Reliability of a New Digital Tool for Photographic Analysis in Quantifying Body Asymmetry in Scoliosis

Background: Advancements in non-ionizing methods for quantifying spinal deformities are crucial for assessing and monitoring scoliosis. In this study, we analyzed the observer variability of a newly developed digital tool for quantifying body asymmetry from clinical photographs. Methods: Prospective observational multicenter study. Initially, a digital tool was developed using image analysis software, calculating quantitative measures of body asymmetry. This tool was integrated into an online platform that exports data to a database. The tool calculated 10 parameters, including angles (shoulder height, axilla height, waist height, right and left waistline angles, and their difference) and surfaces of the left and right hemitrunks (shoulders, waists, pelvises, and total). Subsequently, an online training course on the tool was conducted for twelve observers not involved in its development (six research coordinators and six spine surgeons). Finally, 15 standardized back photographs of adolescent idiopathic scoliosis patients were selected from a multicenter image bank, representing various clinical scenarios (different age, gender, curve type, BMI, and pre- and postoperative images). The 12 observers measured the photographs at two different times with a three-week interval. For the second round, the images were randomly mixed. Inter- and intra-observer variabilities of the measurements were analyzed using intraclass correlation coefficients (ICCs), and reliability was measured by the standard error of measurement (SEM). Group comparisons were made using Student's t-test. Results: The mean inter-observer ICC for the ten measurements was 0.981, the mean intra-observer ICC was 0.937, and SEM was 0.3-1.3°. The parameter with the strongest inter- and intra-observer validity was the difference in waistline angles 0.994 and 0.974, respectively, while the highest variability was found with the waist height angle 0.963 and 0.845, respectively. No test-retest differences (p > 0.05) were observed between researchers (0.948 ± 0.04) and surgeons (0.925 ± 0.05). Conclusion: We developed a new digital tool integrated into an online platform demonstrating excellent reliability and inter- and intra-observer variabilities for quantifying body asymmetry in scoliosis patients from a simple clinical photograph. The method could be used for assessing and monitoring scoliosis and body asymmetry without radiation.

Reliability and validity of the dutch eating behavior questionnaire in an online format for university students from low-income regions in a pandemic context: A 24 hour MESYN study

Objective

To test the reliability and validity of the Dutch Eating Behavior Questionnaire (DEBQ) in an online format in university students from low-income regions.

Methods

We applied the questionnaire to a sample of 195 and 117 university students from a low-income region (Gini index of 0.56) to study validity and reliability, respectively. The DEBQ consists of 33 items on eating behavior in three dimensions/factors: emotional eating, restrained eating and external eating. The questionnaire was administered twice at 2-week intervals. We tested the reliability via temporal stability and internal consistency and construct validity via exploratory and confirmatory factor analysis.

Results

For reliability, we identified an acceptable Spearman correlation coefficient (rho > 0.30 and p < 0.05) and Cronbach's alpha (α ≥ 0.70) for all DEBQ items. In the exploratory analysis, we identified 6 factors representing a mix of original and additional factors, with an explained variance of 69.1%. In the confirmatory analysis with structural equation modeling, we observed better global model adjustment for the 6-factor model with the Tucker-Lewis index and comparative fit index closer to one, as well as root mean square error of approximation closer to zero than the original (3-factor) model. Using generalized structural equation modeling, we also observed a better fit in latent class modeling for the 6-factor model (AIC: 16990.67; BIC. 17874.38) than for the 3-factor model (AIC: 17904.09; BIC: 18342.67).

Conclusion

The online format of the DEBQ has acceptable reliability and validity for measuring eating behavior in university students from low-income regions.

