Goniometric reliability in a clinical setting. Elbow and knee measurements

Reliability of goniometric measurements has been examined only under standardized conditions and usually with healthy subjects. The purpose of this study was to assess goniometric reliability in a clinical setting. The reliability of goniometric measurements of passive elbow and knee positions was assessed using patients as subjects. The effect of using the means of repeated measurements and the interdevice reliability of three common goniometers were also examined. Results showed that intratester reliability for flexion and extension of the knee and the elbow joints was high (r = .91 to .99). Intertester reliability was also high (r = .88 to .97) for these measurements except for measurements of knee extension (r = .63 to .70). Although previous investigators have suggested that using the means of multiple measurements improves reliability, our data indicate that this procedure never improves the correlation coefficient more than .12. The reliability was similar for all three devices. The results of this study indicate that for the knee and elbow joints, goniometric measurements performed in a clinical setting can be highly reliable. The method described in this study provides a simple protocol that can be used clinically to investigate goniometric reliability.     

Comparative study of cardiac troponin I and T measurements in a routine extra-cardiological clinical setting.

This study compared troponin I (cTnI) to troponin T (cTnT) in a population admitted to General Medicine Divisions in whom acute myocardial infarction (AMI) was suspected; 98 consecutive patients were included. Diagnoses were made without knowledge of troponin results: 51 patients had AMI, and 47 (including 8 with unstable angina) had no AMI. Patients were considered to be troponin positive if the marker concentration was >99th percentile value of the reference population. Both troponins were associated with an almost absolute sensitivity for AMI (100% for cTnI and 98.0% for cTnT), while the specificity was marginally higher for cTnI (78.7% vs. 68.1%). Increased cTnI and/or cTnT were observed in 15 patients out of 39 without acute coronary syndromes. Simultaneous positivity was seen in 8 patients with severe disorders and complications. Discordances were more frequent in favor of increased cTnT (n = 5) than the opposite (n = 2), even if this difference did not achieve statistical significance. cTnI and cTnT detected AMI with comparable efficiency. Cases without coronary syndrome positively concordant for troponins confirmed the ability of these biomarkers to detect myocardial injury undetectable by conventional diagnostic approaches.     

Integration of technology in a clinical research setting.

The use of wireless technology to collect and retrieve relevant patient data has been in use on many nursing units for the past decade. The technology continues to advance as it relates to patient data collection devices. The utilization of computers (in the form of a wireless tablet) is used in the General Clinical Research Unit (GCRC) at Howard University Hospital. The wireless technology is used for the compilation and retrieval of pertinent research data.     

The reliability of clinical measurements designed to quantify shoulder mobility

Abstract

Background: The assessment of shoulder mobility is an integral component of the physical therapy examination. Recognizing a mobility loss may assist the physical therapist in making a differential diagnosis, measuring improvement or deterioration, determining functional impairment, and planning interventions. Reliable measurement instruments and procedures are therefore essential to both the clinician and researcher desiring to objectively monitor disease progression, outcomes, and mobility impairments.

Objectives: The purpose of this review is to summarize the literature on the reliability and concurrent validity of clinical measurements used to quantify osteokinematic mobility of the shoulder.

Major findings: The reliability of shoulder mobility measurements is highly variable with no consistent advantage of instrumentation or procedures. Inclinometric measurement reliability coefficients ranged from 0·11 to 0·99, with goniometry ?0·22 to 0·99 and visual inspection 0·18 to 0·98. Reliability was independent of symptom state and measurement approach (passive versus active), although there was a trend for intrarater reproducibility exceeding interrater. Extension, horizontal abduction, and adduction measurements were limited to one investigation which utilized passive goniometric measurements. Research investigating the concurrent validity of instruments and procedures was limited, although favorable when comparing small versus large goniometers and goniometry to a digital level.

Conclusions: A consensus for choosing instruments and/or procedures was not conclusive based on comparable reliability reports and ranges. Instruments used to quantify shoulder mobility cannot be used interchangeably with confidence given the paucity of concurrent validity reports. Clinicians should recognize both the merits and limitations of the instruments and procedures that they incorporate into practice.     

