Reliability of assessment tools in rehabilitation: an illustration of appropriate statistical analyses

Confidence sets for intraclass correlation coefficients in test-retest curve measurements

Evaluating test-retest reliability is crucial in biomechanical research, as it validates experimental results. While methods for reliability of scalar outcome variables are well-established, methods to assess reliability of continuous curve data (such as joint angle trajectories during gait) remain less explored. This study investigates methods for constructing confidence sets for curve-level intraclass correlation coefficients (ICC), which can be expressed as either an ICC curve or an integrated ICC. Currently, no standardised guidelines exist in biomechanics for reporting curve-level ICC uncertainty. Nonparametric bootstrapping techniques are proposed for both the ICC curve's confidence bands and the integrated ICC's confidence intervals, and these methods are validated through Monte Carlo simulations, covering various effect sizes and curve characteristics. Additionally, these methods are applied to assess the test-retest reliability of knee kinematics in three different planes during landing of one-leg hops, where less uncertainty is observed for the ICC curve and integrated ICC in the frontal plane compared to other planes. When the entire time domain is of primary empirical interest, we recommend using a rank-based bootstrap confidence band to express ICC uncertainty, as it yields increasingly precise and valid results as the number of individuals increases, with the coverage rate approaching the correct level of 95%. When a single summary metric is of primary interest, we recommend using the integrated ICC along with a typical bootstrap confidence interval based on the normal distribution, as the coverage rate remains adequately accurate and stable at around the correct level of 95% across varying number of individuals.

Balance measures for fall risk screening in community-dwelling older adults with COPD: A longitudinal analysis

BACKGROUND

Chronic obstructive pulmonary disease (COPD) increases fall risk, but consensus is lacking on suitable balance measures for fall risk screening in this group. We aimed to evaluate the reliability and validity of balance measures for fall risk screening in community-dwelling older adults with COPD.

METHODS

In a secondary analysis of two studies, participants, aged ≥60 years with COPD and 12-month fall history or balance issues were tracked for 12-month prospective falls. Baseline balance measures - Brief Balance Evaluation Systems Test (Brief BESTest), single leg stance (SLS), Timed Up and Go (TUG), and TUG Dual-Task (TUG-DT) test - were assessed using intra-class correlation (ICC2,1) for reliability, Pearson/Spearman correlation with balance-related factors for convergent validity, t-tests/Wilcoxon rank-sum tests with fall-related and disease-related factors for known-groups validity, and area under the receiver operator characteristic curve (AUC) for predictive validity.

RESULTS

Among 174 participants (73 ± 8 years; 86 females) with COPD, all balance measures showed excellent inter-rater and test-retest reliability (ICC2,1 = 0.88-0.97) and moderate convergent validity (r = 0.34-0.77) with related measures. Brief BESTest and SLS test had acceptable known-groups validity (p < 0.05) for 12-month fall history, self-reported balance problems, and gait aid use. TUG test and TUG-DT test discriminated between groups based on COPD severity, supplemental oxygen use, and gait aid use. All measures displayed insufficient predictive validity (AUC<0.70) for 12-month prospective falls.

CONCLUSION

Though all four balance measures demonstrated excellent reliability, they lack accuracy in prospectively predicting falls in community-dwelling older adults with COPD. These measures are best utilized within multi-factorial fall risk assessments for this population.

Remote versus face-to-face fall risk assessment in home dwelling older adults: a reliability study

BACKGROUND

Falls are a leading cause of severe injury and death in older adults. Remote screening of fall risk may prevent falls and hence, advance health and wellness of older adults. While remote health care is becoming a common practice, we question if remote evaluation of fall risk is as reliable as face-to-face (FTF).

OBJECTIVE

To assess the inter-tester reliability of synchronized remote and FTF fall risk assessment.

METHODS

This inter-format, inter-rater reliability study included 48 home dwelling older adults aged 65 and over. Five valid functional and balance tests were conducted: 30 Second Sit-to-Stand (STS), MiniBESTest, Timed up and go (TUG), 4-Meter Walk (4MWT), and Berg Balance Scale (BBS). Instructions were provided via videoconferencing, and two physiotherapists scored performance simultaneously, one remotely, and one in the room. Inter-rater reliability between remote and FTF scores was analyzed using intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM), minimal detectable change (MDC95) and Bland and Altman analysis.

RESULTS

Excellent ICCs were found for STS, MiniBESTest, TUG, and BBS (0.90-0.99), and moderate for 4MWT (0.74). SEM and MDC95 values were STS (0.37,1.03 repetitions), MiniBESTest (1.43,3.97 scores), TUG (1.22,3.37 seconds), 4MWT (0.17,0.47 m/second), and BBS (1.79,4.95 scores). The Bland and Altman analysis showed excellent agreement between remote and FTF assessments of the STS. All other tests showed low to moderate agreement. Mean difference ± SD and 95%LOA were as follows: STS (-0.11 ± 0.52), (-1.13,0.91) repetitions, MiniBESTest (0.45 ± 1.98), (-3.43,4.32) scores, TUG (-0.35 ± 1.54), (-3.37,2.67) seconds, 4MWT (-0.08 ± 0.22), (-0.35,0.51) meter/second, and BBS (0.04 ± 2.53), (-4.93,5.01) scores.

CONCLUSIONS

The findings support the responsible integration of remote fall risk assessment in clinical practice, enabling large-scale screenings and referrals for early intervention to promote healthy aging and fall prevention.

Validation of an Artificial Intelligence-Based Ultrasound Imaging System for Quantifying Muscle Architecture Parameters of the Rectus Femoris in Disease-Related Malnutrition (DRM)

(1) Background: The aim was to validate an AI-based system compared to the classic method of reading ultrasound images of the rectus femur (RF) muscle in a real cohort of patients with disease-related malnutrition. (2) Methods: One hundred adult patients with DRM aged 18 to 85 years were enrolled. The risk of DRM was assessed by the Global Leadership Initiative on Malnutrition (GLIM). The variation, reproducibility, and reliability of measurements for the RF subcutaneous fat thickness (SFT), muscle thickness (MT), and cross-sectional area (CSA), were measured conventionally with the incorporated tools of a portable ultrasound imaging device (method A) and compared with the automated quantification of the ultrasound imaging system (method B). (3) Results: Measurements obtained using method A (i.e., conventionally) and method B (i.e., raw images analyzed by AI), showed similar values with no significant differences in absolute values and coefficients of variation, 58.39-57.68% for SFT, 30.50-28.36% for MT, and 36.50-36.91% for CSA, respectively. The Intraclass Correlation Coefficient (ICC) for reliability and consistency analysis between methods A and B showed correlations of 0.912 and 95% CI [0.872-0.940] for SFT, 0.960 and 95% CI [0.941-0.973] for MT, and 0.995 and 95% CI [0.993-0.997] for CSA; the Bland-Altman Analysis shows that the spread of points is quite uniform around the bias lines with no evidence of strong bias for any variable. (4) Conclusions: The study demonstrated the consistency and reliability of this new automatic system based on machine learning and AI for the quantification of ultrasound imaging of the muscle architecture parameters of the rectus femoris muscle compared with the conventional method of measurement.

Modified Chinese disabilities of arm, shoulder and hand tool: Validity and reliability for upper extremity injuries

DESIGN

Clinimetric evaluation study.

INTRODUCTION

The Chinese Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire has necessitated the development of a revised version to the specific needs of individuals with upper extremity injuries with the progress of times and lifestyle changes.

PURPOSE OF THE STUDY

This research aimed to evaluate the reliability and validity of Modified Chinese Disability of Arm, Shoulder and Hand (MC-DASH) questionnaire in individuals with upper extremity injuries.

METHODS

One hundred and one individuals with upper extremity injuries (UEI) were recruited. The function of upper extremity was measured using the electronic version of MC-DASH, and compared against the Chinese Disability of Arm, Shoulder and Hand. The MC-DASH was reassessed within three days in all individuals. We investigated the internal consistency, test-retest reliability, content validity, criterion validity, and construct validity of MC-DASH.

RESULTS

The internal consistency was deemed sufficient, as indicated by a Cronbach's alpha of 0.986 and an intraclass correlation coefficient of 0.957. Moreover, the mean total scores of MC-DASH on the first-test and retest were 37.86 and 38.19, respectively (ICC: 0.957, 95 %CI: 0.937-0.971, p < 0.001). Furthermore, the MC-DASH version exhibited satisfactory content validity evidenced by its strong correlation (R= 0.903, p < 0.001) with the Chinese DASH. Three major influencing factors were identified from 37 items. The cumulative variance contribution rate of the MC-DASH questionnaire was 75.76 %, confirming its construct validity.

CONCLUSION

The Modified Chinese Disability of Arm, Shoulder and Hand questionnaire has been shown to be a valid, reliable, and practical tool for use in patients with upper extremity injuries.

Test-retest, intra- and inter-rater reliability of the reactive balance test in patients with chronic ankle instability

Introduction

The Reactive Balance Test (RBT) could be a valuable addition to research on chronic ankle instability (CAI) and clinical practice, but before it can be used in clinical practice it needs to be reliable. It has already been proven reliable in healthy recreational athletes, but not yet in patients with CAI who have shown persistent deficits in dynamic balance. The study aimed to determine the test-retest, intra-, and inter-rater reliability of the RBT in patients with CAI, and the test-retest and inter-rater reliability of the newly developed RBT score sheet.

Methods

We used a repeated-measures, single-group design to administer the RBT to CAI patients on three occasions, scored by multiple raters. We included 27 participants with CAI. The study used multiple reliability measures, including Pearson r, intra-class correlations (ICC), standard error of measurement (SEM), standard error of prediction (SEP), minimal detectable change (MDC), and Bland-Altman plots, to evaluate the reliability of the RBT's outcome measures (visuomotor response time and accuracy). It also assessed the test-retest and inter-rater reliability of the RBT score sheet using the same measures.

