ASIA2000标准信度初步分析

目的测定ASIA2000标准的重测信度和评测者间一致性。方法对我院2004年4月在院的脊髓损伤患者按照入选标准筛选出25例进行信度分析，由同一检查者于第1次记录后1周使用ASIA2000标准进行再次评定，测定重测信度。同一组患者由另一名专科医师于第1次记录后24h进行检查，测定评定者间一致性。结果重测信度为，针刺觉评分、触觉评分、运动评分的Pearson相关系数均〉0．90（P〈0．05）；残损分级和损伤完全性测定的Kappa值分别为0．787和0．756（P〈0．05）；评测者间一致性为，针刺觉评分、触觉评分、运动评分的Pearson相关系数均〉0．85（P〈00．05）；残损分级和损伤完全性测定的Kappa值分别为0．802和0．764（P〈0．05）。结论ASIA2000标准各项目具有较高的重测信度和评测者间一致性。     

Intra-rater reliability of measurement of abdominal perimuscular connective tissue thickness on ultrasound images

[Purpose] The thickness of the perimuscular connective tissue (PMCT) reflects muscular atrophy and decreased flexibility that may cause low back pain. However, few studies have used ultrasound imaging to measure PMCT thickness. We aimed to examine and confirm the reliability of ultrasound in measuring the thickness of the PMCT of the abdominal wall muscle. [Participants and Methods] The participants were 38 healthy adult males without chronic back pain. The images were acquired in B mode with the participants in the supine position and the PMCT thickness of the abdominal wall muscle was measured on the images. The intraclass correlation coefficient (ICC) was used to confirm reliability. [Results] The ICC for both within-day and between-day PMCT measurements by ultrasound were 0.7–0.9. The 95% confidence interval ranged from 0.5–0.9. The standard error of measurement (SEM) was 0.02–0.1 mm in the abdominal wall muscle and 0.5 mm in the interrecti distance (IRD). The 95% confidence interval (95% CI) of the minimum detectable change (MDC95) was 0.1–0.3 mm in the abdominal wall muscle and 1.3–1.4 mm in the IRD. [Conclusion] We conducted a study to confirm the reliability of ultrasound-based measurement of PMCT thickness of the abdominal wall muscle, and the ICC results established reliability. However, since the values measured were small (0.02–1.4 mm) and there is a limit to visual observation, it was necessary to measure using computer software.Key words: Ultrasound measurement, Perimuscular connective tissue, Reliability     

Intra-rater Reliability of a Qualitative Landing Scale for the Single-Hop Test: A Pilot Study

BackgroundThe test battery classically used for return-to-sport (RTS) decision-making after anterior cruciate ligament (ACL) reconstruction (ACLR) may not be sufficient, as it does not include a qualitative analysis of movement. Therefore, the Landing Error Scoring System (LESS) scale was adapted to a primary functional test in the typical RTS test battery: the single leg hop for distance (SHD).Hypothesis/ PurposeThe aim of this study was to determine the intra-rater reliability of the LESS scale adapted to the SHD (SHD-LESS scale) in healthy young athletes.Study DesignReliability analysisMethodsNineteen healthy individuals (14 men, 5 women; mean age: 22.4 years) participated in the study. Participants performed the SHD tasks on both limbs (dominant and non-dominant) using a standardized protocol in two sessions that were one week apart (single reviewer; 2-dimensional video). Intra-class correlation coefficients (ICC2,1) were used to measure the reproducibility of the scale in the dominant (dom) and non-dominant (nondom) limbs. Additionally, limb data (dom and nondom) were pooled and evaluated collectively with intra-class correlation coefficients. The Kappa coefficient was used to assess the reproducibility of each individual item of SHD-LESS scale.ResultsThe intra-rater reliability was good (ICCdom = 0.77; ICCnondom = 0.87; ICCpooled = 0.87) for the overall SHD-LESS scale scores. Agreement of SHD-LESS individual items ranged from 62% to 100%. Dorsiflexion at initial contact (97% agreement; kappa value=0.79) and knee valgus after landing (88% agreement; kappa value=0.65) had excellent agreement and kappa values.ConclusionThe newly-adapted SHD-LESS scale showed good intra-rater reliability overall. Further studies should evaluate the impact of using the SHD-LESS scale within the RTS test battery on outcomes in patients after ACLR.Level of Evidence3     