Measurement of Social Strain in People with Dementia: A Preliminary Study of the Reliability and Validity of the Negative Relationship Quality Questionnaire in Indonesia

People with dementia (PWD) may exhibit symptoms that negatively affect their relationships with their families or friends which could cause social strain. The Negative Relationship Quality (NRQ) questionnaire can be used to measure social strain in PWD. There has never been an Indonesian adaptation of the NRQ. This preliminary study aimed to measure the validity and reliability of the NRQ among PWD in Indonesia (NRQ-INA). This study used a cross-sectional design. Forward−backward translation methods were conducted first. Pearson’s correlation and factor analysis were employed for the validity test. Cronbach’s alpha and test−retest were used to determine reliability. The NRQ-INA has four parallel items related to social strain that are divided into three subscales and asked to spouse/partner, family members, and friends, leading to a total of 12 questions. The results of validity testing from 60 respondents showed that all items in the NRQ-INA were strongly valid with correlation coefficients (r) of >0.8 (p < 0.01). Factor analysis showed a convergence with the variance explained of more than 50% for all items in each subscale, which also indicated that NRQ-INA had acceptable construct validity to measure social strain. Cronbach’s alpha values (α) were 0.926, 0.942, and 0.938 for the subscales of spouse, friends, and family members, respectively. The correlations of test−retest reliability for all items were >0.7 (p < 0.01), demonstrating a reliable NRQ-INA measurement. In conclusion, NRQ-INA had a good validity and reliability to measure social strain in PWD. Further study of the concurrent validity among PWD is still needed.

Comparison of the Neer classification to the 2018 update of the Orthopedic Trauma Association/AO fracture classification for classifying proximal humerus fractures

Background

The classification of fractures is necessary to ensure a reliable means of communication for clinical interaction, education and research. The Neer classification is the most commonly used classification for proximal humerus fractures. In 2018 the Orthopedic Trauma Association (OTA) and the AO Foundation provided an update to the OTA/AO Fracture Classification Scheme addressing many of the concerns about the previous versions of the classification. The objective of the present study was to evaluate the rater reliability of the 2 classifications and if the classifications subjectively better characterized the fracture patterns.

Methods

X-rays and CT scans of 24 proximal humerus fractures were given to 7 independent raters for classification according to the Neer and 2018 OTA/AO classification. Both full-forms and short-forms of the classifications were tested. The Fleiss Kappa statistic was used to assess inter-rater agreement and intra-rater consistency for the 2 classifications. For each case the raters subjectively commented on how well each classification was able to characterize the fracture pattern.

Results

All raters graded the 2018 OTA/AO classification as good as or better than the Neer classification for an adequate description of the fracture patterns. The short-form 2018 OTA/AO classification had the most 4 rater and 5 rater agreement cases and the second most 6 rater agreement cases. The short-form Neer classification had the second most 4 rater and 5 rater agreement cases and the most 6 rater agreement cases. The full 2018 OTA/AO had the least 4, 5, or 6 rater agreement cases of all the classification systems. Inter-rater agreement was fair for the full and short form of both the Neer and 2018 OTA/AO classification. The full and short Neer classifications together with the short 2018 OTA/AO classification had moderate intra-rater consistency, while the full 2018 OTA/AO classification only had slight intra-rater consistency.

Conclusions

The 2018 OTA/AO classification is equivalent in its short-form to the Neer classification in inter-rater reliability and intra-rater consistency; and is superior in its full form for characterizing specific fracture types. The low inter-rater reliability of the full 2018 OTA/AO classification is a concern that may need to be addressed in the future.

Translation, Cultural Adaptation, and Reliability and Validity Testing of a Chinese Version of the Freezing of Gait Questionnaire (FOGQ-CH)

