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Korsholm-Rosfort, Tina, Simone Larsen, Thomas Aagaard, Gunn Ammitzbøll, and Susanne O. Dalton. "Interrater Reliability of Dynamic Muscle Testing After Breast Cancer Surgery in Women at High Risk of Lymphedema: To Improve Quality in Clinical Practice." Integrative Cancer Therapies 19 (January 2020): 153473542090380. http://dx.doi.org/10.1177/1534735420903801.
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Background: The purpose of this study is to determine the interrater reliability of dynamic muscle tests in the early rehabilitation phase in women after breast cancer surgery with axillary lymph node dissection (ALND) based on the “preventive intervention against lymphedema after breast cancer” (LYCA) randomised controlled trial. Methods: Fifteen women treated with breast cancer surgery including ALND were recruited from participants in the LYCA trial. In this interrater reliability study, women were tested in 4 dynamic muscle tests by 2 physiotherapists at a Capital Hospital in Denmark. Intraclass correlation coefficients (ICCs) with 95% confidence intervals (CIs) was used to assess the relative reliability between raters. A Bland-Altman plot and limits of agreement were calculated to describe the absolute reliability. Results: All 6 subtests displayed high interrater reliability. ICC values were: leg press 0.96 (95% CI = 0.87-0.99), elbow flexion (contralateral) 0.94 (0.83-0.98), elbow flexion (affected arm) 0.93 (0.80-0.98), elbow extension 0.80 (0.41-0.93), shoulder abduction (contralateral) 0.89 (0.68-0.96), and shoulder abduction (affected arm) 0.91 (0.74-0.97). Cumulated interrater reliability for the test battery was very high (ICC = 0.99, 95% CI = 0.990-1.0). The absolute reliability of this study was considered high, and the absence of large shifts between mean and the line of 0 difference suggest no systematic bias that could influence clinical interpretation. Conclusions: The dynamic muscle tests evaluated in this study had high interrater reliability and can be used reliably in women in the postoperative phase after breast cancer surgery with ALND.
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Albo, Michael E., Charles W. Nager, Philippe E. Zimmern, Mary Pat FitzGerald, Anne Stoddard, Heather J. Litman, and Susan McDermott. "INTERRATER RELIABILITY OF PRESSURE FLOW STUDY INTERPRETATION IN THE SISTER TRIAL." Journal of Urology 179, no. 4S (April 2008): 522–23. http://dx.doi.org/10.1016/s0022-5347(08)61539-6.
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Rockwood, Kenneth, David Strang, Chris MacKnight, Robert Downer, and John C. Morris. "Interrater Reliability of the Clinical Dementia Rating in a Multicenter Trial." Journal of the American Geriatrics Society 48, no. 5 (May 2000): 558–59. http://dx.doi.org/10.1111/j.1532-5415.2000.tb05004.x.
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Cumming, Toby B., Danielle Lowe, Thomas Linden, and Julie Bernhardt. "The AVERT MoCA Data: Scoring Reliability in a Large Multicenter Trial." Assessment 27, no. 5 (June 7, 2018): 976–81. http://dx.doi.org/10.1177/1073191118771516.
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The Montreal Cognitive Assessment (MoCA) is a widely used cognitive screening tool in stroke. As scoring the visuospatial/executive MoCA items involves subjective judgement, reliability is important. Analyzing data on these items from A Very Early Rehabilitation Trial (AVERT), we compared the original scoring of assessors ( n = 102) to blind scoring by a single, independent rater. In a sample of scoresheets from 1,119 participants, we found variable interrater reliability. The match between original assessors and the independent rater was the following: trail-making 97% (κ = 0.94), cube copy 90% (κ = 0.80), clock contour 92% (κ = 0.49), clock numbers 89% (κ = 0.67), and clock hands 72% (κ = 0.46). For all items except clock contour, the independent rater was “stricter” than the original assessors. Discrepancies were typically errors in original scoring, rather than borderline differences in subjective judgement. In trials that include the MoCA, researchers should emphasize scoring rules to assessors and implement independent data checking, especially for clock hands, to maximize accuracy.
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Skougaard, Marie, Henning Bliddal, Robin Christensen, Karen Ellegaard, Sabrina M. Nielsen, Jakub Zavada, Sabina Oreska, et al. "Patients with Rheumatoid Arthritis Acquire Sustainable Skills for Home Monitoring: A Prospective Dual-country Cohort Study (ELECTOR Clinical Trial I)." Journal of Rheumatology 47, no. 5 (August 15, 2019): 658–67. http://dx.doi.org/10.3899/jrheum.181362.
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Objective.In an eHealth setting, to investigate intra- and interrater reliability and agreement of joint assessments and Disease Activity Score using C-reactive protein (DAS28-CRP) in patients with rheumatoid arthritis (RA) and test the effect of repeated joint assessment training.Methods.Patients with DAS28-CRP ≤ 5.1 were included in a prospective cohort study (clinicaltrials.gov: NCT02317939). Intrarater reliability and agreement of patient-performed joint counts were assessed through completion of 5 joint assessments over a 2-month period. All patients received training on joint assessment at baseline; only half of the patients received repeated training. A subset of patients was included in an appraisal of interrater reliability and agreement comparing joint assessments completed by patients, healthcare professionals (HCP), and ultrasonography. Cohen’s κ coefficients and intraclass correlation coefficients (ICC) were used for quantifying of reliability of joint assessments and DAS28-CRP. Agreement was assessed using Bland-Altman plots.Results.Intrarater reliability was excellent with ICC of 0.87 (95% CI 0.83–0.90) and minimal detectable change of 1.13. ICC for interrater reliability ranged between 0.69 and 0.90 (good to excellent). Patients tended to rate DAS28-CRP slightly higher than HCP. In patients receiving repeated training, a mean difference in DAS28-CRP of −0.08 was observed (limits of agreements of −1.06 and 0.90). After 2 months, reliability between patients and HCP was similar between groups receiving single or repeated training.Conclusion.Patient-performed assessments of joints and DAS28-CRP in an eHealth home-monitoring solution were reliable and comparable with HCP. Patients can acquire the necessary skills to conduct a correct joint assessment after initial and thorough training. [clinicaltrials.gov (NCT02317939)]
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Everton, Lisa F., Jacqueline K. Benfield, Emilia Michou, Shaheen Hamdy, and Philip M. Bath. "Reliability of the Penetration–Aspiration Scale and Temporal and Clearance Measures in Poststroke Dysphagia: Videofluoroscopic Analysis From the Swallowing Treatment using Electrical Pharyngeal Stimulation Trial." Journal of Speech, Language, and Hearing Research 65, no. 3 (March 8, 2022): 858–68. http://dx.doi.org/10.1044/2021_jslhr-21-00083.
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Purpose: Information on reliability of outcome measures used to assess the effectiveness of interventions in dysphagia rehabilitation is lacking, particularly when used by different research groups. Here, we report on reliability of the penetration–aspiration scale (PAS) and temporal and clearance measures, determined using videofluoroscopy. Method: Secondary analysis used videofluoroscopies from the Swallowing Treatment using Electrical Pharyngeal Stimulation trial in subacute stroke. PAS scores (719 scores from 18 participants) were evaluated and compared to the original PAS scores from the trial. Five conditions were assessed, including reliability for every swallow and overall mean of the worst PAS score. Operational rules for assessing temporal and clearance measures were also developed using the same data, and reliability of these rules was assessed. Reliability of component-level and derivative-level scores was assessed using the intraclass correlation coefficient (ICC) and weighted kappa. Results: Image quality was variable. Interrater reliability for the overall mean of the worst PAS score was excellent (ICC = .914, 95% confidence interval [CI] [.853, .951]) but moderate for every swallow in the bolus (ICC = .743, 95% CI [.708, .775]). Intrarater reliability for PAS was excellent (all conditions). Excellent reliability (both inter- and intrarater > .90) was seen for temporal measures of stage transition duration (ICC = .998, 95% CI [.993, .999] and ICC = .995, 95% CI [.987, .998], respectively) as well as initiation of laryngeal closure and pharyngeal transit time and all individual swallow events. Strong scores were obtained for some clearance measures; others were moderate or weak. Conclusions: Interrater reliability for PAS is acceptable but depends on how the PAS scores are handled in the analysis. Interrater reliability for most temporal measures was high, although some measures required additional training. No clearance measures had excellent reliability. Supplemental Material: https://doi.org/10.23641/asha.19090088
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Hussain, Shaun A., Grace Kwong, John J. Millichap, John R. Mytinger, Nicole Ryan, Joyce H. Matsumoto, Joyce Y. Wu, Jason T. Lerner, and Raman Sankar. "Hypsarrhythmia assessment exhibits poor interrater reliability: A threat to clinical trial validity." Epilepsia 56, no. 1 (November 10, 2014): 77–81. http://dx.doi.org/10.1111/epi.12861.
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Mayes, Susan Dickerson, and Edward O. Bixler. "Reliability of Global Impressions for Assessing Methylphenidate Effects in Children with Attention-Deficit Hyperactivity Disorder." Perceptual and Motor Skills 77, no. 3_suppl (December 1993): 1215–18. http://dx.doi.org/10.2466/pms.1993.77.3f.1215.
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Agreement between raters using global impressions to assess methylphenidate response was analyzed for children with Attention-Deficit Hyperactivity Disorder (ADHD) undergoing double-blind, placebo-controlled, crossover methylphenidate trials. Caregivers were more likely to disagree than agree when asked to rate the children as “better, same, or worse” during each day of the trial. Over-all agreement was 42.9%, only 9.6% above what would be expected based on chance alone. Further, none of the interrater reliability coefficients (Cohen's kappa) for the individual children were statistically significant.
