Accurate estimation of skeletal muscle mass by comparison of computed tomographic images of the third lumbar and third cervical vertebrae in Japanese patients with oral squamous cell carcinoma

OBJECTIVES

We evaluated the accuracy of estimating the cross-sectional area (CSA) at the third lumbar vertebra (L3) based on the CSA at the third cervical vertebra (C3) using computed tomographic images, and we identified the sources of error and bias using the evaluation of absolute reliability in 89 Japanese patients with oral squamous cell carcinoma.

METHODS

Skeletal muscle CSA was measured at the C3 and L3 on pretreatment computed tomographic images. We used the CSA at the C3 to estimate CSA at the L3 in an existing prediction formula. Correlation coefficients were used to evaluate the relative reliability of the estimate, and Bland-Altman analysis and minimum detectable change (MDC) were used to evaluate its absolute reliability.

RESULTS

Estimated and actual CSAs at L3 were strongly correlated (r = 0.885, p < 0.001). The mean difference between the estimated and actual CSAs was - 1.0887 cm², the 95% confidence interval was - 4.09 to 1.91 cm² (p = 0.472), and the 95% limits of agreement were - 29.0 and 26.8 cm². The MDC at the 95% level of confidence in estimated and actual CSAs was 27.9 cm².

CONCLUSIONS

The estimation of CSA at the L3 from the existing prediction formula with the CSA at the C3 had no systematic biases, but it did have random errors. Random errors resulted from measurement errors and biological variation. Usefulness of the existing formula is limited by physical differences in populations.

Investigation of absolute intra-rater and inter-rater reliabilities during the muscle hardness estimation

[Purpose] This study aimed to investigate the absolute intra-rater and inter-rater reliabilities during the measurement of muscle hardness, which is used to evaluate physical therapy. Moreover, we examined the effects of using different equipment types and their positioning on the intra-rater and inter-rater reliabilities. [Participants and Methods] Participants of this study comprised 12 healthy adult male individuals. Two experts and two beginners measured the muscle hardness of the lumbar erector spinae and rectus femoris using three types of hardness meters at two positions, including when the muscle was relaxed and stretched. [Results] Intra-rater fixed bias was observed during some measurements by both experts and beginners. Inter-rater fixed bias was observed during measurements by some experts and not the beginners. [Conclusion] In this study, the measurement of muscle hardness demonstrated a need to reconsider the measurement position and acclimation time. These examinations require the consideration of relative and absolute reliabilities.

Test-Retest Reliability of the Timed Up and Go Test in Subjects with Parkinson's Disease: Implications for Longitudinal Assessments

BACKGROUND

Despite the frequent use of the Timed Up and Go (TUG) test in clinical trials, evaluation of longitudinal test-retest reliability is generally lacking and still inconclusive for patients with Parkinson's disease (PD).

OBJECTIVE

We aimed to further investigate long-term reliability and sensitivity of the TUG test among this population. Furthermore, we explored alternative assessment strategies of the test aimed at elucidating whether the inclusion or combination of timed trials may have potential implications on outcome measure.

METHODS

Relative and absolute reliability of the TUG performance were obtained in forty-three subjects with PD over three timed trials in two different testing sessions separated by a two-months period.

RESULTS

Our results reported excellent intra-session and moderate inter-session reliability coefficients. The use of different assessment strategies of the TUG was found to have an important impact on outcome measure, highlighting the averaging of several timed trials in each testing session as a recommended alternative to minimize measurement error and increase reliability in longitudinal assessments. Nevertheless, beyond acceptable reliability, poor trial-to-trial stability of the measure appears to exist, since the ranges of expected variability upon retesting were wide and the incidence of spurious statistical effects was not negligible, especially in longitudinal repeated testing.

CONCLUSION

Limitations may exist in the interpretation of the TUG outputs as part of longitudinal assessments aimed at evaluating treatment effectiveness in PD population. Researchers and practitioners should be aware of these concerns to prevent possible misrepresentations of functional ability in patients for a particular intervention.

