Clinical instruments: reliability and validity critical appraisal

Nursing Staff Presenteeism Scale: Development and psychometric test

BACKGROUND AND OBJECTIVES

Nurses tend to exhibit higher rates of presenteeism compared to other professions. Presenteeism can cause the work performance of nurses to suffer, jeopardizing their own and their patients' safety and leading to decreased quality of care and increased risks of errors. However, there is a lack of a validated assessment tool for presenteeism in Taiwan. Thus, the purpose of this study was to develop a Nursing Staff Presenteeism Scale (NSPS).

METHODS

To develop questionnaire items, participants from three medical centers in Taiwan were recruited. Through convenience sampling, 500 nurses who met the selection criteria were recruited from November 1, 2022 to January 18, 2023. The scale was developed based on a systematic literature review, a previous study, and expert consultation, and 50 items were initially generated. After removing three items that lacked discriminative power, the reliability and validity of the remaining 47 items were evaluated. An exploratory factor analysis was used to establish the construct validity. A confirmatory factor analysis and structural equation modeling for cross-validation were used to assess relationships of factors with items and the overall NSPS.

RESULTS

The final scale consisted of 44 items assessed on a five-point Likert scale that loaded onto three different factors of physical or mental discomfort (18 items), work performance (15 items), and predisposing factors (11 items). These three factors were found to explain 63.14% of the cumulative variance. Cronbach's alpha for the overall final scale was 0.953. The item-to-total correlation coefficients ranged 0.443 to 0.795.

CONCLUSIONS

The NSPS exhibited satisfactory reliability and validity. It can be applied to assess the level of presenteeism among clinical nurses and provide medical institutions with information regarding the causes of presenteeism, predisposing factors, and the impacts of presenteeism on their work performance to enhance the safety and quality of clinical care.

Instruments for assessing back pain in athletes: A systematic review

Back pain in athletes varies with sport, age, and sex, which can impair athletic performance, thereby contributing to retirement. Studies on back pain in this population use questionnaires to assess components, such as pain intensity and location and factors associated with pain, among others. This study aimed to review validated questionnaires that have assessed back pain in athletes. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) by searching the databases Embase, MEDLINE, SPORTDiscus, CINAHL, and Scopus. The articles were selected regardless of language and date of publication. Titles and abstracts were independently selected by two reviewers; disagreements were resolved by a third reviewer. All the steps were conducted using the software Rayyan. The methodological quality of the questionnaire validation articles was assessed using a critical appraisal tool checklist proposed by Brink and Louw. The search returned 4748 articles, of which 60 were selected for this review, including 5 questionnaire validation studies. These articles were published between 2004 and 2022, which were performed in more than 20 countries, particularly Germany (14) and Sweden (5). Thirteen different instruments were identified, of which 46.1% were developed in Europe. The most commonly used questionnaires were the Oswestry Disability Index and Nordic Standardized Questionnaire. In addition, five questionnaire validation studies were selected for methodological quality assessment, with only two studies demonstrating high methodological quality. The following three instruments were identified for assessing back pain specifically in athletes: Micheli Functional Scale, Persian Functional Rating Index, and Athlete Disability Index. This review confirmed that all three instruments were specifically designed to assess this condition.

Reliability and validity of assessing lower-limb muscle architecture of patients with cerebral palsy (CP) using ultrasound: A systematic review

AIMS

To investigate the reliability, validity, and level of evidence of applying ultrasound in assessing the lower-limb muscles of patients with cerebral palsy (CP).

METHOD

Publications in Medline, PubMed, Web of Science, and Embase were searched on May 10, 2023, to identify and examine relevant studies investigating the reliability/validity of ultrasound in evaluating the architecture of CP lower-limb muscles systematically, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines.

RESULTS

Out of 897 records, 9 publications with 111 CP participants aged 3.8-17.0 years were included (8 focused on intra-rater and inter-rater reliability, 2 focused on validity, and 4 were with high quality). The ultrasound-based measurements of muscle thickness (intra-rater only), muscle length, cross-sectional area, muscle volume, fascicle length, and pennation angle showed high reliability, with the majority of intraclass correlation coefficient (ICC) values being larger than 0.9. Moderate-to-good correlations between ultrasound and magnetic resonance imaging measurements existed in muscle thickness and cross-sectional area (0.62 ≤ ICC ≤ 0.82).

INTERPRETATION

Generally, ultrasound has high reliability and validity in evaluating the CP muscle architecture, but this is mainly supported by moderate and limited levels of evidence. More high-quality future studies are needed.

Validity and reliability of two-dimensional video-based assessment to measure joint angles during running: A systematic review and meta-analysis

Two-dimensional video analysis systems (2DVAS) are commonly used by clinicians and researchers to determine angles during running. The aim of this systematic review (PROSPERO: CRD42022322798) was to synthesize the literature on the criterion validity and reliability of 2DVAS for measuring angles during running compared to three-dimensional motion analysis systems (3DMAS). We searched for articles on MEDLINE/Pubmed, EMBASE, SciELO, and LILACS up to October/2022. We included studies that evaluated the validity of 2DVAS (when compared to 3DMAS) and/or the reliability of 2DVAS measurements of lower limb and trunk angles during running. Qualitative and quantitative analyses were performed. Seven hundred and five studies were found and 17 were included. Ten studies analysed criterion validity between 2DVAS and 3DMAS and the results ranged from poor to excellent, with most of the parameters assessed presenting poor or moderate validity. Inter-rater reliability of 2DVAS was assessed in nine studies and most of the parameters investigated had good to excellent reliability. Intra-rater reliability (between-day processing) of angular running parameters - investigated in ten studies - was considered excellent for most of the parameters analysed. Inter-session reliability was assessed in three studies and was defined as good or excellent for most of the variables assessed. 2DVAS is a reliable method for measuring joint angles during running. However, the validity of 2DVAS compared to 3DMAS ranges from low to moderate for most running parameters. Therefore, based on the available evidence, caution should be taken when applying 2DVAS, particularly for frontal and transverse plane angles.

A Systematic Review of the Measurement Properties of Face, Legs, Activity, Cry and Consolability Scale for Pediatric Pain Assessment

Purpose

We performed this systematic review to summarize the psychometric properties of Face, Legs, Activity, Cry and Consolability (FLACC) scale in pediatric patients in different settings.

Methods

Two investigators independently searched PubMed, EMBASE, OVID and China National Knowledge Infrastructure (CNKI) for eligible studies through July 2021. We assessed the psychometric properties using the modified critical appraisal tool (CAT). Finally, we systematically reviewed the results of the included studies.

Results

A total of 15 studies were eventually included. The overall quality of each eligible study was low to moderate. The FLACC scale has been available in different versions and in different settings. Although eligible studies have demonstrated significant clinical benefit in assessing postoperative pain in pediatric patients aged 0 to 10 years from post-anesthetic care unit (PACU), pediatric intensive care unit (PICU) and inpatient unit, and in assessing procedural pain in pediatric patients aged 0.5 to 7 years from emergency unit, immunization center and PICU, mostly without test-retest analysis.

Conclusion

Although the absence of a gold standard of pain assessment, the currently available data support the usefulness of the FLACC from the perspective of criterion validity. Therefore, the FLACC scale can be considered for measuring observational pain in infants and children. However, further studies are still needed to provide more robust evidence.

Análisis cinemático del ángulo de proyección frontal de rodilla en 2D: enfoque metodológico

La evaluación cinemática del comportamiento del miembro inferior en tres dimensiones (3D) requiere el uso de alta tecnología, formación especializada y laboratorios que no se ajustan a las demandas del ámbito clínico y deportivo. La valoración del APFR (ángulo de proyección frontal de rodilla)en dos dimensiones (2D) ha mostrado consistentemente su validez, objetividad y confiabilidad al ser comparada con la metodología de análisis en 3D para la detección del valgo dinámico asociado al incremento de torques externos de aducción y rotación interna de cadera durante la ejecución de tareas funcionales que exigen control muscular excéntrico. El valgo dinámico ha mostrado ser un predictor de lesión del ligamento cruzado anterior y de síndrome de dolor patelofemoral, especialmente en mujeres. La detección oportuna y el seguimiento del comportamiento cinemático con instrumentos de bajo costo, poca complejidad y un nivel de experticia básico utilizando análisis en 2D, se perfila como estrategia de valoración importante en el entrenamiento deportivo y el abordaje clínico para la prevención y rehabilitación de lesiones de rodilla asociados a estos desórdenes del movimiento. Por tanto, esta revisión narrativa pretende proveer de conocimientos esenciales para la correcta valoración, interpretación y análisis del APFR en Fisioterapeutas y Profesionales del Deporte.

Measurement Techniques for Leg Length Discrepancy in Total Hip Arthroplasty: A Systematic Review of Reliability and Validity

BACKGROUND

Total hip arthroplasty (THA) carries a substantial litigative burden. THA may introduce leg length discrepancy (LLD), necessitating a valid and reliable technique for LLD measurement. This study investigates the reliability and validity of techniques quantitively measuring LLD in both pre- and post-THA.

