scholarly journals Establishing Intra- and Inter-Rater Agreement of the Face, Legs, Activity, Cry, Consolability Scale for Evaluating Pain in Toddlers During Immunization

2013 ◽  
Vol 18 (6) ◽  
pp. e124-e128 ◽  
Author(s):  
Rebecca J Gomez ◽  
Nick Barrowman ◽  
Sonja Elia ◽  
Elizabeth Manias ◽  
Jenny Royle ◽  
...  
Keyword(s):  
Young Children ◽  
Controlled Trial ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Random Order ◽  
Video Data ◽  
Rater Agreement ◽  
Convenience Sample ◽  
Final Injection ◽  
The Face

BACKGROUND: The Face, Legs, Activity, Cry, Consolability (FLACC) scale is a five-item tool that was developed to assess postoperative pain in young children. The tool is frequently used as an outcome measure in studies investigating acute procedural pain in young children; however, there are limited published psychometric data in this context.OBJECTIVE: To establish inter-rater and intrarater agreement of the FLACC scale in toddlers during immunization.METHODS: Participants comprised a convenience sample of toddlers recruited from an immunization drop-in service, who were part of a larger pilot randomized controlled trial. Toddlers were video- and audiotaped during immunization procedures. The first rater scored each video twice in random order over a period of three weeks (intrarater agreement), while the second rater scored each video once and was blinded to the first rater’s scores (inter-rater agreement). The FLACC scale was scored at four time-points throughout the procedure. Intraclass correlation coefficients were used to assess agreement of the FLACC scale.RESULTS: Thirty toddlers between 12 and 18 months of age were recruited, and video data were available for 29. Intrarater agreement coefficients were 0.88 at baseline, 0.97 at insertion of first needle, and 0.80 and 0.81 at 15 s and 30 s following the final injection, respectively. Inter-rater coefficients were 0.40 at baseline, 0.95 at insertion of first needle, and 0.81 and 0.78 at 15 s and 30 s following the final injection, respectively.CONCLUSIONS: The FLACC scale has sufficient agreement in assessing pain in toddlers during immunizations, especially during the most painful periods of the procedure.

scholarly journals Preliminary evidence that high levels of nicotine on children’s hands may contribute to overall tobacco smoke exposure

2017 ◽  
Vol 27 (2) ◽  
pp. 217-219 ◽  
Author(s):  
E Melinda Mahabee-Gittens ◽  
Ashley L Merianos ◽  
Georg E Matt
Keyword(s):  
Young Children ◽  
Tobacco Smoke ◽  
Controlled Trial ◽  
Positive Association ◽  
Preliminary Evidence ◽  
Tobacco Smoke Exposure ◽  
Second Hand Smoke ◽  
Significant Positive Association ◽  
Convenience Sample ◽  
Salivary Cotinine

BackgroundDust and surfaces are important sources of lead and pesticide exposure in young children. The purpose of this pilot study was to investigate if third-hand smoke (THS) pollutants accumulate on the hands of children who live in environments where tobacco is used and if hand nicotine levels are associated with second-hand smoke (SHS), as measured by salivary cotinine.MethodsParticipants were parents and children (n=25; age mean (SD)=5.4 (5.3) years) presenting to the emergency department with a potentially SHS-related illness. A convenience sample of participants were recruited at baseline from an ongoing two-group, randomised controlled trial of a SHS reduction and tobacco cessation intervention. Parents were current smokers; thus, all children were at risk of SHS and THS exposure to varying extents. Primary outcome measures, which were assessed in child participants only, were hand nicotine and salivary cotinine. Parents reported sociodemographics and smoking patterns; children’s medical records were abstracted for chief complaint, medical history and discharge diagnosis.ResultsAll children had detectable hand nicotine (range=18.3–690.9 ng/wipe). All but one had detectable cotinine (range=1.2–28.8 ng/mL). Multiple linear regression results showed a significant positive association between hand nicotine and cotinine (p=0.009; semipartial r2=0.24), independent of child age.DiscussionThe higher-than-expected nicotine levels and significant association with cotinine indicate that THS may play a role in the overall exposure of young children to tobacco smoke toxicants and that hand wipes could be a useful marker of overall tobacco smoke pollution and a proxy for exposure.Trial registration numberClinicalTrials.gov Identifier: NCT02531594

Influence of Handgrip Stabilization During Isokinetic Knee Strength Assessment in Older Women