Freezing of gait is a disabling symptom with a complex episodic nature that is frequently experienced by people with Parkinson's disease (PD). Although China has the largest population with PD in the world, no Chinese version of the freezing of gait questionnaire (FOGQ), the instrument that has been most widely used to assess FOG, has yet been developed. This study aimed to translate and adapt the original version of FOGQ to create a Chinese version, the FOGQ-CH, then assess its reliability, calculate the Minimal Detectable Change (MDC) and investigate its validity. The forward-backwards translation model was adopted, and cultural adaptation included expert review and pretesting. For the reliability study, 31 Chinese native speaking patients with PD were assessed two times in a 7–10 days interval. Internal consistency and test-retest reliability of the FOGQ-CH were measured by Cronbach's alpha (Cα) and the Intraclass Correlation Coefficient (ICC). For the validity study, 34 native speakers of Chinese with PD were included. To explore the convergent validity, relationships between the FOGQ-CH and the Unified Parkinson's Disease Rating Scale Part II (UPDRS II) and Part III (UPDRS III), Timed Up and Go Test (TUGT), Timed Up and Go Test in cognitive task (TUGT-Cog), walking speed (10 MWT speed), and step length (10 MWT step length) in a 10-m Walk Test were tested. To explore predictive validity, the number of falls followed up for 6 months were assessed. The area under the ROC curve (AUC) was employed to test the capacity of FOGQ-CH to discriminate those with falls. From the reliability study, Cα = 0.823, ICC = 0.786. The MDC_0.90 = 4.538. From the validity study, the FOGQ-CH showed moderate correlations with UPDRS II (rho = 0.560, p = 0.001), UPDRS III (rho = 0.451, p = 0.007), TUGT (rho = 0.556, p = 0.007), TUGT-Cog (rho = 0.557, p = 0.001), 10MWT-speed (rho = −0.478, p = 0.004), 10MWT-step length (rho = −0.419, p = 0.014), and the number of falls followed up for 6 months (rho = 0.356, p = 0.045). The AUC = 0.777 (p = 0.036) for predicting whether the participants will have multiple falls (two or more) in the following 6 months. The FOGQ-CH showed good reliability and validity for assessing Chinese native speaking patients with PD. In addition, the FOGQ-CH showed good efficacy for predicting multiple falls in the following 6 months.

The "self-treatment of wounds for venous leg ulcers checklist" (STOW-V Checklist V1.0): Part 2-The reliability of the Checklist

The “Self‐Treatment of Wounds for Venous Leg Ulcers Checklist” (STOW‐V Checklist V1.0) is an evidence‐based, standardised tool designed to assist nurses to appraise the conduct of wound treatment when undertaken by patients who have venous leg ulcers. A prospective reliability study was conducted to determine the reliability of the STOW‐V Checklist V1.0. Video‐recordings of patients who self‐treated their leg ulcer were obtained (n = 5) and nurses (n = 15) viewed each video‐recording three times and concurrently completed the Checklist. Internal consistency, inter‐rater reliability and intra‐rater reliability were evaluated. Cronbach's alpha for items in the Checklist was 0.792, 0.791 and 0.783 for Occasions 1, 2 and 3, respectively, indicating good reliability. Inter‐rater reliability was 0.938, 0.958 and 0.927 for Occasions 1, 2 and 3, respectively; these results were statistically significant and indicative of excellent reliability. Intra‐rater reliability was 0.403 to 0.999; these results were statistically significant and meeting or exceed adequacy in the case of all except two raters. The study provides preliminary evidence that the Checklist is measuring the concepts that it intends to measure and that there is a high level of agreement among raters. It is recommended that the STOW‐V Checklist V1.0 is utilised with patients in a shared‐care model, with nurses and other healthcare professionals providing supervision and oversight of self‐treatment practices whenever this is feasible and acceptable to the patient.

A Tutorial of Bland Altman Analysis in A Bayesian Framework

There are two schools of thought in statistical analysis, frequentist, and Bayesian. Though the two approaches produce similar estimations and predictions in large-sample studies, their interpretations are different. Bland Altman analysis is a statistical method that is widely used for comparing two methods of measurement. It was originally proposed under a frequentist framework, and it has not been used under a Bayesian framework despite the growing popularity of Bayesian analysis. It seems that the mathematical and computational complexity narrows access to Bayesian Bland Altman analysis. In this article, we provide a tutorial of Bayesian Bland Altman analysis. One approach we suggest is to address the objective of Bland Altman analysis via the posterior predictive distribution. We can estimate the probability of an acceptable degree of disagreement (fixed a priori) for the difference between two future measurements. To ease mathematical and computational complexity, an interface applet is provided with a guideline.

