Interrater Reliability of Muscle Ultrasonography Image Acquisition by Physical Therapists in Patients Who Have or Who Survived Critical Illness

2020 ◽  
Vol 100 (9) ◽  
pp. 1701-1711 ◽  
Author(s):  
Kirby P Mayer ◽  
Sanjay Dhar ◽  
Evan Cassity ◽  
Aaron Denham ◽  
Johnny England ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Interrater Reliability ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Image Acquisition ◽  
Intraclass Correlation

Abstract Objective Previous studies have demonstrated that muscle ultrasound (US) can be reliably performed at the patient bedside by novice assessors with minimal training. The primary objective of this study was to determine the interrater reliability of muscle US image acquisition by physical therapists and physical therapist students. Secondarily, this study was designed to elucidate the process for training physical therapists to perform peripheral skeletal muscle US. Methods This was a cross-sectional observational study. Four novices and 1 expert participated in the study. Novice sonographers engaged in a structured training program prior to implementation. US images were obtained on the biceps brachii, quadriceps femoris, and tibialis anterior muscles in 3 groups: patients in the intensive care unit, patients on the hospital ward, and participants in the outpatient gym who were healthy. Reliability of image acquisition was analyzed compared with the expert sonographer. Results Intraclass correlation coefficient values ranged from 0.76 to 0.97 with an average for all raters and all muscles of 0.903, indicating excellent reliability of image acquisition. In general, the experienced physical therapist had higher or similar intraclass correlation coefficient values compared with the physical therapist students in relation to the expert sonographer. Conclusions Excellent interrater reliability for US was observed regardless of the level of experience, severity of patient illness, or patient setting. These findings indicate that the use of muscle US by physical therapists can accurately capture reliable images in patients with a range of illness severity and different clinical practice settings across the continuum of care. Impact Physical therapists can utilize US to obtain images to assess muscle morphology. Lay Summary Physical therapists can use noninvasive US as an imaging tool to assess the size and quality of peripheral skeletal muscle. This study demonstrates that physical therapists can receive training to reliably obtain muscle images in patients admitted to the intensive care unit who may be at risk for muscle wasting and may benefit from early rehabilitation.

Accuracy and precision of cardiac output estimation by an automated, brachial cuff-based oscillometric device in patients with shock

2019 ◽  
Vol 234 (11) ◽  
pp. 1330-1336 ◽  
Author(s):  
Theodore G Papaioannou ◽  
Dimitrios Xanthis ◽  
Antonis Argyris ◽  
Pavlos Vernikos ◽  
Georgia Mastakoura ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Output ◽  
Intensive Care ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Intraclass Correlation ◽  
Percentage Error ◽  
Non Invasive ◽  
Oscillometric Device ◽  
Cardiac Output Measurements

Non-invasive monitoring of cardiac output is a technological and clinical challenge, especially for critically ill, surgically operated, or intensive care unit patients. A brachial cuff-based, automated, oscillometric device used for blood pressure and arterial stiffness ambulatory monitoring (Mobil-O-Graph) provides a non-invasive estimation of cardiac output values simultaneously with regular blood pressure measurement. The aim of the study was to evaluate the feasibility of this apparatus to estimate cardiac output in intensive care unit patients and to compare the non-invasive estimated cardiac output values with the respective gold standard method of thermodilution during pulmonary artery catheterization. Repeated sequential measurements of cardiac output were performed, in random order, by thermodilution (reference) and Mobil-O-Graph (test), in 24 patients hospitalized at intensive care unit. Reproducibility and accuracy of the test device were evaluated by Bland–Altman analysis, intraclass correlation coefficient, and percentage error. Mobil-O-Graph underestimated significantly the cardiac output by −1.12 ± 1.38 L/min ( p < 0.01) compared to thermodilution. However, intraclass correlation coefficient was >0.7 indicating a fair agreement between the test and the reference methods, while percentage error was approximately 39% which is considered to be within the acceptable limits. Cardiac output measurements were reproducible by both Mobil-O-Graph (intraclass correlation coefficient = 0.73 and percentage error = 27.9%) and thermodilution (intraclass correlation coefficient = 0.91 and percentage error = 26.7%). We showed for the first time that cardiac output estimation in intensive care unit patients using a non-invasive, automated, oscillometric, cuff-based apparatus is reproducible (by analyzing two repeated cardiac output measurements), exhibiting similar precision to thermodilution. However, the accuracy of Mobil-O-Graph (error compared to thermodilution) could be considered fairly acceptable. Future studies remain to further examine the reliability of this technology in monitoring cardiac output or stroke volume acute changes which is a more clinically relevant objective.