Results

The ICC measures for test-retest reliability were similar for accuracy (0.609) and VMRT (0.594). Intra-rater reliability had high correlations and ICCs for accuracy (r = 0.816, ICC = 0.815) and VMRT (r = 0.802, ICC = 0.800). Inter-rater reliability had a higher ICC for VMRT (0.868) than for accuracy (0.690).

Conclusion

Test-retest reliability was moderate, intra-rater reliability was good, and inter-rater reliability showed moderate reliability for accuracy and good reliability for VMRT. Additionally, the RBT shows robust SEM and mean difference measures. The score sheet method also demonstrated moderate test-retest reliability, while inter-rater reliability was good to excellent. This suggests that the RBT can be a valuable tool in assessing and monitoring balance in patients with CAI.

Assessing the validity of two-dimensional video analysis for measuring lower limb joint angles during fencing lunge

Introduction

The fencing lunge (lunge), characterized by minimal body rotation, offers a movement well-suited for 2D video analysis. However, to the best of our knowledge, the validity of 2D video analysis for fencing has not been verified. This study aimed to validate 2D video analysis by comparing lower limb joints (hip, knee, and ankle joints) angles during lunge using both 2D video analysis and 3D motion analysis methods.

Methods

Twenty-two male fencers performed lunge trials that were simultaneously recorded using eight motion capture cameras (Qualisys Miqus M1) and two digital video cameras (Sony AX-450 and AX450a).

Results

The 2D video analysis results exhibited an extremely large correlation in knee joint angles of the front and rear legs in the sagittal with those from 3D motion analysis (r = 0.93-0.99). However, while a robust correlation was found between the ankle joint angles of the front and rear legs (r = 0.82-0.84), a large bias was also observed (-5.23° to -21.31°). Conversely, for the hip joints of the rear leg, a moderate correlation (r = 0.31) and a large bias (-10.89°) were identified.

Conclusions

The results of this study will contribute to the development of coaching using 2D video analysis in competition settings because such analysis can be a useful alternative to 3D motion analysis when measuring the knee joint angle of the front leg and rear leg in the sagittal plane. However, for the ankle joint angle, further research on the optimal shooting position and height of the digital video camera is needed, whereas for the hip joint angle, 3D motion analysis is recommended at this time.

Evaluation of an adapted virtual training for master trainers of the WHO Caregiver Skills Training Program during the COVID-19 pandemic

LAY ABSTRACT

The COVID-19 pandemic interrupted in-person professional activities. We developed and evaluated a remote training approach for master trainers of the Caregiver Skills Training Program. Master trainers support community practitioners, who in turn deliver the Caregiver Skills Training Program to caregivers of children with developmental delays or disabilities. The Caregiver Skills Training Program teaches caregivers how to use strategies to enhance learning and interactions during everyday play and home activities and routines with their child. The aim of this study was to evaluate the remote training of master trainers on Caregiver Skills Training Program. Twelve out of the 19 practitioners who enrolled in the training completed the study. The training consisted of a 5-day in-person session completed prior to the pandemic, followed by supporting participants' ability to identify Caregiver Skills Training Program strategies through coding of video recordings over 7 weekly meetings and group discussions and ended with participants independently coding a set of 10 videos for Caregiver Skills Training Program strategies. We found all but one participant was able to reliably identify Caregiver Skills Training Program strategies from video recordings despite a lack of ability to practice the Caregiver Skills Training Program strategies with children due to the pandemic. Taken together, our findings illustrate the feasibility and value of remote training approaches in implementing interventions.

Pinch force sense test-retest reliability evaluation using contralateral force matching task

A high test-retest reliability in measurement of pinch force sense is required to assess a clinical parameter accurately over a longitudinal study. Ipsilateral reproduction (IR) task and contralateral matching (CM) task have commonly been used for the assessment of force sense. To date, there has been little research on the test-retest reliability of pinch force sense utilizing the contralateral force matching task. This research aimed to explore this phenomenon across a spectrum of reference force levels (10, 30, and 50 percent maximum voluntary isometric contraction (MVIC)) using a contralateral matching task. Every participant in the study was tested twice by the same skilled experts, with each session separated by one week. Although normalized variable error indicated a poor level of reliability (intraclass correlation coefficient (ICC) = - 0.25 to 0.05) for these force sense tests, normalized constant error (ICC = 0.76-0.85) and normalized absolute error (ICC = 0.61-0.81) results indicated a fair to good of reliability. The lower bound of 95% CI of ICC for NAE and NCE indicated fair test-retest reliability (0.41-0.69). These findings suggest that investigators can reasonably obtain a fair to good test-retest reliability when investigating pinch force sense using the contralateral matching task. The Bland-Altman plots, SEM, and MDD95% were lower at these lower reference force level (10% MVIC) compared to the level of higher reference forces (30% and 50% MVIC). Therefore, when the reference force level increases, the participant needs a larger NAE or NCE decrease to show that their pinch force sense has indeed improved.

Agreement Between the Gross Motor Ability Estimator-2 and the Gross Motor Ability Estimator-3 in Young Children With Cerebral Palsy

PURPOSE

The purpose of this study was to determine the agreement between Gross Motor Ability Estimator-2 (GMAE-2) and Gross Motor Ability Estimator-3 (GMAE-3) calculations of Gross Motor Function Measure-66 (GMFM-66) scores in infants and young children with cerebral palsy.

METHODS

Data from 53 children 5 to 53 months of age were analyzed. Agreement between GMFM-66 scores using the GMAE-2 and the GMAE-3 was calculated using Bland-Altman plots and interclass correlation coefficients (ICCs). Eleven participants who had at least 1 GMFM-66 score of less than 25 using either method were identified for further analysis.

RESULTS

The average difference between GMFM-66 scores was 0.27 for all participants and 0.63 for the subset of lower-scoring participants. Good agreement was found for GMFM-66 scores for all participants (ICC = 0.998) and for subset of lower-scoring participants (ICC = 0.879).

CONCLUSIONS

High levels of agreement exist between the GMAE-2 and the GMAE-3, which suggests that scores are comparable using either algorithm.

An exploratory study of behavioral traits and the establishment of social relationships in female laboratory rats

There is growing evidence that social relationships influence individual fitness through various effects. Clarifying individual differences in social interaction patterns and determinants for such differences will lead to better understanding of sociality and its fitness consequences for animals. Behavioral traits are considered one of the determining factors of social interaction. The purpose of this study was to explore the effects of individual behavioral traits on social relationship building in laboratory rats (Rattus norvegicus), a highly social species. Initially, the following behavioral characteristics were measured in individuals: tameness (glove test), activity (open field test), exploration (novel object test), sociability (three-chamber test), and boldness (elevated plus maze test). We then used DeepLabCut to behaviorally track three groups of four individuals (12 total) and analyze social behaviors such as approach and avoidance behaviors. Principal component analysis based on behavioral test results detected behavioral traits interpreted as related to exploration, boldness, activity, and tameness, but not sociability. In addition, behavioral tracking results showed consistent individual differences in social behavior indices such as isolation time and partner preference. Furthermore, we found that different components were correlated with different phases of social behavior; exploration and boldness were associated with the early stages of group formation, whereas activity was associated with later stages of relationship building. From these results, we derived hypothesize that personality traits related to the physical and social environment have a larger influence in the relationship formation phase, and the behavioral trait of activity becomes important in the maintenance phase of relationships. Future studies should examine this hypothesis by testing larger group sizes and ensuring there is less bias introduced into group composition.

Inflammatory markers in persons with clinically-significant depression, anxiety or PTSD: A systematic review and meta-analysis

BACKGROUND

Depression, anxiety and PTSD appear to be risk factors for dementia, but it is unclear whether they are causal or prodromal. The inflammatory-mediated neurodegeneration hypothesis suggests a causal link, proposing that mental illness is associated with an inflammatory response which, in turn, triggers neurodegenerative changes that lead to dementia. Existing meta-analyses have yet to examine inflammatory markers in depression, anxiety or PTSD with the view to exploring the inflammatory-mediated neurodegeneration hypothesis. The current meta-analysis therefore examined whether: a) depression, anxiety and PTSD are individually associated with inflammation, independently of comorbid mental illnesses and physical health problems with known inflammatory responses, and b) there are any similarities in the inflammatory profiles of these disorders in order to provide a basis for exploring inflammation in people with dementia who have a history of clinically-significant anxiety, depression or PTSD.

METHODS

PubMed, EMBASE, PsycINFO and CINAHL searches identified 64 eligible studies.

RESULTS

Depression is associated with an inflammatory response, with tentative evidence to suggest anxiety and PTSD are also associated with inflammation. However, the specific response may differ across these disorders.

LIMITATIONS

The data for anxiety, PTSD and multiple inflammatory markers were limited.

CONCLUSIONS

Depression, anxiety, and PTSD each appear to be associated with an inflammatory response in persons who do not have comorbid mental or physical health problems that are known to be associated with inflammation. Whether this inflammatory response underlies the increased risk of dementia in persons with a history of depression and anxiety, and possibly PTSD, remains to be determined.