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Haddad, Tufia, Jane M. Helgeson, Katharine E. Pomerleau, Anita M. Preininger, M. Christopher Roebuck, Irene Dankwa-Mullan, Gretchen Purcell Jackson, and Matthew P. Goetz. "Accuracy of an Artificial Intelligence System for Cancer Clinical Trial Eligibility Screening: Retrospective Pilot Study." JMIR Medical Informatics 9, no. 3 (March 26, 2021): e27767. http://dx.doi.org/10.2196/27767.
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Background Screening patients for eligibility for clinical trials is labor intensive. It requires abstraction of data elements from multiple components of the longitudinal health record and matching them to inclusion and exclusion criteria for each trial. Artificial intelligence (AI) systems have been developed to improve the efficiency and accuracy of this process. Objective This study aims to evaluate the ability of an AI clinical decision support system (CDSS) to identify eligible patients for a set of clinical trials. Methods This study included the deidentified data from a cohort of patients with breast cancer seen at the medical oncology clinic of an academic medical center between May and July 2017 and assessed patient eligibility for 4 breast cancer clinical trials. CDSS eligibility screening performance was validated against manual screening. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for eligibility determinations were calculated. Disagreements between manual screeners and the CDSS were examined to identify sources of discrepancies. Interrater reliability between manual reviewers was analyzed using Cohen (pairwise) and Fleiss (three-way) κ, and the significance of differences was determined by Wilcoxon signed-rank test. Results In total, 318 patients with breast cancer were included. Interrater reliability for manual screening ranged from 0.60-0.77, indicating substantial agreement. The overall accuracy of breast cancer trial eligibility determinations by the CDSS was 87.6%. CDSS sensitivity was 81.1% and specificity was 89%. Conclusions The AI CDSS in this study demonstrated accuracy, sensitivity, and specificity of greater than 80% in determining the eligibility of patients for breast cancer clinical trials. CDSSs can accurately exclude ineligible patients for clinical trials and offer the potential to increase screening efficiency and accuracy. Additional research is needed to explore whether increased efficiency in screening and trial matching translates to improvements in trial enrollment, accruals, feasibility assessments, and cost.
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Ruud, Torleif, Karin Drivenes, Robert E. Drake, Vegard Øksendal Haaland, Matthew Landers, Bjørn Stensrud, Kristin S. Heiervang, Lars Tanum, and Gary R. Bond. "The Antipsychotic Medication Management Fidelity Scale: Psychometric properties." Administration and Policy in Mental Health and Mental Health Services Research 47, no. 6 (February 6, 2020): 911–19. http://dx.doi.org/10.1007/s10488-020-01018-1.
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Abstract The paper describes the Antipsychotic Medication Management Fidelity Scale and its psychometric properties, including interrater reliability, frequency distribution, sensitivity to change and feasibility. Fidelity assessors conducted fidelity reviews four times over 18 months at eight sites receiving implementation support for evidence-based antipsychotic medication management. Data analyses shows good to fair interrater reliability, adequate sensitivity to change over time and good feasibility. At 18 months, item ratings varied from poor to full fidelity on most items. Use of the scale can assess fidelity to evidence-based guidelines for antipsychotic medication management and guide efforts to improve practice. Further research should improve and better calibrate some items, and improve the procedures for access to information. Trial registration: ClinicalTrials.gov Identifier: NCT03271242.
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Ruud, Torleif, Tordis Sørensen Høifødt, Delia Cimpean Hendrick, Robert E. Drake, Anne Høye, Matthew Landers, Kristin S. Heiervang, and Gary R. Bond. "The Physical Health Care Fidelity Scale: Psychometric Properties." Administration and Policy in Mental Health and Mental Health Services Research 47, no. 6 (February 8, 2020): 901–10. http://dx.doi.org/10.1007/s10488-020-01019-0.
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Abstract Mental health programs need an instrument to monitor adherence to evidence-based physical health care for people with serious mental illness. The paper describes the Physical Health Care Fidelity Scale and study interrater reliability, frequency distribution, sensitivity to change and feasibility. Four fidelity assessments were conducted over 18 months at 13 sites randomized to implementation support for evidence-based physical health care. We found good to excellent interrater reliability, adequate sensitivity for change, good feasibility and wide variability in fidelity across sites after 18 months of implementation. Programs were more successful in establishing Policies stating physical health care standards than in implementing these Policies. The Physical Health Care Fidelity Scale measures and guides implementation of evidence-based physical health care reliably. Trial registration: ClinicalTrials.gov Identifier: NCT03271242
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Morris, Susan, Meg E. Morris, and Robert Iansek. "Reliability of Measurements Obtained With the Timed “Up & Go” Test in People With Parkinson Disease." Physical Therapy 81, no. 2 (February 1, 2001): 810–18. http://dx.doi.org/10.1093/ptj/81.2.810.
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Abstract Background and Purpose. The Timed “Up & Go” Test (TUG) is used to measure the ability of patients to perform sequential locomotor tasks that incorporate walking and turning. This study investigated the retest reliability, interrater reliability, and sensitivity of TUG scores in detecting changes in mobility in subjects with idiopathic Parkinson disease (PD). Subjects. The performance of 12 people with PD was compared with that of 12 age-matched comparison subjects without PD. Methods. The subjects with PD completed 5 trials of the TUG after withdrawal of levodopa for 12 hours (“off” phase of the medication cycle) as well as an additional 5 trials 1 hour after levodopa was administered (“on” phase of the medication cycle). They were scored on the Modified Webster Scale at both sessions. The comparison subjects also performed 5 TUG trials. All trials were videotaped and timed by 2 experienced raters. The videotape was later rated by 3 experienced clinicians and 3 inexperienced clinicians. Results. For the subjects with PD, within-session performance was highly consistent, with correlations (r) ranging from .80 to .98 for the “off” phase and from .73 to .99 for the “on” phase. The performance of the comparison subjects across the 5 trials was also highly consistent (r=.90–.97). Comparisons showed differences between trials 1 and 2 on the TUG for both groups. Removal of data for trial 1 (the practice trial) further enhanced retest reliability. There was close agreement in TUG scores among raters despite different levels of experience (intraclass correlation coefficient [3,1]=.87–.99). Mean TUG scores were different between the “on” and “off” phases of the levodopa cycle and between subjects with PD and comparison subjects during the “on” phase. Conclusion and Discussion. Retest reliability and interrater reliability of the TUG measurements were high, and the measurements reflected changes in performance according to levodopa use. The TUG can also be used to detect differences in performance between people with PD and elderly people without PD.
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Viljoen, Jodi L., Ronald Roesch, and Patricia A. Zapf. "Interrater Reliability of the Fitness Interview Test across 4 Professional Groups." Canadian Journal of Psychiatry 47, no. 10 (December 2002): 945–52. http://dx.doi.org/10.1177/070674370204701006.
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Objective: This study investigated the interrater reliability of the Fitness Interview Test (FIT), revised edition, a semistructured interview that assesses fitness to stand trial. Method: Physicians, forensic psychologists, nurses, and graduate students in psychology were trained in the FIT, and they subsequently viewed 2 videotaped interviews of actual fitness assessments. Using the FIT, they rated the fitness of each defendant portrayed in the videotapes. Results: For overall judgment of fitness, the average intraclass correlation based on the full samples of raters was found to be 0.98, and for most items on the FIT, intraclass correlations fell within the 0.80s and 0.90s. Reliability estimates were high across professional groups. Conclusions: Overall, this study provides further support for the psychometric properties of the FIT, as well as for the ability of various professionals to conduct reliable fitness assessments using the FIT.
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Egeland, Karina Myhren, Kristin Sverdvik Heiervang, Matthew Landers, Torleif Ruud, Robert E. Drake, and Gary R. Bond. "Psychometric Properties of a Fidelity Scale for Illness Management and Recovery." Administration and Policy in Mental Health and Mental Health Services Research 47, no. 6 (November 7, 2019): 885–93. http://dx.doi.org/10.1007/s10488-019-00992-5.
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Abstract This study examined the psychometric properties and feasibility of the Illness Management and Recovery (IMR) Fidelity scale. Despite widespread use of the scale, the psychometric properties have received limited attention. Trained fidelity assessors conducted assessments four times over 18 months at 11 sites implementing IMR. The IMR Fidelity scale showed excellent interrater reliability (.99), interrater item agreement (94%), internal consistency (.91–.95 at three time points), and sensitivity to change. Frequency distributions generally showed that item ratings included the entire range. The IMR Fidelity scale has excellent psychometric properties and should be used to evaluate and guide the implementation of IMR. Trial registration: ClinicalTrials.gov Identifier: NCT03271242.
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EVERINGTON, CAROLINE, and CHARLES DUNN. "A Second Validation Study of the Competence Assessment for Standing Trial for Defendants with Mental Retardation (CAST-MR)." Criminal Justice and Behavior 22, no. 1 (March 1995): 44–59. http://dx.doi.org/10.1177/0093854895022001004.
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This study investigated the reliability and validity of the Competence Assessment for Standing Trial for Defendants with Mental Retardation (CAST-MR) with defendants with mental retardation referred for evaluation of competence to stand trial in the state of Ohio. The CAST-MR demonstrated strong internal consistency and interrater reliability. With respect to the instrument's validity, the group referred as competent had significantly higher total scores, significantly higher scores on each subsection, and significantly higher scores on seven individual test items. The results of discriminant function analyses further supported the CAST-MR's validity. These findings are discussed in relation to a previous CAST-MR validation study with a similar population.