Reliability of an Integrated Inertial Sensor for the Continuous Measurement of Active Cervical Range of Motion in a Group of Younger and Elderly Individuals

The aim of this study was to evaluate the test-retest reliability of an integrated inertial sensor (IIS) for cervical range of motion assessment. An integrated inertial sensor was placed on the forehead center of thirty older adults (OA) and thirty younger adults (YA). Participants had to perform three continuous rotations, lateral bandings and flexion-extensions with their head. Test-retest reliability was assessed after 7 days. YA showed moderate to good agreement for rotation (0.54-0.82), lateral bending (0.74-0.8), and flexion-extension (0.74-0.81) movements and poor agreement for zero point (ZP). OA showed moderate to good agreement for rotation (0.65-0.86), good to excellent agreement in lateral bending (0.79-0.92), and poor to moderate agreement for flexion-extension (0.37-0.72). Zero point showed poor to moderate agreement. In conclusion, we can affirm that this IIS is a reliable device for cervical range of motion assessment in young and older adults; on the contrary, the ZP seems to be unreliable and the addition of an external reference point could help the subject to solve this shortcoming and reduce possible biases.

Ultrasound Doppler Flow in Patients With Chronic Midportion Achilles Tendinopathy: Is Surface Area Quantification a Reliable Method?

OBJECTIVES

Ultrasound assessments of patients with chronic midportion Achilles tendinopathy include determining the degree of neovascularization using Doppler flow. A frequently used measure to quantify neovascularization is the modified Öhberg score. It is unknown whether the semiquantitative modified Öhberg score (0-4+) has higher reliability than a quantified measure of Doppler flow (0-100%). The purpose of this cross-sectional study was to evaluate the interobserver reliability of the modified Öhberg score and a surface area quantification (SAQ) method for Doppler flow in patients with chronic midportion Achilles tendinopathy.

METHODS

Two observers examined the degree of Doppler flow independently using SAQ and the modified Öhberg score during a single consultation. The intraclass correlation coefficient, standard error of measurement, and minimal detectable difference were determined to evaluate the reliability and measurement properties of the SAQ method and the modified Öhberg score.

RESULTS

In total, 28 consecutive patients with chronic midportion Achilles tendinopathy participated. The intraclass correlation coefficient for interobserver reliability of the SAQ method was 0.81 (95% confidence interval, 0.58-0.91), compared to 0.64 (95% confidence interval, 0.45-0.81) for the modified Öhberg score. The standard error of measurement and minimal detectable difference values for the SAQ method were 2.9% and 8.0%, respectively, and for the modified Öhberg score, they were 0.55 and 1.53 points.

CONCLUSIONS

The SAQ method shows good reliability to evaluate the degree of Doppler flow in patients with chronic midportion Achilles tendinopathy, and it overcomes the ceiling effect of the modified Öhberg score. Future research should focus on the relationship between the SAQ method and clinical outcomes and use this method to monitor treatment responses.

A Comparison of the Reliability of the Patellar Tendon-Trochlear Groove (PTTG) Distance and the Tibial Tuberosity-Trochlear Groove (TTTG) Distance Measured on MRI

Introduction:

An increased tibial tuberosity-trochlear groove (TTTG) distance is used for deciding a treatment plan in patello-femoral instability (PFI). The centre of the patellar tendon and the chondral trochlear groove can be directly visualised on MRI, and measured, giving the patellar tendon-trochlear groove (PTTG) distance. A study was designed to compare the inter-rater and the test-retest reliabilities of PTTG and TTTG measurements in MRI of patients without PFI and in a group with PFI.

Materials and Methods:

This cross-sectional reliability study was done on archival MRI films of 50 patients without patellar instability and 20 patients with patellar instability. TTTG and PTTG distances were independently measured by two orthopaedic surgeons and two radiologists. A hybrid PTTG measurement with bony landmarks on the femoral side and the patellar tendon landmark on the tibial side, was used to estimate the influence of the differences in the femoral and tibial landmarks on the difference in reliabilities. The intra-class correlation coefficient (ICC) was calculated for all four raters, as well as separately for each rater.

Results:

The PTTG distance had a higher inter-rater reliability (ICC=0.86, 95% CI=0.79-0.92) compared to the TTTG distance (ICC=0.70, 95% CI=0.59-0.80) in patients without PFI. Similar trends were seen in patients with PFI (0.83 vs 0.66). The inter-rater reliability for the hybrid PTTG distance was found to lie in between the TTTG and PTTG.