Measurement error of the Mini-Mental State Examination among individuals with dementia that reside in nursing homes

Few studies have investigated the measurement error of the Mini-Mental State Examination (MMSE) in the same unit of measurement, also known as absolute reliability. This measurement can help determine whether an observed score change for an individual is likely to represent true change. The aim of this study was to investigate the absolute reliability of the MMSE among individuals with dementia that reside in nursing homes. Among 88 participants, 19 (21.6%) were men, 35 (39.8%) had Alzheimer’s disease, 35 (39.8%) had vascular dementia, and the mean age was 84.0 years (range 65–98). The participants were tested and retested with the MMSE within 1–6 days. Both tests were administered by the same assessor at the same time of day. The mean MMSE score was 13.7 (range 0–28). The absolute difference between MMSE scores varied from 0 to 6 points, and the differences did not correlate with the corresponding score means (p = 0.874). The smallest detectable change (SDC) between two measurements was 4.00. The SDC was independent of depression, impaired vision and hearing, delirium within the last week, dementia type and age. However, the SDC was 5.56 among men and 3.50 among women (p = 0.003). In conclusion, for individuals with dementia that reside in nursing homes, it seems like their MMSE score needs to change by four or more points between two measurements in order for their score change to be reliably higher than the measurement error.

The relative and absolute reliability of maximum phonation time in community-dwelling Japanese people

BACKGROUND AND AIMS

The aim of the present study was to examine the approximate value of maximum phonation time in community-dwelling Japanese people and to set the range of error after ascertaining relative and absolute reliability.

METHODS

Participants in the present study were adults living in Kobe and Himeji City, Hyogo Prefecture, Japan. Participants were seated in the upright sitting position and were asked to produce an /a/ sound at their normal speaking volume for as long as they possibly could. The examiner measured the time until the sound became inaudible. Two trials were performed.

RESULTS

The subjects in the final analysis comprised 380 adults (246 women, 134 men; age, 72.7 ± 5.9 years). The values of trial 1 and trial 2 were analyzed with intraclass correlation coefficient (ICC_(1,1)), and Bland-Altman plot. Average values of the women, men, and both sexes combined were 16.1, 18.7, and 17.0 s, respectively. Average values of age groups 60-69, 70-79, and 80-89 years were 17.9, 16.8, and 15.9 s, respectively. The ICC_(1,1) was 0.87 (P < 0.001). Both fixed bias and proportional bias existed. Limits of agreement (LOA) were -5.0 to 7.7 and % change ranged from -27.1 to 41.8 %.

CONCLUSIONS

These normative data indicated that sufficiently reliable values could be measured in two trials. LOA showed that the second value tended to be higher. In determining the effect of treatment, one must consider that the value will be slightly higher at re-test.

The relative and absolute reliability of the Functional Independence and Difficulty Scale in community-dwelling frail elderly Japanese people using long-term care insurance services

BACKGROUND

The newly developed Functional Independence and Difficulty Scale is a tool for assessing the performance of basic activities of daily living in terms of both independence and difficulty. The reliability of this new scale has not been assessed.

AIMS

The aim of this study was to examine the relative reliability and absolute reliability of the newly developed scale in community-dwelling frail elderly people in Japan.

METHODS

Participants were 47 community-dwelling elderly subjects (22 for assessing test-retest reliability and 25 for assessing inter-rater reliability). As relative reliability indices, intra-class correlation coefficients were used. From an absolute reliability perspective, we conducted Bland-Altman analysis and calculated the limit of agreement or minimal detectable change to determine the acceptable range of error.

RESULTS

Intra-class correlation coefficients for test-retest and inter-rater reliability were 0.90 (P < 0.001) and 0.97 (P < 0.001), respectively. The limit of agreement for test-retest reliability was -5.2 to 1.8, representing an increase of over six points for improvement and a decrease of over two points for decline of basic activities of daily living ability. The minimal detectable change for inter-rater reliability was 3.7, indicating that a three-point difference might be existed between difference raters. The results of this study demonstrated that the FIDS appeared to be a reliable instrument for use in Japanese community-dwelling frail elderly people.