2020 ◽  
Vol 127 (4) ◽  
pp. 671-683
Author(s):  
João P. Nunes ◽  
Paolo M. Cunha ◽  
Jerry L. Mayhew ◽  
Alex S. Ribeiro ◽  
Paulo S. Junior ◽  
...  
Keyword(s):  
Older Women ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Knee Extension ◽  
Convenience Sample ◽  
Strength Assessment ◽  
Intraclass Correlation Coefficients ◽  
Knee Strength ◽  
Hands On ◽  
Angular Velocities

The present study aimed to evaluate the influence of holding the chair handles during the assessment of older women’s knee flexion and extension isokinetic and isometric strength. Of 57 older women (≥60 years) selected from a convenience sample for this research, 23 were randomly chosen to perform the tests twice for reliability analyses. Each participant performed maximal isokinetic knee extension and flexion at 60°/s and 180°/s angular velocities and isometric tests under two conditions: (a) holding the lateral handle of the chair (HOLD) and (b) supporting the hands on the shoulders with the arms crossed (i.e., not holding the handle [NHOLD]). Participants performed significantly better in the HOLD compared with the NHOLD condition. Slightly lower intraclass correlation coefficients (ICC = 0.870–0.956) were noted for the HOLD than for the NHOLD condition (ICC = 0.900–0.981) so that the HOLD performance on Days 1 and 2 was different on some measures. Owing to the higher reliability coefficients in the NHOLD condition, results suggest that, when assessing knee strength in older women, the evaluee should place their hands over their shoulders with arms crossed in front of the chest (NHOLD) to maximize assessment reliability (reproducibility of performance).

scholarly journals Comparison of Anterior Ocular Biometric Measurements Using Swept-Source and Time-Domain Optical Coherence Tomography

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Sisi Chen ◽  
Rongrong Gao ◽  
Colm McAlinden ◽  
Junming Ye ◽  
Yiran Wang ◽  
...  
Keyword(s):  
Time Domain ◽  
Corneal Thickness ◽  
Intraclass Correlation ◽  
Anterior Segment ◽  
Anterior Chamber Depth ◽  
Correlation Coefficients ◽  
Random Order ◽  
Optical Coherence ◽  
Swept Source ◽  
Significant Difference

Purpose. To compare central corneal thickness (CCT), aqueous depth (AQD), and anterior chamber depth (ACD) measurements using the swept-source (CASIA SS-1000, Tomey, Japan) and time-domain (Visante, Carl Zeiss Meditec, USA) anterior segment optical coherence tomographers (OCT) in normal eyes. Methods. Sixty-eight eyes of 68 subjects were included. Three consecutive scans of each subject were obtained using both devices in a random order by one experienced operator. Standard deviation (Sw), coefficient of repeatability (CoR), coefficients of variation (CoV), and intraclass correlation coefficients (ICC) were used to evaluate the intraoperator repeatability. Agreement was assessed using the Bland–Altman plots and 95% limits of agreement (LoA). Results. All measurements of the swept-source OCT (SS-OCT) and time-domain OCT (TD-OCT) showed high repeatability with low CoR (CCT: 2.34 μm and 6.16 μm; AQD: 0.05 mm and 0.09 mm; ACD: 0.06 mm and 0.09 mm), low CoV (CCT: 0.16% and 0.42%; AQD: 0.61% and 0.97%; ACD: 0.53% and 0.83%), and high ICC (>0.98). The mean CCT with SS-OCT was slightly thicker than the results with TD-OCT (difference = 4.55 ± 2.62 μm, P<0.001). There was no statistically significant difference in AQD or ACD measurements between the two devices (0.01 ± 0.05 mm, P=0.111; 0.02 ± 0.05 mm, P=0.022, respectively). The 95% LoA between the SS-OCT and TD-OCT were −0.59 to 9.69 μm for CCT, −0.10 to 0.12 mm for AQD, and −0.09 to 0.12 mm for ACD. Conclusions. High levels of repeatability and agreement were found between the two devices for all three parameters, suggesting interchangeability. SS-OCT demonstrated superior repeatability compared with TD-OCT.