Medico-legal indicators and cut-offs in different age classes through quantitative analysis of epiphyseal fusion segments on knee CT scans

Scientists are interested in determining age in subadults for several forensic purposes. High- resolution instrumental techniques are being increasingly used for age estimation, driven by the need to minimize errors; in this context, several studies have focused on the knee joint, recognized as a potential site for age examination in late adolescence. We analyzed 200 CT scans performed on Russian subjects (106 males and 94 females) between 13 and 20 years, without growth diseases, endocrine disorders, or osteodystrophy. Each subject underwent two scans, one for each leg. Two indicators were measured for each bone (femur, tibia and fibula): the entire length of the epiphyseal scar and the length of the part/s that is/are fused with metaphysis. Intra class Correlation Coefficient (ICC) was performed to evaluate the intra-operator reproducibility. The ratio between the two lengths was calculated for each bone (FemurR, TibiaR and FibulaR). The first aim was to evaluate a correlation between the ratios of the three bones and the three bones treated as a single parameter (given by the sum of the ratios) versus age. The results showed good correlations in both cases (τ a = 0.74, 0.64, 0.57 and 0.67). The second aim was to estimate the cut-offs derived from the sum of the three ratios respect to four age classes (14-15 years: cut-off ≤ 0.63, 15-16 years: cut-off ≤ 1.19, 16-17 years: cut-off ≥ 0.68 and 17-18 years: cut-off ≥ 1.49. The results from this research encourage further studies of the knee joint as an indicator of legal adult age.

Validity and reliability of a new hip flexor muscles flexibility assessment tool: The reactive hip flexor (RHF) test

BACKGROUND

The modified Thomas test is the most used and most reliable test to assess the hip flexors' flexibility. However it does not evaluate the interaction of both legs. The objective of this study is to propose a new assessment tool for hip flexor flexibility, the Reactive Hip Flexion (RHF) Test.

METHODS

An observational, intra-test, and test-retest study with repeated measures was carried out with the aim of assessing the validity and reliability of the RHF Test. The participants were males and females aged between 18 and 35 years old who had a training schedule of at least 2 days a week, without a musculoskeletal lower limb or lumbopelvic pathology. The reliability of the test was examined using the intraclass correlation coefficients (ICCs) by a two-way random model to establish inter-rater reliability and a two-way mixed model to assess intra-rater reliability. The precision was measured by the standard error of measurement (SEM). In addition, the minimum detectable change (MDC95%) was calculated.

RESULTS

Twenty-six participants (52 hips) (47% female) completed the study. No correlations were observed between anthropometric variables and RHF peak force or active knee extension (AKE) measurements. There was an excellent intra-rater and inter-rater ICC in the hip flexors' reactive peak force and the AKE measurements, with a low SEM.

CONCLUSIONS

This study demonstrated that the proposed RHF test technique is valid and reliable when used in healthy youth population.

Patients with patellofemoral pain have lower soft tissue flexibility of the kinetic chain compared to healthy controls: A case-control study

INTRODUCTION

Patellofemoral pain (PFP) is a common musculoskeletal condition. Lower limb range of motion (LLROM) evaluates soft tissue flexibility over multiple joints as part of the kinetic chain. The aims were to study: 1) the reliability of a new LLROM test; 2) differences in LLROM between PFP patients and controls; and 3) the relationship between LLROM and pain-free knee function.

METHODS

Patients with PFP and matched controls were recruited from a university campus and private physiotherapy clinics, while observers were blinded for health status. Testing LLROM for maximal knee flexion and hip adduction and the sum of these (total ROM) were performed. Measures of reliability (ICC2,1) were established. Univariate linear regression between LLROM and health status and multivariate analysis between LLROM and knee function were performed.

RESULTS

Patients (n = 32 (7 male/25 female, age = 22, BMI = 22.7)) and controls (n = 32 (7 male/25 female, age = 20, BMI = 22.3)) were included. The ICC's for intra- and interobserver reliability ranged from 0.83 (95%CI 0.30-0.93) to 0.89 (0.72-0.95). Symptomatic legs had 7°(3-11, p = 0.014) lower knee flexion, 6°(4-8, p ≤ 0.001) lower hip adduction and 13°(8-17, p ≤ 0.001) lower total ROM than non-symptomatic legs. Multivariate analysis revealed an association between total ROM and pain-free knee function (R2 = 0.438, F = 6.544, p ≤ 0.001).

CONCLUSIONS

The new LLROM test was found to be reliable. Patients with PFP had lower LLROM, which was associated with impaired pain-free knee function. Whether improving soft tissue flexibility results in enhanced pain-free knee function should be the subject of future research.

Self-performed Five Times Sit-To-Stand test at home as (pre-)screening tool for frailty in cancer survivors: Reliability and agreement assessment

AIMS AND OBJECTIVES

The self-performance of a Five-Times-Sit-To-Stand (FTSTS)-test, without the usual supervision by a medical professional, provides valuable opportunities for clinical practice and research. This study aimed: (1) to determine the validity of the self-performed FTSTS test in comparison to a supervised reference test and (2) to determine the reliability of a self-performed FTSTS test by cancer survivors.

BACKGROUND

Early detection of frailty in cancer survivors may enable prehabilitation interventions before surgery or intensive treatment, improving cancer outcomes.

DESIGN

A repeated measures reliability and agreement study, with one week in between measures, was performed.

METHODS

Cancer survivors (n = 151) performed two FTSTS tests themselves. One additional reference FTSTS test was supervised by a physical therapist. The intraclass correlation coefficient (ICC), structural error of measurement (SEM) and minimally important clinical difference (MID) were calculated comparing a self-performed FTSTS test to the reference test, and comparing two self-performed FTSTS tests. The Guidelines for Reporting Reliability and Agreement Studies (GRASS) have been used.

RESULTS

Mean age of cancer survivors was 65.6 years (SD = 9.3), 54.6% were female, median time since diagnosis was 2 years [IQR = 1], and tumour type varied (e.g., breast cancer (31.8%), prostate cancer (17.2%), gastrointestinal cancer (11.9%) and haematological cancer (11.9%)). Validity of the self-performed FTSTS test at home was acceptable in comparison with the reference test (ICC = .74; SEM = 3.2; MID = 3.6) as was the reliability of the self-performed FTSTS test (ICC = .70; SEM = 2.2; MID = 3.8).

CONCLUSIONS

The self-performed FTSTS test is a valid and reliable measure to assess lower body function and has potential to be used as objective (pre-)screening tool for frailty in cancer survivors.

RELEVANCE TO CLINICAL PRACTICE

The self-performed FTSTS test at home may indicate the cancer survivors in need of prehabilitation in advance of surgery or intensive treatment. The feasibility, short amount of time needed and potential cost-effectiveness of the self-performed FTSTS test can make it a valuable contribution to personalised care and precision medicine.

The reliability of lower limb 3D gait analysis variables during a change of direction to 90- and 135-degree manoeuvres in recreational soccer players

BACKGROUND

Several biomechanical outcomes are being used to monitor the risk of injuries; therefore, their reliability and measurement errors need to be known.

OBJECTIVE

To measure the reliability and measurement error in lower limb 3D gait analysis outcomes during a 90∘ and 135∘ change of direction (COD) manoeuvre.

METHODS

A test re-test reliability study for ten healthy recreational players was conducted at seven-day intervals. Kinematics (Hip flexion, adduction, internal rotation angles and knee flexion abduction angles) and kinetics (Knee abduction moment and vertical ground reaction force) data during cutting 90∘ and 135∘ were collected using 3D gait analysis and force platform. Five trials for each task and leg were collected. Standard error of measurement (SEM) and the intraclass correlation coefficient (ICC) were calculated from the randomised leg.

RESULT

The ICC values of the kinematics, kinetics, and vertical ground reaction force (VGRF) outcomes (90∘ and 135∘) ranged from 0.85 to 0.95, showing good to excellent reliability. The SEM for joint angles was less than 1.69∘. The VGRV showed a higher ICC value than the other outcomes.

CONCLUSION

The current study results support the use of kinematics, kinetics, and VGRF outcomes for the assessment of knee ACL risk in clinic or research. However, the hip internal rotation angle should be treated with caution since the standard measurement error exceeded 10% compared to the mean value. The measurement errors provided in the current study are valuable for future studies.

Reproducibility, Construct Validity, and Responsiveness of the Tetraplegia Upper Limb Activities Questionnaire, TUAQ. Part 2

OBJECTIVE

To test reliability, construct validity and responsiveness of the Tetraplegia Upper Limb Activities Questionnaire (TUAQ), a patient-reported outcome measure that assesses perceived performance and satisfaction with 10 standardized activities.

DESIGN

Outcome measure psychometric evaluation.

SETTING

Spinal cord injury units in 2 countries.

PARTICIPANTS

Reproducibility: 47 individuals with tetraplegia. Construct validity and responsiveness: 33 individuals with tetraplegia undergoing surgery to restore hand function (N=80).

INTERVENTIONS

Reproducibility: The TUAQ was completed on 2 occasions, 2 weeks apart. Construct validity and responsiveness: Participants completed the TUAQ prior to surgery and 3-12 months after hand reconstruction surgery. Internal consistency was examined using Cronbach α. Two agreement parameters were examined: the SEM and minimal detectable change with 90% confidence interval (MDC₉₀). Construct validity was evaluated using Pearson product moment correlation against a priori hypotheses. Responsiveness was assessed using paired t tests and effect size.

RESULTS

Test-retest reliability and internal consistency was high (intraclass correlation coefficient of 0.89 for performance scale and 0.88 for satisfaction, Cronbach α of 0.92 and 0.90, respectively). For agreement the SEM scores were 4.7 and 3.5, with MDC₉₀ of 10.9 and 8.2, respectively. Responsiveness and construct validity showed sound results with no ceiling or floor effects and with large effect size (>1.05).

CONCLUSIONS

The TUAQ demonstrates good psychometric properties for reliability and agreement for persons with tetraplegia and responsiveness and construct validity for surgical reconstruction of hand function for persons with tetraplegia. The TUAQ appears appropriate to be used as a patient-reported outcome measure for clinical and research purposes in this population.