METHODS

Embase and MEDLINE databases were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for articles assessing either the validity or reliability of LLD measurement techniques. Data was pooled using random effects meta-analysis to derive reliability estimates. Study quality was assessed using the Brink and Louw checklist.

RESULTS

Forty-two articles with 2059 participants were included. Thirty-three investigated reliability and 25 validity. Reliability displayed high heterogeneity. Poor to excellent intra-rater reliability was reported for antero-posterior pelvis radiographs, moderate to excellent for computed tomography scanograms, and good to excellent for clinical methods and teleradiography, and excellent for bi-planar radiography (BPR). Poor to excellent inter-rater reliability was reported for antero-posterior pelvis radiographs and clinical methods, moderate to excellent for teleradiography, good to excellent for computed tomography scanogram and excellent for BPR. The tape measure method is a valid clinical measure of LLD whilst markerless motion analysis and the block method are not. Imaging techniques are appropriately cross-validated with the exception of BPR.

CONCLUSION

The reported intra- and inter-rater reliability for most measurement techniques vary widely. The tape measure method is a valid clinical measurement of LLD. Imaging techniques have been appropriately cross-validated, with the exception of BPR, although they lack validation against a common reference technique.

Validation studies of verbal autopsy methods: a systematic review

BACKGROUND

Verbal autopsy (VA) has emerged as an increasingly popular technique to assign cause of death in parts of the world where the majority of deaths occur without proper medical certification. The purpose of this study was to examine the key characteristics of studies that have attempted to validate VA cause of death against an established cause of death.

METHODS

A systematic review was conducted by searching the MEDLINE, EMBASE, Cochrane-library, and Scopus electronic databases. Included studies contained 1) a VA component, 2) a validation component, and 3) original analysis or re-analysis. Characteristics of VA studies were extracted. A total of 527 studies were assessed, and 481 studies screened to give 66 studies selected for data extraction.

RESULTS

Sixty-six studies were included from multiple countries. Ten studies used an existing database. Sixteen studies used the World Health Organization VA questionnaire and 5 studies used the Population Health Metrics Research Consortium VA questionnaire. Physician certification was used in 36 studies and computer coded methods were used in 14 studies. Thirty-seven studies used high level comparator data with detailed laboratory investigations.

CONCLUSION

Most studies found VA to be an effective cause of death assignment method and compared VA cause of death to a high-quality established cause of death. Nonetheless, there were inconsistencies in the methodologies of the validation studies, and many used poor quality comparison cause of death data. Future VA validation studies should adhere to consistent methodological criteria so that policymakers can easily interpret the findings to select the most appropriate VA method.

PROSPERO REGISTRATION

CRD42020186886.

Reliability and Validity of Scoliosis Measurements Obtained with Surface Topography Techniques: A Systematic Review

BACKGROUND

Surface topography (ST) is one of the methods in scoliosis assessment. This study aimed to systematically review the reliability and validity of the ST measurements for assessing scoliosis.

METHODS

A literature search of four databases was performed and is reported following PRISMA guidelines. The methodological quality was evaluated using Brink and Louw appraisal tool and data extraction was performed. The results were analyzed and synthesized qualitatively using the level of evidence method.

RESULTS

Eighteen studies were included and analyzed. Four were evaluated for reliability, six for validity, and eight for reliability and validity. The methodological quality of fourteen studies was high. Good to excellent intra-investigator reliability was shown on asymmetry, sagittal, horizontal, and most frontal ST measurements (evidence level: strong). Asymmetry and most frontal, sagittal, horizontal ST measurements showed good to excellent inter-investigator reliability (evidence level: moderate). When comparing corresponding ST and radiological measurements, good to strong validity was shown on most frontal, sagittal, and asymmetry measurements (evidence level: strong). Formetric measurements had good intra-investigator reliability and validity (evidence level: strong).

CONCLUSIONS

Most asymmetry, sagittal, and frontal ST measurements showed satisfactory reliability and validity. Horizontal ST measurements showed good reliability and poor validity. The ST technique may have great potential in assessing scoliosis, especially in reducing radiation exposure and performing cosmetic assessments.

Reliability of trunk strength measurements with an isokinetic dynamometer in non-specific low back pain patients: A systematic review

BACKGROUND

Imbalance or decreased trunk strength has been associated with non-specific low back pain (NSLBP).

OBJECTIVE

This systematic review aimed (I) to evaluate the quality of evidence of studies evaluating the reliability of trunk strength assessment with an isokinetic dynamometer in NSLBP patients, (II) to examine the reliability of trunk strength assessment using an isokinetic dynamometer in NSLBP patients and (III) to determine the most reliable protocol for trunk strength assessment in NSLBP patients.

METHOD

PRISMA guidelines were followed. Three databases were used: PubMed, Scopus, and Web of Science with the following keywords: Isokinetic, Dynamometer, Trunk strength testing, Muscle testing, Isokinetic measurement, CORE, Abdominal muscles, Abdominal wall, Torso, Trunk, Spine, Reliability and, Reproducibility. We included only test-retest studies, focused on the reliability of isometric and isokinetic strength assessed with an isokinetic dynamometer in NSLBP adults' patients, published in English and from inception to March 30, 2021. The methodological quality was evaluated with the CAT scale and QAREL checklist.

RESULTS

Five hundred and seventy-seven articles were retrieved, of which five are included in this review. Three articles provide good quality of evidence, the reliability of trunk strength assessment in NSLBP patients is excellent, and the most reliable protocol for isometric assessment is in a seated position (ICC = 0.94-0.98) and for isokinetic strength in standing position, at 60∘/s and 120∘/s (ICC = 0.98).

CONCLUSION

There is good quality evidence regarding the trunk strength assessment's reliability. Reliability is excellent in NSLBP patients; however, a familiarization process should be considered to obtain clinically reliable data. The most reliable protocol is in a seated position for isometric strength and a standing position for isokinetic strength.

Tools for Assessing Knowledge of Back Health in Adolescents: A Systematic Review Protocol

Back pain is common in adolescents as a result of their typical daily activities. There is a critical need for developing instruments that can assess the adolescents' knowledge of proper posture, because adequate postural habits are essential for preventing back pain and facilitating physical well-being. Unfortunately, there is insufficient understanding about appropriate back health in the general public, even though this knowledge is decisive in the development of physical skills and attainment of health literacy. Furthermore, relevant substantive literature is scarce. Therefore, the proposed systematic review aims to identify instruments that are used for assessing knowledge of back health in adolescents. Relevant search terms and descriptors will be combined, and searches will be carried out in a uniform sequence within the PubMed, Embase, CINAHL, and Cochrane Library databases. Eligible articles must present data on the assessment of the adolescents' knowledge of back health and describe the applied instrumentation. Articles will be selected by two reviewers independently; all disagreements will be resolved by a third reviewer. Mendeley and the Rayyan software will be used for the systematic review, and the checklist proposed by Brink and Louw will be used to verify the methodological quality of the included studies. Our findings may confirm the relevance of constructing and validating back health instruments for use in Brazil and other countries.

Management of Subacute Thyroiditis - A Systematic Review of Current Treatment Protocols

Purpose

This systematic review endeavors to find an effective treatment protocol for subacute thyroiditis (SAT) to minimize side effects, recurrence and long-term hypothyroidism.

Materials and Methods

We analyzed available original studies on treatment protocols for SAT. A thorough literature search was performed on the following online databases PubMed, Cochrane library nd Google Scholar using appropriate keywords for choosing relevant articles. Two reviewers assessed the methodological quality of selected articles independently using a critical appraisal instrument. The results were analyzed and synthesized qualitatively using the level of evidence method.

Results

The literature search retrieved a total of 460 publications after abstract screening; out of which 36 articles met the inclusion criteria. After full text screening, 23 articles were further excluded as they were focusing on aspects of SAT other than management, the remaining 15 articles were investigated for both reliability and validity. Thirteen studies provided low-quality evidence, and two randomized control trials (RCT) provided a high quality of evidence. Steroid therapy was found to be the most effective for moderate to severe SAT and provided relief from acute symptoms but was found to not be a risk factor for recurrence. Low initial doses of steroid (15 mg) were preferred over high initial dosage (30–40 mg). Furthermore, a look into the mode of steroid delivery (RCT) revealed that intrathyroidal steroid therapy can potentially become a safer and faster mode of therapy. The duration of tapering was found to be of significance as a short tapering period was linked with greater recurrence rates.

Conclusion

Low initial doses of steroid along with an extended tapering period may help lower recurrence rates; also, intrathyroidal steroid injections are potentially a better alternative to oral prednisone (PSN) with regard to safety and speed of action. However, the evidence is of moderate quality and further investigation is required.