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Joa, I., J. O. Johannessen, K. S. Heiervang, A. A. Sviland, H. A. Nordin, M. Landers, T. Ruud, R. E. Drake, and G. R. Bond. "The Family Psychoeducation Fidelity Scale: Psychometric Properties." Administration and Policy in Mental Health and Mental Health Services Research 47, no. 6 (April 23, 2020): 894–900. http://dx.doi.org/10.1007/s10488-020-01040-3.
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Abstract This study examined psychometric properties and feasibility of the Family Psychoeducation (FPE) Fidelity Scale. Fidelity assessors conducted reviews using the FPE fidelity scale four times over 18 months at five sites in Norway. After completing fidelity reviews, assessors rated feasibility of the fidelity review process. The FPE fidelity scale showed excellent interrater reliability (.99), interrater item agreement (88%), and internal consistency (mean = .84 across four time points). By the 18-month follow-up, all five sites increased fidelity and three reached adequate fidelity. Fidelity assessors rated feasibility as excellent. The FPE fidelity scale has good psychometric properties and is feasible for evaluating the implementation of FPE programs. Trial registration ClinicalTrials.gov Identifier: NCT03271242.
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Karim, Annette Y., Caleb Ashmore, Sara Burris, Toni Roddey, Alexis Ortiz, and Sharon Olson. "Assessment of Countermovement Jump Performance in First Position (Sauté) in Healthy Adults." Sports Health: A Multidisciplinary Approach 11, no. 2 (January 24, 2019): 186–91. http://dx.doi.org/10.1177/1941738118824569.
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Background: Prior studies have examined muscle power via the countermovement jump (CMJ). Studies to date have examined neither the reliability nor the construct validity of the ballet first position CMJ (hips in lateral rotation, toes facing away from one another, legs straight) as a measure of power. Hypotheses: There would be (1) good interrater reliability in the visual assessment of the best-quality first position CMJ (κ ≥ 0.60), (2) good test-retest reliability in the height of the first position CMJ of good quality (intraclass correlation coefficient [ICC] ≥ 0.80), and (3) a significant relationship between isokinetic torque of the quadriceps femoris and first position CMJ height ( r ≥ 0.40). Study Design: Correlational study. Level of Evidence: Level 3. Methods: A convenience sample of 39 healthy young adults who reported moderate activity levels participated in a warm-up and 2 sessions of 6 jumps. Quadriceps femoris isokinetic torque was measured in the first session. Results: Significant agreement was found within the same day for the best-quality first position CMJ (κ = 0.81), and in the highest, best-quality first position CMJ between days (ICC2,1 = 0.88). The highest, best-quality first position CMJ, when solving for a single trial, was comparable to the average of 2 trials (single trial: ICC2,1 = 0.96 vs average of 2 trials: ICC2,k = 0.98). There was a good relationship between quadriceps femoris isokinetic strength and first position CMJ height (Pearson r = 0.69 and P < 0.001 at 60 deg/s; r = 0.64 and P < 0.001 at 180 deg/s; r = 0.65 and P < 0.001 at 300 deg/s). Conclusion: Visual video movement analysis has good to excellent interrater agreement and test-retest reliability. Selecting the single highest jump of good quality is acceptable. The first position CMJ is a measure of power. Clinical Relevance: Video analysis of the single highest first position CMJ of good quality is an acceptable method of assessing movement quality.
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ROSENFELD, BARRY, and ALYSA WALL. "Psychopathology and Competence to Stand Trial." Criminal Justice and Behavior 25, no. 4 (December 1998): 443–62. http://dx.doi.org/10.1177/0093854898025004003.
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This study incorporated multiple indices of competence as well as diagnostic and symptom ratings to determine the symptoms and diagnostic categories associated with incompetence to stand trial and whether these correlates differ as a function of the defendant's diagnosis. One hundred thirty-eight pretrial criminal defendants evaluated for competence were rated by at least one of eight clinicians for (a) overall degree of competence (on a 0-10 rating scale), (b) whether they were able to understand the charges against them and/or assist in their defense, (c) the severity of several psychiatric symptoms, and (d) clinical diagnosis. Interrater reliability estimates for competence and most symptom ratings were quite high, whereas reliability of diagnostic classification, ratings of depression, and estimated overall intelligence were modest. A stepwise discriminant analysis predicting competence for defendants with a psychotic disorder diagnosis generated a model that contained only two variables—thought disorder symptoms and delusional beliefs—whereas a model predicting competence findings for nonpsychotic defendants contained four variables: disorientation, hallucinations, history of prior clinic findings of incompetence, and manic symptoms.
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Fossli Jensen, Bård, Pål Gulbrandsen, Jurate Saltyte Benth, Fredrik A. Dahl, Edward Krupat, and Arnstein Finset. "Interrater reliability for the Four Habits Coding Scheme as part of a randomized controlled trial." Patient Education and Counseling 80, no. 3 (September 2010): 405–9. http://dx.doi.org/10.1016/j.pec.2010.06.032.
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Raza, Syed Ali, Michael R. Frankel, and Srikant Rangaraju. "Abbreviation of the Follow-Up NIH Stroke Scale Using Factor Analysis." Cerebrovascular Diseases Extra 7, no. 3 (October 2, 2017): 120–29. http://dx.doi.org/10.1159/000479933.
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Background: The NIH Stroke Scale (NIHSS) is a 15-item measure of stroke-related neurologic deficits that, when measured at 24 h, is highly predictive of long-term functional outcome. We hypothesized that a simplified 24-h scale that incorporates the most predictive components of the NIHSS can retain prognostic accuracy and have improved interrater reliability. Methods: In a post hoc analysis of the Interventional Management of Stroke-3 (IMS-3) trial, we performed principal component (PC) analysis to resolve the 24-h NIHSS into PCs. In the PCs that explained the largest proportions of variance, key variables were identified. Using these key variables, the prognostic accuracies (area under the curve [AUC]) for good outcome (3-month modified Rankin Scale [mRS] 0–2) and poor outcome (mRS 5–6) of various abbreviated NIHSS iterations were compared with the total 24-h NIHSS. The results were validated in the NINDS intravenous tissue plasminogen activator (NINDS-TPA) study cohort. Based on previously published data, interrater reliability of the abbreviated 24-h NIHSS (aNIHSS) was compared to the total 24-h NIHSS. Results: In 545 IMS-3 participants, 2 PCs explained 60.8% of variance in the 24-h NIHSS. The key variables in PC1 included neglect, arm and leg weakness; while PC2 included level-of-consciousness (LOC) questions, LOC commands, and aphasia. A 3-variable aNIHSS (aphasia, neglect, arm weakness) retained excellent prognostic accuracy for good outcome (AUC = 0.90) as compared to the total 24-h NIHSS (AUC = 0.91), and it was more predictive (p < 0.001) than the baseline NIHSS (AUC = 0.73). The prognostic accuracy of the aNIHSS for good outcome was validated in the NINDS-TPA trial cohort (aNIHSS: AUC = 0.89 vs. total 24-h NIHSS: 0.92). An aNIHSS >9 predicted very poor outcomes (mRS 0–2: 0%, mRS 4–6: 98.5%). The estimated interrater reliability of the aNIHSS was higher than that of the total 24-h NIHSS across 6 published datasets (mean weighted kappa 0.80 vs. 0.73, p < 0.001). Conclusions: At 24 h following ischemic stroke, aphasia, neglect, and arm weakness are the most prognostically relevant neurologic findings. The aNIHSS appears to have excellent prognostic accuracy with higher reliability and may be clinically useful.
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Dukelow, Sean P., Troy M. Herter, Kimberly D. Moore, Mary Jo Demers, Janice I. Glasgow, Stephen D. Bagg, Kathleen E. Norman, and Stephen H. Scott. "Quantitative Assessment of Limb Position Sense Following Stroke." Neurorehabilitation and Neural Repair 24, no. 2 (September 30, 2009): 178–87. http://dx.doi.org/10.1177/1545968309345267.
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Background. Impairment of position sense of the upper extremity (UE) may impede activities of daily living and limit motor gains after stroke. Most clinical assessments of position sense rely on categorical or ordinal ratings by clinicians that lack sensitivity to change or the ability to discriminate subtle deficits. Objective. Use robotic technology to develop a reliable, quantitative technique with a continuous scale to assess UE position sense following stroke. Methods. Forty-five patients recruited from an inpatient stroke rehabilitation service and 65 age-matched healthy controls performed an arm position matching task. Each UE was fitted in the exoskeleton of a KINARM device. One UE was passively placed in one of 9 positions, and the subject was told to match his or her position with the other UE. Patients were compared with statistical distributions of control data to identify those with deficits in UE position sense. Test—retest sessions using 2 raters established interrater reliability. Results. Two thirds of left hemiparetic and one third of right hemiparetic patients had deficits in limb position sense. Left-affected stroke subjects demonstrated significantly more trial-to-trial variability than right-affected or control subjects. The robotic assessment technique demonstrated good interrater reliability but limited agreement with the clinical thumb localizing test. Conclusions. Robotic technology can provide a reliable quantitative means to assess deficits in limb position sense following stroke.
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Mofsen, Aaron M., Thomas L. Rodebaugh, Ginger E. Nicol, Colin A. Depp, J. Philip Miller, and Eric J. Lenze. "When All Else Fails, Listen to the Patient: A Viewpoint on the Use of Ecological Momentary Assessment in Clinical Trials." JMIR Mental Health 6, no. 5 (April 21, 2019): e11845. http://dx.doi.org/10.2196/11845.