CONCLUSIONS

While further research using a large and more diverse sample of participants is needed, our findings support the use of FIDS in clinical practice or clinical research targeting frail elderly Japanese people.

Reliability and sensitivity to change of the timed standing balance test in children with down syndrome

Objective:

To estimate the reliability and sensitivity to change of the timed standing balance test in children with Down syndrome (DS).

Methods:

It was a nonblinded, comparison study with a convenience sample of subjects consisting of children with DS (n = 9) aged 8–17 years. The main outcome measure was standing balance which was assessed using timed standing balance test, the time required to maintain in four conditions, eyes open static, eyes closed static, eyes open dynamic, and eyes closed dynamic.

Results:

Relative reliability was excellent for all four conditions with an Interclass Correlation Coefficient (ICC) ranging from 0.91 to 0.93. The variation between repeated measurements for each condition was minimal with standard error of measurement (SEM) of 0.21–0.59 s, suggestive of excellent absolute reliability. The sensitivity to change as measured by smallest real change (SRC) was 1.27 s for eyes open static, 1.63 s for eyes closed static, 0.58 s for eyes open dynamic, and 0.61 s for eyes closed static.

Conclusions:

Timed standing balance test is an easy to administer test and sensitive to change with strong absolute and relative reliabilities, an important first step in establishing its utility as a clinical balance measure in children with DS.

Absolute reliability of shoulder joint horizontal adductor muscle strength measurements using a handheld dynamometer

[Purpose] The aim of this study was to verify the absolute reliability of shoulder joint horizontal adductor muscle strength measurements using a handheld dynamometer (HHD). [Subjects and Methods] The subjects were 33 healthy college students. The measurements were made three times with the HHD fixed using a belt (BFHHD) or with the examiner's hand (conventional method; HFHHD). The absolute reliability of measurements was verified using Bland-Altman analysis, both in the all subjects group and a group of subjects showing measurements less than a fixed limit of 30 kgf. [Results] In the <30 kgf group, a systematic bias was not observed, and BFHHD values were greater than HFHHD values. BFHHD values in the all subjects group showed a systematic bias; the 3rd measurement value was less than the maximum value obtained during the 1st and 2nd measurements. [Conclusion] For obtaining an acceptable value during clinical measurements of horizontal adductor muscle strength, single measurements obtained using an HFHHD in the case of a <30 kgf group and the maximum value of two measurements obtained using a BFHHD are reliable.

Between-day reliability of a hand-held dynamometer and surface electromyography recordings during isometric submaximal contractions in different shoulder positions

Functional shoulder assessments require the use of objective and reliable standardized outcome measures. Therefore, the aim of this study was to examine the between-day reliability of a hand-held dynamometer when measuring muscle strength during flexion, abduction, and internal and external rotation as well as surface electromyography (EMG) when measuring muscle activity from m. trapezius superior and deltoideus anterior. Twenty-four healthy subjects participated and performed four isometric contractions measured with a hand-held dynamometer and EMG. Both relative and absolute reliability were calculated based on the mean of the last three of the four repetitions. EMG amplitude was assessed calculating both absolute and normalized root-mean-square (RMS) values. The reliability of the hand-held dynamometer was high (LOA=3.2-7.6% and ICC=0.89-0.98). The absolute reliability for EMG showed similar results for absolute RMS values (LOA=20.0-68.4%) and normalized RMS values (LOA=42.4-66.5%). However, the results concerning the relative reliability showed higher ICC for absolute RMS values (ICC=0.82-0.92) compared with normalized values (ICC=0.57-0.72).The outcome measurements of this study with healthy subjects were found reliable and, therefore, have the potential to detect changes in muscle strength and muscle activity.