Reliability of Measures of Scapular Protraction Strength in the Supine and Seated Positions

[Purpose] The purpose of this study was to investigate the intra-rater reliability of measures of scapular protraction strength using a novel method. [Subjects] Forty-nine healthy subjects participated in this study. [Methods] Subjects performed maximal isometric scapular protraction on the left and right sides in the supine and seated positions. During scapular protraction, resistance was applied to the olecranon, and the strength of scapular protraction was measured using a load cell. Intra-rater reliability was calculated as the intra-class correlation coefficient (ICC_3,1). [Results] High intra-rater reliability scores (0.97–0.98) for scapular protraction strength were observed in the supine and seated positions. [Conclusion] These findings demonstrate that the method described herein may provide a more reliable and convenient method to measure scapular protraction strength than common current practice does.Key words: Reliability, Scapular protraction, Serratus anterior     

Reliability and Measurement error of Active Knee extension Range of Motion in a Modified slump Test Position: A Pilot study

Abstract

The slump test is a tool to assess the mechanosensitivity of the neuromeningeal structures within the vertebral canal. While some studies have investigated the reliability of aspects of this test within the same day, few have assessed the reliability across days. Therefore, the purpose of this pilot study was to investigate reliability when measuring active knee extension range of motion (AROM) in a modified slump test position within trials on a single day and across days. Ten male and ten female asymptomatic subjects, ages 20–49 (mean age 30.1, SD 6.4) participated in the study. Knee extension AROM in a modified slump position with the cervical spine in a flexed position and then in an extended position was measured via three trials on two separate days. Across three trials, knee extension AROM increased significantly with a mean magnitude of 2° within days for both cervical spine positions (P>0.05). The findings showed that there was no statistically significant difference in knee extension AROM measurements across days (P>0.05). The intraclass correlation coefficients for the mean of the three trials across days were 0.96 (lower limit 95% CI: 0.90) with the cervical spine flexed and 0.93 (lower limit 95% CI: 0.83) with cervical extension. Measurement error was calculated by way of the typical error and 95% limits of agreement, and visually represented in Bland and Altman plots. The typical error for the cervical flexed and extended positions averaged across trials was 2.6° and 3.3°, respectively. The limits of agreement were narrow, and the Bland and Altman plots also showed minimal bias in the joint angles across days with a random distribution of errors across the range of measured angles. This study demonstrated that knee extension AROM could be reliably measured across days in subjects without pathology and that the measurement error was acceptable. Implications of variability over multiple trials are discussed. The modified set-up for the test using the Kincom dynamometer and elevated thigh position may be useful to clinical researchers in determining the mechanosensitivity of the nervous system.     

Reliability and Measurement Error of Active Knee Extension Range of Motion in a Modified Slump Test Position: A Pilot Study