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A major problem in mental health clinical trials, such as depression, is low assay sensitivity in primary outcome measures. This has contributed to clinical trial failures, resulting in the exodus of the pharmaceutical industry from the Central Nervous System space. This reduced assay sensitivity in psychiatry outcome measures stems from inappropriately broad measures, recall bias, and poor interrater reliability. Limitations in the ability of traditional measures to differentiate between the trait versus state-like nature of individual depressive symptoms also contributes to measurement error in clinical trials. In this viewpoint, we argue that ecological momentary assessment (EMA)—frequent, real time, in-the-moment assessments of outcomes, delivered via smartphone—can both overcome these psychometric challenges and reduce clinical trial failures by increasing assay sensitivity and minimizing recall and rater bias. Used in this manner, EMA has the potential to further our understanding of treatment response by allowing for the assessment of dynamic interactions between treatment and distinct symptom response.
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Pace, Agnes K., Melanio Bruceta, John Donovan, Sonia J. Vaida, and Jill M. Eckert. "An Objective Pain Score for Chronic Pain Clinic Patients." Pain Research and Management 2021 (February 8, 2021): 1–8. http://dx.doi.org/10.1155/2021/6695741.
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Objectives. Although numerous studies have looked at the numeric rating scale (NRS) in chronic pain patients and several studies have evaluated objective pain scales, no known studies have assessed an objective pain scale for use in the evaluation of adult chronic pain patients in the outpatient setting. Subjective scales require patients to convert a subjective feeling into a quantitative number. Meanwhile, objective pain scales utilize, for the most part, the patient’s behavioral component as observed by the provider in addition to the patient’s subjective perception of pain. This study aims to examine the reliability and validity of an objective Chronic Pain Behavioral Pain Scale for Adults (CBPS) as compared to the traditional NRS. Methods. In this cross-sectional study, patients were assessed before and after an interventional pain procedure by a researcher and a nurse using the CBPS and the NRS. Interrater reliability, concurrent validity, and construct validity were analyzed. Results. Interrater reliability revealed a fair-good agreement between the nurse’s and researcher’s CBPS scores, weighted kappa values of 0.59 and 0.65, preprocedure and postprocedure, respectively. Concurrent validity showed low positive correlation for the preprocedure measurements, 0.34 (95% CI 0.16–0.50) and 0.47 (95% CI 0.31–0.61), and moderate positive correlation for the postprocedure measurements, 0.68 (95% CI 0.56–0.77) and 0.67 (95% CI 0.55–0.77), for the nurses and researchers, respectively. Construct validity demonstrated an equally average significant reduction in pain from preprocedure to postprocedure, CBPS and NRS median (IQR) scores preprocedure (4 (2–6) and 6 (4–8)) and postprocedure (1 (0–2) and 3 (0–5)), p < 0.001 . Discussion. The CBPS has been shown to have interrater reliability, concurrent validity, and construct validity. However, further testing is needed to show its potential benefits over other pain scales and its effectiveness in treating patients with chronic pain over a long-term. This study was registered with ClinicalTrial.gov with National Clinical Trial Number NCT02882971.
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Stieglitz, R., M. Zaudig, H. Freyberger, and V. Dittmann. "Feasibility, Suitability, and Interrater Reliability of ICD-10 During Different Stages of the ICD-10 Field Trial." Pharmacopsychiatry 23, S 4 (June 1990): 188–91. http://dx.doi.org/10.1055/s-2007-1014563.
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Bird, Victoria J., Clair Le Boutillier, Mary Leamy, Julie Williams, Simon Bradstreet, and Mike Slade. "Evaluating the feasibility of complex interventions in mental health services: standardised measure and reporting guidelines." British Journal of Psychiatry 204, no. 4 (April 2014): 316–21. http://dx.doi.org/10.1192/bjp.bp.113.128314.
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BackgroundThe feasibility of implementation is insufficiently considered in clinical guideline development, leading to human and financial resource wastage.AimsTo develop (a) an empirically based standardised measure of the feasibility of complex interventions for use within mental health services and (b) reporting guidelines to facilitate feasibility assessment.MethodA focused narrative review of studies assessing implementation blocks and enablers was conducted with thematic analysis and vote counting used to determine candidate items for the measure. Twenty purposively sampled studies (15 trial reports, 5 protocols) were included in the psychometric evaluation, spanning different interventions types. Cohen's kappa (κ) was calculated for interrater reliability and test–retest reliability.ResultsIn total, 95 influences on implementation were identified from 299 references. The final measure – Structured Assessment of FEasibility (SAFE) – comprises 16 items rated on a Likert scale. There was excellent interrater (κ = 0.84, 95% CI 0.79–0.89) and test–retest reliability (κ = 0.89, 95% CI 0.85–0.93). Cost information and training time were the two influences least likely to be reported in intervention papers. The SAFE reporting guidelines include 16 items organised into three categories (intervention, resource consequences, evaluation).ConclusionsA novel approach to evaluating interventions, SAFE, supplements efficacy and health economic evidence. The SAFE reporting guidelines will allow feasibility of an intervention to be systematically assessed.
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Tyrer, Peter, Jessica Nagar, Rosie Evans, Patricia Oliver, Paul Bassett, Natalie Liedtka, and Aris Tarabi. "The Problem Behaviour Checklist: short scale to assess challenging behaviours." BJPsych Open 2, no. 1 (January 2016): 45–49. http://dx.doi.org/10.1192/bjpo.bp.115.002360.
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BackgroundChallenging behaviour, especially in intellectual disability, covers a wide range that is in need of further evaluation.AimsTo develop a short but comprehensive instrument for all aspects of challenging behaviour.MethodIn the first part of a two-stage enquiry, a 28-item scale was constructed to examine the components of challenging behaviour. Following a simple factor analysis this was developed further to create a new short scale, the Problem Behaviour Checklist (PBCL). The scale was subsequently used in a randomised controlled trial and tested for interrater reliability. Scores were also compared with a standard scale, the Modified Overt Aggression Scale (MOAS).ResultsSeven identified factors – personal violence, violence against property, self-harm, sexually inappropriate, contrary, demanding and disappearing behaviour – were scored on a 5-point scale. A subsequent factor analysis with the second population showed demanding, violent and contrary behaviour to account for most of the variance. Interrater reliability using weighted kappa showed good agreement (0.91; 95% CI 0.83–0.99). Good agreement was also shown with scores on the MOAS and a score of 1 on the PBCL showed high sensitivity (97%) and specificity (85%) for a threshold MOASscore of 4.ConclusionsThe PBCL appears to be a suitable and practical scale for assessing all aspects of challenging behaviour.
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Magimairaj, Beula M., Philip Capin, Sandra L. Gillam, Sharon Vaughn, Greg Roberts, Anna-Maria Fall, and Ronald B. Gillam. "Online Administration of the Test of Narrative Language–Second Edition: Psychometrics and Considerations for Remote Assessment." Language, Speech, and Hearing Services in Schools 53, no. 2 (April 11, 2022): 404–16. http://dx.doi.org/10.1044/2021_lshss-21-00129.
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Purpose: Our aim was to evaluate the psychometric properties of the online administered format of the Test of Narrative Language–Second Edition (TNL-2; Gillam & Pearson, 2017), given the importance of assessing children's narrative ability and considerable absence of psychometric studies of spoken language assessments administered online. Method: The TNL-2 was administered to 357 school-age children at risk for language and literacy difficulties as part of a randomized controlled trial, across three annual cohorts, at three time points (pretest, posttest, and 5-month follow-up). Cohort 3 students were tested using an online format at posttest and at follow-up. We compared the Cronbach's alpha internal consistency reliability of the TNL-2 online testing scores with in-person scores from TNL-2 normative data and Cohort 3 in-person testing at pretest, and interrater reliability for Cohort 3 across test points. In addition, we examined measurement invariance across test occasions and the criterion validity of the TNL-2, the latter based on its correlations with narrative sample measures (Mean Length of Utterance in words and the Monitoring Indicators of Scholarly Language rubric). Results: Internal consistency reliability, interrater reliability, and measurement invariance analyses of the online and in-person administration of the TNL-2 yielded similar outcomes. The criterion validity of the TNL-2 was found to be good. Conclusions: TNL-2 psychometric properties from online administration were generally in the good range and were not significantly different from in-person testing. When administered online using standardized procedures, the TNL-2 is valid and reliable for use in assessing narrative language proficiency in school-age children at risk for language and learning difficulties.
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Boisseau, William, Cyril Dargazanli, Stanislas Smajda, Jean Capron, Michel Piotin, Celina Ducroux, Michel Shamy, Dariush Dowlatshahi, Richard I. Aviv, and Robert Fahed. "Use of the ABC/2 Method to Select Patients for Thrombectomy After 6 Hours of Symptom Onset." Neurology 96, no. 1 (October 12, 2020): e10-e18. http://dx.doi.org/10.1212/wnl.0000000000010999.
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ObjectiveTo determine whether the ABC/2 method could accurately and reliably measure infarct volume and guide thrombectomy decision in acute stroke cases presenting with late or unknown onset.MethodsFour physicians who routinely use MRI for acute stroke imaging, blinded to the RAPID results, measured the diffusion-weighted imaging (DWI) infarct volume using the ABC/2 method. Measurements with ABC/2 (the index test) were compared with RAPID (the reference standard) to calculate sensitivity, specificity, and accuracy measures for various volume cutpoints. Thrombectomy decisions based on RAPID and raters' measurements using the criteria from the Diffusion-Weighted Imaging or Computerized Tomography Perfusion Assessment With Clinical Mismatch in the Triage of Wake-Up and Late-Presenting Strokes Undergoing Neurointervention With Trevo (DAWN) trial criteria were compared. Interrater and intrarater agreement was measured using kappa statistics.ResultsAccuracy with the ABC/2 method was greater than 80% for each rater and each volume cut point. Interrater and intrarater agreement was substantial to excellent for each volume cut point. Treatment decisions with ABC/2 volume estimations showed strong interrater and intrarater agreement, and led to similar thrombectomy decisions compared with RAPID in more than 85% of cases.ConclusionDWI infarct volume measurement using ABC/2 method shows strong accuracy and reliability and may be an acceptable alternative to RAPID software for the application of DAWN criteria for thrombectomy decision-making.