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Reliability and Validity of Non-radiographic Methods of Forward Head Posture Measurement: A Systematic Review

Forward head posture measurement can be conducted using various methods and instruments. The selection of the appropriate method requires the factors of validity and reliability to be considered. This systematic review reports on the reliability and validity of the non-radiographic methods examined for measuring forward head posture. The review identified relevant studies following a systematic search of electronic databases. The studies were assessed for quality by two independent reviewers using a critical appraisal tool. The studies’ data were extracted and assessed, and the results were synthesized qualitatively using a level of evidence approach. Twenty-one studies met the eligibility criteria and were included in the review. Both reliability and validity were investigated for five studies, whereas reliability only was investigated for 17 studies. In total, 11 methods of forward head posture measurement were evaluated in the retrieved studies. The validity of the methods ranged from low to very high. The reliability of the methods ranged from moderate to excellent. The strongest levels of evidence for reliability support the use of classic photogrammetry. For validity, the evidence is not conclusive. Further studies are required to strengthen the level of evidence on the reliability and validity of the remaining methods. It is recommended that this point be addressed in future research.

Adaptation and Validation of a Test for the Evaluation of Tactical Knowledge in Soccer: Test de Conocimiento Táctico Ofensivo en Fútbol for the Brazilian Context (TCTOF-BRA)

Background

Studies and tests to assess the tactical domain of young soccer players are recent, and few instruments meet the majority of quality criteria.

Objective

To adapt and validate the Test de Conocimiento Táctico Ofensivo en Fútbol (TCTOF) for the Brazilian context (TCTOF-BRA).

Methods

The article consists of two studies. Study 1 (n = 111) included the translation, theoretical/semantic analysis, back translation, cross-cultural equivalence, and content and face validity (pre-test). In study 2 (n = 768), a theoretical and empirical item analysis was carried out, followed by construct validity [exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and the known-groups method] and reliability (internal consistency and repeatability).

Results

In the cross-cultural evaluation, the Coefficient of content validity total (CCV_t) of the instrument was 0.96 and in the content validity, the CCV_t of the instrument was 0.87. The face validity was confirmed (>95%). After theoretical and empirical analysis, 15 questions were included in the Teste de Conhecimento Tático Ofensivo no Futebol (TCTOF-BRA). The EFA showed a model with adequate fit (KMO = 0.69; Bartlett p < 0.001), with a factor structure considered very good, composed of four factors (decision making, operational tactical principles, collective tactical-technical elements, and rules). The CFA by the Asymptotically Distribution-Free estimation method demonstrated good and very good goodness of fit indices (X²/df = 1.54, GFI = 0.99, CFI = 0.94, TLI = 0.92, PGFI = 0.71, PCFI = 0.76, RMSEA = 0.03, and ECVI = 0.26). The known-groups method showed significant differences (p < 0.01) and effect sizes varying from small-to-medium to large. With respect to reliability, coefficients of 0.89 (CR) and 0.74 (KR20) for internal consistency and 0.85 for repeatability were found.

Conclusion

The TCTOF-BRA presented satisfactory evidence, demonstrating it to be an instrument with valid and reliable measures for the evaluation of tactical knowledge (declarative and theoretical procedural), based on specific knowledge and decision making (cognitive domain), of Brazilian young soccer players from 12 to 17.9 years old.

Development of a Psychometric Test: A Care Risk Scale for Homebound Older People With Dementia

Background

Homebound older people with dementia (OPWD) face a series of care risks due to disease characteristics, care issues, and the family environment. However, China lacks a quantitative assessment tool for care risk. Thus, we attempted to develop a care risk scale for homebound OPWD.

Methods

A care risk scale, with initially 18 items, was designed based on a systematic literature review, expert consultation, and a pilot study with 20 OPWD. The initial scale was validated among 1,045 homebound OPWD in Ningbo, China from November 1, 2020 to July 30, 2021. After removing three items that lacked discrimination power, the reliability and validity of the remaining 15 items was evaluated. Factor extraction was performed via principal axis factoring and Cattell's scree plot analysis, with the resulting factors then being subjected to a varimax rotation.

Results

The final scale consisted of 15 items assessed on a 5-point Likert scale that loaded on to three different factors, including dementia symptoms (four items), family support (four items), and home environment (seven items). These three factors were found to explain 72.9% of the cumulative variance. The overall Cronbach's alpha for the final scale was 0.907. The correlation coefficients in the item-to-total analysis ranged from 0.511 to 0.662.

Conclusion

The validation analysis indicated satisfactory reliability and validity of the 15-item scale for assessing care risk of homebound OPWD. This scale can help long-term care professionals and family caregivers identify care risks and help them take targeted measures to enhance safety of care for OPWD.

Guidelines for performing systematic reviews in sports science

Most of the reviews carried out in sports science have used the general items suggested by Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Due to the specific requirements of each knowledge area, several modifications of the PRISMA are necessary to optimize the process of the systematic reviews and, in consequence, the quality of the conclusions provided in this type of study. Therefore, this work aimed to adapt PRISMA to provide specific guidelines to carry out systematic reviews in sports science. The methodology criteria (search strategy, databases, and eligibility) and the results section (flow diagrams and study contents) were adapted based on previous studies, and several new considerations were added to design the new guidelines. We compiled 28 items suggested by sports science researchers and included two new items: (i) population/problem (i.e., age, level, and country) and (ii) the entire training process, which is monitored and compared between groups (e.g., total training load). To maximize the benefit of this document, we encourage people to read it in conjunction with the PRISMA statement. The main differences between PRISMA and the PRISMA adapted to sports science were related to registration, search strategy, flow diagrams, and results. Application of the new guidelines could improve the information provided to readers and make it easier to generalize and compare the results in sports science.

The utility of physiotherapy assessments delivered by telehealth: A systematic review

BACKGROUND

Telehealth use is increasing due to its ability to overcome service access barriers and provide continued care when disease transmission is of concern. However, little is known of the validity, reliability and utility of performing physiotherapy assessments using synchronous forms of telehealth across all physiotherapy practice areas. The aim of this systematic review was to determine the current clinometric value of performing physiotherapy assessments using synchronous forms of telehealth across all areas of physiotherapy practice.

METHODS

A comprehensive search of databases (PubMed/MEDLINE, The Cochrane Library, Embase and EBSCO) was undertaken to identify studies investigating the clinometric value of performing physiotherapy assessments using synchronous forms of telehealth across all physiotherapy practice areas. Following selection, a quality appraisal was conducted using the Brink and Louw or Mixed Methods Appraisal Tool. Evidence regarding validity, reliability and utility of synchronous telehealth physiotherapy assessments was extracted and synthesised using a critical narrative approach.

RESULTS

Thirty-nine studies conducted in a variety of simulated (n = 15) or real-world telehealth environments (n = 24), were included. The quality of the validity, reliability and utility studies varied. Assessments including range of movement, muscle strength, endurance, pain, special orthopaedic tests (shoulder/elbow), Berg Balance Scale, timed up and go, timed stance test, six-minute walk test, steps in 360-degree turn, Movement Assessment Battery for Children (2nd Edition), step test, ABILHAND assessment, active straight leg raise, and circumferential measures of the upper limb were reported as valid/reliable in limited populations and settings (many with small sample sizes). Participants appeared to embrace telehealth technology use, with most studies reporting high levels of participant satisfaction. If given a choice, many reported a preference for in-person physiotherapy assessments. Some inconsistencies in visual/auditory quality and challenges with verbal/non-verbal communication methods were reported. Telehealth was considered relatively cost-effective once services were established.

CONCLUSIONS

Performing physiotherapy assessments using synchronous forms of telehealth appears valid and reliable for specific assessment types in limited populations. Further research is needed in all areas of physiotherapy practice, to strengthen the evidence surrounding its clinometric value. Clinicians contemplating using this assessment mode should consider the client/family preferences, assessment requirements, cultural needs, environment, cost considerations, access and confidence using technology.

PROTOCOL REGISTRATION

PROSPERO: CRD42018108166.

Moiré topography as a screening and diagnostic tool-A systematic review

Diagnostic investigation can be carried out using non-radiological and non-contact methods. Moiré topography (MT) seems to be a viable alternative to radiographic research in evaluating the spine and/or trunk deviations. The aim of this systematic review was to analyze the current knowledge regarding the reliability and validity of Moiré topography as a screening and diagnostic tool. The systematic review was performed from 2010 until March 2021 in the PubMed, EBSCO, Web of Science, and Scopus databases, according to the eligibility criteria. This review fulfilled the following criteria according to the PICO system: population (children and adolescents), intervention (MT measurement), comparison (repeated MT measurements, MT compared to Cobb angle or scoliometer), outcome (reliability and validity of MT). Eight studies fulfilled the inclusion criteria for further analysis. All the studies were assessed to be of high quality. Included studies found that MT had high repeatability and high intraobserver and interobserver correlation, and correlation between MT parameters and radiographic Cobb angle ranged from moderate to high. The authors reported difficulty in defining the cut-off values for MT parameter (Surface Trunk Rotation-STR), and unsatisfactory sensitivity and specificity of MT examination. The studies did not reveal the advantage of MT as a screening method in the detection of idiopathic scoliosis in comparison to radiograph. Based on the evidence from eight studies, the results indicated moderate evidence for reliability and validity of Moiré topography as a screening and diagnostic tool. There is still no strong evidence for the accuracy of MT.