Assessment of grip force sense test-retest reliability in healthy male participants

There has been a lack of research to date regarding the test-retest reliability of grip force sense in healthy adult males. This study was therefore designed to explore this topic across a series of target force levels using an ipsilateral force reproduction task. The same experienced research staff conducted two testing sessions for each study participant, with 1 week between test sessions. Intraclass correlation coefficient values indicated that these force sensing tests exhibited good to fair reliability with respect to both absolute error (0.42-0.63) and constant error (0.49-0.60), although variable error was indicative of poor reliability (-0.85 to 0.14). Together, these results suggest that researchers can achieve a fair level of test-retest reliability when analysing grip force sense in healthy adult males, with results being most reliable at force levels of 20 N and 50 N, as determined based upon measured constant error and absolute error. Practitioner summary: To ensure that grip force sense can be accurately interpreted over time, it is important to assess the test-retest reliability. It is recommended that practitioners measure the absolute error and constant error at force levels of 20 N and 50 N when assessing grip force sense in a clinical setting.

Accuracy of different sonomammographic imaging modalities in assessment of breast tumor size

Background

Accurate breast cancer size is crucial for staging and an important prognostic factor in patient management. Therapeutic decisions heavily depend on tumor size detection by radiological imaging. The purpose of our prospective comparative study is to compare the diagnostic accuracy of different sonomammographic breast imaging modalities, namely DM, DBT, CESM, 2D US and 3D US in the preoperative tumor size measurement.

Results

CESM, 3D US and 2D US achieved moderately strong correlation with the pathological size measurements, while (DM) and (DBT) showed fair correlation with the pathology. CESM showed the highest correlation coefficient (0.789), while (DBT) showed the lowest correlation coefficient (0.411). Regarding the agreement, there was good agreement of the size measured by CESM, 3D US and 2D US with the pathology as the ICC was (0.798), (0.769) and (0.624), respectively. The highest agreement with the pathology was achieved with CESM. The agreement of the size measured by (DM) and (DBT) with the pathology was moderate as the ICC was (0.439) and (0.416), respectively. The lowest agreement was achieved with the size measured by (DBT).

Conclusions

CESM and 3D US are more superior to DM, 2D US and DBT regarding preoperative size measurement. 3D US can be used as preoperative noninvasive technique, especially in patients with impaired renal function who cannot tolerate CESM.

Assessment of spine length in scoliosis patients using EOS imaging: a validity and reliability study

PURPOSE

Knowledge about spinal length and subsequently growth of each individual patient with adolescent idiopathic scoliosis (AIS) helps with accurate timing of both conservative and surgical treatment. Radiographs taken by a biplanar low-dose X-ray device (EOS) have no divergence in the vertical plane and can provide three-dimensional (3D) measurements. Therefore, this study investigated the criterion validity and reliability of EOS spinal length measurements in AIS patients.

METHODS

Prior to routine EOS radiograph, a radiographic calibrated metal beads chain (MBC) was attached on the back of 120 patients with AIS to calibrate the images. Spinal lengths were measured from vertebra to vertebra on EOS anteroposterior (AP), lateral view and on the combined 3D EOS view (EOS 3D). These measurements were compared with MBC length measurements. Secondly, intra- and interobserver reliability of length measurements on EOS-images were determined.

RESULTS

50 patients with accurately positioned MBC were included for analysis. The correlations between EOS and MBC were highest for the 3D length measurements. Compared to EOS 3D measurements, the total spinal length was systematically measured 4.3% (mean difference = 1.97 ± 1.12 cm) and 1.9% (mean difference = 0.86 ± 0.63 cm) smaller on individual EOS two-dimensional (2D) AP and lateral view images, respectively. Both intra- and interobserver reliability were excellent for all length measurements on EOS-images.

CONCLUSION

The results of this study indicate a good validity and reliability for spinal length measurements on EOS radiographs in AIS patients. EOS 3D length measure method is preferred above spinal length measurements on individual EOS AP or lateral view images.

The evaluation of ultrasonographic hip measurement differences among physicians according to the Graf method in newborns

Background/Aim: Hip ultrasonography (USG) is the most important diagnostic method in developmental hip dysplasia in newborns. However, a disadvantage of the ultrasonography method is that there can be measurement differences among doctors measuring the same hip. We aimed to investigate the causes and solutions of this situation. We further strived to measure the hip ultrasonography performed by different physicians using the Graf method and comparing the obtained values. Methods: Hip USGs of newborns admitted to Malatya Turgut Ozal University Faculty of Medicine Hospital between Jan. 8, 2020 and Jan. 5,.2021 were measured and classified using the Graf method. The study type is consistent with retrospective cohort studies. Newborns aged 0-22 weeks without any additional pathology were included in the study. A radiologist and two orthopedists measured and interpreted the images separately in accordance with the Graf method. The first hip measurements (R1) were made by the radiologist (R) with the USG device, and they were classified according to alpha and beta angles; two printouts were made. The first orthopedic specialist (OS1) and the second orthopedic specialist (OS2) made their measurements with printouts. Subsequently, the results from the physicians were compared. Results: A statistically significant difference was found between R1-OS2 (P < 0.001) and OS1-OS2 (P < 0.001) in terms of the Graf classifications. No statistically significant difference was found between R1 and OS1 in terms of the Graf classification (P = 0.562). A statistically significant difference was found between R1-OS2 (P < 0.001) and OS1-OS2 (P = 0.048) angles (alpha and beta) measurements. While R1 and OS1 measurements were compatible with each other, OS2 measurements were found to be inconsistent. Conclusion: We think that there may be differences in angle measurements and the Graf classification among physicians who perform hip ultrasonography in newborns, and the most important way to correct this is through regular participation of physicians in subject-specific trainings.

THE INTER-RATER AND INTRA-RATER RELIABILITY OF GLENOHUMERAL JOINT POSITION AND MOVEMENT SENSE TESTS APPLIED USING AN ISOKINETIC DYNAMOMETER

Purpose: The aim of this study was to test the inter-rater and intra-rater reliability of glenohumeral joint (GHJ) position and movement sense tests of an isokinetic dynamometer in healthy individuals. Methods: The study included 17 healthy subjects. GHJ position and movement sense tests were applied with an isokinetic dynamometer to the dominant extremity. Results: The different error types calculated for position sense were in the range of mean 0.02±1.62 - 5.42±1.74. The ICC value for the different error types was determined in the range of 0.038 - 0.657 for the intra-rater tests, and 0.095 - 0.779 for the inter-rater tests. The movement sense test results for different directions and angles ranged from 9.61±2.61 to 11.18±2.89. The ICC values for movemeent sense were in the range of 0.687 – 0.912 for the intra-rater tests, and 0.844 - 0.925 for the inter-rater tests. Conclusion: The isokinetic dynamometer showed moderate-good intra-rater and inter-rater test reliability in the measurement of the GHJ internal rotation movement sense. The intra-rater test reliability was poor in external rotation but the inter-rater test reliability was moderate-good. However in the measurement of movement sense, the isokinetic dynamometer showed intra-rater and inter-rater test reliability at an excellent level. The conformity of both the position and the movement sense tests, and therefore, the repeatability, was extremely good.

Validation of the North Star Assessment for Limb-Girdle Type Muscular Dystrophies

OBJECTIVE

The North Star Assessment for limb-girdle type muscular dystrophies (NSAD), a clinician-reported outcome measure (ClinRO) of motor performance, was initially developed and validated for use in dysferlinopathy, an autosomal recessive form of limb-girdle muscular dystrophy (LGMD R2/2B). Recent developments in treatments for limb-girdle muscular dystrophies (LGMD) have highlighted the urgent need for disease-specific ClinROs. The purpose of this study was to understand the ability of the NSAD to quantify motor function across the broad spectrum of LGMD phenotypes.

METHODS

Assessments of 130 individuals with LGMD evaluated by the physical therapy teams at Nationwide Children's Hospital and the John Walton Muscular Dystrophy Research Centre were included in the analysis. NSAD, 100-m timed test (100MTT), and Performance of Upper Limb 2.0 assessment data were collected. Psychometric analysis with Rasch measurement methods was used to examine the NSAD for suitability and robustness by determining the extent to which the observed data "fit" with predictions of those ratings from the Rasch model. The NSAD score was correlated with the 100MTT and Performance of Upper Limb 2.0 assessment scores for external construct validity.

RESULTS

The NSAD demonstrated a good spread of items covering a continuum of abilities across both individuals who had LGMD and were ambulatory and individuals who had LGMD and were weaker and nonambulatory. Items fit well with the construct measured, validating a summed total score. The NSAD had excellent interrater reliability [intraclass correlation coefficient (ICC) = 0.986, 95% CI = 0.981-0.991] and was highly correlated with the 100MTT walk/run velocity (Spearman rho correlation coefficient of rs(134) = .92).

CONCLUSION

Although LGMD subtypes may differ in age of onset, rate of progression, and patterns of muscle weakness, the overall impact of progressive muscle weakness on motor function is similar. The NSAD is a reliable and valid ClinRO of motor performance for individuals with LGMD and is suitable for use in clinical practice and research settings.

IMPACT

Recent developments in potential pharmacological treatments for LGMD have highlighted the urgent need for disease-specific outcome measures. Validated and meaningful outcome measures are necessary to capture disease presentation, to inform expected rates of progression, and as endpoints for measuring the response to interventions in clinical trials. The NSAD, a scale of motor performance for both individuals who have LGMD and are ambulatory and those who are nonambulatory, is suitable for use in clinical and research settings.