The slump test is a tool to assess the mechanosensitivity of the neuromeningeal structures within the vertebral canal. While some studies have investigated the reliability of aspects of this test within the same day, few have assessed the reliability across days. Therefore, the purpose of this pilot study was to investigate reliability when measuring active knee extension range of motion (AROM) in a modified slump test position within trials on a single day and across days. Ten male and ten female asymptomatic subjects, ages 20–49 (mean age 30.1, SD 6.4) participated in the study. Knee extension AROM in a modified slump position with the cervical spine in a flexed position and then in an extended position was measured via three trials on two separate days. Across three trials, knee extension AROM increased significantly with a mean magnitude of 2° within days for both cervical spine positions (P>0.05). The findings showed that there was no statistically significant difference in knee extension AROM measurements across days (P>0.05). The intraclass correlation coefficients for the mean of the three trials across days were 0.96 (lower limit 95% CI: 0.90) with the cervical spine flexed and 0.93 (lower limit 95% CI: 0.83) with cervical extension. Measurement error was calculated by way of the typical error and 95% limits of agreement, and visually represented in Bland and Altman plots. The typical error for the cervical flexed and extended positions averaged across trials was 2.6° and 3.3°, respectively. The limits of agreement were narrow, and the Bland and Altman plots also showed minimal bias in the joint angles across days with a random distribution of errors across the range of measured angles. This study demonstrated that knee extension AROM could be reliably measured across days in subjects without pathology and that the measurement error was acceptable. Implications of variability over multiple trials are discussed. The modified set-up for the test using the Kincom dynamometer and elevated thigh position may be useful to clinical researchers in determining the mechanosensitivity of the nervous system.Key Words: Modified Slump Test, Knee Extension, Within-Trial Reliability, Reliability across Days, Measurement ErrorMaitland¹ proposed the slump test as a tool to assess the mechanosensitivity of the neuromeningeal structures within the vertebral canal. This test and other tests of neuromeningeal structures, such as the upper limb tension tests have been described as “neurodynamic” or “neural provocation” tests^2–4. A neural provocation test is a sequence of movements designed to assess the mechanics and physiology of that part of the nervous system by elongation of the nerve⁴. Physical therapists have found the slump test both a useful test and intervention in patients who present with spinal or lower limb pain^3,5,6. However, in these neurodynamic tests, a number of structures may be responsible for the pain elicited during the test sequence. Many of these nerve tissues interface or run alongside various mono- and poly-articular joint structures that may be mechanically stressed with neural provocation tests, so the sequence and order of the loading components needs to be well controlled in order to differentiate between these structures⁴.While trying to control all the elements of this test or treatment procedure, clinicians may ask the patient to actively extend the knee to increase tension to the neural components⁵. Knee extension range of motion (ROM) has been used as a dependent variable to quantify the slump test^1,8–12. Values of 16–35.4° short of full knee extension have been observed in the slump position^7–9,11,12; these restrictions in knee extension ROM decreased when the neck was extended. From a treatment perspective, some authors have modified the slump position and have placed the patient in long sitting in order to control the knee extension range of motion and have then used cervical flexion as the variable to be altered⁶. It could be argued that this position places significant stress through the neural components of the test and is more useful as a progression towards the end stages of treatment. However, patients who cannot tolerate this position may require an alternative position. One possible alternative position might be to increase the amount of hip flexion and combine this with knee extension. Whereas some patients might be unable to even assume the long sitting position due to other bi-articular influences, using knee extension in a modified slump sitting position with increased hip flexion as described above would reduce the influence that the other polyarticular structures (most notably limitations in hamstring muscle length) have on the outcomes of the test sequence. With those subjects unable to attain full knee extension, this position also eliminates the effect that mono-articular (mainly capsuloligamentous) restraints might have on the amount of knee extension.Coppieters et al⁴ have commented that high reliability and small measurement error is required to render a test (such as neuromeningeal tests) suitable for clinical practice and experimental studies. Two earlier studies have assessed the reliability of the slump test. Phillips et al⁵ studied interrater agreement for the slump test in patients with low back and leg symptoms. These authors reported a κ-value of 0.89 (95% CI: 0.81-0.97) for mean pair-wise interrater agreement on a positive or negative test finding when defining a positive slump test as symptom reproduction and subsequent decrease with cervical extension, whereas adding increased knee extension ROM as a criterion for a positive slump test yielded a mean κ = 0.83 (95% CI: 0.75–0.91). More similar to the current study, Yeung et al¹¹ studied the reliability of instrumented goniometric measurement of knee extension AROM limited by symptom response during slump sitting, but they did not clarify if the measures for this pilot reliability study were taken from asymptomatic controls or subjects with post-whiplash syndrome. They reported excellent intrarater (r = 0.940) and, for one pair of raters, good interrater agreement (r = 0.854). However, neither of these studies undertook testing of the respective slump test parameters across more than one day. Therefore, the purpose of this pilot study was to investigate the measurement error and the reliability of measurements within trials on a single day and across days of knee extension AROM in a modified slump test position involving increased hip flexion. We hypothesized that this position would be reliable as a test procedure in that it would have small measurement error and that it would show little variation within and across days.     

The Intra- and Inter-rater Reliabilities of the Forward Head Posture Assessment of Normal Healthy Subjects

[Purpose] Assessment of posture is an important goal of physical therapy interventions for preventing the progression of forward head posture (FHP). The purpose of this study was to determine the inter- and intra-rater reliabilities of the assessment of FHP. [Subjects and Methods] We recruited 45 participants (20 male subjects, 25 female subjects) from a university student population. Two physical therapists assessed FHP using images of head extension. FHP is characterized by the measurement of angles and distances between anatomical landmarks. Forward shoulder angle of 54° or less was defined as FHP. Intra- and inter-rater reliabilities were estimated using Kendall’s Taub correlation coefficients. [Results] Intra-class correlation of intra-rater measurements indicated an excellent level of reliability (0.91), and intra-class correlation of inter-rater measurements showed a good level of reliability in the assessment of FHP (0.75). [Conclusion] Assessment of FHP is an important component of evaluation and affects the design of the treatment regimen. The assessment of FHP was reliably measured by two physical therapists. It could therefore become a useful method for assessing FHP in the clinical setting. Future studies will be needed to provide more detailed quantitative data for accurate assessment of posture.Key words: Forward head posture, Reliability, Posture assessment     