Non-radiographic validity and reliability measures for assessing foot types: A systematic review

BACKGROUND

Foot type classification is well recognized in clinical practice and orthopedic literature, a universally accepted classification or standardized measures to determine foot types are lacking. The objective of this study was to identify which non-radiographic assessment methods are considered valid and/or reliable for the classification of foot types.

METHOD

A systematic database search was performed. Only cross-sectional studies that performed reliability and/or validity analysis of non-radiographic methods were included. To evaluate the risk of bias, the Critical Appraisal Tool (CAT) was used to evaluate the measurement properties of objective clinical methods.

RESULTS

Twenty-six studies were included. The results of reliability and validity, in general, demonstrated high scores, but, inconsistencies were related to the variability of the measurements, heterogeneity of the methods used to determine reliability and validity, and lack of parameters for classifying foot types, which resulted in few elements to determine which method of foot type evaluation is valid and reliable.

CONCLUSION

Given the Intraclass Correlation Coefficient and CAT results and the presence of normative values, the static measurements of the "Arch Height Index", "Foot Posture Index", and "Staheli Arch Index" can be suggested to classify foot types.

Typical m. triceps surae morphology and architecture measurement from 0 to 18 years: A narrative review

The aim of this review was to report on the imaging modalities used to assess morphological and architectural properties of the m. triceps surae muscle in typically developing children, and the available reliability analyses. Scopus and MEDLINE (Pubmed) were searched systematically for all original articles published up to September 2020 measuring morphological and architectural properties of the m. triceps surae in typically developing children (18 years or under). Thirty eligible studies were included in this analysis, measuring fibre bundle length (FBL) (n = 11), pennation angle (PA) (n = 10), muscle volume (MV) (n = 16) and physiological cross‐sectional area (PCSA) (n = 4). Three primary imaging modalities were utilised to assess these architectural parameters in vivo: two‐dimensional ultrasound (2DUS; n = 12), three‐dimensional ultrasound (3DUS; n = 9) and magnetic resonance imaging (MRI; n = 6). The mean age of participants ranged from 1.4 years to 18 years old. There was an apparent increase in m. gastrocnemius medialis MV and pCSA with age; however, no trend was evident with FBL or PA. Analysis of correlations of muscle variables with age was limited by a lack of longitudinal data and methodological variations between studies affecting outcomes. Only five studies evaluated the reliability of the methods. Imaging methodologies such as MRI and US may provide valuable insight into the development of skeletal muscle from childhood to adulthood; however, variations in methodological approaches can significantly influence outcomes. Researchers wishing to develop a model of typical muscle development should carry out longitudinal architectural assessment of all muscles comprising the m. triceps surae utilising a consistent approach that minimises confounding errors.

Reliability of Isokinetic Hip Flexor and Extensor Strength Measurements in Healthy Subjects and Athletes: A Systematic Review and Meta-Analysis

BACKGROUND

The objective of this systematic review and meta-analysis was to examine the reliability of isokinetic measurements of hip strength in flexion and extension in healthy subjects and athletes.

METHODS

The databases used were Web of Science, SCOPUS, Medline and PubMed. R was used for all statistical analyses.

RESULTS

Hip flexion shows moderate reliability in the supine position (ICC = 0.72; 95% CI: 0.46-0.99) and good reliability in the standing position (ICC = 0.79; 95% CI: 0.54-1.04). Hip extension shows excellent reliability in the supine position (ICC = 0.90; 95% CI: 0.85-0.96) and moderate reliability in the standing position (ICC = 0.72; 95% CI: 0.48-0.96). Flexion of 120°/s and 180°/s showed excellent reliability (ICC = 0.93; 95% CI: 0.85-1.00), (ICC = 0.96; 95% CI: 0.92-1.01). The 60°/s and 120°/s extension showed good reliability (ICC = 0.90; 95% CI: 0.82-0.98), (ICC = 0.87; 95% CI: 0.75-0.99). The 180°/s extension presented excellent reliability (ICC = 0.93; 95% CI: 0.82-1.03).

CONCLUSIONS

The standing position shows good reliability for hip flexion and the supine position shows excellent reliability for hip extension, both movements have excellent reliability at velocities between 120°/s to 180°/s.

Scoping review of tests to assess tactical knowledge and tactical performance of young soccer players

This scoping review aimed to systematically map studies/tests for assessing the tactical domain of young soccer players. The study followed the PRISMA-ScR and Joanna Briggs Institute guidelines. The databases searched were Scopus, SPORTDiscus, SciELO, LILACS, and BDTD. The eligibility criteria were defined based on the elements of population, context, and concept, without restrictions on the period, language, and type of publication. Twenty-four papers were included, from 1997 to 2020, totalling 29 tests/instruments for the assessment of the tactical domain, with the majority of studies having an European sample. Twelve terms were used to nominate the tactical component, regardless of the assessment method and approach. Six tests met eight or nine criteria in the critical appraisal: TCTOF, TACSIS Spanish version, Semi-Structured Interview, TCTP-OE, GPET, and FUTSAT. Thus, it is concluded that studies and tests for the assessment of the tactical domain of young soccer players are recent and mainly European; there is no consensus about the adopted terminology; and few tests met the majority of the quality criteria. Therefore, we suggest: a) the construction/adaptation of tests with samples from other continents; b) the use of the proposed criteria; and c) that the terms tactical knowledge and tactical performance are adopted.

Reliability and validity of smartphone applications to measure the spinal range of motion: A systematic review

Introduction: The objective of this study is to conduct a systematic review on the reliability and validity of various smartphone applications for spinal range of motion (ROM) measurements.Methods: Eleven studies were selected following an electronic search of PubMed, CINAHAL, Medline, Embase and SPORTDiscus. Quality appraisals of selected studies were conducted using a standardized appraisal tool.Results: Most studies demonstrated a good intra- and inter-rater reliability, as well as validity in more than 50% of joint movements. At the same time, relative reliability/validity outcomes (e.g. interclass correlation co-efficient) were stronger than absolute reliability/validity outcomes (e.g. mean differences, limits of agreement). Spinal rotation movement showed less reliability and validity when compared to other spinal movements.ConclusionsːResult of the study supports the use of smartphone applications for ROM measurements of spinal joints. However, we cannot advocate the most appropriate application for spinal ROM measurement or suggest which application is superior to all others. As clinicians have multiple options in selecting applications, it is recommended they use applications that have proven reliable and valid for that particular joint. Data from this study provides clinicians with evidence-based research on smartphone devices for measuring spinal joint ROM in clinical settings.

How to objectively assess and observe maladaptive pain behaviors in clinical rehabilitation: a systematic search and review

Background

Cognitive-affective factors influence the perception of pain and disability. These factors can lead to pain behaviors (PB) that can persist and become maladaptive. These maladaptive PB will further increase the risk of chronicity or persistence of symptoms and disability. Thus, clinicians must be prepared to recognize maladaptive PB in a clinical context. To date, in the context of assessment in a rehabilitation setting, PB in clinical settings are poorly documented. The main objective of this study was to identify direct observation methods and critically appraise them in order to propose recommendations for practice. As a secondary objective, we explored and extracted the different observable PB that patients could exhibit and that clinicians could observe.

Methods

We conducted a comprehensive review on four databases with a generic search strategy in order to obtain the largest range of PB. For the first objective, a two-step critical appraisal used clinical criteria (from qualitative studies on barriers to implement routine measures) and psychometric criteria (from Brink and Louw critical appraisal tool) to determine which observation methods could be recommended for clinical practice. For the second objective, we extracted PB found in the literature to list potential PB that patients could exhibit, and clinicians could observe.

Results

From the 3362 retrieved studies, 47 met the inclusion criteria for the first objective. The clinical criteria allowed us to select three observation methods. After the psychometric step, two observation methods were retained and recommended for clinical practice: the Behavioral Avoidance Test-Back Pain (BAT-Back) and the Pain Behaviour Scale (PaBS). For the second objective, 107 studies met the inclusion criteria. The extraction of the PB allowed us to list a large range of PB and classify the data in 7 categories of PB.

Conclusion

Our results allowed us to recommend two observation methods for clinical practice. However, these methods have limitations and are validated only in chronic low back pain populations. With the extraction of PB presented in the literature, we contribute to better prepare clinicians to recognize PB in all patients who are experiencing pain.

Validity and Reliability of Palpatory Clinical Tests of Sacroiliac Joint Mobility: A Systematic Review and Meta-analysis

OBJECTIVE

The primary objective of this review was to investigate the reliability and validity of palpatory clinical tests of sacroiliac mobility. The secondary objective was to investigate which palpatory clinical tests of sacroiliac mobility exist in the literature.

METHODS

PubMed, Embase, Scopus, Medline, and the Physiotherapy Evidence Database were searched. There was no restriction on the study design or participants. The data extracted from each study were sample size, study deign, and clinical test used. If there was information on reliability values, number of examiners, concurrent validity values, gold standard used, or inferential statistical test used, that was also extracted. For intraexaminer reliability, the data were expressed as κ values that were meta-analyzed using random effects.