A systematic review of the measurement properties of the Michigan Hand Outcomes Questionnaire (MHQ)

This systematic review of the literature aimed to identify studies examining the measurement properties of the Michigan Hand Outcomes Questionnaire (MHQ) in various international populations and investigate its use in various diagnoses and health conditions. The search was conducted in MEDLINE (via PubMed), SCOPUS, CINAHL and Web of Science, with no restrictions on publication date, country or patient age. Study quality and risk of bias were assessed using the COnsensus-based Standards to select the health Measurement INstruments (COSMIN) checklist. 312 publications were identified and screened; 55 studies met the inclusion criteria and were critically reviewed. These publications comprised 16 languages and 11 pathologies and mainly investigated the internal consistency, construct validity and reliability of the MHQ. In general, all the measurement properties of the instrument showed good scores. The present review shows that the MHQ is a valid patient-reported outcome measure (PROM) and can be properly used in different clinical and rehabilitative contexts. LEVEL OF EVIDENCE: 2A.

Reliability of Ulnar Nerve Sensation Tests in Patients with Cubital Tunnel Syndrome and Healthy Subjects

Static two-point discrimination (2PD) and Semmes–Weinstein monofilament (SWM) tests are commonly used to evaluate sensory disorders in the hand. The aim of this study was to evaluate the reliability of 2PD and SWM tests in the ulnar nerve innervation area in patients with cubital tunnel syndrome (CuTS) and healthy individuals. This was a two-group repeated-measures inter-rater and intra-rater reliability study. Twenty-one patients with CuTS and 30 healthy adults participated. The static 2PD test was performed using a standardized Dellon discriminator, whereas the SWM test was conducted using TOUCH TEST monofilaments. Two examiners performed both tests at the hypothenar eminence and the fourth and fifth digits (ulnar nerve innervation hand territory). First, examiner A conducted three series of 2PD and SWM tests twice with a 15-min rest period (within-day intra-rater reliability). Next, examiner B repeated the same examination 5 min after (inter-rater reliability). Examiner A conducted the same examination 7 days after (between-day intra-rater reliability). For single measurements, the inter-rater reliability and within-day intra-rater reliability in the 2PD was at least 0.81 in patients with CuTS or healthy subjects. The between-days intra-rater reliability for a single measurement varied from 0.56 to 0.95 in CuTS patients and healthy subjects. The between-days intra-rater reliability for mean value from three measurements was above 0.80. The kappa for SWM was above 0.8 and the percentage of agreement was at least 90% for all sessions and trials. In conclusion, the 2PD and SWM tests are reliable for assessing sensation in the ulnar nerve innervation area of the hand in patients with CuTS and healthy subjects.

Algorithm for real-time analysis of intracoronary electrocardiogram

Introduction

Since its first implementation in 1985, intracoronary (ic) electrocardiogram (ECG) has shown ample evidence for its diagnostic value given the higher sensitivity for myocardial ischemia detection in comparison to surface ECG. However, a lack of online systems to quantitatively analyze icECG in real-time prevents its routine use. The present study aimed to develop and validate an autonomous icECG analyzing algorithm.

Materials and methods

This is a retrospective observational study in 100 patients with chronic coronary syndrome. From each patient, a non-ischemic as well as ischemic icECG at the end of a 1-min proximal coronary balloon occlusion was available. An ECG expert as well as the newly developed algorithm for autonomous icECG analysis measured the icECG ST-segment shift in mV for each icECG tracing.

Results

Intraclass correlation coefficient (ICC) demonstrated low variability between the two methods (ICC = 0.968). Using the time point of icECG recording as allocation reference for absent or present myocardial ischemia, ROC-analysis for ischemia detection by the manually determined icECG ST-segment shift showed an area under the curve (AUC) of 0.968 ± 0.021 (p &lt; 0.0001). AUC for the algorithm analysis was 0.967 ± 0.023 (p &lt; 0.0001; p = 0.925 for the difference between the ROC curve AUCs). Time to complete analysis was below 1,000 ms for the autonomous icECG analysis and above 5 min for manual analysis.

Conclusion

A newly developed autonomous icECG analysing algorithm detects myocardial ischemia with equal accuracy as manual ST-segment shift assessment. The algorithm provides the technical fundament for an analysing system to quantitatively obtain icECG in real-time.

Intra-Rater Reliability of Shear Wave Elastography for the Quantification of Respiratory Muscles in Adolescent Athletes

The aim of this study was to assess the intra-rater reliability and agreement of diaphragm and intercostal muscle elasticity and thickness during tidal breathing. The diaphragm and intercostal muscle parameters were measured using shear wave elastography in adolescent athletes. To calculate intra-rater reliability, intraclass correlation coefficient (ICC) and Bland-Altman statistics were used. The reliability/agreement for one-day both muscle measurements (regardless of probe orientation) were at least moderate. During the seven-day interval between measurements, the reliability of a single measurement depended on the measured parameter, transducer orientation, respiratory phase, and muscle. Excellent reliability was found for diaphragm shear modulus at the peak of tidal expiration in transverse probe position (ICC_3.1 = 0.91-0.96; ICC₃.₂ = 0.95), and from poor to excellent reliability for the intercostal muscle thickness at the peak of tidal inspiration with the longitudinal probe position (ICC_3.1 = 0.26-0.95; ICC₃.₂ = 0.15). The overall reliability/agreement of the analysed data was higher for the diaphragm measurements (than the intercostal muscles) regardless of the respiratory phase and probe position. It is difficult to identify a more appropriate probe position to examine these muscles. The shear modulus/thickness of the diaphragm and intercostal muscles demonstrated good reliability/agreement so this appears to be a promising technique for their examination in athletes.

Enhancing touch sensibility by sensory retraining in a sensory discrimination task via haptic rendering

Stroke survivors are commonly affected by somatosensory impairment, hampering their ability to interpret somatosensory information. Somatosensory information has been shown to critically support movement execution in healthy individuals and stroke survivors. Despite the detrimental effect of somatosensory impairments on performing activities of daily living, somatosensory training—in stark contrast to motor training—does not represent standard care in neurorehabilitation. Reasons for the neglected somatosensory treatment are the lack of high-quality research demonstrating the benefits of somatosensory interventions on stroke recovery, the unavailability of reliable quantitative assessments of sensorimotor deficits, and the labor-intensive nature of somatosensory training that relies on therapists guiding the hands of patients with motor impairments. To address this clinical need, we developed a virtual reality-based robotic texture discrimination task to assess and train touch sensibility. Our system incorporates the possibility to robotically guide the participants' hands during texture exploration (i.e., passive touch) and no-guided free texture exploration (i.e., active touch). We ran a 3-day experiment with thirty-six healthy participants who were asked to discriminate the odd texture among three visually identical textures –haptically rendered with the robotic device– following the method of constant stimuli. All participants trained with the passive and active conditions in randomized order on different days. We investigated the reliability of our system using the Intraclass Correlation Coefficient (ICC). We also evaluated the enhancement of participants' touch sensibility via somatosensory retraining and compared whether this enhancement differed between training with active vs. passive conditions. Our results showed that participants significantly improved their task performance after training. Moreover, we found that training effects were not significantly different between active and passive conditions, yet, passive exploration seemed to increase participants' perceived competence. The reliability of our system ranged from poor (in active condition) to moderate and good (in passive condition), probably due to the dependence of the ICC on the between-subject variability, which in a healthy population is usually small. Together, our virtual reality-based robotic haptic system may be a key asset for evaluating and retraining sensory loss with minimal supervision, especially for brain-injured patients who require guidance to move their hands.

Preliminary psychometric properties of a standard vocabulary test administered using a non-invasive brain-computer interface

Objective

To examine measurement agreement between a vocabulary test that is administered in the standardized manner and a version that is administered with a brain-computer interface (BCI).

Method

The sample was comprised of 21 participants, ages 9–27, mean age 16.7 (5.4) years, 61.9% male, including 10 with congenital spastic cerebral palsy (CP), and 11 comparison peers. Participants completed both standard and BCI-facilitated alternate versions of the Peabody Picture Vocabulary Test - 4 (PPVT™-4). The BCI-facilitated PPVT-4 uses items identical to the unmodified PPVT-4, but each quadrant forced-choice item is presented on a computer screen for use with the BCI.

Results

Measurement agreement between instruments was excellent, including an intra-class correlation coefficient of 0.98, and Bland-Altman plots and tests indicating adequate limits of agreement and no systematic test version bias. The mean standard score difference between test versions was 2.0 points (SD 6.3).

Conclusion

These results demonstrate that BCI-facilitated quadrant forced-choice vocabulary testing has the potential to measure aspects of language without requiring any overt physical or communicative response. Thus, it may be possible to identify the language capabilities and needs of many individuals who have not had access to standardized clinical and research instruments.

Can Non-Contrast 3T MRI scans predict the type of labral procedure in hip arthroscopy?

PURPOSE

The study proposed a simple classification system that aimed at predicting the labral procedure during hip arthroscopy using images from unenhanced 3T MRI scans.

PATENTS AND METHODS

Forty patients undergoing hip arthroscopy had their MRI scans reviewed pre-operatively by one of two senior radiologists and classified into: type 1: stable labrum with intra-substance degeneration (no labral repair required), type 2: unstable labrum, no intra-substance degeneration (labral repair required), or type 3: unstable labrum with intra-substance degeneration (Labral repair not feasible). Hip arthroscopy is carried out by one of two surgeons and classified accordingly while blinded to the radiologists' assessment.

RESULTS

The pre-operative radiological classification managed to predict the labral procedure in 29 cases out of 40 (72.5%). The gamma value was 0.83, and the kappa value was 0.46 denoting moderate agreement. The inter-class correlation coefficient was 0.52 indicating moderate reliability.

CONCLUSION

The proposed classification showed a moderate agreement between the radiological findings and arthroscopic findings. As we cannot accurately correlate the MRI findings with the type of surgical management, the surgeon should be prepared for all scenarios of labral procedures.