Interrater reliability of 2 sedation scales in a medical intensive care unit: a preliminary report

2001 ◽  
Vol 10 (2) ◽  
pp. 79-83 ◽  
Author(s):  
LH Hogg ◽  
MB Bobek ◽  
LC Mion ◽  
BM Legere ◽  
S Banjac ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Motor Activity ◽  
Correlation Coefficient ◽  
Interrater Reliability ◽  
Medical Intensive Care Unit ◽  
Intraclass Correlation ◽  
Assessment Scale ◽  
Activity Assessment ◽  
Medical Intensive Care

BACKGROUND: Critical care nurses must assess the effectiveness of sedatives and analgesic agents in order to titrate doses. OBJECTIVES: To measure the interrater reliability of 2 sedation scales used to assess patients in medical intensive care units. METHODS: The interrater reliabilities of the Motor Activity Assessment Scale and the Luer sedation scale were compared prospectively in 31 patients receiving mechanical ventilation in an 18-bed medical intensive care unit of a tertiary care institution. Three registered nurses, 1 clinical pharmacist, and 1 physician simultaneously and independently followed a standardized procedure to rate each patient by using the 2 scales. Scales were randomly ordered to counteract ordering effect. Analysis of variance with post hoc Duncan multiple range tests was used to detect bias; a correlation coefficient matrix was used to examine degree of association among raters; and the intraclass correlation coefficient was measured to control for multiple raters. RESULTS: No significant bias was detected with either scale. The Motor Activity Assessment Scale had less variation (Pearson r = 0.75-0.92) than did the Luer scale (Pearson r = 0.37-0.94) and had a stronger intraclass correlation coefficient (0.81 vs 0.79). CONCLUSIONS: The Motor Activity Assessment Scale showed the highest consistency among raters.

scholarly journals A preliminary study of intensivist-performed DVT ultrasound screening in trauma ICU patients (APSIT Study)

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Lloyd Roberts ◽  
Tom Rozen ◽  
Deirdre Murphy ◽  
Adam Lawler ◽  
Mark Fitzgerald ◽  
...  
Keyword(s):  
Intensive Care ◽  
Deep Vein Thrombosis ◽  
High Risk ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Major Trauma ◽  
Intraclass Correlation ◽  
Trauma Patients ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Background Multiple screening Duplex ultrasound scans (DUS) are performed in trauma patients at high risk of deep vein thrombosis (DVT) in the intensive care unit (ICU). Intensive care physician performed compression ultrasound (IP-CUS) has shown promise as a diagnostic test for DVT in a non-trauma setting. Whether IP-CUS can be used as a screening test in trauma patients is unknown. Our study aimed to assess the agreement between IP-CUS and vascular sonographer performed DUS for proximal lower extremity deep vein thrombosis (PLEDVT) screening in high-risk trauma patients in ICU. Methods A prospective observational study was conducted at the ICU of Alfred Hospital, a major trauma center in Melbourne, Australia, between Feb and Nov 2015. All adult major trauma patients admitted with high risk for DVT were eligible for inclusion. IP-CUS was performed immediately before or after DUS for PLEDVT screening. The paired studies were repeated twice weekly until the DVT diagnosis, death or ICU discharge. Written informed consent from the patient, or person responsible, or procedural authorisation, was obtained. The individuals performing the scans were blinded to the others’ results. The agreement analysis was performed using Cohen’s Kappa statistics and intraclass correlation coefficient for repeated binary measurements. Results During the study period, 117 patients had 193 pairs of scans, and 45 (39%) patients had more than one pair of scans. The median age (IQR) was 47 (28–68) years with 77% males, mean (SD) injury severity score 27.5 (9.53), and a median (IQR) ICU length of stay 7 (3.2–11.6) days. There were 16 cases (13.6%) of PLEDVT with an incidence rate of 2.6 (1.6–4.2) cases per 100 patient-days in ICU. The overall agreement was 96.7% (95% CI 94.15–99.33). The Cohen’s Kappa between the IP-CUS and DUS was 0.77 (95% CI 0.59–0.95), and the intraclass correlation coefficient for repeated binary measures was 0.75 (95% CI 0.67–0.81). Conclusions There is a substantial agreement between IP-CUS and DUS for PLEDVT screening in trauma patients in ICU with high risk for DVT. Large multicentre studies are needed to confirm this finding.