RESULTS

Fifteen palpatory clinical tests of sacroiliac mobility were identified from 28 studies; 14 studies performed inferential statistical analysis, all including analysis of interexaminer reliability, with κ values ranging from -0.05 to 0.77. Analysis of intraexaminer reliability was performed in 8 studies, with κ values ranging from 0.08 to 0.73. No study included in this systematic review verified the concurrent validity of the tests. Our meta-analysis of intraexaminer reliability showed moderate to good agreement results for the Gillet test (κ = 0.46), the standing flexion test (κ = 0.61), and the sitting flexion test (κ = 0.68).

CONCLUSION

We found 15 palpatory clinical tests of sacroiliac mobility in this systematic review. According to our meta-analysis, only the sitting flexion test obtained a good and statistically significant intraexaminer agreement. Further studies are necessary to evaluate the reliability and validity of these tests.

Validity and Reliability of Interactive Virtual Reality in Assessing the Musculoskeletal System: a Systematic Review

PURPOSE OF REVIEW

Assessment of the musculoskeletal system requires consideration of its integrated function with the nervous system. This may be assisted by using valid and reliable methods that simulate real-life situations. Interactive virtual reality (VR) technology may introduce various auditory and visual inputs that mimic real-life scenarios. However, evidence supporting the quality and strength of evidence regarding the adequacy of its psychometric properties in assessing the musculoskeletal function has not been evaluated yet. Therefore, this study reviewed the validity and reliability of VR games and real-time feedback in assessing the musculoskeletal system.

RECENT FINDINGS

Nine studies were included in quality assessment. Based on outcome measures, studies were categorized into range of motion (ROM), balance, reaction time, and cervical motion velocity and accuracy. The majority of the studies were of moderate quality and provided evidence of VR adequate concurrent and, in some cases, known-groups validity. Also, VR showed high intra-rater reliability for most of the measured outcomes. Based on the included studies, there is a limited promising evidence that interactive VR using games or real-time feedback is highly valid and reliable in assessing ROM in asymptomatic participants and patients with chronic neck pain and radial fracture. For the remaining outcomes, evidence is limited to draw a robust conclusion. Future studies are recommended to test VR psychometric properties in different patients' population using a rigor research methodology.

Reliability and validity of physical fitness tests in people with mental disorders: A systematic review and meta-analysis

BACKGROUND

Several tests are available to assess the different components of physical fitness, including cardiorespiratory fitness, muscular strength, and flexibility. However, the reliability and validity of physical fitness tests in people with mental disorders has not been meta-analyzed.

AIMS

To examine the reliability, concurrent, and convergent validity of physical fitness tests in people with mental disorders.

METHODS

Studies evaluating the reliability, concurrent, and convergent validity of physical fitness tests in people with mental disorders were searched from major databases until January 20, 2020. Random-effects meta-analyses were performed pooling (1) reliability: test-retest correlations at two-time points, (2) convergent validity between submaximal tests and maximal protocols, or (3) concurrent validity between two submaximal tests. Associations are presented using r values and 95% confidence intervals. Methodological quality was assessed using the Quality Appraisal of Reliability Studies and the Critical Appraisal Tool.

RESULTS

A total of 11 studies (N = 504; 34% females) were included. Reliability of the fitness tests, produced r values ranging from moderate (balance test-EUROFIT; [r = 0.75 (0.60-0.85); p = 0.0001]) to very strong (explosive leg power EUROFIT; [r = 0.96 (0.93-0.97); p = 0.0001]). Convergent validity between the 6-min walk test (6MWT) and submaximal cardiorespiratory tests was moderate (0.57 [0.26-0.77]; p = 0.0001). Concurrent validity between the 2-min walk test and 6MWT (r = 0.86 [0.39-0.97]; p = 0.0004) was strong.

CONCLUSION

The present study demonstrates that physical fitness tests are reliable and valid in people with mental disorders.

Perceived Barriers, Enablers, and Modifications to Tests Assessing Pediatric Lower Limb Neurological Impairment: An International Delphi Survey

OBJECTIVES

Accurate, clinically meaningful outcome measures that are responsive to change are essential for selecting interventions and assessing their effects. Little guidance exists on the selection and administration of neurological impairment tests in children with a neurological condition. Clinicians therefore frequently modify adult assessments for use in children, yet the literature is inconsistent. This study aims to establish consensus on neurological conditions most likely to require neurological impairment test in pediatrics and the barriers, enablers, and modifications perceived to enhance test reliability.

METHODS

Over a 2-round modified Delphi study, a panel of experts (n = 24) identified neurological conditions perceived to typically require pediatric neurological testing and the modifications to address barriers/enablers to testing. Experts comprised physical therapists with evidence of advanced training or research in pediatrics. Using a 6-point Likert scale (6 = strongly agree, 5 = agree, 4 = somewhat agree, 3 = somewhat disagree, 2 = disagree, 1 = strongly disagree), experts rated statements from existing literature. Thematic analyses were conducted on responses to open-ended questions. A priori consensus was pre-set at 65% agreement/disagreement. Median, mode, and interquartile ranges estimated perceived importance. Cessation was pre-determined by non-consensus items <10% and panel fatigue.

RESULTS

Experts reached consensus on 107/112 (96%) items, including identifying 25/26 (96%) neurological conditions they perceived to require routine neurological testing. Experts strongly agreed with high importance that appropriately trained, experienced therapists are less variable when testing children. Communication modifications were perceived as most important.

CONCLUSION

High levels of consensus support the use of lower limb neurological testing in a range of pediatric neurological conditions. Trained clinicians should document modifications such as visual aid use. Using recommended modifications could encourage consistency among clinicians.

IMPACT

This is the first study to our knowledge to identify the barriers and enablers to pediatric neurological testing. Barriers and enablers were partially addressed through suggested modifications. Further rigorous examination of these modifications is required to support their use.

LAY SUMMARY

This study supports that clinicians should adapt their communication for children and young people with neurological problems to include visual aids and equipment demonstration.

Radiography and photogrammetry-based methods of assessing cervical spine posture in the sagittal plane: A systematic review with meta-analysis

BACKGROUND

There are numerous radiography and photogrammetry-based methods of assessing the cervical spine posture in the sagittal plane. The choice of instrument should be based on scientific parameters such as validity and reliability, thus avoiding restrictions to the applicability of the instrument.

RESEARCH QUESTION

What radiography and photogrammetry-based methods used to assess the cervical spine posture in the sagittal plane are valid and/or reliable?

METHODS

Systematic searches were conducted following Meta-analysis of Observational Studies in Epidemiology guidelines. Methodological quality was assessed according to the Brink & Louw appraisal tool.

RESULTS

Twenty-one studies were included in the qualitative analysis. Twenty different methods of calculating cervical spine posture in the sagittal plane were found. Two studies included validation measures, 16 studies assessed inter-rater reliability, and 17 studies assessed intra-rater reliability. Fourteen studies were included for the quantitative analysis. The meta-analysis shows that the cervical arrow and cervical lordosis photogrammetry-based methods present very high intra-rater reliability. In radiography, the meta-analysis also showed that the Cobb method (inferior C2 - inferior C7), Cobb method (middle C1 - inferior C7), absolute rotation angle, and Gore angle (C2-C7) present very high inter-rater reliability, and the Cobb method (inferior C2 - inferior C7) and absolute rotation angle present very high intra-rater reliability.

SIGNIFICANCE

This systematic review presents an overview of the methods used to assess cervical spine posture and the respective information on validity and reliability. This panorama facilitates the choice of method when conducting radiography or photogrammetry-based assessment of the cervical spine in the sagittal plane. In addition, it shows the need for new studies that investigate the accuracy and precision of these methods for their possible use in larger studies.

Psychometric properties of chronic low back pain diagnostic classification systems: a systematic review

OBJECTIVES

To identify and critically appraise studies evaluating psychometric properties of functionally oriented diagnostic classification systems for Non-Specific Chronic Low Back Pain (NS-CLBP).

METHODS

This review employed methodology consistent with PRISMA guidelines. Electronic databases and journals: (PubMed, EMBASE, Cochrane, PEDro, CINAHL, Index to chiropractic literature, ProQuest, Physical Therapy, Journal of Physiotherapy, Canadian Physiotherapy and Physiotherapy Theory and Practice) were searched from inception until January 2020. Included studies evaluated the validity and reliability of NS-CLBP diagnostic classification systems in adults. Risk of bias was assessed using a Critical Appraisal Tool.

RESULTS

Twenty-two studies were eligible: Five investigated inter-rater reliability, and 17 studies analyzed validity of O'Sullivan's classification system (OCS, n = 15), motor control impairment (MCI) test battery (n = 1), and Pain Behavior Assessment (PBA, n = 1). Evidence from multiple low risk of bias studies demonstrates that OCS has moderate to excellent inter-rater reliability (kappa > 0.4). Also, two low risk of bias studies support of OCS-MCI subcategory. Three tests within the MCI test battery show acceptable inter- and intra-rater reliability for clinical use (the "sitting knee extension," the "one leg stance," and the "pelvic tilt" tests). Evidence for the reliability and validity of the PBA is limited to one high bias risk study.

