Test-Retest and Inter-Examiner Reliability of a Novel Bedside Quantitative Sensory Testing Battery in Postherpetic Neuralgia Patients

In health and disease, the somatosensory system has been interrogated with standardized research techniques, collectively referred to as quantitative sensory testing (QST). In neuropathic pain, QST has been used to characterize multiple sensory derangements. However, the use of QST outside the lab has been limited by several factors, including a lack of standardization, variability in procedural technique, and duration of testing that would be unacceptable for clinic. To address these shortcomings, the Neuropathic Pain Research Consortium designed an easy and low-cost “bedside” QST procedure. To test the hypothesis that this procedure would be clinically reliable over time and across different examiners, a multisite, blinded study was performed in subjects with postherpetic neuralgia. Generally, agreement between 2 examiners and over 2 study visits with 1 examiner was high. Additionally, intraclass correlation coefficients and Kappa statistics calculated showed that the battery of QST tests included were highly reliable. Interestingly, mechanical modalities (light brush, pinprick, pressure, and vibration) showed the highest reliability. The least reliable modalities were cool (room temperature) and warmth (38°C). These data demonstrate that the Neuropathic Pain Research Consortium beside QST protocol is reliable across examiner and over time, providing a validated QST tool for use in clinical practice and clinical trials.PerspectiveThis blinded, multicenter trial in 32 patients with postherpetic neuralgia demonstrates bedside QST is reliable and suitable as a clinical trial outcome. The novel bedside battery could be used in clinical trials or in clinical practice over time given the reliability data presented in this article.     

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     

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.

Intra- and Interrater Reliability of the Modified Tardieu Scale for the Assessment of Lower Limb Spasticity in Adults With Neurologic Injuries

Objective

To examine the intra- and interrater reliability of the Modified Tardieu Scale (MTS) for lower limb assessment of adults with chronic neurologic injuries.

Design

Single-center intra- and interrater reliability study.

Setting

Outpatient neurorehabilitation unit.

Participants

Adults (N=30; mean age ± SD, 54.1±12.5y) with various chronic neurologic injuries and lower limb spasticity.

Interventions

Two experienced physiotherapists performed slow (R2) and fast (R1) passive movements for lower limb muscles half an hour apart on the same day (interrater reliability), while a third physiotherapist took goniometric measurements only. One physiotherapist repeated the assessment 1 to 3 days earlier or later (intrarater reliability). Assessors qualitatively rated the resistance to fast passive movements.

Main Outcome Measures

Intraclass correlation coefficients (ICCs) and limits of agreement (LOA) were calculated for R1, R2, and R2–R1. Kappa coefficients were calculated for tibialis range of movement and qualitative spasticity ratings.

Results

Intra- and interrater R1 and R2 measurements showed moderate to high reliability for the affected hamstrings, rectus femoris, gastrocnemius, soleus (mean ICC ± SD, .79±.08), and tibialis anterior (mean κ ± SD, .58±.10). Only intrarater measurements of the affected tibialis posterior were moderately reliable (R1=.57, R2=.77). Seven of 16 spasticity angle measurements of the affected muscles were moderately reliable. LOA were mostly unacceptably wide. Qualitative spasticity ratings were moderately reliable for affected hamstrings, gastrocnemius, and tibialis muscles (mean κ ± SD, .52±.10).

Conclusions

The MTS is reliable for assessing spasticity in most lower limb muscles of adults with chronic neurologic injuries. Repeated MTS measurements of spasticity are best based on R1 measurements rather than spasticity angle or qualitative ratings of spasticity. Optimally, MTS measurements should be undertaken by the same clinician.     