LEVEL OF EVIDENCE

Level IV (case series).

Digesting the Contents: an Analysis of Online Colorectal Cancer Education Websites

Online educational resources have an impact on patient understanding, opinion, and behavior. More colorectal cancer patients are being diagnosed and using the internet to search for information. This study aims to provide the most in-depth and comprehensive examination of online colorectal resources to date. An internet search using the terms "colorectal cancer," "colon cancer," and "rectal cancer" were performed, with meta-search engines "Dogpile," "Yippy," and "Google." A total of 741, 759, and 703 websites were returned by the search engines respectively. A list of the "top 100 websites" was compiled by placing the sites in average rank order. The websites were evaluated using a validated structured rating tool. Inter-rater reliability was evaluated using kappa statistics, and the results were analyzed using descriptive statistics. Website affiliations were 40% commercial and 35% from non-profit organizations. Most websites disclosed ownership (93%) and had no apparent bias (94%). Authorship disclosure was poor (17%). Most sites were interactive (84%) and organized (70% with at least 4/5 features). Readability was at a senior high school level on average. Content coverage and accuracy were the highest in the areas of etiology (96% coverage) and symptoms (95% coverage) and lowest in areas of treatment (72% coverage) and prognosis (43% coverage).Colorectal cancer online information can be improved in accountability, readability, content accuracy, and completeness. Author disclosure, more accurate and updated citations, and a lower grade level of readability are needed. More complete and accurate information are needed, especially in the areas of treatment and prognosis.

Three-dimensional Changes of Maxillary Alveolar Morphology After Using Modified Nasoalveolar Molding in Patients with Complete Unilateral Cleft lip and Palate

OBJECTIVE

This study aimed to evaluate the three-dimensional changes in maxillary alveolar morphology after using modified NAM in patients with complete unilateral cleft lip and palate.

DESIGN

This is a retrospective study.

SETTING

The study was carried out in the dental hospital, Faculty of Dentistry of Naresuan University, Phitsanulok, which serves as a tertiary care center.

PATIENTS

The population sample consisted of 19 patients with nonsyndromic complete unilateral cleft lip and palate.

INTERVENTION

All patients received the modified NAM treatment based on the treatment protocol of the Naresuan University Cleft and Craniofacial Center, Thailand.

MAIN OUTCOME MEASURE

Dental models obtained at pre-treatment (T0) and post-treatment (T1) were scanned to construct the digital models. The maxillary digital models that showed dimensional changes between T0 and T1 were measured using a computer graphic software.

RESULTS

The modified NAM resulted in a significant decrease in the anterior cleft width, posterior cleft width, and anterior arch width. Conversely, it caused a significant increase in the length of the lesser cleft segment and the greater segment rotation. However, the change in the height of both segments and posterior arch width was not found to be significant.

CONCLUSIONS

The modified NAM was an effective device for reducing the alveolar cleft width while improving the alignment of alveolar cleft segments.

A Cross-Sectional, Questionnaire-Based Study on Drug Treatment Awareness in Schizophrenia Patients and Caregivers: An Unexplored Avenue

BACKGROUND

Schizophrenia is associated with high relapse rates, and medication nonadherence is a major factor contributing toward relapse. Since medication adherence and treatment awareness are linked, an alarming need was felt to evaluate the level of drug treatment awareness in patients who have schizophrenia. Besides, patients who have schizophrenia are often dependent on their caregivers for medications. Hence, the current study was also designed to look into drug treatment awareness among caregivers.

METHODS

This was a cross-sectional, questionnaire-based study. Patients diagnosed with schizophrenia as per The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition were included, provided they had good insight and had been prescribed medications at the study center for at least three months. Caregivers were included using the Pollak and Perlick criteria. The sociodemographic profile of the patients and caregivers was recorded, and further assessment for treatment awareness was done using the prevalidated Drug Treatment Awareness Questionnaire (DTAQ).

RESULTS

A total of 166 patients and 157 caregivers were enrolled. Mean drug awareness scores among patients and caregivers did not show statistically significant differences (P= 0.22). Mean ± SD DTAQ awareness scores in patients and caregivers were 12.57 ± 1.81 and 12.84 ± 1.91, respectively. The majority of patients and caregivers (> 90%) possessed awareness in domains related to past medication records and in that of re-visit/re-contact instructions. Awareness was least commonly seen in relation to side effects of medications and details of the prescribed medications, where only about 50% of patients and caregivers possessed awareness. No clinically significant correlation was found between sociodemographic factors and drug treatment awareness scores.

CONCLUSION

Drug treatment awareness in patients and caregivers was comparable and was not reliant on the sociodemographic factors. Special interventions should be conducted to raise drug treatment awareness among patients having insight and their caregivers.

Clinical Imaging-Derived Metrics of Corticospinal Tract Structural Integrity Are Associated With Post-stroke Motor Outcomes: A Retrospective Study

Objective

The primary objective of this study was to retrospectively investigate associations between clinical magnetic resonance imaging-based (MRI) metrics of corticospinal tract (CST) status and paretic upper extremity (PUE) motor recovery in patients that completed acute inpatient rehabilitation (AR) post-stroke.

Methods

We conducted a longitudinal chart review of patients post-stroke who received care in the Emory University Hospital system during acute hospitalization, AR, and outpatient therapy. We extracted demographic information, stroke characteristics, and longitudinal documentation of post-stroke motor function from institutional electronic medical records. Serial assessments of paretic shoulder abduction and finger extension were estimated (E-SAFE) and an estimated Action Research Arm Test (E-ARAT) score was used to quantify 3-month PUE motor function outcome. Clinically-diagnostic MRI were used to create lesion masks that were spatially normalized and overlaid onto a white matter tract atlas delineating CST contributions emanating from six cortical seed regions to obtain the percentage of CST lesion overlap. Metric associations were investigated with correlation and cluster analyses, Kruskal-Wallis tests, classification and regression tree analysis.

Results

Thirty-four patients met study eligibility criteria. All CST overlap percentages were correlated with E-ARAT however, ventral premotor tract (PMv) overlap was the only tract that remained significantly correlated after multiple comparisons adjustment. Lesion overlap percentage in CST contributions from all seed regions was significantly different between outcome categories. Using MRI metrics alone, dorsal premotor (PMd) and PMv tracts classified recovery outcome category with 79.4% accuracy. When clinical and MRI metrics were combined, AR E-SAFE, patient age, and overall CST lesion overlap classified patients with 88.2% accuracy.

Conclusions

Study findings revealed clinical MRI-derived CST lesion overlap was associated with PUE motor outcome post-stroke and that cortical projections within the CST, particularly those emanating from non-M1 cortical areas, prominently ventral premotor (PMv) and dorsal premotor (PMd) cortices, distinguished between PUE outcome groups. Exploratory predictive models using clinical MRI metrics, either alone or in combination with clinical measures, were able to accurately identify recovery outcome category for the study cohort during both the acute and early subacute phases of post-stroke recovery. Prospective studies are recommended to determine the predictive utility of including clinical imaging-based biomarkers of white matter tract structural integrity in predictive models of post-stroke recovery.

Psychometric Evaluation of the German Version of the Social Functioning in Dementia Scale

BACKGROUND

Dementia is one of the most common and most severe disorder in old age. In addition to cognitive decline and functional impairment, changes in social functioning occur in the course of dementia. Currently, there is no valid instrument in German language to assess social functioning in individuals with dementia.

OBJECTIVE

We aim to adapt and psychometrically evaluate a German version of the Social Functioning in Dementia Scale (SF-DEM).

METHODS

First, a multi-step and team-based translation process based on the TRAPD model was performed. Second, we interviewed dyads of individuals with mild dementia and caregivers to test the internal consistency, test-retest reliability, interrater reliability, construct validity, and acceptance of the German version of the SF-DEM.

RESULTS

The internal consistency of the patient-rated (α= 0.72) and the caregiver-rated (α= 0.76) SF-DEM is at an acceptable level. The interrater reliability was excellent for both versions (patients: ICC = 0.98, CI [0.95-0.99]; caregiver: ICC = 0.95, CI [0.89-0.98]) and the test-retest reliability was moderate (patients: ICC = 0.57, CI [0.26-0.77]; caregiver: ICC = 0.58, CI [0.27-0.78]). Caregiver-rated SF-DEM correlated strong with LSNS-6 (rs = 0.60, p < 0.01), QoL-AD (marriage: rs = 0.61, p < 0.01; friends: rs = 0.51, p = 0.01). In addition, the SF-DEM was accepted by the participants.

CONCLUSION

The German SF-DEM is a valid, reliable, and acceptable instrument to assess social functioning in individuals with dementia. Further research should address the psychometric properties in individuals with more severe dementia.

Sarcopenia is Associated with Reduced Survival following Surgery for Adrenocortical Carcinoma

AIM

Adrenocortical cancer (ACC) is an aggressive malignancy and robust prognostic factors remain unclear. The presence of sarcopenia has been shown to negatively impact survival for other malignancies, but has not been extensively analyzed in ACC.

METHODS

Patients who underwent resection of their ACC between 2010 and 2020 were identified; therapeutic, operative, and outcome data were analyzed. Sarcopenia was assessed by calculation of the skeletal muscle index (SMI) and was defined as an SMI <52.4cm²/m² for males and <38.5cm²/m² for females.