scholarly journals Intrarater and Interrater Reliability of Infrared Image Analysis of Forearm Acupoints before and after Moxibustion

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Jiali Lou ◽  
Yongliang Jiang ◽  
Hantong Hu ◽  
Xiaoyu Li ◽  
Yajun Zhang ◽  
...  
Keyword(s):  
Image Analysis ◽  
Correlation Coefficient ◽  
Temperature Change ◽  
Intraclass Correlation Coefficient ◽  
Interrater Reliability ◽  
Intraclass Correlation ◽  
Infrared Image ◽  
Infrared Images ◽  
Intrarater Reliability ◽  
Before And After

The objective of this study was to determine the intrarater and interrater reliabilities of infrared image analysis of forearm acupoints before and after moxibustion. In this work, infrared images of acupoints in the forearm of 20 volunteers (M/F, 10/10) were collected prior to and after moxibustion by infrared thermography (IRT). Two trained raters performed the analysis of infrared images in two different periods at a one-week interval. The intraclass correlation coefficient (ICC) was calculated to determine the intrarater and interrater reliabilities. With regard to the intrarater reliability, ICC values were between 0.758 and 0.994 (substantial to excellent). For the interrater reliability, ICC values ranged from 0.707 to 0.964 (moderate to excellent). Given that the intrarater and interrater reliability levels show excellent concordance, IRT could be a reliable tool to monitor the temperature change of forearm acupoints induced by moxibustion.

Feasibility, Reliability, Responsiveness, and Validity of the Patient-Reported Functional Scale for the Intensive Care Unit: A Pilot Study

2019 ◽  
Vol 35 (12) ◽  
pp. 1396-1404
Author(s):  
Julie C. Reid ◽  
France Clarke ◽  
Deborah J. Cook ◽  
Alexander Molloy ◽  
Jill C. Rudkowski ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Physical Function ◽  
Correlation Coefficient ◽  
Intraclass Correlation ◽  
Stair Climbing ◽  
Minimal Detectable Change ◽  
Functional Scale ◽  
Number Of Patients ◽  
Patient Reported

Background: Although many performance-based measures assess patients’ physical function in intensive care unit (ICU) survivors, to our knowledge, there are no patient-reported ICU rehabilitation-specific measures assessing function. We developed the Patient-Reported Functional Scale-ICU (PRFS-ICU), which measures patients’ perceptions of their ability to perform 6 activities (rolling, sitting edge of bed, sit-to-stand and bed-to-chair transfers, ambulation, and stair climbing). Each item is scored from 0 (unable) to 10 (able to perform at pre-ICU level) to a maximum of 60. Objectives: Estimate the feasibility, reliability, responsiveness, and validity of the PRFS-ICU. Methods: This was a substudy of TryCYCLE, a single-center, prospective cohort examining the safety and feasibility of early in-bed cycling with mechanically ventilated patients (NCT01885442). To determine feasibility, we calculated the number of patients with at least 1 PRFS-ICU assessment during their hospital stay. To assess reliability, 2 raters blinded to each other’s assessments administered the PRFS-ICU within 24-hours of each other. We calculated the intraclass correlation coefficient (ICC; 95% confidence interval [CI]), standard error of measurement (SEM, 95% CI), and minimal detectable change (MDC90). To assess validity, we estimated convergent validity of the PRFS-ICU with the Functional Status Score for ICU (FSS-ICU), Medical Research Council Sum Score (MRC-SS), Physical Function Test for ICU (PFIT-s), Katz Index of Independence in Activities of Daily Living (Katz ADLs), and a pooled index using Pearson's correlation coefficient ( r, 95% CI). Results: Feasibility: 20 patients completed a PRFS-ICU assessment. Reliability and responsiveness: 16 patients contributed data. The ICC, SEM, and MDC90 were 0.91 (0.76, 0.97), 4.75 (3.51, 7.35), and 11.04 points, respectively. Validity: 19 patients contributed data and correlations were ( r [95% CI]): FSS-ICU (0.40 [−0.14, 0.76]), MRC-SS (0.51 [0.02, 0.80]), PFIT-s (0.43 [−0.13, 0.78]), Katz ADLs (0.53 [0.10, 0.79]), and pooled index (0.48 [−0.14, 0.82]). Conclusions: Our pilot work suggests the PRFS-ICU may be a useful tool to assess and monitor patients’ perceptions of function over time.