ICF-CY自理项量表应用于脑性瘫痪儿童评定的信度和效度研究

目的研究《国际功能、健康和残疾分类儿童青少年版》(ICF-CY) 自理项量表在脑瘫儿童评定中的信度和效度。方法选择50 例脑瘫儿童,采用ICF-CY自理项量表、功能性独立测量量表(WeeFIM)和儿童能力评估量表(PEDI)进行评定。ICF-CY自理项量表信度检验采用kappa 一致性分析方法;ICF-CY自理项量表与WeeFIM 和PEDI 同步效度采用Spearman 相关分析。结果ICF-CY自理项8 个类目重测信度kappa 值为0.806~0.932,信度优;ICF-CY自理项8 个类目评定者间信度kappa 值为0.690~0.882,信度中到优;ICF-CY自理项评分与WeeFIM 和PEDI 评分的Spearman 相关系数为-0.832 和-0.767(P<0.01)。结论采用ICF-CY自理项量表对脑瘫儿童进行日常生活自理评定可靠、有效。     

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

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

Reliability of the Autism Spectrum Disorders-Comorbid for Children (ASD-CC)

Autism spectrum disorders (ASD) in children are a serious and complex set of conditions that researchers have been attempting to quantify for many decades. In addition to the core symptoms of ASD, comorbid psychopathology is often present as well. Despite this fact and despite the many attempts to develop scaling methods for ASD, little has been done to develop tests specific to childhood psychopathology in ASD children. In this study we describe the initial psychometric properties of a new scale designed specifically to fill this assessment need, the Autism Spectrum Disorders-Comorbid for Children (ASD-CC). One-hundred and thirteen children with ASD between the ages of 2 and 16 years were assessed in order to determine interrater, test–retest, and internal reliabilities of this new scale. Implications of these promising findings with respect to further development of the ASD-DC are discussed.     

Reliability of the Tardieu Scale for Assessing Spasticity in Children With Cerebral Palsy

Gracies J-M, Burke K, Clegg NJ, Browne R, Rushing C, Fehlings D, Matthews D, Tilton A, Delgado MR. Reliability of the Tardieu Scale for assessing spasticity in children with cerebral palsy.

Objective

To measure the Tardieu Scale's reliability in children with cerebral palsy (CP) when used by raters with and without experience in using the scale, before and after training.

Design

Single-center, intrarater and interrater reliability study.

Setting

Institutional ambulatory care.

Participants

Referred children with CP in the pretraining phase (n=5), during training (n=3), and in the posttraining phase (n=15).

Interventions

The Tardieu Scale involves performing passive muscle stretch at 2 velocities, slow and fast. The rater derives 2 parameters; the Spasticity Angle X is the difference between the angles of arrest at slow speed and of catch-and-release or clonus at fast speed; the Spasticity Grade Y is an ordinal variable that grades the intensity (gain) of the muscle reaction to fast stretch. In phase 1, experienced raters without formalized training in the scale graded elbow, knee, and ankle plantar flexors bilaterally, without and with a goniometer. In phase 2, after training, the experienced and nonexperienced raters graded the same muscles unilaterally.

Main Outcome Measures

Intrarater and interrater reliability of the Tardieu Scale.

Results

After training, nonexperienced raters had mean ± SD intrarater and interrater agreement rates across all joints and parameters of 80%±14% and 74%±16%, respectively. For experienced raters, intrarater and interrater agreement rates before training were 77%±13% and 66%±15%, respectively, versus 90%±8% and 81%±13%, respectively, after training (P<.001 for both). Specific angle measurements at the knee were less reliable for the angles of catch measured at fast speed. Across all joints, agreement rates were similar using visual or goniometric measurements.

Conclusions

Both parameters of the Tardieu Scale have excellent intrarater and interrater reliability when assessed at the elbow and ankle joints of children with CP, with no difference noted between visual and goniometric measurements. Angle measurements were less reliable at the knee joints. Training was associated with a highly significant improvement in reliability.     

Intra- and Interrater Reliability and Concurrent Validity of a New Tool for Assessment of Breast Cancer–Related Lymphedema of the Upper Extremity

Objective

The goal of this study was to develop and assess intra- and interrater reliability and validity of a clinical evaluation tool for breast cancer–related lymphedema, for use in the context of outcome evaluation in clinical trials.

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.     

Reliability of Barker's Method for PBI in Serum

Arteriograms from 132 limbs in claudicating patients were compared with the results of oscillography, venous occlusion plethysmography, skin temperature measurements, and digital pulse plethysmography. Arterial pulse curve analysis proved to be particularly sensitive to non-obstructive arteriosclerosis. In distinguishing between normal and obstructed limbs, oscillography demonstrated less overlapping than peak flow determinations. The results of both methods were correlated to the degree and length of the main leg artery obstruction. Walking tolerance could not be predicted from any of the actual methods.     