Reliability of the Craniocervical Posture Assessment: Visual and Angular Measurements Using Photographs and Radiographs

ObjectiveThe purposes of this study were to determine the intrarater and interrater reliability of the craniocervical posture in a sagittal view using quantitative measurements on photographs and radiographs and to determine the agreement of the visual assessment of posture between raters.MethodsOne photograph and 1 radiograph of the sagittal craniocervical posture were simultaneously taken from 39 healthy female subjects. Three angles were measured on the photographs and 10 angles on the radiographs of 22 subjects using Alcimage software (Alcimage; Uberlândia, MG, Brazil). Two repeated measurements were performed by 2 raters. The measurements were compared within and between raters to test the intrarater and interrater reliability, respectively. Intraclass correlation coefficient and SEM were used. κ Agreement was calculated for the visual assessment of 39 subjects using photographs and radiographs between 2 raters.ResultsGood to excellent intrarater and interrater intraclass correlation coefficient values were found on both photographs and radiographs. Interrater SEM was large and clinically significant for cervical lordosis photogrammetry and for 1 angle measuring cervical lordosis on radiographs. Interrater κ agreement for the visual assessment using photographs was poor (κ = 0.37).ConclusionThe raters were reliable to measure angles in photographs and radiographs to quantify craniocervical posture with exception of 2 angles measuring lordosis of the cervical spine when compared between raters. The visual assessment of posture between raters was not reliable.     

Reliability of a New Instrument to Measure Scapular Position

Abstract

The purpose of this study was to develop an objective method to measure scapular position as it relates to the frontal, sagittal and transverse reference planes of the human body. Contemporary shoulder rehabilitation programs place great emphasis on the role of the scapula in the treatment of shoulder pathology. While clinicians employ many treatment techniques aimed at improving scapular function, a literature review reveals that clinicians lack objective measurement techniques to measure scapular position. A Scapular Measurement Instrument (SMI) was used to objectify scapular position. Eleven subjects, who reported no current history of shoulder pain or pathology, were included in the study. Testers obtained measurements of scapulae position with respect to the frontal, sagittal, and transverse planes of the body. Inferior angle scapular measurements (IAM) and spine of the scapula measurements (SM) were taken. Two test positions were used. Position 1 was termed the “rest position” and involved subjects sitting with their arms resting at their side; position 2 involved subjects placing their arms in a “reach position” touching their opposite shoulder blade. Statistical analysis was carried out in an attempt to estimate reliability. Intratester and intertester correlation coefficients (ICC), and Standard Error of Measurement (SEM) values were calculated for all measurements. In an attempt to validate the frontal and sagittal plane referenced measurements, subjects' scapulae positions were quantified via radiographic (x-ray) analysis. Pearson Moment Correlation Coefficients were used to assess the measurement relationships between x-ray and (SMI) obtained values. Intratester ICC values for the rest condition ranged from .68 to .88 (IAM) and .68 to 86 (SM). Intratester ICC values for the reach condition ranged from .51 to .91 (IAM) and .60 to .95 (SM). Intertester ICC values for the rest condition ranged from .68 to .80 (IAM) and .80 to .95 (SM), and intertester ICC for the reach condition ranged from .48 to .66 (IAM) and .30 to .86 (SM). These values indicate better reliability for the rest condition. Intratester reliability values were generally greater than intertester values. SEM was 1 cm or less for all measurements. In regard to the validation of testers' measurements via x-ray, Pearson Moment Correlation Coefficients revealed a general trend of greater validity for rest versus reach conditions. Rest-condition correlation data ranged from .87 to .96, while reach-condition correlation data ranged from .23 to .93. The large range in correlation data was believed to be representative of random error of measurement. The authors feel that this technique is a viable option for objective measurement of at-rest scapular position. Further research is suggested, including refinement of the SMI and investigation into alternative radiographic and measurement procedures.     