CONCLUSIONS

Multiple low risk of bias studies demonstrate strong inter-rater reliability for OCS classification specifically OCS-MCI subcategory. Future studies with low risk of bias are needed to evaluate reliability and validity of the MCI test battery and the PBA.

Instruments for Detecting Moral Distress in Clinical Nurses: A Systematic Review

Moral distress (MD) has become a seriously negative problem experienced by healthcare professionals, especially clinical nurses. Early and accurate detection of MD by the validated and reliable instrument is critically important to further develop an effective intervention strategy. We performed the current systematic review to comprehensively summarize the evidence of instruments for the detection of MD in clinical nurses. The research design was a systematic literature review. We assigned 2 investigators to independently search potential studies in PubMed, EMBASE, and China National Knowledge Infrastructure (CNKI) from their inception to June 2020. We used data extraction table extracting essential information, and the modified critical appraisal tool evaluating the reliability and validity of eligible instruments. Finally, we qualitatively summarized results of all included instruments. No ethical approval was required because this systematic review was performed based on published studies. We included 16 eligible studies covering 10 original and 6 revised or modified instruments for the final analysis. The overall quality of all instruments was moderate because test-retest reliability was inadequately examined in most instruments. Of 16 instruments, MDS-revised (MDS-R) was broadly validated and employed in different working or cultural settings. Meanwhile, it also extensively expands to specifically detect MD. Moreover, other instruments including moral distress risk scale (MDSR) and moral distress thermometer (MDT) should be further validated and utilized because it covered the gap missed by most instruments. Although several instruments have been made available for clinical nurses, some of them have inadequate psychometric properties test, especially test-retest reliability evaluation. Meanwhile, most of them have not be validated and employed in other working or cultural settings. We therefore suggested further studies to validate the psychometric properties of existing instruments and then employed instruments with high reliability and validity to detect MD in clinical nurses.

Reliability and Convergent Validity of Self-Reported Physical Activity Questionnaires for People With Mental Disorders: A Systematic Review and Meta-Analysis

PURPOSE

To examine the reliability and convergent validity of self-reported questionnaires (SRQs) to measure physical activity (PA).

METHODS

Systematic review with meta-analysis. The validity and reliability of SRQs to assess PA in people with mental disorders (January 20, 2020). Random-effects meta-analyses were performed pooling (1) test-retest correlations or (2) the convergent validity between the SRQs and objective measures (eg, accelerometry). Associations were provided in r values with the 95% confidence interval. Methodological quality was assessed.

RESULTS

A total of 9 unique studies (N = 1344; 40.5% females) were included. The authors found a moderate correlation test-retest reliability for PA SRQs in the assessment of vigorous PA (r = .69 [.38 to .85]; P = .001), moderate to vigorous PA (r = .63 [.25 to .84]; P = .003), moderate PA (r = .63 [.39 to .79]; P = .001), and good correlation total PA (r = .75 [.37 to .92]; P = .001). The SRQs have moderate correlations with objective measures for moderate to vigorous PA (r = .25 [.18 to .32]; P = .0001) and total PA (r = .47 [.28 to .62]; P = .005), a poor correlation for moderate PA (r = .18 [.03 to .36]; P = .047), and no correlation with vigorous PA (r = .06 [-.10 to .22]; P = .440).

CONCLUSION

Current evidence indicates that SRQs are reliable over time to assess moderate, vigorous, and total PA levels and valid when assessing moderate PA.

Validity and Reliability of Smartphones in Assessing Spinal Kinematics: A Systematic Review and Meta-analysis

OBJECTIVE

Advances in mobile technology have led to the development of smartphones, whose applications present numerous utilities, such as the analysis of human movement based on inertial sensors. The purpose of this review was to investigate validity and reliability of smartphones in assessing the kinematics of the human spine.

METHODS

A systematic search was performed on MEDLINE, Embase, Scopus, and LILACS databases, as well as manual searches. The included studies evaluated psychometric properties of smartphones in assessing kinematic variables of the spine (range of motion [ROM], speed, and acceleration). Two independent reviewers performed the selection, reading, data extraction, and risk of bias assessment of the studies.

RESULTS

Of the 2651 articles initially found, 9 were included and had their results for ROM analyzed. The meta-analyses for validity showed very high correlation coefficients in the evaluation of cervical flexion, extension, and lateral flexion; high ones in the evaluation of cervical rotation; and also high ones for intrarater and interrater reproducibility of all cervical movements. The meta-analyses for interrater reproducibility showed high correlation coefficients in the evaluation of lumbar flexion and very high ones for intrarater reproducibility.

CONCLUSION

The use of smartphones for assessing the ROM of cervical flexion, extension, and lateral flexion and lumbar flexion is feasible. Their use for assessing thoracic rotation is potentially viable, but further validation studies are still needed to ensure a safe use. There is a lack of validation studies that evaluate the applicability of this device in assessing other kinematic characteristics, such as speed and acceleration.

Objective quantification of burn scar stiffness using shear-wave elastography: Initial evidence of validity

Shear-wave elastography (SWE) is an ultrasound based technology that can provide reliable measurements (velocity) of scar stiffness. The aim of this research was to evaluate the concurrent validity of using both the measured velocity and the calculated difference in velocity between scars and matched controls, in addition to evaluating potential patient factors that may influence the interpretation of the measurements.

METHODS

A cross-sectional study of 32 participants, with 48 burn scars and 48 matched contralateral control sites were evaluated with SWE, the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS) tactile sub-scores.

RESULTS

Spearman's rho demonstrated high correlations (r > 0.7) between the measured scar velocity and both the POSAS and VSS pliability sub-scores, whereas moderate correlations (r > 0.6) were found with the calculated difference in velocity. Regression analysis indicated that the association of increased velocity in scars, varied by length of time after burn injury and gender. Body location and Fitzpatrick skin type also demonstrated significant associations with velocity, whereas age did not.

CONCLUSION

SWE shows potential as a novel tool to quantify burn scar stiffness, however patient factors need to be considered when interpreting results. Further research is recommended on a larger variety of scars to support the findings.

The I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: a clinimetric evaluation

OBJECTIVE

To describe the clinimetric validation of the I-DECIDED tool for peripheral intravenous catheter assessment and decision-making.

DESIGN AND SETTING

I-DECIDED is an eight-step tool derived from international vascular access guidelines into a structured mnemonic for device assessment and decision-making. The clinimetric evaluation process was conducted in three distinct phases.

METHODS

Initial face validity was confirmed with a vascular access working group. Next, content validity testing was conducted via online survey with vascular access experts and clinicians from Australia, the UK, the USA and Canada. Finally, inter-rater reliability was conducted between 34 pairs of assessors for a total of 68 peripheral intravenous catheter (PIVC) assessments. Assessments were timed to ensure feasibility, and the second rater was blinded to the first's findings. Content validity index (CVI), mean item-level CVI (I-CVI), internal consistency, mean proportion of agreement, observed and expected inter-rater agreements, and prevalence-adjusted bias-adjusted kappas (PABAK) were calculated. Ethics approvals were obtained from university and hospital ethics committees.

RESULTS

The I-DECIDED tool demonstrated strong content validity among international vascular access experts (n=7; mean I-CVI=0.91; mean proportion of agreement=0.91) and clinicians (n=11; mean I-CVI=0.93; mean proportion of agreement=0.94), and high inter-rater reliability in seven adult medical-surgical wards of three Australian hospitals. Overall, inter-rater reliability was 87.13%, with PABAK for each principle ranging from 0.5882 ('patient education') to 1.0000 ('document the decision'). Time to complete assessments averaged 2 min, and nurse-reported acceptability was high.

CONCLUSION

This is the first comprehensive, evidence-based, valid and reliable PIVC assessment and decision tool. We recommend studies to evaluate the outcome of implementing this tool in clinical practice.

TRIAL REGISTRATION NUMBER

12617000067370.

Mobile Apps to Quantify Aspects of Physical Activity: a Systematic Review on its Reliability and Validity

The purpose of this study was to systematically review and evaluate the evidence on the accuracy (validity) and consistency (reliability) of mobile apps used to quantify physical activity. Systematic literature searches were conducted in Pubmed, Science Direct, Web of Science, Physiotherapy Evidence Database (PEDro), Academic Search Complete and IEEE Xplore. Studies were included if they reported on the validity and/or reliability of a mobile application aiming primarily at measuring physical activity in humans with or without pathology. The reference lists of included articles were also screened for reports not identified through electronic searches. The methodological quality of included studies was assessed by 2 independent reviewers and data extracted by one reviewer and checked for accuracy by a second reviewer. A total of 25 articles were included in this review, of which 18 refer to validity and 7 to both validity and reliability. Mean percentage difference was used as an indicator of validity and varied between 0.1% and 79.3%. Intraclass Correlation Coefficients varied between 0.02 and 0.99 indicating poor to excellent reliability. There is conflicting and insufficient evidence on the validity and reliability, respectively, of apps for measuring physical activity. Nevertheless, velocity and the place where the smartphone is carried seem to have an impact on validity.

