The diagnostic reliability and validity of noninvasive imaging modalities to assess leptomeningeal collateral flow for ischemic stroke patients: A systematic review and meta-analysis

Leptomeningeal collateral flow (LMF) is associated with infarct area and clinical outcome for ischemic stroke patients. Although LMF can be detected by multiple imaging methods, but their diagnostic performance is uncertain.The aim of this study was to evaluate the diagnostic validity or reliability of noninvasive image methods in assessing LMF.Databases included PubMed, Web of Science, Embase, and Cochrane Library.Original observational cohort studies.Ischemic stroke patients.Different noninvasive image methods to assess LMF.Newcastle–Ottawa Scale to evaluate the quality of the studies; forest plot to show pooled results; I² and Egger test to evaluate the heterogeneity and publication bias.Thirty of the 126 selected studies were eligible. For CT angiography, the interobserver agreement ranged from 0.494 to 0.93 and weighted kappa was 0.888; for patients receiving thrombolysis or endovascular treatment, 0.68 to 0.91; 0.494 to 0.89 for the 2-point system, 0.60 to 0.93 for the 3-point system, 0.68 to 0.87 for the system of >4 points; area under the curve (AUC) was 0.78. For perfusion computed tomography (CTP), the interobserver agreement ranged from 0.724 to 0.872; for patients receiving thrombolysis or endovascular treatment, 0.74 to 0.872; 0.724 for the 2-point system, 0.783 to 0.953 for the 3-point system; the intraobserver agreement was 0.884; AUC was 0.826. For MRI-fluid attenuated inversion recovery (FLAIR), the interobserver agreement ranged from 0.58 to 0.86; for patients receiving thrombolysis or endovascular treatment, 0.75 to 0.86; 0.86 for the two-point system, 0.77 to 0.87 for the system of more than 5 points; AUC was 0.82.No pooled data of CTP and FLAIR. The difference cohort study had difference bias. The unpublished data were not included.CT angiography is a good tool for assessing LMF. CTP shows a good validity and reliability, but its diagnostic value needs more evidence. FLAIR is a good modality to assess LMF. These image methods had better validity and reliability to evaluate LMF of patients receiving thrombolysis or endovascular treatment than all ischemic stroke patients.     

Breast density in dedicated breast computed tomography: Proposal of a classification system and interreader reliability

The aim of this study was to develop a new breast density classification system for dedicated breast computed tomography (BCT) based on lesion detectability analogous to the ACR BI-RADS breast density scale for mammography, and to evaluate its interrater reliability.In this retrospective study, 1454 BCT examinations without contrast media were screened for suitability. Excluding datasets without additional ultrasound and exams without any detected lesions resulted in 114 BCT examinations. Based on lesion detectability, an atlas-based BCT density (BCTD) classification system of breast parenchyma was defined using 4 categories. Interrater reliability was examined in 40 BCT datasets between 3 experienced radiologists.Among the included lesions were 63 cysts (55%), 18 fibroadenomas (16%), 7 lesions of fatty necrosis (6%), and 6 breast cancers (5%) with a median diameter of 11 mm. X-ray absorption was identical between lesions and breast tissue; therefore, the lack of fatty septae was identified as the most important criteria for the presence of lesions in glandular tissue. Applying a lesion diameter of 10 mm as desired cut-off for the recommendation of an additional ultrasound, an atlas of 4 BCTD categories was defined resulting in a distribution of 17.5% for density A, 39.5% (B), 31.6% (C), and 11.4% (D) with an intraclass correlation coefficient (ICC) among 3 readers of 0.85 to 0.87.We propose a dedicated atlas-based BCTD classification system, which is calibrated to lesion detectability. The new classification system exhibits a high interrater reliability and may be used for the decision whether additional ultrasound is recommended.     