Reliability of the modified Thomas test using a lumbo-plevic stabilization

[Purpose] The purpose of this study was to examine the test-retest reliability of the modified Thomas test using lumbo-pelvic stabilization. [Subjects] Thirteen subjects (male=10, female=3) with hip flexor tightness voluntarily participated in the study. [Methods] The participants underwent the modified Thomas test under three conditions: 1) the general modified Thomas test (GM), 2) active lumbo-pelvic stabilization (ALS), and 3) passive lumbo-pelvic stabilization (PLS). Intra-class correlation coefficients (ICC) were used to determine the test-retest reliability of the knee joint angle measurement under three conditions. The standard error of measurement (SEM) and minimal detectable difference (95% confidence interval) (MDD⁹⁵) were calculated for each measurement to assess absolute consistency. [Results] The ALS (ICC = 0.99) and PLS (ICC = 0.98) methods for the modified Thomas test were more reliable than GM method (ICC = 0.97). The MDD⁹⁵ score for the ALS method, 2.35 degrees, indicated that a real difference existed between two testing sessions compared with the scores for the PLS (3.70 degrees) and GM methods (4.17 degrees) [Conclusion] Lumbo-pelvic stabilization is one of the considerations for precise measurement and may help to minimize measurement error when evaluating hip flexor tightness using the modified Thomas test.Key words: Lumbo-pelvic stabilization, Modified Thomas test     

Intra- and Inter-rater Reliability of Peripheral Arterial Blood Flow Velocity by Means of Doppler Ultrasound

Objective

Although it is possible to find studies that analyze the velocity of blood flow in different arteries, the reliability of Doppler ultrasound on peripheral arteries has not yet been completely established. Our objective was to evaluate intra- and inter-rater reliability of the measurement of blood flow velocity by Doppler ultrasound of brachial, radial, popliteal, and posterior tibial arteries.

Inter-rater Accuracy and Reliability of a Palpation Protocol of the C7 Spinous Process Comprising a Combination of 3 Traditional Palpation Techniques

ObjectiveThe purpose of this study was to determine the accuracy and intrarater reliability of a palpatory protocol based on a combination of 3 palpatory methods to identify both the C7 spinous process (C7 SP) and the factors that affect the errors and inaccuracy of palpation.MethodsTwenty-five women between the ages of 18 and 60 years were submitted to a palpation protocol of the C7 SP, and a radiopaque marker was fixed on the skin at the possible location of the vertebrae. A radiograph and a photograph of the cervical spine were obtained in the same posture by a first rater. A second rater performed the same palpation protocol and took a second photograph. The accuracy and measurement error of the palpation protocol of C7 SP were assessed through radiographic images. The inter-rater reliability was estimated by the interclass correlation coefficient and assessed using photographs of each rater. The Pearson's correlation coefficients (r), the Fisher exact test, and the χ² test were used to identify the factors associated with the error and inaccuracy of palpation.ResultsAccuracy of the C7 palpation was 76% with excellent reliability (interclass correlation coefficient = 0.99). There was a moderate correlation between weight and the measurement of palpation error (r = –0.6; P = .003). One hundred percent of inaccuracy palpation was related to the increased soft-tissue thickness (P = .005) in the cervical region.ConclusionThe palpation protocol described in this study was accurate and presented excellent reliability in identifying the C7 SP. Increased weight and dorsocervical fat pad were associated to error and palpation inaccuracy, respectively.     

中文版阿尔茨海默病联合注册表-神经心理学成套测试的测试者间信度与受试者工作特征

目的评价中文版阿尔茨海默病联合注册表-神经心理学成套测试(CERAD-NAB)判别轻度认知障碍(MCI)的测试者间信度和效度。方法52 例60 岁以上老年人采用中文版CERAD-NAB 进行测评,根据Petersen 等制定的标准确定MCI 诊断。计算不同测试者间组内相关系数(ICC);绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC)。结果CERAD-NAB 各子测试ICC=0.945~1。CERAD-NAB 总分AUC 为0.747,在界值为62.5 时,敏感性和特异性分别为0.52 和0.90;CERAD-NAB 总分和子测试J3、J8 AUC较高。结论中文版CERAD-NAB测试者间信度很高,在判别MCI 方面效度满意。