Conclusions:

The MRI-based PTTG distance had better inter-rater reliability compared with the MRI-based TTTG distance.

Reliability of an Online Geriatric Assessment Procedure Using the interRAI Acute Care Assessment System

OBJECTIVES

To determine whether geriatric triage decisions made using a comprehensive geriatric assessment (CGA) performed online are less reliable than face-to-face (FTF) decisions.

DESIGN

Multisite noninferiority prospective cohort study. Two specialist geriatricians assessed individuals sequentially referred for an acute care geriatric consultation. Participants were allocated to one FTF assessment and an additional assessment (FTF or online (OL)), creating two groups-two FTF (FTF-FTF, n = 81) or online and FTF (OL-FTF, n = 85).

SETTING

Three acute care public hospitals in two Australian states.

PARTICIPANTS

Admitted individuals referred for CGA.

INTERVENTION

Nurse-administered CGA, based on the interRAI Acute Care assessment system accessed online and other online clinical data such as pathology results and imaging enabling geriatricians to review participants' information and provide input into their care from a distance.

MEASUREMENTS

The primary decision subjected to this analysis was referral for permanent residential care. Geriatricians also recorded recommendations for referrals and variations for medication management and judgment regarding prognosis at discharge and after 3 months.

RESULTS

Overall percentage agreement was 88% (n = 71) for the FTF-FTF group and 91% (n = 77) for the OL-FTF group. The difference in agreement between the FTF-FTF and OL-FTF groups was -3%, indicating that there was no difference between the methods of assessment. Judgements made regarding diagnoses of geriatric syndromes, medication management, and prognosis (with regard to hospital outcome and location at 3 months) were found to be equally reliable in each mode of consultation.

CONCLUSION

Geriatric assessment performed online using a nurse-administered structured CGA system was no less reliable than conventional assessment in making clinical triage decisions.

Inter- and intra-rater agreement in the assessment of the vascularity of spinal metastases using digital subtraction angiography tumor blush

Background Preoperative embolization is based on the preoperative digital subtraction angiography (DSA) tumor blush, and as such is considered the "gold standard" for determining tumor vascularity. However, to our knowledge reliability studies evaluating vascularity ratings of DSA tumor blush in spinal metastases have not been published previously. Purpose To evaluate inter- and intra-rater agreement in the assessment of the vascularity of spinal metastases using DSA tumor blush. Material and Methods This reliability study included 46 patients with symptomatic metastatic spinal cord compression requiring surgery. DSA data stored in the hospital picture archiving and communication system (PACS) from the participants of a randomized controlled trial were used. Inter- and intra-rater agreement on vascularity assessment using DSA tumor blush according to a three-step ordinal scale was evaluated: no hypervascularity; moderate hypervascularity; and pronounced hypervascularity. The statistical analysis was based on the linear weighted kappa's for multiple raters that extend Cohen's κ. Three raters and κ = 0.2 in the null hypothesis implied that the power of the study was 0.96. Results Inter- and intra-rater agreements were moderate in rating the vascularity of spinal metastases and the agreements were significantly higher than the κ = 0.20 in the null hypothesis ( P = 0.0002 and P = 0.0001). The κ value for inter-rater agreement was 0.57 (95% confidence interval [CI], 0.41-0.72) and for intra-rater agreement 0.55 (95% CI, 0.38-0.71). Conclusion There is moderate inter-rater and intra-rater agreement in classifying the vascularity of spinal metastases on a three-step ordinal scale for DSA tumor blush.

[Evaluation of the usefulness of the EOS 2D/3D system for the measurement of lower limbs anatomical and biomechanical parameters in children]

INTRODUCTION

Lower limbs anatomical and biomechanical parameters are essential in several paediatric orthopaedic disease, which makes their exact measurement necessary.

AIM

The aim of the author was to evaluate the reliability of the EOS 2D/3D System, a 3D reconstruction capable imaging device in children.