Reliability of isokinetic knee strength measurements in children: A systematic review and meta-analysis

Measuring muscle strength using isokinetic dynamometry allows evaluating and comparing normal and sick children, establishing recovery and rehabilitation goals, and quantitatively monitoring the course of a disease and the response to treatment. The purpose of this study was to carry out a systematic review and meta-analysis focusing on studies that examined the test-retest reliability of isokinetic knee strength measurements in children. This study is important because isokinetic dynamometry is the gold standard for evaluating muscle strength and it allows comparing muscle performance in children. The databases used were PubMed, Web of Science Scopus, and Embase (up to July 26, 2019). Only studies published in English were included in this review. All studies focused on the reliability of isokinetic knees in healthy children or those with cerebral palsy applied to dynamic contractions (concentric or eccentric) and provided measures of strength, reproducibility, ICC, peak torque, or SEM. We found a total of 143 abstracts and examined 94 articles to determine if they met the inclusion criteria. Finally, 10 articles were included in the systematic review and five studies (96 subjects) formed the meta-analysis sample, all of which focused on the reliability of isokinetic knees in the concentric mode. The CAT and QAREL scales were used to assess the quality of the included studies. The meta-analysis revealed high intra-class correlation coefficients (ICC) (0.84; p < 0.001; n = 96 subjects) in the flexion and excellent intra-class correlation coefficients (ICC 0.90; p < 0.001; n = 96 subjects) in the extension. Isokinetic dynamometry could be indicated as a method for measuring muscle strength training in children. However, the reviewed studies suggest some methodological issues in isokinetic tests, such as the rest days between testing and retesting, using the same speeds, protocols, and evaluators, and the performance of the subjects, so more research is required.

A Scale to Assess the Methodological Quality of Studies Assessing Usability of Electronic Health Products and Services: Delphi Study Followed by Validity and Reliability Testing

BACKGROUND

The usability of electronic health (eHealth) and mobile health apps is of paramount importance as it impacts the quality of care. Methodological quality assessment is a common practice in the field of health for different designs and types of studies. However, we were unable to find a scale to assess the methodological quality of studies on the usability of eHealth products or services.

OBJECTIVE

This study aimed to develop a scale to assess the methodological quality of studies assessing usability of mobile apps and to perform a preliminary analysis of of the scale's feasibility, reliability, and construct validity on studies assessing usability of mobile apps, measuring aspects of physical activity.

METHODS

A 3-round Delphi panel was used to generate a pool of items considered important when assessing the quality of studies on the usability of mobile apps. These items were used to write the scale and the guide to assist its use. The scale was then used to assess the quality of studies on usability of mobile apps for physical activity, and it assessed in terms of feasibility, interrater reliability, and construct validity.

RESULTS

A total of 25 experts participated in the Delphi panel, and a 15-item scale was developed. This scale was shown to be feasible (time of application mean 13.10 [SD 2.59] min), reliable (intraclass correlation coefficient=0.81; 95% CI 0.55-0.93), and able to discriminate between low- and high-quality studies (high quality: mean 9.22 [SD 0.36]; low quality: mean 6.86 [SD 0.80]; P=.01).

CONCLUSIONS

The scale that was developed can be used both to assess the methodological quality of usability studies and to inform its planning.

Movement Control Impairment and Low Back Pain: State of the Art of Diagnostic Framing

Background and objectives: Low back pain is one of the most common health problems. In 85% of cases, it is not possible to identify a specific cause, and it is therefore called Non-Specific Low Back Pain (NSLBP). Among the various attempted classifications, the subgroup of patients with impairment of motor control of the lower back (MCI) is between the most studied. The objective of this systematic review is to summarize the results from trials about validity and reliability of clinical tests aimed to identify MCI in the NSLBP population. Materials and Methods: The MEDLINE, Cochrane Library, and MedNar databases have been searched until May 2018. The criteria for inclusion were clinical trials about evaluation methods that are affordable and applicable in a usual clinical setting and conducted on populations aged > 18 years. A single author summarized data in synoptic tables relating to the clinical property; a second reviewer intervened in case of doubts about the relevance of the studies. Results: 13 primary studies met the inclusion criteria: 10 investigated inter-rater reliability, 4 investigated intra-rater reliability, and 6 investigated validity for a total of 23 tests (including one cluster of tests). Inter-rater reliability is widely studied, and there are tests with good, consistent, and substantial values (waiter's bow, prone hip extension, sitting knee extension, and one leg stance). Intra-rater reliability has been less investigated, and no test have been studied for more than one author. The results of the few studies about validity aim to discriminate only the presence or absence of LBP in the samples. Conclusions: At the state of the art, results related to reliability support the clinical use of the identified tests. No conclusions can be drawn about validity.

Validity and reliability of speed tests used in soccer: A systematic review

Introduction

Speed is an important prerequisite in soccer. Therefore, a large number of tests have been developed aiming to investigate several speed skills relevant to soccer. This systematic review aimed to examine the validity and reliability of speed tests used in adult soccer players.

Methods

A systematic search was performed according to the PRISMA guidelines. Studies were included if they investigated speed tests in adult soccer players and reported validity (construct and criterion) or reliability (intraday and interday) data. The tests were categorized into linear-sprint, repeated-sprint, change-of-direction sprint, agility, and tests incorporating combinations of these skills.

Results

In total, 90 studies covering 167 tests were included. Linear-sprint (n = 67) and change-of-direction sprint (n = 60) were studied most often, followed by combinations of the aforementioned (n = 21) and repeated-sprint tests (n = 15). Agility tests were examined fewest (n = 4). Mainly based on construct validity studies, acceptable validity was reported for the majority of the tests in all categories, except for agility tests, where no validity study was identified. Regarding intraday and interday reliability, ICCs>0.75 and CVs<3.0% were evident for most of the tests in all categories. These results applied for total and average times. In contrast, measures representing fatigue such as percent decrement scores indicated inconsistent validity findings. Regarding reliability, ICCs were 0.11–0.49 and CVs were 16.8–51.0%.

Conclusion

Except for agility tests, several tests for all categories with acceptable levels of validity and high levels of reliability for adult soccer players are available. Caution should be given when interpreting fatigue measures, e.g., percent decrement scores. Given the lack of accepted gold-standard tests for each category, researchers and practitioners may base their test selection on the broad database provided in this systematic review. Future research should pay attention to the criterion validity examining the relationship between test results and match parameters as well as to the development and evaluation of soccer-specific agility tests.

A Hope-enhancement Instrument for Palliative Care Cancer Patients

Aim

Millions of new cancer cases are diagnosed each year. ‎Patients often become hopeless during the disease. This study aimed to develop a short-intervention instrument targeted to raise hope in cancer patients.

Methods

Using a panel of experts, an instrument was developed, which consisted of 11 counseling items. The instrument was applied to a sample of 153 palliative care cancer patients randomized into three groups (G1: instrument applied by Rater 1, G2: control, and G3: instrument applied by Rater 2). Application of the instrument required 20-30 minutes. Using the Herth Hope Index (HHI) scores as the main outcome, changes over time (baseline, 1-hour, and one-week) were evaluated.

Results

The mean baseline HHI scores were 41.38‎±4.46. ‎The HHI scores were statistically similar at the ‎baseline (p>0.05) but significantly different at one hour and one week in favor of the G1 and G3 groups (p<0.001). In G1, the HHI significantly increased from baseline to one-hour measurements (t=-12.413, ‎p<0.001) and remained unchanged at one week (t=1.088, ‎p=0.282). Similarly, there was a significant increase in the HHI scores from baseline to one-hour ‎measurements in G3 (t=-9.144, p<0.001), which remained unchanged between one hour and one week (t=-0.099, p=0.921).

Conclusion

This study demonstrated the effectiveness of a structured, short counseling intervention in increasing ‎hope among palliative care cancer patients.

Normative Yo-Yo Intermittent Recovery Level 1 and Yo-Yo Intermittent Endurance Level 1 test values of boys aged 9-16years

OBJECTIVES

To provide age- and sex-specific reference values of Yo-Yo tests in children and adolescents.

DESIGN

Systematic review.

METHODS

A literature search for articles on Yo-Yo Intermittent (YYI) tests was performed in MEDLINE, SPORTDiscus, Web of Science and Google Scholar. Original reports on healthy children/adolescents 6-16years of age were eligible. For each test, age- and sex-related reference values were calculated using global means and percentiles.