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Davarzani, Samaneh, Daniel Helzer, Jennifer Rivera, David Saucier, Edward Jo, Reuben F. Burch V, Harish Chander, et al. "Validity and Reliability of StriveTM Sense3 for Muscle Activity Monitoring During the Squat Exercise." International Journal of Kinesiology and Sports Science 8, no. 4 (October 31, 2020): 1. http://dx.doi.org/10.7575/aiac.ijkss.v.8n.4p.1.
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Background: Recent innovations in surface electromyographic (sEMG) technology have enabled the measurement of muscle activity using smart textiles. Objective: In this study, the StriveTM Sense3 performance monitoring system is evaluated against a research-grade system, NoraxonTM, in measuring activity during the back squat exercise. Method: Seventeen participants performed three total trials of the squat exercise with a progressive load for individual trials equal to 30%, 60%, and 80% of their estimated maximum 1RM (one-repetition maximum). sEMG measurements from the rectus femoris were captured for the left and right leg by both systems. Pearson product-moment correlation coefficient (r) and intraclass correlation coefficient (ICC) values were computed for each trial to assess concurrent validity and interrater reliability of the StriveTM Sense3 device. Additionally, five coaches at the collegiate- and professional-level of Men’s Basketball speak from an autoethnographic frame to the findings from this study. Results: Results ranged from “Poor” to “Excellent” validity and “Poor to Moderate” to “Excellent” reliability, with a majority of trials achieving “Good” or better results across all loads [93% trials: r >= 0.7; 87% trials: lower ICC 95% CI bound >= 0.75 (absolute sEMG); 98% trials: lower ICC 95% CI bound >= 0.75 (normalized sEMG)]. Higher validity and reliability for medium and heavy loads were observed in comparison to the light load, and several outliers indicate the need for coaches to lubricate sensors and ensure proper fit to collect accurate data. Conclusion: Examining results alongside practitioner feedback indicate the StriveTM Sense3 system is capable of tracking sEMG activity in comparison to a research-grade system.
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Stewart, Christopher M. B., Haseem Raja, Emma Torrance, and Lennard Funk. "In Vivo Randomized Controlled Study of the Bone Response of All-Suture Anchors and Biocomposite Anchors." Orthopaedic Journal of Sports Medicine 8, no. 4 (April 1, 2020): 232596712091496. http://dx.doi.org/10.1177/2325967120914965.
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Background: Suture anchors are widely used for labral reconstruction surgery. However, there has been some concern over the development of osteolysis around the anchor. This has been reported for both biocomposite and all-suture anchors, but they have not been compared directly in vivo. Purpose: To compare the bone response to 2 common suture anchors: a traditional biocomposite push-fit anchor and an all-suture anchor. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Included in this study were 17 patients with a total of 37 unique suture anchors. Magnetic resonance imaging scans were performed at 3 weeks and 6 months postoperatively. A total of 38 senior radiologists and shoulder surgeons evaluated the images using a previously validated system for grading the bone response around suture anchors. The mean difference in grading at 3 weeks and 6 months was calculated using unpaired t tests, and the interrater reliability was evaluated with an intraclass correlation coefficient (ICC). Results: At 3 weeks, there was no statistically significant difference in the degree of osteolysis surrounding each suture anchor type ( P = .258), with little bone response. However, on the 6-month scans, there was a significantly lower level of osteolysis seen in the all-suture anchors compared with the biocomposite anchors ( P = .040). Interrater reliability was excellent, with an ICC value of 0.975 (95% CI, 0.962-0.985). Conclusion: All-suture anchors cause significantly less osteolysis in glenoid bone at 6 months compared with biocomposite anchors.
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Seaman, Jennifer B., Anna C. Evans, Andrea M. Sciulli, Amber E. Barnato, Susan M. Sereika, and Mary Beth Happ. "Abstracting ICU Nursing Care Quality Data From the Electronic Health Record." Western Journal of Nursing Research 39, no. 9 (September 7, 2016): 1271–88. http://dx.doi.org/10.1177/0193945916665814.
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The electronic health record is a potentially rich source of data for clinical research in the intensive care unit setting. We describe the iterative, multi-step process used to develop and test a data abstraction tool, used for collection of nursing care quality indicators from the electronic health record, for a pragmatic trial. We computed Cohen’s kappa coefficient (κ) to assess interrater agreement or reliability of data abstracted using preliminary and finalized tools. In assessing the reliability of study data ( n = 1,440 cases) using the finalized tool, 108 randomly selected cases (10% of first half sample; 5% of last half sample) were independently abstracted by a second rater. We demonstrated mean κ values ranging from 0.61 to 0.99 for all indicators. Nursing care quality data can be accurately and reliably abstracted from the electronic health records of intensive care unit patients using a well-developed data collection tool and detailed training.
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Fang, Ge, Yaxin Wang, Zhenqian Yan, Xiaowen Zhou, Xingyu Fan, Xiaoqian Liao, Zhixi Hu, and Xiantao Li. "Test-Retest Reliability of the Coronary Heart Disease Damp Phlegm and Blood Stasis Pattern Questionnaire: Results from a Multicenter Clinical Trial." Evidence-Based Complementary and Alternative Medicine 2021 (November 16, 2021): 1–6. http://dx.doi.org/10.1155/2021/6291301.
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Background. Damp phlegm and blood stasis pattern (DPBSP) is the main pattern in coronary heart disease (CHD) patients. To quantify and standardize the diagnosis of DPBSP, questionnaires are usually administered. The CHD Damp Phlegm and Blood Stasis Pattern Questionnaire (CHD-DPBSPQ) is the standard metric for measuring CHD-DPBSP signs and symptoms in practice and clinical research. The CHD-DPBSPQ has moderate diagnostic efficiency, as evidenced by its receiver operating characteristic curves. Furthermore, and high reliability and validity have been shown in some studies but not in a multicenter clinical trial. Our purpose was to evaluate the test-retest reliability of a proprietary CHD-DPBSPQ. Methods. The CHD-DPBSPQ uses a standard procedure for measuring symptoms. The (interrater) reliability and validity of this questionnaire have been previously studied. Here, we evaluated the test interval and weighted kappa value of items of test-retest (intrarater) reliability of the CHD-DPBSPQ. The test-retest reliability was evaluated by the intraclass correlation coefficient (ICC) for the total CHD-DPBSPQ score and the phlegm domain and blood stasis domain scores. Weighted kappa statistics were calculated for the individual CHD-DPBSPQ items. Results. Using the CHD-DPBSPQ, 79 patients with late-stage CHD who were participating in a multicenter clinical trial were assessed twice. The ICCs for the CHD-DPBSPQ score were as follows: 0.827 for the total CHD-DPBSPQ, 0.778 for the phlegm domain score, and 0.828 for the blood stasis domain score. The reliability was slightly better in patients whose test interval was ≤14 days. The weighted kappa values of individual items showed moderate consistency. Conclusions. The CHD-DPBSPQ was found to have excellent test-retest reliability in this sample of patients.
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Heiervang, Kristin Sverdvik, Karina Myhren Egeland, Matthew Landers, Torleif Ruud, Inge Joa, Robert E. Drake, and Gary R. Bond. "Psychometric Properties of the General Organizational Index (GOI): A Measure of Individualization and Quality Improvement to Complement Program Fidelity." Administration and Policy in Mental Health and Mental Health Services Research 47, no. 6 (February 27, 2020): 920–26. http://dx.doi.org/10.1007/s10488-020-01025-2.
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Abstract To assess the implementation of effective practices, mental health programs need standardized measures. The General Organizational Index (GOI), although widely used for this purpose, has received minimal psychometric research. For this study, we assessed psychometric properties of the GOI scale administered four times over 18 months during the implementation of a new program in 11 sites. The GOI scale demonstrated high levels of interrater reliability (.97), agreement between assessors on item ratings (86% overall), internal consistency (.77–.80 at three time points), sensitivity to change, and feasibility. We conclude that the GOI scale has acceptable psychometric properties, and its use may enhance implementation and research on evidence-based mental health practices. Trial registration: REK2015/2169. ClinicalTrials.gov Identifier: NCT03271242
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Fanniff, Amanda M., and Elizabeth J. Letourneau. "Another Piece of the Puzzle." Sexual Abuse 24, no. 4 (February 17, 2012): 378–408. http://dx.doi.org/10.1177/1079063211431842.
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The authors reviewed nine studies examining psychometric properties of the Juvenile Sex Offender Assessment Protocol–II (J-SOAP-II) and examined the psychometric properties of the J-SOAP-II when items were scored based on probation records obtained at or near disposition and prior to treatment. Data from 73 boys ages 12 to 17 who participated in a larger randomized clinical trial informed this study. Reliability (internal consistency and interrater agreement) and validity (concurrent, discriminant, and predictive) were examined. Scale 1, Sexual Drive/Preoccupation, was characterized by adequate reliability and concurrent validity but did not predict scores on a measure of concerning sexual behavior. This is consistent with seven studies that failed to find evidence of predictive validity using measures of sexual recidivism. Also consistent with the literature, Scale 2, Impulsive/Antisocial Behavior, performed well with respect to nearly all psychometric properties including predictive validity. Review of remaining scales and scores and clinical policy implications are discussed.