Assessment of Occupational Functioning for Screening of Patients to Occupational Therapy in General Psychiatric Care

1998 ◽  
Vol 18 (4) ◽  
pp. 193-206 ◽  
Author(s):  
Lena Haglund ◽  
Lars-Hakan Thorell ◽  
Jan Walinder
Keyword(s):  
Occupational Therapy ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Interrater Reliability ◽  
Psychiatric Care ◽  
Rating Scale ◽  
Intraclass Correlation ◽  
Case Analysis ◽  
Occupational Therapist ◽  
Swedish Version

A Swedish version of the Occupational Case Analysis Interview and Rating Scale (OCAIRS-S) has been tested earlier for interrater reliability. The present study, using the second version of OCAIRS-S and including a sample of 145 patients, showed interrater correlations between .88 and .96 (Intraclass Correlation Coefficient). The results indicate that OCAIRS-S predicts which patients should be included in and excluded from occupational therapy and identifies patients who should be observed more before making such decisions. The study indicates a need for further investigations regarding which components in OCAIRS-S influence the occupational therapist in judging the patient's need for occupational therapy.

scholarly journals The reliability and validity of goniometric elbow measurements in adults: A systematic review of the literature

2018 ◽  
Vol 10 (4) ◽  
pp. 274-284 ◽  
Author(s):  
Suzanne F van Rijn ◽  
Elisa L Zwerus ◽  
Koen LM Koenraadt ◽  
Wilco CH Jacobs ◽  
Michel PJ van den Bekerom ◽  
...  
Keyword(s):  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Interrater Reliability ◽  
Literature Search ◽  
Meta Analysis ◽  
Intraclass Correlation ◽  
Reliability And Validity ◽  
Diagnostic Reliability ◽  
Measuring Tool ◽  
Simple Measuring

Background The universal goniometer is a simple measuring tool. With this review we aimed to investigate the reliability and validity of the universal goniometer in measurements of the adults' elbow. Methods Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines were followed and our study protocol was published online at PROSPERO. A literature search was conducted on relevant studies. Methodological quality was assessed using the Quality Appraisal of Diagnostic Reliability (QAREL) scoring system. Results Out of 697 studies yielded from our literature search, 12 were included. Six studies were rated as high quality. The intrarater reliability intraclass correlation coefficient ranged from 0.45 to 0.99, the interrater reliability ranged from intraclass correlation coefficient 0.53–0.97. One study providing instructions on goniometric alignment did not find a difference in expert versus non-expert examiners. Another study in which examiners were not instructed found a higher interrater reliability in expert examiners. One study investigating the validity of the goniometer in elbow measurements found a maximum standard error of the mean of 11.5° for total range of motion. Discussion Overall, the studies showed high intra- and interrater reliability of the universal goniometer. The reliability of the universal goniometer in non-expert examiners can be increased by clear instructions on goniometric alignment.

scholarly journals Reliability of the Function in Sitting Test (FIST)

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Sharon L. Gorman ◽  
Monica Rivera ◽  
Lise McCarthy
Keyword(s):  
Interrater Reliability ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Inpatient Rehabilitation ◽  
Neurological Dysfunction ◽  
Retest Reliability ◽  
Reliability Characteristics ◽  
Test Retest Reliability

The function in sitting test (FIST) is a newly developed, performance-based measure examining deficits in seated postural control. The FIST has been shown to be internally consistent and valid in persons with neurological dysfunction but intra- and interrater reliability and test-retest reliability have not been previously described. Seven patients with chronic neurologic dysfunction were tested and videotaped performing the FIST on two consecutive days. Seventeen acute care and inpatient rehabilitation physical therapist raters scored six of the videotaped performance of the FIST on two occasions at least 2 weeks apart. Intraclass correlation coefficients were used to calculate the test-retest and intra- and interrater reliability of the FIST. ICC of 0.97 (95% CI 0.847–0.995) indicated excellent test-retest reliability of the FIST. Intra- and interrater reliability was also excellent with ICCs of 0.99 (95% CI 0.994–0.997) and 0.99 (95% CI 0.988–0.994), respectively. Physical therapists and other rehabilitation professionals can confidently use the FIST in a variety of clinical practice and research settings due to its favorable reliability characteristics. More studies are needed to describe the responsiveness and minimal clinically important level of change in FIST scores to further enhance clinical usefulness of this measure.