RESULTS

Ninety-two studies (7398 participants) fulfilled the eligibility criteria. The YYI tests most frequently used were the Yo-Yo Intermittent Recovery Level 1 test (YYIR1, 57.8%), Yo-Yo Intermittent Endurance Level 1 test (YYIE1, 14.7%), Yo-Yo Intermittent Recovery Level 1 Children's test (YYIR1C, 12.7%), Yo-Yo Intermittent Endurance Level 2 test (YYIE2, 8.8%) and the Yo-Yo Intermittent Recovery Level 2 test (YYIR2, 5.9%). Of these, 71.6% reported test results of boys, 17.6% reported mixed test results and 10.8% reported test results of girls. Smoothed centile curves for the YYIR1 and YYIE1 over the entire age range were generated for boys, revealing constantly increasing performance with increasing age.

CONCLUSIONS

YYI tests values differ with respect to age and sex. In boys, development of YYIR1 and YYIE1 test values (6-16years of age) was different, suggesting better applicability of the YYIR1 test for boys >13years of age. The results may be used to rate YYI test performance for continuous screening and to identify children with low physical fitness. Since limited data was available of females, further research on YYI tests is needed with respect to sex-specific results.

A systematic review on the validity and reliability of tape measurement method in leg length discrepancy

Background: Leg length discrepancy measurement is an essential part of musculoskeletal clinical assessment, and tape measurement is a common clinical method. This study aimed to systematically review the results of the findings of studies on validity and reliability of the tape measurement method and the quality of reporting the literature on this topic. Methods: A search was performed in PubMed, EBSCO, Science Direct, Web of Knowledge, Scopus, Embase, and Google Scholar using selected keywords from inception to December 2017.This systematic review was based on the PRISMA guideline. After a systematic selection process, the quality of the included studies was assessed independently by 2 reviewers using the Brink and Louw Scale for quality assessment. Results: A total of 11 studies were finally considered for this systematic review. Two studies were about the validity of (a measurement tool) studies and 4 were reliability analysis only. Validity and reliability analyses were simultaneously applied to 5 studies. Also, 9 out of 11 studies were deemed to be of high quality based on Brink and Louw Scale. Studies showed high (ICC=0.7) to very high (ICC=0.9) levels of interrater and intrarater reliability. The validity of the methods ranged from low to very high depending on subjects. Conclusion: Tape measurement method has acceptable reliability and validity in healthy people, but it does not have acceptable validity in measuring obese people and patients with musculoskeletal disorders. Thus, using a suitable method for LLD leg length discrepancy measurement seems to be necessary for obese and individuals with leg length discrepancy.

Reliability and validity of clinically accessible smartphone applications to measure joint range of motion: A systematic review

Measuring joint range of motion is an important skill for many allied health professionals. While the Universal Goniometer is the most commonly utilised clinical tool for measuring joint range of motion, the evolution of smartphone technology and applications (apps) provides the clinician with more measurement options. However, the reliability and validity of these smartphones and apps is still somewhat uncertain. The aim of this study was to systematically review the literature regarding the intra- and inter-rater reliability and validity of smartphones and apps to measure joint range of motion. Eligible studies were published in English peer-reviewed journals with full text available, involving the assessment of reliability and/or validity of a non-videographic smartphone app to measure joint range of motion in participants >18 years old. An electronic search using PubMed, Medline via Ovid, EMBASE, CINAHL, and SPORTSDiscus was performed. The risk of bias was assessed using a standardised appraisal tool. Twenty-three of the eligible 25 studies exceeded the minimum 60% score to be classified as a low risk of bias, although 3 of the 13 criteria were not achieved in >50% of the studies. Most of the studies demonstrated adequate intra-rater or inter-rater reliability and/or validity for >50% of the range of motion tests across all joints assessed. However, this level of evidence appeared weaker for absolute (e.g. mean difference ± limit of agreement, minimal detectable change) than relative (e.g. intraclass correlation, correlation) measures; and for spinal rotation than spinal extension, flexion and lateral flexion. Our results provide clinicians with sufficient evidence to support the use of smartphones and apps in place of goniometers to measure joint motion. Future research should address some methodological limitations of the literature, especially including the inclusion of absolute and not just relative reliability and validity statistics.

Anatomical reference marks, evaluation parameters and reproducibility of surface topography for evaluating the adolescent idiopathic scoliosis: a systematic review with meta-analysis

BACKGROUND

Surface topography is a radiation-free examination that provides relevant information for the evaluation of patients with Adolescent Idiopathic Scoliosis (AIS). However, its usage is not standardized, which restricts the applicability of this instrument.

RESEARCH QUESTIONS

(a) To identify the anatomical reference markers used on surface topography; (b) to identify the parameters used on surface topography; and (c) to pool correlation and reproducibility results.

METHODS

Systematic searches were conducted following MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. The methodological quality was assessed according to Brink & Louw appraisal tool.

RESULTS

Twenty-three studies were included for the qualitative synthesis. The most commonly used anatomical reference markers were: the prominent vertebra (C7 or T1), the posterior superior iliac spines (PSISs) and the sacrum (S1). The parameters for the evaluation of the AIS by surface topography are: spinal inclination angle (analogous to Cobb), gibbosity, thoracic kyphosis angle, lumbar lordosis angle, pelvic obliquity, spine length, apex of the curve, C7-S1 distance (frontal plane), and C7-S1 displacement (sagittal plane). Data from eleven studies were metanalyzed and evidenced the correlation of the surface topography with X-ray exams and the reproducibility of the surface topography in the sagittal and frontal planes.

SIGNIFICANCE

The findings of this study recommend the use of a protocol for the application of the equipment. The analyzed studies predict the use of only four markers for anatomical reference. The evaluation of the AIS can be carried out observing nine parameters. Surface topography correlates with radiography when the spinal inclination angle (Cobb angle), thoracic kyphosis angle and lumbar lordosis angle are compared. Also, surface topography presents inter and intra-rater reproducibility in the sagittal plane and intra-rater reproducibility in the frontal plane.

Quantifying skeletal muscle volume and shape in humans using MRI: A systematic review of validity and reliability

AIMS

The aim of this study was to report the metrological qualities of techniques currently used to quantify skeletal muscle volume and 3D shape in healthy and pathological muscles.

METHODS

A systematic review was conducted (Prospero CRD42018082708). PubMed, Web of Science, Cochrane and Scopus databases were searched using relevant keywords and inclusion/exclusion criteria. The quality of the articles was evaluated using a customized scale.

RESULTS

Thirty articles were included, 6 of which included pathological muscles. Most evaluated lower limb muscles. Partially or completely automatic and manual techniques were assessed in 10 and 24 articles, respectively. Manual slice-by-slice segmentation reliability was good-to-excellent (n = 8 articles) and validity against dissection was moderate to good(n = 1). Manual slice-by-slice segmentation was used as a gold-standard method in the other articles. Reduction of the number of manually segmented slices (n = 6) provided good to excellent validity if a sufficient number of appropriate slices was chosen. Segmentation on one slice (n = 11) increased volume errors. The Deformation of a Parametric Specific Object (DPSO) method (n = 5) decreased the number of manually-segmented slices required for any chosen level of error. Other automatic techniques combined with different statistical shape or atlas/images-based methods (n = 4) had good validity. Some particularities were highlighted for specific muscles. Except for manual slice by slice segmentation, reliability has rarely been reported.

CONCLUSIONS

The results of this systematic review help the choice of appropriate segmentation techniques, according to the purpose of the measurement. In healthy populations, techniques that greatly simplified the process of manual segmentation yielded greater errors in volume and shape estimations. Reduction of the number of manually segmented slices was possible with appropriately chosen segmented slices or with DPSO. Other automatic techniques showed promise, but data were insufficient for their validation. More data on the metrological quality of techniques used in the cases of muscle pathology are required.

Dual energy X-ray absorptiometry positioning protocols in assessing body composition: A systematic review of the literature

OBJECTIVES

To systematically identify and assess methods and protocols used to reduce technical and biological errors in published studies that have investigated reliability of dual energy X-ray absorptiometry (DXA) for assessing body composition.

DESIGN

Systematic review.

METHODS

Systematic searches of five databases were used to identify studies of DXA reliability. Two independent reviewers used a modified critical appraisal tool to assess their methodological quality. Data was extracted and synthesised using a level of evidence approach. Further analysis was then undertaken of methods used to decrease DXA errors (technical and biological) and so enhance DXA reliability.

RESULTS

Twelve studies met eligibility criteria. Four of the articles were deemed high quality. Quality articles considered biological and technical errors when preparing participants for DXA scanning. The Nana positioning protocol was assessed to have a strong level of evidence. The studies providing this evidence indicated very high test-retest reliability (ICC 0.90-1.00 or less than 1% change in mean) of the Nana positioning protocol. The National Health and Nutrition Examination Survey (NHANES) positioning protocol was deemed to have a moderate level of evidence due to lack of high quality studies. However, the available studies found the NHANES positioning protocol had very high test-retest reliability. Evidence is limited and reported reliability has varied in papers where no specific positioning protocol was used or reported.

CONCLUSIONS

Due to the strong level of evidence of excellent test-retest reliability that supports use of the Nana positioning protocol, it is recommended as the first choice for clinicians when using DXA to assess body composition.