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Facchini, Stephanie J., Matthew C. Hoch, Deanna H. Smith, and Johanna M. Hoch. "Intrarater and Interrater Agreement of the Intrinsic Foot Muscle Test." International Journal of Athletic Therapy and Training 20, no. 3 (May 2015): 53–57. http://dx.doi.org/10.1123/ijatt.2014-0088.
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Context:The intrinsic foot muscle test (IFMT) is purported to identify intrinsic foot muscle (IFM) weakness during clinical examination. However, before this test can be used in clinical practice the clinometric properties must be determined. In addition, it is unclear if the IFMT provides information regarding the integrity of the foot arch beyond static foot posture assessments such as the navicular drop test (NDT).Objective:To determine the reliability of the IFMT as well as its correlation with the NDT.Setting:Laboratory.Patients or other Participants:Two novice ATs served as the raters. The NDT was assessed by a third investigator during the first session. Twenty-five participants (16 females, 9 males; age: 22.4 ± 1.7 years; height: 170.8 ± 10.2 cm; mass: 73.5 ± 12.8 kg) completed two data collection sessions separated by one week.Interventions:During each session the IFMT was assessed bilaterally in a counterbalanced order by the raters. Each test was rated simultaneously by both raters during each trial and the raters were blinded to each other’s results during and between test sessions.Main Outcome Measures:The independent variable was time (session one and session two) and the dependent variables included rating on the IFMT and navicular drop height.Results:Intrarater agreement was poor to fair (κ = .03−.41) and interrater agreement was fair to moderate (κ = .25−.60). Post hoc Wilcoxon rank tests demonstrated a significant number of participants improved between sessions for both raters. A weak correlation was observed between the NDT and IFMT for both right (r = −.14 to .04, p < .49) and left (r = −.19 to .07, p < .37) feet.conclusion:The IFMT demonstrated poor to fair intrarater and fair to moderate interrater agreement, suggesting future research is needed to modify this method of measuring IFM function. The improvement between sessions indicates a potential familiarization period within the test. The weak correlation between the IFMT and NDT indicates these tests evaluate different aspects of foot function.
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Donk, Roland D., Michael G. Fehlings, Wim I. M. Verhagen, Hisse Arnts, Hans Groenewoud, André L. M. Verbeek, and Ronald H. M. A. Bartels. "An assessment of the most reliable method to estimate the sagittal alignment of the cervical spine: analysis of a prospective cohort of 138 cases." Journal of Neurosurgery: Spine 26, no. 5 (May 2017): 572–76. http://dx.doi.org/10.3171/2016.10.spine16632.
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OBJECTIVEAlthough there is increasing recognition of the importance of cervical spinal sagittal balance, there is a lack of consensus as to the optimal method to accurately assess the cervical sagittal alignment. Cervical alignment is important for surgical decision making. Sagittal balance of the cervical spine is generally assessed using one of two methods; namely, measuring the angle between C-2 and C-7, and drawing a line between C-2 and C-7. Here, the best method to assess sagittal alignment of the cervical spine is investigated.METHODSData from 138 patients enrolled in a randomized controlled trial (Procon) were analyzed. Two investigators independently measured the angle between C-2 and C-7 by using Harrison's posterior tangent method, and also estimated the shape of the sagittal curve by using a modified Toyama method. The mean angles of each quantitative assessment of the sagittal alignment were calculated and the results were compared. The interrater reliability for both methods was estimated using Cronbach's alpha.RESULTSFor both methods the interrater reliability was high: for the posterior tangent method it was 0.907 and for the modified Toyama technique it was 0.984. For a lordotic cervical spine, defined by the modified Toyama method, the mean angle (defined by Harrison's posterior tangent method) was 23.4° ± 9.9° (range 0.4°–52.4°), for a kyphotic cervical spine it was −2.2° ± 9.2° (range −16.1° to 16.9°), and for a straight cervical spine it was 10.5° ± 8.2° (range −11° to 36°).CONCLUSIONSAn absolute measurement of the angle between C-2 and C-7 does not unequivocally define the sagittal cervical alignment. As can be seen from the minimum and maximum values, even a positive angle between C-2 and C-7 could be present in a kyphotic spine. For this purpose, the modified Toyama method (drawing a line from the posterior inferior part of the vertebral body of C-2 to the posterior upper part of the vertebral body of C-7 without any measurements) is a better tool for a global assessment of cervical sagittal alignment.Clinical trial registration no.: ISRCTN41681847 (https://www.isrctn.com)
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Anderson, Gene Cranston, Doreen Radjenovic, Sheau-Huey Chiu, Michael Conlon, and Ann E. Lane. "Development of an Observational Instrument to Measure Mother-Infant Separation Post Birth." Journal of Nursing Measurement 12, no. 3 (October 2004): 215–34. http://dx.doi.org/10.1891/jnum.12.3.215.
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The importance of the timing, quality, and quantity of early maternal-infant contact has gained prominence over the years. However, no researcher has adequately documented the nature of maternal-infant contact and separation. This study assessed the psychometric properties of the Index of Mother-Infant Separation (IMIS), pronounced “I miss,” which is a 37-item observational measure of the process of mother-infant contact or separation post birth. Assessment of reliability and validity of the IMIS was conducted using data collected in a randomized clinical trial with 224 healthy newborn infants assigned at 1 hour post birth to self-regulatory or routine nursery care (control) groups. Time-sampled observations occurred every 15 minutes. Content validity indices of the IMIS, determined by nine nationally known perinatal experts, were 77% to 100% for instrument items. Construct validity was supported through known-groups hypothesis testing (p < .0001). Interrater reliability was from 86% to 90%. The IMIS is a valid observational measure of maternal contact when raters are trained to score it reliably.
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Farhani, Farid, Hamid Rajabi, Raoof Negaresh, Ajmol Ali, Sadegh Amani Shalamzari, and Julien S. Baker. "Reliability and Validity of a Novel Futsal Special Performance Test Designed to Measure Skills and Anaerobic Performance." International Journal of Sports Physiology and Performance 14, no. 8 (September 1, 2019): 1096–102. http://dx.doi.org/10.1123/ijspp.2018-0850.
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Purpose: To examine the validity and reliability of a novel futsal special performance test (FSPT) as a measure of futsal performance and skills. Methods: Thirty-six futsal players with different levels of experience were recruited and divided into 2 groups (elite and nonelite). Players participated in 4 sessions (at least 7 d apart): (1) familiarization session, (2) anaerobic power (Wingate test), (3) FSPT trial 1, and (4) FSPT trial 2. The FSPT was carried out on a futsal court (wooden sprung floor) and skills such as dribbling, rotation, long and short passing, and shooting were examined. Content validity was assessed by 6 experienced futsal coaches and instructors. Results: There was a significant correlation between FSPT and various aspects of anaerobic power (r = .5–.91; P ≤ .001). Moreover, significant large correlations were observed between test and retest of FSPT (r = .77; 95% confidence interval [CI], .56–.98; P ≤ .001). All instructors and coaches confirmed the content validity. There was high interrater reliability of the FSPT (r = .89; 95% CI, .85–.93; P < .001). FSPT total time (P = .001), penalty time (P = .022), and performance time (P = .001) were superior in elite relative to nonelite players. Anaerobic power was greater in elite players (P < .001). Conclusion: The results support the use of the FSPT to assess futsal players’ performance in conjunction with skill and anaerobic fitness.
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Raab, Hans-Rudolf. "Pankreaskarzinom: Internistische und chirurgische Onkologen können gemeinsam mehr erreichen." Kompass Onkologie 7, no. 4 (2020): 201–3. http://dx.doi.org/10.1159/000512770.
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<b>Background:</b> One critical step in the therapy of patients with localized pancreatic cancer is the determination of local resectability. The decision between primary surgery versus upfront local or systemic cancer therapy seems especially to differ between pancreatic cancer centers. In our cohort study, we analyzed the independent judgement of resectability of five experienced high volume pancreatic surgeons in 200 consecutive patients with borderline resectable or locally advanced pancreatic cancer. <b>Methods:</b> Pretherapeutic CT or MRI scans of 200 consecutive patients with borderline resectable or locally advanced pancreatic cancer were evaluated by 5 independent pancreatic surgeons. Resectability and the degree of abutment of the tumor to the venous and arterial structures adjacent to the pancreas were reported. Interrater reliability and dispersion indices were compared. <b>Results:</b> One hundred ninety-four CT scans and 6 MRI scans were evaluated and all parameters were evaluated by all surgeons in 133 (66.5%) cases. Low agreement was observed for tumor infiltration of venous structures (κ = 0.265 and κ = 0.285) while good agreement was achieved for the abutment of the tumor to arterial structures (interrater reliability celiac trunk κ = 0.708 P < 0.001). In patients with vascular tumor contact indicating locally advanced disease, surgeons highly agreed on unresectability, but in patients with vascular tumor abutment consistent with borderline resectable disease, the judgement of resectability was less uniform (dispersion index locally advanced vs. borderline resectable p < 0.05). <b>Conclusion:</b> Excellent agreement between surgeons exists in determining the presence of arterial abutment and locally advanced pancreatic cancer. The determination of resectability in borderline resectable patients is influenced by additional subjective factors. <b>Trial registration:</b> EudraCT: 2009–014476–21 (2013–02–22) and NCT01827553 (2013–04–09).
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Al-Okshi, Ayman, Liselotte Paulsson, Madeleine Rohlin, Eman Ebrahim, and Christina Lindh. "Measurability and reliability of assessments of root length and marginal bone level in cone beam CT and intraoral radiography: a study of adolescents." Dentomaxillofacial Radiology 48, no. 5 (July 2019): 20180368. http://dx.doi.org/10.1259/dmfr.20180368.