RESULTS

Data on 35 patients (18 F: 17 M; median age 54 [range: 18-86]) who had primary surgical treatment were analyzed. Median tumor size was 10 cm [range:3-15]. In eleven patients (31%), the tumor was hormonally active (cortisol = 8;23%). Seventeen patients (49%) were classified as having sarcopenia on their pre-operative CT scan. The Intraclass Correlation Coefficient (ICC) for intra- and inter-observer variability showed very good agreement (0.99 and 0.98). There was no difference in incidence of sarcopenia stratifying for sex, BMI, or tumor-size, but incidence was higher with increasing age (p < .05). Overall median survival was 36 months, with 1- and 3-year survival rates of 77% and 52%. The presence of sarcopenia was strongly associated with a shorter overall survival (HR = 3.21; [95%CI: 1.06-9.69];p = .03) on unadjusted analyses. Moreover, age, higher T-stage, and presence of capsular invasion were also associated with poorer survival on univariable analyses.

CONCLUSION

The presence of sarcopenia in patients undergoing surgery for ACC could be a predictor of reduced overall survival, although replications of these analyses should be performed in similar, larger cohorts. Specifically, the influence of a patient's hormonal status on the manifestation of sarcopenia should be further defined.

Adjacent Joint Restriction Differentially Influences Intra- and Inter-rater Reliability and Agreement of Goniometric Measurements

BACKGROUND

Reliability and agreement of goniometric measurements can be altered by variations in measurement technique such as restricting adjacent joints to influence bi-articular muscles. It is unknown if the influence of adjacent joint restriction is consistent across different range of motion (ROM) tests, as this has yet to be assessed within a single study. Additionally, between-study comparisons are challenged by differences between methodology, participants and raters, obscuring the development of a conceptual understanding of the extent to which adjacent joint restriction can influence goniometric ROM measurements.

PURPOSE

To quantify intra- and inter-rater reliability and levels of agreement of goniometric measurements across five ROM tests, with and without adjacent joint restriction.

STUDY DESIGN

Descriptive reliability study.

METHODS

Three trained and experienced raters made two measurements of bilateral ankle dorsiflexion, first metatarsophalangeal dorsiflexion, hip extension, hip flexion, and shoulder flexion, with and without adjacent joint restriction. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), along with participant, measurement/rater and random error variance were estimated.

RESULTS

Eleven females (age 21.4 ±2.3 years) and 19 males (age 22.1 ±2.8 years) participated. Adjacent joint restriction did not influence the reliability and agreement in a consistent way across the five ROM tests. Changes in the inter-rater reliability and agreement were more pronounced compared to the intra-rater reliability and agreement. Assessing variance components (participant, measurement/rater and random error variance) that are used to calculate the ICC and SEM, improved interpretation of ICC and SEM scores.

CONCLUSION

The effects of adjacent joint restriction on reliability and agreement of goniometric measurements depend on the ROM test and should be considered when comparing measurements between multiple raters. Reporting variance components that are used to calculate the ICC and SEM can improve interpretation and may improve between-study comparisons, towards developing a conceptual framework to guide goniometric measurement technique.

LEVEL OF EVIDENCE

3b.

The SWING test: A more reliable test than passive clinical tests for assessing sagittal plane hip mobility

BACKGROUND

Clinical assessment of sagittal plane hip mobility is usually performed using the Modified Thomas Test (for extension) and the Straight-Leg-Raise (for flexion) with a goniometer. These tests have limited reliability, however. An active swinging leg movement test (the SWING test), assessed using 3D motion analysis, could provide an alternative to these passive clinical tests.

RESEARCH QUESTION

Is the SWING test a more reliable alternative to evaluate hip mobility, in comparison to the clinical extension and flexion tests?

METHODS

Ten asymptomatic adult participants were evaluated by two investigators over three sessions. Participants performed 10 maximal hip extensions and flexions, with both legs straight and no trunk movement (the SWING test). Hip kinematics was assessed using a 3D motion analysis system. Maximal and minimal hip angles were calculated for each swing and represented maximal hip flexion (SWING flexion) and extension (SWING extension), respectively. The Modified Thomas Test and Straight-Leg-Raise were repeated 3 times for each leg. On the first day, both investigators performed all the tests (SWING + Modified Thomas Test + Straight-Leg-Raise). A week later, a single investigator repeated all the tests. Inter-rater, intra-rater, within-day and between-day reliability were evaluated using intra-class correlation.

RESULTS

Intra-class correlation coefficients for all the tests were superior to 0.8, except for the Modified Thomas Test's intra-rater, between-day (intra-class correlation 0.673) and the Straight-Leg-Raise's inter-rater, within-day (intra-class correlation 0.294). The SWING test always showed a higher intra-class correlation coefficient than the passive clinical tests. The only significant correlation found was for the Straight-Leg-Raise and SWING flexion (r = 0.48; P < 0.001).

SIGNIFICANCE

The SWING test seems to be an alternative to existing passive clinical tests, offering better reliability for assessing sagittal plane hip mobility.

Reliability of hip joint position sense tests using a clinically applicable measurement tool in elderly participants with unilateral hip osteoarthritis

Hip joint proprioception is vital in maintaining posture and stability in elderly individuals. Examining hip joint position sense (JPS) using reliable tools is important in contemporary clinical practice. The objective of this study is to evaluate the intra-rater and inter-rater reliability of hip JPS tests using a clinically applicable measurement tool in elderly individuals with unilateral hip osteoarthritis (OA). Sixty-two individuals (mean age = 67.5 years) diagnosed with unilateral hip OA participated in this study. The JPS tests were evaluated using a digital inclinometer in hip flexion and abduction directions. The absolute difference between target and reproduced angle (repositioning error) in degrees was taken to measure JPS accuracy. The intraclass correlation coefficient (ICC (2.k), was used to assess the reliability. The Intra rater-reliability for hip JPS tests showed very good agreement in the lying position (hip flexion-ICC = 0.88–0.92; standard error of measurement (SEM) = 0.06–0.07, hip abduction-ICC = 0.89–0.91; SEM = 0.06–0.07) and good agreement in the standing position (hip flexion-ICC = 0.69–0.72; SEM = 0.07, hip abduction-ICC = 0.66–0.69; SEM = 0.06–0.08). Likewise, inter-rater reliability for hip JPS tests demonstrated very good agreement in the lying position (hip flexion-ICC = 0.87–0.89; SEM = 0.06–0.07, hip abduction-ICC = 0.87–0.91; SEM = 0.07) and good agreement in the standing position (hip flexion-ICC = 0.64–0.66; SEM = 0.08, hip abduction-ICC = 0.60–0.72; SEM = 0.06–0.09). The results support the use of hip JPS tests in clinical practice and should be incorporated in assessing and managing elderly participants with hip OA.

Concurrent Validity of the Garmin Vivofit®4 to Accurately Record Step Count in Older Adults in Challenging Environments

There is little evidence of the concurrent validity of commercially available wrist-worn long battery life activity monitors to measure steps in older adults at slow speeds and with real-world challenges. Forty adults aged over 60 years performed a treadmill protocol at four speeds, a 50-m indoor circuit, and a 200-m outdoor circuit with environmental challenges while wearing a Garmin Vivofit®4, the activPAL3™, and a chest-worn camera angled at the feet. The Garmin Vivofit®4 showed high intraclass correlation coefficients2,1 (.98-.99) and low absolute percentage error rates (<2%) at the fastest treadmill speeds and the outdoor circuit. Step counts were underestimated at the slowest treadmill speed and the indoor circuit. The Garmin Vivofit®4 is accurate for older adults at higher walking speeds and during outdoor walking. However, it underestimates steps at slow speeds and when walking indoors with postural transitions.

Normalisation of a biarticular muscle EMG signal using a submaximal voluntary contraction: Choice of the standardised isometric task for the rectus femoris, a pilot study

BACKGROUND

Electromyography (EMG) signal amplitude is often altered by factors related to the participants and the measurement system. To overcome this issue, a normalisation of the EMG signal amplitude can be performed. Recently, it has been demonstrated that a submaximal voluntary contraction (subMVC) normalisation approach, inspired by grade 3 of manual muscle testing, could produce reliable results. However, rectus femoris (RF) normalisation resulted in low reliability. While the normalisation task chosen for this biarticular muscle was to maintain a knee extension against gravity (ISO-K), a hip flexion isometric task (ISO-H) could also be applied.

RESEARCH QUESTION

This pilot study aimed to assess the impact of the normalisation task on the RF EMG signal quality and related intra-rater within-day reliability during ISO-K and ISO-H, and intra-rater between-day reliability of the EMG signal amplitude during gait.

METHODS

Twenty-four asymptomatic participants were asked to perform ISO-K and ISO-H tasks with both legs and then to walk at self-spontaneous speed, in two identical sessions one week apart. A wireless EMG system was used to record the EMG signal of bilateral RF during each task.

RESULTS

Signal-to-noise ratio during ISO-K and ISO-H was ≥ 15 dB in respectively 51% and 98% of all task repetitions. Intra-rater within-day reliability was acceptable using ISO-K (ICC = 0.71 (0.57; 0.83)) with high %SEM of 35%, and excellent using ISO-H (ICC = 0.94 (0.90; 0.96)) with high %SEM of 34%. Intra-rater between-day reliability during gait was acceptable using ISO-K (ICC = 0.74 (0.61; 0.81)) with a high %SEM of 49%, and excellent using ISO-H (ICC = 0.87 (0.76; 0.93)) with a high %SEM of 38%.

SIGNIFICANCE

The reliability (ICC) of RF EMG signal normalisation was higher using ISO-H than using ISO-K. However, even if signal-to-noise ratio was notably improved using ISO-H, %SEM remains high whatever the normalisation task used. Some additional improvements might thus still be needed to obtain a normalisation protocol allowing more reproducible measurements.

Quality Analysis of Online Patient Resources for Hepatocellular Carcinoma

GOAL

This study aims to evaluate the quality of online hepatocellular carcinoma (primary liver cancer) resources by using a validated tool to determine the strengths and limitations of hepatocellular carcinoma Web sites designed for patient education.