Medication administration evaluation and feedback tool: Inter-rater reliability in the clinical setting

AimsThis study assessed the inter-rater reliability, acceptability and usability of the Medication Administration Evaluation and Feedback Tool for nurses in the clinical setting.BackgroundMedication administration is a complex nursing task requiring multiple steps to ensure safe and accurate delivery of medications to patients. Currently, registered nurses are not routinely provided the opportunity for regular review of their practice. The Medication Administration Evaluation and Feedback Tool has been previously validated in the simulated environment.MethodsFour nurse observers were trained to use the tool. Thirty nurses participated to be observed in the clinical setting. Each nurse was assessed simultaneously by two observers. Inter-rater reliability was assessed using Fleiss’ Kappa coefficient. A postobservation survey was conducted to assess user acceptability. The Guideline for Reporting Reliability and Agreement Studies Enhancing the Quality and Transparency of Health Research was used.ResultsThe observed agreement between observers using the Medication Administration Evaluation and Feedback Tool in clinical practice was 0.90 and Fleiss’ kappa coefficient was 0.77 demonstrating excellent agreement and inter-rater reliability. Both nurses and observers reported the tool was useful and practical for use in evaluating medication administration practice in the clinical environment.ConclusionsInter-rater reliability testing of the Medication Administration Evaluation and Feedback Tool in the clinical environment demonstrated it is a reliable and valid tool when used by different observers. Both nurses and observers found using the tool a positive and useful experience when evaluating medication administration practice.     

Reliability of goniometric measurements and visual estimates of knee range of motion obtained in a clinical setting

The purpose of this study was to examine the intratester and intertester reliability for goniometric measurements of knee flexion and extension passive range of motion (PROM). In addition, parallel-forms reliability for PROM measurements of the knee obtained by use of a goniometer and by visual estimation was examined. The intertester reliability for visual estimates of the PROM of the knee was also examined. Repeated measurements were obtained on 43 patients in a clinical setting. The intraclass correlation coefficients (ICCs) for intratester reliability of measurements obtained with a goniometer were .99 for flexion and .98 for extension. Intertester reliability for measurements obtained with a goniometer was .90 for flexion and .86 for extension. The ICCs for parallel-forms reliability for measurements obtained with a goniometer and by visual estimation ranged from .82 to .94. The intertester reliability for measurements obtained by visual estimation was .83 for flexion and .82 for extension. Results suggest clinicians should use a goniometer to take repeated PROM measurements of a patient's knee to minimize the error associated with these measurements.     

Public schools as a clinical setting for RN students.

The challenge to select meaningful clinical sites for RN students is a problem for educators. The significance of the public schools as an initial clinical site, the contribution of RNs to school health programs, student responses, and adaptations to the school setting are presented. Outcomes of the experience will interest nurse educators attempting to provide a professional education for RN to BSN students and provide a service to the community.     

Applying linear mixed models to estimate reliability in clinical trial data with repeated measurements

Repeated measures are exploited to study reliability in the context of psychiatric health sciences. It is shown how test-retest reliability can be derived using linear mixed models when the scale is continuous or quasi-continuous. The advantage of this approach is that the full modeling power of mixed models can be used. Repeated measures with a different mean structure can be used to usefully study reliability, correction for covariate effects is possible, and a complicated variance-covariance structure between measurements is allowed. In case the variance structure reduces to a random intercept (compound symmetry), classical methods are recovered. With more complex variance structures (e.g., including random slopes of time and/or serial correlation), time-dependent reliability functions are obtained. The methodology is motivated by and applied to data from five double-blind randomized clinical trials comparing the effects of risperidone to conventional antipsychotic agents for the treatment of chronic schizophrenia. Model assumptions are investigated through residual plots and by investigating the effect of influential observations.     

Heparin interference in whole blood sodium measurements in a pediatric setting

OBJECTIVES: In a pediatric setting, the incomplete filling of heparinized syringes is not an uncommon occurrence and has led to reports of falsely low hyponatremia in our institution. Little is known about heparin interference on sodium determination in whole blood, and our study aimed to investigate this interference due to excessive concentrations of heparin in pediatric specimens. DESIGN AND METHODS: Three different types of syringes were filled with various amounts of blood to mimic greater than normal concentrations of heparin. Specimens were analyzed on an ABL 725 blood gas analyzer, and corresponding plasma fractions were analyzed on a VITROS 950 chemistry system. In a separate study, paired patient samples consisting of a capillary tube and microtainer clot were similarly analyzed. RESULTS: The presence of lithium heparin at 100 units/mL in blood caused a significant negative bias of 2-3 mmol/L in sodium concentration with the ABL 725, but no significant bias occurred when the corresponding plasma fraction was analyzed on the VITROS 950. For syringes containing electrolyte-balanced heparin, a similar negative bias was observed for blood but was not significant. Capillary tubes contained high concentrations of heparin (>100 units/mL) even when completely filled. Sodium results from capillary samples averaged 3.4 mmol/L lower than the corresponding serum values. These effects were independent of the sodium concentration across a wide range. CONCLUSIONS: Small blood volumes collected with heparinized sampling devices in pediatric samples lead to excess heparin that may significantly affect sodium determinations and spur false reports of critical hyponatremia.