Analysis of the factors which influence the measurement of synovial power Doppler signals with semi-quantitative and quantitative measures – a pilot multicenter exercise in Japan

Abstract

Objectives. This pilot multicenter exercise aimed to evaluate the inter-observer reproducibility of synovial power Doppler (PD) signals in rheumatoid arthritis (RA) patients and to determine the factors influencing the measurements.

Methods. Two representative RA patients were assessed by four independent experienced sonographers. The influence of machine difference, deterioration of the transducer and pulse repetition frequency (PRF) on the assessment of synovial PD signals was investigated.

Results. Intra-class correlation coefficient (ICC) for the scanner–reader reproducibility of semi-quantitative PD score was high (0.867). ICC for the inter-scanner reproducibility of synovial PD pixel count was higher than that of semi-quantitative PD score. The assessment of PD signals significantly differed between two machines with quantitative measurements but did not with semi-quantitative score. The assessment of PD signals with a deteriorated transducer was much less sensitive than that with an intact one. The semi-quantitative scores for PD signals were comparable between three different PRFs (500/800/1,300 Hz), whereas the pixel count was significantly lower with the highest one in the knee joint.

Conclusions. Measurement of PD signal can be substantially affected by deteriorated quality of the transducer, whereas the differences are relatively modest between machines with similar specifications and also between PRF settings within a low range.     

The Upper Limb Tension Test: Inter-tester Reliability for Assessing the Onset of Passive Resistance R 1

Abstract

The aim of this trial was to assess the inter-tester reliability of the Upper Limb Tension Test (ULTT). The onset of passive resistance (R1) of the left elbow was determined by four experienced manual therapists in a group of asymptomatic subjects. A recording of the degrees of elbow extension was obtained using a goniometer, having first positioned the upper extremity in a bracket maintaining 110 degrees of shoulder abduction and 10 degrees of shoulder extension. Each rater then moved the subjects' left shoulder into full external rotation and the forearm into full supination with the wrist and fingers in a neutral position. Data was collected four consecutive days. The data was analyzed by a two-way analysis of variance. The means of the readings among the four raters was found to be significantly different. It was concluded that the ULTT has a low inter-tester reliability when R1 is compared. Several suggestions are made for future research projects in this area.     

Validity and reliability of the Unified Classification System applied to periprosthetic femur fractures: a comparison with the Vancouver system

Abstract

Objective: The Unified Classification System (UCS) presents itself as an evolution of the Vancouver Classification (VCS) for the evaluation of periprosthetic fractures of the proximal femur (PPF). The aim of our study was to highlight any loss of reproducibility or validity of the new classification system, compared to the previous one.

Material and methods: We tested the interobserver and intraobserver agreement using 40 PPF clinical cases. Each classifying subtype of the UCS and VCS was present in at least two cases. Six experienced hip surgeons (Senior Surgeon, SS) and 5 surgeons in training (Junior Surgeon, JS) classified the clinical cases, using VCS and UCS. The validity of both classifications was then tested with intraoperative surveys.

Results: The mean κ value for interobserver agreement for the VCS in the JS group was 0.65 and 0.81 for the SS group. The mean κ value for interobserver agreement for the UCS in the JS group was 0.63 and 0.65 for the SS group. The mean κ value for intraobserver agreement for the VCS in the JS group was 0.71 and 0.73 for the SS group. The mean κ value for intraobserver agreement for the UCS in the JS group was 0.72 and 0.7 for the SS group. Validity analysis showed a moderate agreement for the VCS and a good agreement for the UCS.

Conclusion: The UCS completes the Vancouver classification, expanding it. It is reliable, despite the increase in classification categories and number of parameters to evaluate, with a slightly higher validity.     

The outcome measures for loss of functionality in the activities of daily living of adults after stroke: a systematic review

Objective: To provide clinicians and researchers information regarding (1) the existing outcome measures to assess the loss of functionality in the activities of daily living (ADLs) of patients with stroke and (2) the presence of these assessment tools in the Italian context.

Study Design and Setting: For this Systematic Review Medline, CINAHL, and PsycINFO were searched for articles published up to 4 July 2017. Two authors independently identified eligible studies on the basis of prede?ned inclusion criteria and extracted data. Study quality and risk of bias were assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Results: Of 370 publications identified and screened, 46 studies fell within the inclusion criteria and were critically reviewed. The most commonly used tools were: the Frenchay Activities Index and the Functional Independence Measure.

Conclusion: This review has emphasized the need for agreement among researchers as to which tool must be studied in depth or adapted to other national contexts in order to develop universal norms and standards.     

Test–Retest Reliability of the Preroad DriveABLE Competence Screen

ABSTRACT

Objective: To determine the test–retest reliability of a computerized preroad screen of prerequisite skills required for safe driving. Subjects & Methods: Driveable Screen administered to 39 individuals referred for driving evaluation due to cognitive decline or stroke. The Screen provides three recommendations—driving cessation, indeterminate, no evidence of reduced competence. Predicted probability of failing the road test is also generated. Results: Reliability according to the recommendation was substantial for the entire group (K = 0.654; CI = 0.459–0.848) and subgroup with stroke (K = 0.742; CI = 0.540–0.944). The numbers of participants with cognitive decline was too small to allow subgroup analyses. Of the nine participants with test–retest disagreement in recommendation, Test 2 was always better (McNemar's X² = 9.00, p = 0.01). Excellent reliability was found on probability of failing the Road Test (Intraclass Correlation Coefficient = 0.908; CI = 0.832–0.950). The test–retest reliability of the subtests ranged from fair to substantial. Conclusions: The Screen demonstrates sufficient test–retest reliability to encourage its use. However, the finding of significantly better scores on Test 2 for a portion of participants raises concern regarding its validity with repeat testing.     

Sports concussion assessment: the effect of exercise on dynamic and static balance

This study determined the effect of exercise on measures of static and dynamic balance used in the assessment of sports‐related concussion (SRC). A balanced three‐group cross‐over randomized design was used with three levels of exercise verified by blood‐lactate, heart rate and “perceived‐exertion”: no exercise/rest (NE), moderate‐intensity exercise (ME), and high‐intensity exercise (HE). Participants performed two timed balance tasks: tandem gait (TG) and single‐leg stance (SLS); pre‐ and post‐exercise and 15 min after exercise. Linear mixed‐models with adjusted means and contrasts compared exercise effects. Ninety asymptomatic participants (45♂:45♀) were recruited. When times were contrasted with NE; HE resulted in a significant decrease in SLS (P<0.001) and TG (P<0.001) performance immediately following exercise. Fifteen minutes of recovery improved SLS (P<0.001) and TG (P=0.011) from post‐exercise performance. ME caused a significant decrease in performance in SLS (P=0.038) but not TG (P=0.428). No statistically significant change occurred following ME in any tasks after 15‐min recovery (SLS P=0.064; TG P=0.495). Test–retest reliability was considerably higher for the dynamic task compared with the static task. The reliability of static and dynamic balance tasks, and the change in performance following exercise, have implications for the immediate assessment of SRC, as these measures are utilized in concussion assessment instruments.