BACKGROUND

In recent years, online health information-seeking behavior has become more prevalent. Meanwhile, hepatocellular carcinoma incidence rates have also increased. However, there is currently limited literature assessing the quality of online hepatocellular carcinoma information.

MATERIALS AND METHODS

The term "hepatocellular carcinoma" was searched using the search engine Google and the meta-search engines Dogpile and Yippy. A validated rating tool was used to assign quality scores to 100 Web sites based on the domains of Web site affiliation, accountability, interactivity, structure and organization, readability, and content quality. Overall quality scores were tallied for all Web sites.

RESULTS

Noncommercial hepatocellular carcinoma Web sites received significantly higher overall quality scores compared with their commercial counterparts. Overall, 30% of the Web sites identified their author(s), 42% cited sources, and 33% were updated within the past 2 years. The majority of Web sites utilized at least 1 interactive feature and 4 structural tools. Average readability was at a grade 11.8 level using the Flesch-Kincaid grading system, which is significantly higher than the recommended grade 6 level. Definition and treatment were the most commonly covered topics, while prevention and prognosis were the least commonly covered.

CONCLUSIONS

The quality of online hepatocellular carcinoma information is highly variable. Health care professionals should be aware of its limitations and be proactive in guiding patients to reliable resources.

The Keystone device as a clinical tool for measuring the supination resistance of the foot: A reliability study

BACKGROUND

The supination resistance test (SRT) is a kinetic test used in clinical and research contexts to estimate the amount of force required to supinate the foot. Previous studies either used a manual, less reliable version of this test or a more reliable instrumented version, but with devices inconvenient for clinical use. The clinically available Keystone device has been developed for the SRT, and could be better suited for clinical purposes. The objective of this study is to determine the intrarater and interrater reliability of the Keystone device for the SRT.

METHOD

Thirty young adults underwent two prospective experimental sessions, 1 week apart, during which SRT measures with the Keystone device were registered. Intrarater and interrater reliability were calculated using intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable difference (MDD) and limits of agreements (LoA).

RESULTS

The intrarater reliability of the SRT was good (ICC = 0.86, p < 0.001). The SEM, MDD and 95% LoA were 7.3, 20.4 and -31.6-14.3 N, respectively. The interrater reliability of the SRT was good (ICC = 0.76, p < 0.001). The SEM, MDD and 95% LoA were 9.0, 24.9 and -36.6-24.9 N, respectively.

CONCLUSION

The Keystone device is a reliable tool that can be used in clinical and research contexts. Prospective studies aiming to determine if SRT measures are predictors of musculoskeletal injuries or if they can predict the effects of external supports on the biomechanics of the foot and ankle are warranted.

Are in Person and Telephone Interviews Equivalent Modes of Administrating the CAT, the FACIT-FS and the SGRQ in People With COPD?

Background: The COVID-19 pandemic brought numerous challenges, namely in routine assessment of people with chronic obstructive pulmonary disease (COPD). The COPD Assessment Test (CAT), the Functional Assessment of Chronic Illness-Fatigue-Subscale (FACIT-FS) and the St. George's respiratory questionnaire (SGRQ) are important patient-reported outcome measures used to assess people with COPD, but its face-to-face application has been compromised. The telephone interview offers a simple and effective alternative, yet uncertainty regarding its equivalence remains. This study aimed to establish the reliability and validity of the CAT, the FACIT-FS and the SGRQ administered by telephone interview in people with COPD.

Methods: Data from an observational prospective study including people with COPD were analyzed. Participants answered to the CAT, FACIT-FS and SGRQ questionnaires in person and by telephone, with a maximum interval of 48-h. Participants were randomly selected to answer first to the in-person questionnaire followed by telephone or vice versa. Reliability measures included internal consistency with Cronbach's alpha, test-retest reliability with the intraclass correlation coefficient (ICC_2,1), test-retest measurement error with the standard error of measurement (SEM) and agreement with the Bland and Altman 95% limits of agreement. Validity was assessed with the Spearman correlation (rho).

Results: Fifty-five people with COPD (44 men; 68.1 ± 7.9 years; FEV₁: 59.1 ± 20.3% predicted) were included. Similar internal consistency was observed between in person vs. telephone interview for the CAT (0.82 vs. 0.84), the FACIT-FS (0.83 vs. 0.84) and the SGRQ (0.92 vs. 0.93). Test-retest reliability was excellent, with an ICC_2,1 of 0.77 (95% CI: 0.65; 0.86), 0.86 (95% CI: 0.77; 0.92) and 0.94 (95% CI: 0.90; 0.96) for the CAT, FACIT-FS and SGRQ total scores, respectively. The SEM showed a low level of associated measurement error and the Bland and Altman plots illustrated a good level of agreement between both modes of administration, with no evidence of systematic bias. Robust positive correlations (rho 0.87–0.94, p < 0.001) were found for the CAT, FACIT-FS and SGRQ total scores applied by both methods.

Conclusion: The telephonic administration of the CAT, the FACIT-FS and the SGRQ are a valid and reliable alternative approach to in person interviews for monitoring symptoms and health-related quality of life in people with COPD. The telephone might be an important add-on for personalized assessment and management of COPD thru remote monitoring.

Test-Retest Reliability of Short-Interval Intracortical Inhibition Assessed by Threshold-Tracking and Automated Conventional Techniques

Two novel short-interval intracortical inhibition (SICI) protocols, assessing SICI across a range of interstimulus intervals (ISIs) using either parallel threshold-tracking transcranial magnetic stimulation (TT-TMS) or automated conventional TMS (cTMS), were recently introduced. However, the test-retest reliability of these protocols has not been investigated, which is important if they are to be introduced in the clinic. SICI was recorded in 18 healthy subjects using TT-TMS (T-SICI) and cTMS (A-SICI). All subjects were examined at four identical sessions, i.e., morning and afternoon sessions on 2 d, 5-7 d apart. Both SICI protocols were performed twice at each session by the same observer. In one of the sessions, another observer performed additional examinations. Neither intraobserver nor interobserver measures of SICI differed significantly between examinations, except for T-SICI at ISI 3 ms (p = 0.00035) and A-SICI at ISI 2.5 ms (p = 0.0103). Intraday reliability was poor-to-good for A-SICI and moderate-to-good for T-SICI. Interday and interobserver reliabilities of T-SICI and A-SICI were moderate-to-good. Although between-subject variation constituted most of the total variation, SICI repeatability in an individual subject was poor. The two SICI protocols showed no considerable systematic bias across sessions and had a comparable test-retest reliability profile. Findings from the present study suggest that both SICI protocols may be reliably and reproducibly employed in research studies, but should be used with caution for individual decision-making in clinical settings. Studies exploring reliability in patient cohorts are warranted to investigate the clinical utility of these two SICI protocols.

Practice Effects, Test-Retest Reliability, and Minimal Detectable Change of the Ruff 2 and 7 Selective Attention Test in Patients with Schizophrenia

BACKGROUND

The Ruff 2 and 7 Selective Attention Test (RSAT) is designed to measure selective attention. It tests automatic detection speed (ADS), automatic detection errors (ADE), automatic detection accuracy (ADA), controlled search speed (CSS), controlled search errors (CSE), and controlled search accuracy (CSA). The purpose of this study was to examine the test-retest reliability, practice effect, and minimum detectable change (MDC) of the RSAT in patients with schizophrenia.

METHODS

A total of 101 patients with schizophrenia completed the RSAT twice at a 4-week interval. The intra-class correlation coefficient (ICC), paired t test, and effect size were used to examine the test-retest reliability and practice effect. The standard error of measurement (SEM) and MDC were calculated.

RESULTS

The difference scores between the two assessments were significant in all the indexes. The absolute effect sizes were 0.14 to 0.30. The ICCs of the RSAT ranged from 0.69 to 0.91. The MDC% in the indexes of ADS, ADA, and CSA of the RSAT were <30%.

CONCLUSIONS

The RSAT is reliable for assessing selective attention in patients with schizophrenia. The RSAT has good to excellent test-retest reliability, a trivial to small practice effect, and indexes of ADS, ADA, and CSA, representing acceptable random measurement error.

Comparison between different tonometers following intrastromal corneal ring segments implantation

PURPOSE

To compare different intraocular pressure (IOP) readings in corneas with intrastromal corneal ring segments (ICRS) taken by three different tonometers; Goldmann applanation tonometry (GAT), air puff tonometer, and ocular response analyzer (ORA) corneal-compensated IOP (ORA-IOPcc) and determine the relation of these measurements to different corneal parameters taken by Pentacam.

METHODS

An observational cross-sectional analytic study included patients who underwent ICRS keraring implantation at 3 months. In each eye, the two rings were placed using the femtosecond laser assisted technique 5.5 or 6 mm from the center. IOP was measured using three different tonometers; GAT, air puff tonometer, and ocular response analyzer (ORA) corneal-compensated IOP (ORA-IOPcc).

RESULTS

Fifty eyes of 30 patients (20 males and 10 females) aged 27.56 ± 6.38 years were included. IOP measurements by GAT, air puff tonometer, and ORA-IOPcc were 13.28 ± 2.13 mmHg, 10.47 ± 2.55 mmHg, and 13.19 ± 2.78 mmHg, respectively. Comparisons between air puff and each of GAT and ORA-IOPcc were statistically highly significant (p-value <0.001).

CONCLUSION

IOP measurements taken by air puff tonometer were significantly lower than those taken by GAT and ORA-IOPcc. These differences were not constant across the pressure range but increased as the pressure values determined using GAT and ORA increased. ORA-IOPcc and GAT showed similar readings. No correlation was found between any of the IOP readings taken by the three tonometers and the central corneal thickness.