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Objectives: To evaluate measurability and reliability of measurements of root length and marginal bone level in CBCT, periapical (PA) and bitewing (BW) radiographs. Methods: CBCT of both jaws, PA of maxillary incisors and posterior BW radiographs of 10 adolescents (mean age 13.4) were selected. The radiographs comprised part of the baseline examinations of a trial of orthodontic treatment. Six raters assessed measurability and measured root length and marginal bone level. Three raters repeated their assessments. Measurability was expressed as frequency of interpretable sites and reliability as intraclass correlation coefficient (ICC). Results: Measurability was 100 % in CBCT and 95 % in PA of maxillary incisors for root length measurements. For marginal bone level, measurability was 100 % in CBCT, 76 % in PA and 86 % in posterior BW. Mean ICC for interrater reliability for root length measurements in CBCT was 0.88 (range 0.27–0.96 among different teeth) and 0.69 in PA of maxillary incisors. For marginal bone level measurements, mean ICC was 0.4 in CBCT, 0.38 in PA of maxillary incisors and 0.4 in posterior BW. Intrarater reliability varied among methods, root length or marginal bone level and among raters, except for root length measurements in CBCT, which presented high reliability (above 0.8) for all raters. Conclusions: As measurability and reliability were high for root length measurements in CBCT, this may be the method of choice for scientific analyses in orthodontics. For clinical praxis, we recommend PA following the “as low as diagnostically acceptable” principle, as clinical decisions seem to be influenced only when severe root resorption occurs.
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A, Garagozzo, Hunter S, and Smith D. "A-042 Incongruence Between Self- and Parent- Report Measures of Executive Function on the Behavior Rating Inventory of Executive Function (BRIEF) in Adolescents with Attention Deficit Hyperactivity Disorder." Archives of Clinical Neuropsychology 35, no. 6 (August 28, 2020): 832. http://dx.doi.org/10.1093/arclin/acaa068.042.
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Abstract Objective Research has demonstrated that adolescents with ADHD show executive dysfunction, although they do not always endorse such difficulties. We investigated inter-rater agreement between parent- and self-reported executive function (EF) in adolescents with ADHD, using the BRIEF. We also sought to investigate the relationship between scores on parent and self-report EF measures with performance on objective EF measures. Method Utilizing a clinical database, we identified 75 participants (13-17 years; Mage = 14.9; 60% male; 27% African American, 63% White, 3% Hispanic, 7% Other) with a diagnosis of ADHD. We examined inter-rater reliability between parent and self-reported factors on the BRIEF. We then examined the association between parent and self-report BRIEF Inhibition scores and the D-KEFS Color Word Interference (CWI) Inhibition trial, and parent and self-report BRIEF Shift scores and the D-KEFS CWI Inhibition/Switching trial and Trails Letter Number Sequencing trial. Results Significant associations were found between parent and self-ratings on BRIEF Inhibition (ICC = .22; 95% CI = -.24-.50), Shift (ICC = .24; 95% CI = -.21-.52), Emotional Control (ICC = .45, 95% CI = .137-.655), Plan/Organize (ICC = -.143; 95% CI = -.81–28), and Working Memory (ICC = -.193; 95% CI = -.89-.25) subscales. Correlation comparisons were significant for BRIEF self-report Inhibition and CWI Inhibition (r(73) = −.405, p = .000) only. Conclusion Results support standing findings regarding poor interrater reliability between parent and self-ratings of daily executive functioning in adolescents with ADHD. Self-report was seen to correlate with performance on objective EF tasks. Clinically, these results highlight the need for multidimensional assessment of ADHD in adolescents.
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Duong, Tina, Gale Harding, Sally Mannix, Cristina Abel, Dawn Phillips, Lindsay N. Alfano, Carsten G. Bönnemann, et al. "Use of the Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) in X-Linked Myotubular Myopathy: Content Validity and Psychometric Performance." Journal of Neuromuscular Diseases 8, no. 1 (January 1, 2021): 63–77. http://dx.doi.org/10.3233/jnd-200479.
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X-linked myotubular myopathy (XLMTM) is a life-threatening, congenital myopathy characterized by extreme hypotonia, weakness, delayed motor milestones, and respiratory failure, often resulting in pediatric mortality. This study evaluated the content validity and psychometric performance of the Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders as a measure of neuromuscular functioning in children with X-linked myotubular myopathy. This study was conducted in two phases. Phase I assessed the content validity of the measure for use in an XLMTM pediatric population through: literature review, clinical expert interviews, caregiver interviews, and a modified-Delphi panel among clinicians. Phase II assessed psychometric performance based on the INCEPTUS observational clinical study and the ASPIRO interventional gene therapy study, including tests of reliability (internal consistency, test-retest, and interrater), validity (construct and criterion), and responsiveness based on observational and interventional clinical trial data analyses. Data established construct validity and reliability of the Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders among XLMTM patients before administration of resamirigene bilparvovec, and sensitivity to study drug administration as evidenced by the significant post-administration response in ASPIRO. Findings support the Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders as an appropriate neuromuscular functioning assessment in a pediatric X-linked myotubular myopathy patient population.
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Chen, Yu-Pin, Chung-Ying Lin, Yi-Jie Kuo, and Oscar Kuang-Sheng Lee. "Feasibility and Effect of a Wearable Motion Sensor Device in Facilitating In-Home Rehabilitation Program in Patients after Total Knee Arthroplasty: A Preliminary Study." Applied Sciences 12, no. 5 (February 25, 2022): 2433. http://dx.doi.org/10.3390/app12052433.
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Postoperative home-based rehabilitation programs are essential for facilitating functional recovery after total knee replacement (TKA). This study aimed to verify the feasibility of applying a wearable motion sensor device (MSD) to assist patients in performing home-based exercises after TKA. The interrater reliability of the measurement for knee mobility and the time spent completing the 5-times sit-to-stand test (5TSST) by two experienced physicians and using the MSD in 12 healthy participants was first assessed. A prospective control trial was then conducted, in which 12 patients following TKA were allocated to two groups: the home-based exercise group and the MSD-assisted rehabilitation group. Changes in knee range of motion, pain, functional score, performance, and exercise completion rates were compared between the groups over two months of follow-up. MSD-measured knee mobility and 5TSST exhibited excellent reliability compared with the physician measurements. Furthermore, patients in the MSD-assisted rehabilitation group reported higher training compliance than participants in the home-based exercise group, which led to better outcomes in the knee extension angle and maximal and average angular velocity in 5TSST. MSD-assisted home-based rehabilitation following TKA is a feasible treatment model for telerehabilitation because it enhances patients’ compliance to training, which improves functional recovery.
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Gupta, Aditya K., Jennifer E. Ryder, Robyn Bluhm, Andrew Johnson, and Richard C. Summerbell. "Onychomycosis: Quality of Studies." Journal of Cutaneous Medicine and Surgery 7, no. 4 (July 2003): 312–16. http://dx.doi.org/10.1007/s10227-002-0137-y.
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Objective: The quality of original clinical trial publications pertaining to the use of oral antifungal agents to treat onychomycosis was evaluated using predetermined criteria. Methods: The list of studies included in this analysis was determined by conducting a search in Medline. For each clinical trial, two independent reviewers each determined a composite score by evaluating a list of criteria that were felt to represent a good study, for example, randomization and blinding, prior sample size calculated, and treatment regimen clearly explained. A citation count was performed to determine whether higher-quality papers were cited more often than lower-quality papers. Results: Forty-five studies were included in this quality analysis of study design. Of these, 27 were considered to be “high quality” (score greater than or equal to 11 out of 20). A significant correlation coefficient of 0.997 was found between the two reviewers ( P < 0.00001). Higher-quality papers were cited significantly more often than lower-quality papers ( P = 0.03). Conclusion: The scale that we use to evaluate the quality of onychomycosis studies has high interrater reliability. According to this scale, many published studies (18 out of 45) pertaining to treatments for onychomycosis do not meet the criteria required to be considered “high quality.”
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Noble, Adam J., Darlene Snape, Leone Ridsdale, Myfanwy Morgan, Sarah J. Nevitt, Steve Goodacre, and Anthony Marson. "Assessing Treatment Fidelity within an Epilepsy Randomized Controlled Trial: Seizure First Aid Training for People with Epilepsy Who Visit Emergency Departments." Behavioural Neurology 2019 (February 3, 2019): 1–11. http://dx.doi.org/10.1155/2019/5048794.
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Purpose. To measure fidelity with which a group seizure first aid training intervention was delivered within a pilot randomized controlled trial underway in the UK for adults with epilepsy who visit emergency departments (ED) and informal carers. Estimates of its effects, including on ED use, will be produced by the trial. Whilst hardly ever reported for trials of epilepsy interventions—only one publication on this topic exists—this study provides the information on treatment fidelity necessary to allow the trial’s estimates to be accurately interpreted. This rare worked example of how fidelity can be assessed could also provide guidance sought by neurology trialists on how to assess fidelity. Methods. 53 patients who had visited ED on ≥2 occasions in prior year were recruited for the trial; 26 were randomized to the intervention. 7 intervention courses were delivered for them by one facilitator. Using audio recordings, treatment “adherence” and “competence” were assessed. Adherence was assessed by a checklist of the items comprising the intervention. Using computer software, competence was measured by calculating facilitator speech during the intervention (didacticism). Interrater reliability was evaluated by two independent raters assessing each course using the measures and their ratings being compared. Results. The fidelity measures were found to be reliable. For the adherence instrument, raters agreed 96% of the time, PABAK-OS kappa 0.91. For didacticism, raters’ scores had an intraclass coefficient of 0.96. In terms of treatment fidelity, not only were courses found to have been delivered with excellent adherence (88% of its items were fully delivered) but also as intended they were highly interactive, with the facilitator speaking for, on average, 55% of course time. Conclusions. The fidelity measures used were reliable and showed that the intervention was delivered as attended. Therefore, any estimates of intervention effect will not be influenced by poor implementation fidelity.