Clinical Feasibility of Quantitative Ultrasound Imaging for Suspected Hepatic Steatosis: Intra- and Inter-examiner Reliability and Correlation with Controlled Attenuation Parameter

This study was aimed at investigating the clinical feasibility of quantitative ultrasound (QUS) imaging in the evaluation of suspected hepatic steatosis through assessment of the reliability of measurements and its correlation with the controlled attenuation parameter (CAP). This retrospective study included 117 patients who underwent liver B-mode ultrasound (US) with QUS imaging with a clinical US machine (RS85, Samsung Medison, Seoul, Korea) and CAP measurements between December 2019 and March 2020. For QUS examination, tissue attenuation imaging (TAI) and tissue scatter-distribution imaging (TSI) parameters were obtained. Intra- and inter-examiner reliability were assessed using intra-class correlation coefficients (ICCs), and QUS imaging parameters were correlated with CAP measurements using Spearman's correlation analysis. TAI and TSI revealed excellent intra- and inter-examiner reliability with ICCs of 0.994 and 0.975 and 0.991 and 0.947, respectively. Both TAI and TSI were significantly positively correlated with CAP values. QUS imaging provided good intra-and inter-observer reliability and correlated well with CAP in assessing suspected hepatic steatosis.     

Reliability of a Problem-Classification Index for Well Mothers and Children in Community Health Nursing

Community health nurses in county health departments continue to provide disease-prevention and health-promotion services to mothers or families with children who are considered well. We lack available instruments with demonstrated reliability that can classify the nursing problems of these clients by type and seventy. The purpose of this pilot study was to determine the reliability of a classification index for well mothers and children in community health nursing practice. The study indicated that Cronbach's alpha was 0.98 for the composite index and that the internal consistency for each of the six component subscales in the index ranged from 0.91 to 0.98.     

A Study on the Reliability of Tape Recordings in Analysing Articulation in Grade I School Children

Recent literature concerning the failure of many laryngectomees to develop oesophageal speech has been reviewed. Material has been obtained from a wide variety of sources, and physiological, surgical and psychosocial factors have been discussed. No one factor has been found to account for the high failure rate. Explanations for some of the literature's conflicting results have been provided. The need to research further in certain areas, to investigate individual reasons for failure and to take account of the inter-relationship between the factors, has also been stressed.     

Interrater Reliability of Goal Attainment Scaling in Rehabilitation of Children With Cerebral Palsy

Steenbeek D, Ketelaar M, Lindeman E, Galama K, Gorter JW. Interrater reliability of goal attainment scaling in rehabilitation of children with cerebral palsy.

Objectives

To determine the interrater reliability of Goal Attainment Scaling (GAS) in the routine practice of interdisciplinary rehabilitation of children with cerebral palsy, and to examine the difference in the interrater reliability of the scores between GAS scales constructed by the children's own therapists and the scales constructed by independent therapists.

Design

Individually tailored GAS scales, based on predetermined criteria, were constructed at the start of a 6-month rehabilitation period. The outcome was rated independently by 2 therapists at the end of the treatment period. Two different data sets were acquired, one consisting of scores on GAS scales constructed by the children's own therapists, the other of scores on GAS scales constructed by matched independent raters of the same profession.

Setting

A children's unit of a medium-sized rehabilitation center in The Netherlands.

Participants

Physical therapists (n=8), occupational therapists (n=8), and speech therapists (n=4) participated in pairs. They constructed 2 sets of 64 GAS scales each, for 23 children with cerebral palsy.

Interventions

A 6-month interdisciplinary pediatric rehabilitation program.

Main Outcome Measure

Interrater reliability was assessed using linear-weighted Cohen's kappa.

Results

The scales constructed by the children's therapists had an interrater reliability of .82 (95% confidence interval [CI], .73-.91). The interrater reliability for scales constructed by the independent raters was .64 (95% CI, .49-.79). The main reason for disagreement between raters was discrepancies in the professionals' interpretation of the children's capacities versus their actual performance during assessment.

Conclusions

The interrater reliability of GAS used under optimal conditions was good, particularly for scales constructed by the children's own therapists.