The application of the Chinese version of the Body Image Disturbance Questionnaire in patients with systemic lupus erythematosus

This study aimed to translate the Body Image Disturbance Questionnaire (BIDQ) into Chinese and evaluate its reliability and validity in a sample of patients with systemic lupus erythematosus (SLE).Following the translation and revision of the Chinese version of the BIDQ, 169 patients with SLE were chosen as respondents to test the questionnaire''s reliability and validity. We tested the content''s validity through expert group evaluation. It is structural validity was examined through exploratory factor analysis and confirmatory factor analysis, and reliability was evaluated using Cronbach''s α and test-retest reliability.The Chinese version of the BIDQ showed a content validity of .92. A two-factor structure was revealed by exploratory factor analysis, which explained 67.83% of the variance and proved by confirmatory factor analysis. Its overall Cronbach''s α was .82 (P < .001), and the Cronbach''s α for each item ranged from .76 to .83. The test-retest reliability was .82, with the Cronbach''s α for each item ranging from .76 to .84.Thus, adequate reliability and validity of the Chinese version of the BIDQ were demonstrated for use in patients with SLE.     

韦克斯勒记忆量表第四版中文版(成人版)的修订

目的:修订韦克斯勒记忆量表第四版(WMS-IV)中文版(成人版),并考察其效度和信度。方法:将全国16岁以上人口作为取样总体,以年龄、性别、教育程度为主要变量按比例分层取样,选取16~69岁有效样本1561人,应用WMS-IV中文版(成人版)对样本进行个别记忆测验。该量表包括5个基本分量表(逻辑记忆、词语配对、图形重置、视觉再现、空间叠加),用于导出5个指数分;还包含1个简明认知状况测验的可选分量表。同时施测韦氏成人智力量表第四版(WAIS-IV)中文版来检验效标效度。选取样本中95名被试间隔22天后重测WMS-IV中文版(成人版)。结果:验证性因子分析表明量表的二因素结构拟合较好(χ2/df=14.77/4,RM SEA=0.04,NFI=0.99,NNFI=0.99,RFI=0.99,AGFI=0.99,SRM R=0.02);各指数分与WAIS-IV中文版工作记忆指数的相关系数为0.50~0.64,各指数分及总记忆商与总智商的相关系数为0.61~0.73(均P<0.05)。各分量表得分、过程分、指数分及总记忆商的平均信度系数分别为0.79~0.93、0.67~0.86、0.93~0.97;分量表得分、指数分及总记忆商的重测信度分别为0.40~0.69、0.68~0.76、0.78;各再认分量表分类判定的一致性系数均>0.90;评分者一致性>0.95。结论:WM S-IV中文版(成人版)具有良好的效度和信度,可以在中国成人群体中进行应用。     

Measurement properties of the Wheelchair Skills Test for scooters among experienced users

Purpose: To investigate the score distribution, reliability, and validity of the objective Wheelchair Skills Test (WST) for scooter users.

Method: A study using a test–retest design was conducted with 20 people who had mobility limitations that prevented them from ambulating more than one city block without a mobility aid, and who had owned a scooter for ≥3 months. Objective scooter skills, confidence, and physical accessibility were measured at both time points, while anxiety, depression, visual attention and task switching, functional independence, and visual acuity were measured only at baseline.

Results: The mean total WST scores at Time 1 and Time 2 were 86.3% and 87.5%. The WST ICC was 0.889. The WST had a SEM of 2.50 and a Cronbach’s alpha of 0.74. The total WST scores were significantly correlated with total subjective WST-Q scores (r?=?0.547, p?=?0.013), scooter confidence (r?=?0.466, p?=?0.038), and were affected by gender (p?=?0.005).

Conclusion: The WST for scooters has good test–retest reliability and generally varies as anticipated with other measures. Although further study is needed, the WST for scooters appears to have promise for use in research and clinical practice.

• Implications for Rehabilitation

• It is important to understand the measurement properties of the tools we use in rehabilitation so the results can be interpreted correctly.

• As scooter use increases, better measurement of skills is required.

     

Prevalence and reliability of treatment-based classification for subgrouping patients with low back pain

Objectives: To observe the distribution of patients who presented with low back pain (LBP) and to determine the between therapists’ interrater reliability of assessments in a private outpatient setting using treatment-based classification (TBC) subgroups.