METHOD

3D reconstructions were performed in 523 cases aged between 2 and 16 years in whom no abnormality influencing lower limbs biomechanics was observed. For statistical analysis intraclass correlation, paired-samples t-test, Spearman-correlation and Welch-test were used.

RESULTS

Excellent results were found for all parameters in reliability test used by the operator. The step-forward position used during the examination influenced the sagittal tibiofemoral angle only. All examined parameters showed significant correlation with age and gender. Height correlated with neck-shaft angle, hip-knee shift, femoral and tibial torsion only.

CONCLUSIONS

The EOS technology proved to be an appropriate method to measure lower limbs anatomical parameters in children. Changes in these parameters during development correlated with age and gender.

[An alternative word-list for the Free and cued selective reminding test (FCSRT): list presentation and reliability study]

The Free and cued selective reminding test (FCSRT) is one of the most effective neuropsychological test used to assess verbal memory in elderly people with memory problems. There are currently two lists of words: the initial French version (list A) and an alternative one (list B). However, diagnosing early Alzheimer's disease in memory clinics often requires more than two evaluations, particularly in patients with very mild cognitive symptoms and patients with young onset disease. Usually, memory tests can be affected by practice effect, so several expositions of the same list of words could limit its clinical utility. The aim of our study was to create and validate a second alternative version (list C). The study sample was composed of 222 healthy volunteers aged from 17 to 84 years with a mean age of 44.6 years of whom 57% were females and 71% had a higher education. Within a two-month interval, each subject performed the test with one word-list and then the second one. The order of lists presentation was counterbalanced. Our findings indicate that the new alternative list (list C) is equivalent to the initial list of word (list A) for all the recall and recognition subscores, except the number of intrusive errors. This new list of words should be helpful to minimise potential practice effect and better assess memory decline in situations where the FCSRT has to be repeated across follow-up.

Reliability of magnetic resonance imaging readings for lumbar disc herniation in the Spine Patient Outcomes Research Trial (SPORT)

STUDY DESIGN

Assessment of the reliability of standardized magnetic resonance imaging (MRI) interpretations and measurements.

OBJECTIVE

To determine the intra- and inter-reader reliability of MRI parameters relevant to patients with intervertebral disc herniation (IDH), including disc morphology classification, degree of thecal sac compromise, grading of nerve root impingement, and measurements of cross-sectional area of the spinal canal, thecal sac, and disc fragment.

SUMMARY OF BACKGROUND DATA

MRI is increasingly used to assess patients with sciatica and IDH, but the relationship between specific imaging characteristics and patient outcomes remains uncertain. Although other studies have evaluated the reliability of certain MRI characteristics, comprehensive evaluation of the reliability of readings of herniated disc features on MRI is lacking.

METHODS

Sixty randomly selected MR images from patients with IDH enrolled in the Spine Patient Outcomes Research Trial were each rated according to defined criteria by 4 independent readers (3 radiologists and 1 orthopedic surgeon). Quantitative measurements were performed separately by 2 other radiologists. A sample of 20 MRIs was re-evaluated by each reader at least 1 month later. Agreement for rating data were assessed with kappa statistics using linear weights. Reliability of the quantitative measurements was assessed using intraclass correlation coefficients (ICCs) and summaries of measurement error.

RESULTS

Inter-reader reliability was substantial for disc morphology [overall kappa 0.81 (95% confidence interval (CI): 0.78, 0.85)], moderate for thecal sac compression [overall kappa 0.54 (95% CI: 0.37, 0.68)], and moderate for grading nerve root impingement [overall kappa 0.47 (95% CI: 0.36, 0.56)]. Quantitative measures showed high ICCs of 0.87 to 0.96 for spinal canal and thecal sac cross-sectional areas. Measures of disc fragment area had moderate ICCs of 0.65 to 0.83. Mean absolute differences between measurements ranged from approximately 15% to 20%.

CONCLUSION

Classification of disc morphology showed substantial intra- and inter-reader agreement, whereas thecal sac and nerve root compression showed more moderate reader reliability. Quantitative measures of canal and thecal sac area showed good reliability, whereas measurement of disc fragment area showed more modest reliability.