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Parikh, Divya Ahuja, Lisa Kody, Susie Brain, Diane Heditsian, Vivian Lee, Christina Curtis, George W. Sledge, and Jennifer Lee Caswell-Jin. "Understanding patient perspectives on window of opportunity clinical trials." Journal of Clinical Oncology 38, no. 29_suppl (October 10, 2020): 181. http://dx.doi.org/10.1200/jco.2020.38.29_suppl.181.
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181 Background: In “window of opportunity” (WOO) clinical trials, people with newly diagnosed early-stage cancer are exposed to an experimental drug during the period of time between diagnosis and definitive anti-cancer treatment. These trials allow investigators to study drug efficacy in untreated disease, which can expedite drug development. However, for trial participants, the WOO approach requires them to decide about an altruistic clinical trial during an intense time immediately after cancer diagnosis. This qualitative study aimed to understand patient perspectives on WOO clinical trials. Methods: We recruited adults newly diagnosed with early-stage breast cancer who were awaiting definitive therapy at a single academic medical center. We developed an interview guide grounded in the theoretical framework, the Theory of Planned Behavior (TPB). TBP is a well-validated decision-making model with three domains that guide behavior: (1) attitudes (2) normative factors and (3) perceived difficulty of a behavior. We conducted one-on-one semi-structured interviews that were audio-recorded and transcribed. Transcripts were analyzed to ensure interrater reliability and content analysis was performed to assess themes that emerged. Results: We interviewed 15 women (age 32-72) with early-stage breast cancer, and the majority were White (n = 12, 80%) and at least college educated (n = 12, 80%). Key themes that emerged included favorable attitudes towards participating in a WOO trial that were altruistic, including the desire to contribute to science (n = 10, 67%) and to help future breast cancer patients (n = 5, 33%). Several individuals also identified a potential benefit to themselves (n = 10, 67%), including access to a targeted drug (n = 4, 27%) and adding meaning to their diagnosis (n = 3, 20%). However, most interviewees reported concerns about drug side effects (n = 12, 80%) and whether side effects would impact other planned treatments (n = 10, 67%). Interviewees also expressed family would be an important normative factor in decision-making (n = 8, 53%). A key theme that emerged as a difficulty was the potential delay in standard treatment (n = 14, 93%). Despite this concern, at the end of the interviews, most interviewees stated they would participate in a WOO trial if offered (n = 10, 67%). Conclusions: WOO trials are becoming increasingly common in oncology research. In this qualitative study, interviewees weighed altruism against the possibility delaying or impacting other treatments. Our results may inform trial design and communication approaches in future WOO efforts.
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Ro'uf, Ahmad, Samsudi Samsudi, and Zaim Elmubarok. "The Characteristics of Standard Instruments for Early Detection of Terrorism in the Name of Jihad in High School Students." Journal of Educational Research and Evaluation 11, no. 1 (March 30, 2022): 23–33. http://dx.doi.org/10.15294/jere.v11i1.55419.
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Radical religious understanding has become a horrendous phenomenon, because religion, especially Islam, does not teach radicalism or even terrorism. This study aims to (1) analyze the design of instruments for early detection, (2) analyze the characteristics of the standard’s instrument in the form of the level of instrument validity and (3) analyze the level of reliability on the instrument for early detection of terrorism in the name of jihad in students of SMA Negeri 2 Semarang. This research uses descriptive qualitative and quantitative research. The content validity of the instrument was tested by 3 experts. The statement items developed were tested on 30 respondents (small class) and 145 respondents (large class). Data was collected using interview techniques, documentation and questionnaires. The results of this study produced 45 standard instrument items for early detection of terrorism in the name of jihad in the form of a Likert scale of 1-4 and presented online using a google form. The results of validation by experts are that there are 14 items that are declared invalid or have an Aiken V index value of less than 0.3 so that these items must be discarded. The non-test instrument has an interrater reliability coefficient, a small class trial, and a large class trial, respectively, which is 0.88; 0.92; 0.91. There are 17 items that are invalid or less than the correlation coefficient rcount in the small class trial. Based on the large class trial, the final results of the valid items were 45 items with an r-count value greater than 0.1362 and a non-negative value. The results of the KMO in the field trial were 0.803 so that the instrument items could be analyzed further. The instrument is formed into 12 factors. The instrument developed is constructivly valid because it is able to explain the overall variation in the terrorism early detection instrument of 66.79%. The conclusion from this study is that the the non-test instrument in the form of a Likert scale. The characteristics standard’s instruments of early detection for terrorism in the name of jihad is constructivly valid and reliable.
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Wohlrab, T., S. Flechtenmacher, J. Krisam, D. Saure, D. Wolff, and C. Frese. "Diagnostic Value of the Basic Erosive Wear Examination for the Assessment of Dental Erosion on Patients, Dental Photographs, and Dental Casts." Operative Dentistry 44, no. 6 (November 1, 2019): E279—E288. http://dx.doi.org/10.2341/18-127-c.
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SUMMARY Objectives: The aim of this trial was to investigate the diagnostic value of the basic erosive wear examination (BEWE) in clinical use, on dental photographs, and on dental casts over a two-year follow-up period (2013-2015). According to the main hypothesis for longitudinal monitoring of dental erosion, the BEWE is equally reproducible by the three assessment methods. Methods and Materials: The clinical assessment included intraoral photographic documentation, dental impressions, oral examination, and assessment of BEWE. Clinical assessment of BEWE was done by one blinded examiner, whereas assessment on photographs and dental casts was performed by three calibrated examiners and repeated after 14 days. The three assessment methods were analyzed separately by longitudinal agreement and inter- and intrarater reliability (intraclass correlation coefficient) alongside 95% confidence intervals (CIs). Results: Comparing the longitudinal data of the years 2013-2015, clinical use and photographs showed no significant difference (p=0.0681-0.9963), whereas the statistical analysis showed a significant difference for dental casts by comparing data from 2013 vs 2014 (p=0.0266) as well as data from 2013 vs 2015 (p=0.0001). Statistical evaluation of overall BEWE showed an intrarater reliability of 0.79-0.91 for photographs and 0.60-0.87 for dental casts. The interrater reliability was 0.77 (95% CI=[0.69; 0.84]) for photographs and 0.63 (95% CI=[0.52; 0.72]) for dental casts. Conclusion: This investigation showed that in longitudinal clinical monitoring, the assessment of the BEWE on patients and dental photographs yielded comparable results. In addition, based on these findings, the assessment of the BEWE on dental casts showed moderate reproducibility. Therefore, dental casts may be better used for laboratory assessment techniques.
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Nigro, Carlos Alberto, Eduardo Dibur, Sofía Grandval, and Facundo Nogueira. "Indication of CPAP in Patients with Suspected Obstructive Sleep Apnea, Based on Clinical Parameters and a Novel Two-Channel Recording Device (ApneaLink): A Pilot Study." Sleep Disorders 2012 (2012): 1–6. http://dx.doi.org/10.1155/2012/346181.
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Objective.To evaluate the accuracy and reliability of the medical decision based on the results of the hand scoring from a two-channel recording device (ApneaLink) plus clinical data for the prescription of a CPAP assay in patients with suspected OSA.Methods.39 subjects were assessed in the sleep laboratory with polysomnography and ApneaLink. The patients completed the Epworth sleepiness scale and a clinical history. Two blinded independent observers decided to prescribe CPAP according to the results of the PSG (gold standard, observer A), ApneaLink (alternative method, observer B), and the clinical parameters. Sensitivity and specificity of observer B on the indication of CPAP were calculated. The interobserver agreement for the indication of CPAP was assessed using kappa statistics.Results.38 subjects were included (26 men, mean age 47.5, mean RDI 28.7, mean BMI 31.4 kg/m2). The prevalence of OSA was 84%. The sensitivity and specificity of observer B to initiate a CPAP trial were 90.6% and 100%, respectively. The interrater agreement for the prescription of CPAP was good (kappa: 0.75).Conclusion.This study has shown that the use of ApneaLink plus clinical data has made it possible to indicate CPAP reliably in most patients with high-clinical pretest for OSA.
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Trauer, Tom, Tom Callaly, Paul Hantz, John Little, Robert B. Shields, and Jenny Smith. "Health of the Nation Outcome Scales." British Journal of Psychiatry 174, no. 5 (May 1999): 380–88. http://dx.doi.org/10.1192/bjp.174.5.380.
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BackgroundIn Victoria, Australia, systematic assessment of outcomes in mental health services are being instituted.AimsTo carry out a large-scale field trial of the Health of the Nation Outcome Scales (HoNOS).Method2137 clients were rated by mental health workers on the HoNOS, and about half were rated again within a few months.ResultsWhile interrater reliability of the total score was satisfactory, that of some individual items was unacceptable. Significant associations with age and gender were found, and clients with non-psychotic disorders obtained higher (i.e. worse) ratings than those with psychotic disorders. There were relationships between service use and HoNOS total score. For the group as a whole, total scores had not changed at the second rating, but admissions and discharges were associated with increases and decreases in total score. Among clients in the community, there was no relationship between change in HoNOS total score and frequency of contacts.ConclusionsCertain items, notably 11 and 12, were unreliable. The absence of evidence of sensitivity to change may be due to the short re-rating interval, little real change in the clients, or the characteristics of the scale itself.