Methods: An observational and methodological study was conducted. Four hundred and twenty-nine patients (231 male; 198 female) presenting LBP symptoms and referred to conservative treatment were assessed by 13 physical therapists who conducted a 60-min examination process utilizing TBC subgroups. Interrater reliability analyses from six raters were assessed using Fleiss’ kappa and previously recorded data (n = 30).

Results: In this study, 65.74% of patients were classified in only one subgroup, the most prevalent being stabilization (21.91%), followed by extension (15.38%), traction (11.89%), flexion (10.96%), manipulation (5.13%), and lateral shift (0.47%). Approximately 20.98% of patients were classified in two subgroups, where the most frequent overlaps were flexion + stabilization (7.46%), extension + stabilization (6.06%), flexion + traction (4.20%), extension + manipulation (1.86%), and 13.29% of patients were not classified in any TBC subgroup. Analysis of interrater reliability showed a kappa value of 0.62 and an overall agreement of 66% between raters.

Discussion: LBP is a heterogeneous clinical condition and several classification methods are proposed in the attempt to observe better outcomes for patients. Eighty-five percent of patients assessed were able to be classified when using the TBC assessment and reliability analysis showed a substantial agreement between raters.

Level of Evidence: 2c.     

自编军事应激条件下心理健康状况量表的信度与效度检验

目的编制军事应激条件下心理健康状况量表,检验其信度与效度,为更好地了解军事应激环境下执行特殊任务官兵的心理健康状况提供较为科学的工具。方法随机抽取经常执行特殊军事任务的官兵568人,分为A组(n=217)、B组(n=351),用自编军事应激条件下心理健康状况量表分别对2组进行测试,用A组数据对其进行探索性因素分析,用B组数据进行信度分析和验证性因素分析。结果此量表包括3个分量表:自我认知、应对方式、压力反应,其因素负荷分别为0.39~0.85、0.40~0.76、0.45~0.94,方差解释率均大于40.0%;信度分析结果显示,自我认知、应对方式、压力反应内部一致性系数分别为0.79~0.93、为0.83~0.86、0.91~0.94,分半信度系数分别为0.75~0.88、0.79~0.84、0.82~0.91;验证性因素分析结果表明,3个分量表的拟合程度较高,拟合指标的χ2值与自由度df的比值均介于2~3之间,近似误差均方根MSREA均0.08,拟合结果可以接受,说明该量表的结构效度较好。结论自编的军事应激条件下心理健康状况量表有良好的信度和效度,可在特殊任务部队推广使用。     

A Reliable Method for Quantification of Tendon Structure Using B‐Mode Ultrasound

Structure is an important clinical marker of tendon health; however, current standards use qualitative scores that are not strongly reliable. Therefore, the purpose of this study was to establish the reliability of an image‐processing technique that quantifies tendon collagen structure using B‐mode ultrasound images. Longitudinal images of the Achilles tendon were collected in 12 healthy young adults, and intra‐ and inter‐rater reliability was assessed over multiple image selections and multiple days. Intraclass correlation coefficients were strong (r ≥ 0.71) for all comparisons. These findings demonstrate that quantitative assessments of tendon structure using B‐mode ultrasound are reliable.     

Can in Vivo Medial Gastrocnemius Muscle–Tendon Unit Lengths be Reliably Estimated by Two Ultrasonography Methods? A Within-Session Analysis

A clinically feasible method to reliably estimate muscle–tendon unit (MTU) lengths could provide essential diagnostic and treatment planning information. A 3-D freehand ultrasound (3-DfUS) method was previously validated for extracting in vivo medial gastrocnemius (MG) lengths, although the processing time can be considered substantial for the clinical environment. This investigation analyzed a quicker and simpler method using the US transducer as a spatial pointer (US-PaP), where the within-session reliability of extracting the muscle–tendon unit (MTU) and tendon lengths are estimated. MG MTU lengths were extracted in a group of 14 healthy adults using both 3-DfUS and US-PaP. Two consecutive acquisitions were performed per participant, and the data processed by two researchers independently. The intra-class correlation coefficients were above 0.97, and the standard error of measurements below 3.6?mm (1.5%). This investigation proposes that the simplified US-PaP method is a viable alternative for estimating MG MTU lengths.