool in rehabilitation. However, no measurement method is currently available to reliably measure range of motion (ROM) of the wrist in the DTM plane. Objectives: To determine the reliability and responsiveness of a goniometric device to measure wrist ROM in the DTM plane. Methods: ROM of the wrist in the DTM plane was measured in 70 healthy participants. The intra-class correlation coefficient (ICC) was used to evaluate the relative reliability of measurement, and a Bland–Altman analysis conducted to establish its absolute reliability, including the 95% limits of agreement (95% LOA). The standard error of the measurement (SEM) and minimal detectable change at the 95% confidence level (MDC₉₅) were calculated as measures of responsiveness. Results: The intra-rater ICC was 0.87, and an inter-rater ICC of 0.71. There was no evidence of a fixed or proportional bias. For intra- and inter-rater reliability, 95% LOA ranged from ?13.83 to 11.12 and from ?17.75 to 16.19, respectively. The SEM and MDC₉₅ were 4.5° and 12.4°, respectively, for intra-rater reliability, and 6.0° and 16.6°, respectively, for inter-rater reliability. Conclusion: The ROM of the wrist in the DTM plane was measured with fair-to-good reliability and responsiveness and, therefore, has the potential to become an evaluation tool for rehabilitation.     

Reliability of the Dynamic Gait Index (Finnish version) in individuals with neurological disorders

Purpose: To produce a Finnish version of the Dynamic Gait Index (DGI) and establish its reliability in people with neurological disorders affecting balance. Method: A consecutive sample of 33 participants in inter-rater and 30 participants in intra-rater sample were tested. The DGI was administered in two testing sessions 1–2?h apart. Reliability was assessed with the intra-class correlation coefficient (ICC), Bland–Altman 95% limits of agreement, coefficient of reproducibility (CR), and standard error of the mean (SEM). Results: The instructions from the original DGI were preserved during the translation process with no need for cultural adaptations. The relative reliability of the total scores proved to be high in inter-rater (ICC?=?0.90) and intra-rater (ICC?=?0.91) testing. The relative reliability between single items varied from poor to high in inter-rater (r?=?0.57–0.96) and intra-rater (r?=?0.20–0.97) testing. Absolute reliability of the total score was high, and in single items, it varied similarly to relative reliability. The SEM was 1.2 points in inter-rater and 0.8 points in intra-rater testing. Conclusions: The Finnish version of DGI was produced and found to be a reliable tool for clinical testing of balance in neurological patients with balance disorder.

Implications for Rehabilitation

• The Dynamic Gait Index (DGI) is a promising test for the fall-risk evaluation, since it is a standardized tool for evaluating the quality of dynamic balance during walking and an individual’s ability to modify walking in different kinds of situations and dual tasks.

• In this study, the Finnish version of the DGI was produced and the total score was reliable. Thus, the Finnish DGI can be recommended for clinical testing in individuals with neurological diseases involving balance disorder.

     

Standardized voluntary force measurement in a lower extremity rehabilitation robot

Background

Isometric force measurements in the lower extremity are widely used in rehabilitation of subjects with neurological movement disorders (NMD) because walking ability has been shown to be related to muscle strength. Therefore muscle strength measurements can be used to monitor and control the effects of training programs. A new method to assess isometric muscle force was implemented in the driven gait orthosis (DGO) Lokomat. To evaluate the capabilities of this new measurement method, inter- and intra-rater reliability were assessed.

Methods

Reliability was assessed in subjects with and without NMD. Subjects were tested twice on the same day by two different therapists to test inter-rater reliability and on two separate days by the same therapist to test intra-rater reliability.

Results

Results showed fair to good reliability for the new measurement method to assess isometric muscle force of lower extremities. In subjects without NMD, intraclass correlation coefficients (ICC) for inter-rater reliability ranged from 0.72 to 0.97 and intra-rater reliability from 0.71 to 0.90. In subjects with NMD, ICC ranged from 0.66 to 0.97 for inter-rater and from 0.50 to 0.96 for intra-rater reliability.

Conclusion

Inter- and intra- rater reliability of an assessment method for measuring maximal voluntary isometric muscle force of lower extremities was demonstrated. We suggest that this method is a valuable tool for documentation and controlling of the rehabilitation process in patients using a DGO.     

Gift exchange and organ donation: donor and recipient experiences of live related kidney transplantation

Background

Live transplantation presents many stressors for donors and recipients, yet a holistic understanding of the process, from both perspectives, is limited. Gift exchange is a theory governed by the principles of giving, receiving and reciprocating and has many similarities with the process of organ transplantation. It may therefore provide a framework for understanding donor and recipient experiences of live kidney transplantation. However, the relevance of this theory to live kidney transplantation has not previously been properly explored.

Objectives

To gain a theoretical understanding of the live transplantation experience from the perspectives of donors and recipients.

Design

A phenomenological, longitudinal study.

Participants

All donors and their recipients undergoing live kidney transplantation in a regional renal transplant centre in South-West England (between July 2003 and February 2004) were invited to participate in this study. Of this cohort, 11 families (n = 55%) volunteered to participate.

Methods

Data were collected through a series of 3 recorded, semi-structured interviews with donors and recipients. Interviews were conducted pre transplant and at 3 and 10 months post transplant. Data were analysed using a process of thematic content analysis. Findings were also considered within a theoretical framework of gift exchange.

Results

All donors initially made an instantaneous, voluntary decision to donate and found the decision relatively easy to make. In contrast, recipients found accepting the donors’ offer arduous, because of concern for their wellbeing. They were only able to accept the transplant after discussing the matter with their donor and establishing that it was something that they wanted to do. Recipients’ lives were transformed by a successful transplant and they were subsequently very grateful to the donors for donating. Donors derived immense personal satisfaction from this outcome and it helped to confirm to them that what they had done had been worthwhile. The transplant did not have a detrimental effect on donor-recipient relationships.

Conclusions

The concept of gift exchange provides a logical explanation of donor and recipients experiences in this study, particularly in relation to factors that influence giving, receiving and reciprocating. This understanding should help health professionals assist donors, recipients and their families throughout this process.