scholarly journals Reliability of Measurement of Glenohumeral Internal Rotation, External Rotation, and Total Arc of Motion in 3 Test Positions

2014 ◽  
Vol 49 (5) ◽  
pp. 640-646 ◽  
Author(s):  
Mark A. Kevern ◽  
Michael Beecher ◽  
Smita Rao
Keyword(s):  
Internal Rotation ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Interrater Reliability ◽  
External Rotation ◽  
Intraclass Correlation ◽  
Test Procedure ◽  
Intrarater Reliability ◽  
Testing Procedures ◽  
Test Position

Context: Athletes who participate in throwing and racket sports consistently demonstrate adaptive changes in glenohumeral-joint internal and external rotation in the dominant arm. Measurements of these motions have demonstrated excellent intrarater and poor interrater reliability. Objective: To determine intrarater reliability, interrater reliability, and standard error of measurement for shoulder internal rotation, external rotation, and total arc of motion using an inclinometer in 3 testing procedures in National Collegiate Athletic Association Division I baseball and softball athletes. Design: Cross-sectional study. Setting: Athletic department. Patients or Other Participants Thirty-eight players participated in the study. Shoulder internal rotation, external rotation, and total arc of motion were measured by 2 investigators in 3 test positions. The standard supine position was compared with a side-lying test position, as well as a supine test position without examiner overpressure. Results: Excellent intrarater reliability was noted for all 3 test positions and ranges of motion, with intraclass correlation coefficient values ranging from 0.93 to 0.99. Results for interrater reliability were less favorable. Reliability for internal rotation was highest in the side-lying position (0.68) and reliability for external rotation and total arc was highest in the supine-without-overpressure position (0.774 and 0.713, respectively). The supine-with-overpressure position yielded the lowest interrater reliability results in all positions. The side-lying position had the most consistent results, with very little variation among intraclass correlation coefficient values for the various test positions. Conclusions: The results of our study clearly indicate that the side-lying test procedure is of equal or greater value than the traditional supine-with-overpressure method.

scholarly journals Recommendations for Hospital-Based Physical Therapists Managing Patients With COVID-19

2020 ◽  
Vol 100 (9) ◽  
pp. 1444-1457 ◽  
Author(s):  
Karin M Felten-Barentsz ◽  
Roel van Oorsouw ◽  
Emily Klooster ◽  
Niek Koenders ◽  
Femke Driehuis ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
The Netherlands ◽  
Working Group ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Treatment Recommendations ◽  
Hospitalized Patients ◽  
Respiratory Support ◽  
Active Mobilization

Abstract Objective The COVID-19 pandemic is rapidly evolving and has led to increased numbers of hospitalizations worldwide. Hospitalized patients with COVID-19 experience a variety of symptoms, including fever, muscle pain, tiredness, cough, and difficulty breathing. Elderly people and those with underlying health conditions are considered to be more at risk of developing severe symptoms and have a higher risk of physical deconditioning during their hospital stay. Physical therapists have an important role in supporting hospitalized patients with COVID-19 but also need to be aware of challenges when treating these patients. In line with international initiatives, this article aims to provide guidance and detailed recommendations for hospital-based physical therapists managing patients hospitalized with COVID-19 through a national approach in the Netherlands. Methods A pragmatic approach was used. A working group conducted a purposive scan of the literature and drafted initial recommendations based on the knowledge of symptoms in patients with COVID-19 and current practice for physical therapist management for patients hospitalized with lung disease and patients admitted to the intensive care unit. An expert group of hospital-based physical therapists in the Netherlands provided feedback on the recommendations, which were finalized when consensus was reached among the members of the working group. Results The recommendations include safety recommendations, treatment recommendations, discharge recommendations, and staffing recommendations. Treatment recommendations address 2 phases of hospitalization: when patients are critically ill and admitted to the intensive care unit, and when patients are severely ill and admitted to the COVID ward. Physical therapist management for patients hospitalized with COVID-19 comprises elements of respiratory support and active mobilization. Respiratory support includes breathing control, thoracic expansion exercises, airway clearance techniques, and respiratory muscle strength training. Recommendations toward active mobilization include bed mobility activities, active range-of-motion exercises, active (assisted) limb exercises, activities-of-daily-living training, transfer training, cycle ergometer, pre-gait exercises, and ambulation.

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