Development and assessment of the inter-rater and intra-rater reproducibility of a self-administration version of the ALSFRS-R

2019 ◽  
Vol 91 (1) ◽  
pp. 75-81 ◽  
Author(s):  
Leonhard A Bakker ◽  
Carin D Schröder ◽  
Harold H G Tan ◽  
Simone M A G Vugts ◽  
Ruben P A van Eijk ◽  
...  
Keyword(s):  
Rating Scale ◽  
Clinical Care ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
The Self ◽  
Coefficient Alpha ◽  
Rater Agreement ◽  
Self Administration ◽  
Limits Of Agreement ◽  
Rater Reliability

ObjectiveThe Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) is widely applied to assess disease severity and progression in patients with motor neuron disease (MND). The objective of the study is to assess the inter-rater and intra-rater reproducibility, i.e., the inter-rater and intra-rater reliability and agreement, of a self-administration version of the ALSFRS-R for use in apps, online platforms, clinical care and trials.MethodsThe self-administration version of the ALSFRS-R was developed based on both patient and expert feedback. To assess the inter-rater reproducibility, 59 patients with MND filled out the ALSFRS-R online and were subsequently assessed on the ALSFRS-R by three raters. To assess the intra-rater reproducibility, patients were invited on two occasions to complete the ALSFRS-R online. Reliability was assessed with intraclass correlation coefficients, agreement was assessed with Bland-Altman plots and paired samples t-tests, and internal consistency was examined with Cronbach’s coefficient alpha.ResultsThe self-administration version of the ALSFRS-R demonstrated excellent inter-rater and intra-rater reliability. The assessment of inter-rater agreement demonstrated small systematic differences between patients and raters and acceptable limits of agreement. The assessment of intra-rater agreement demonstrated no systematic changes between time points; limits of agreement were 4.3 points for the total score and ranged from 1.6 to 2.4 points for the domain scores. Coefficient alpha values were acceptable.DiscussionThe self-administration version of the ALSFRS-R demonstrates high reproducibility and can be used in apps and online portals for both individual comparisons, facilitating the management of clinical care and group comparisons in clinical trials.

Development and Validation of MRI Sacroiliac Joint Scoring Methods for the Semiaxial Scan Plane Corresponding to the Berlin and SPARCC MRI Scoring Methods, and of a New Global MRI Sacroiliac Joint Method

2017 ◽  
Vol 45 (1) ◽  
pp. 70-77 ◽  
Author(s):  
Pernille Hededal ◽  
Mikkel Østergaard ◽  
Inge Juul Sørensen ◽  
Anne Gitte Loft ◽  
Jens S. Hindrup ◽  
...  
Keyword(s):  
Sacroiliac Joint ◽  
Controlled Trial ◽  
Linear Regression Analysis ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Scoring Methods ◽  
Double Blind ◽  
Smallest Detectable Change ◽  
Observed Score ◽  
Very High

Objective.To develop semiaxial magnetic resonance imaging (MRI) scoring methods for assessment of sacroiliac joint (SIJ) bone marrow edema (BME) in patients with axial spondyloarthritis, and to compare the reliability with equivalent semicoronal scoring methods.Methods.Two semiaxial SIJ MRI scoring methods were developed based on the principles of the semicoronal Berlin and Spondyloarthritis Research Consortium of Canada (SPARCC) methods. A global quadrant-based method was also developed. Baseline and 12-week MRI of the SIJ from 51 patients participating in a randomized double-blind placebo-controlled trial of adalimumab 40 mg every other week versus placebo were scored by the semiaxial and the corresponding semicoronal methods. Results were compared by linear regression analysis. The reproducibility and sensitivity were evaluated by intraclass correlation coefficients (ICC) and smallest detectable change [SDC, absolute values and percentage of the highest observed score (SDC-HOS)].Results.Interreader and intrareader ICC were moderate to very high for semiaxial scoring methods (baseline 0.83–0.88 and 0.85–0.97; change 0.33–0.78), while high to very high for semicoronal scoring methods (baseline 0.90–0.92 and 0.93–0.97; change 0.77–0.89). Association between semiaxial and semicoronal scores were high for both the Berlin and SPARCC method (baseline: R2 = 0.93 and 0.88; change: R2 = 0.82 and 0.87, respectively), while lower for the global method (baseline: R2 = 0.79; change: R2 = 0.54). The SDC-HOS were 9.8–18.6% and 5.9–10.7% for the semiaxial and semicoronal methods, respectively.Conclusion.Detection of SIJ BME in the semiaxial scan plane is feasible and reproducible. However, a slightly lower reliability of all 3 semiaxial methods supports the general practice of using the coronal scan-plane in therapeutic studies.

Intertester Reliability of the Acceptable Noise Level

2012 ◽  
Vol 23 (07) ◽  
pp. 534-541 ◽  
Author(s):  
Susan Gordon-Hickey ◽  
Elizabeth Adams ◽  
Robert Moore ◽  
Ashley Gaal ◽  
Katie Berry ◽  
...  
Keyword(s):  
Noise Level ◽  
Background Noise ◽  
Hearing Aid ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Random Order ◽  
Instruction Set ◽  
Intraclass Correlation Coefficients ◽  
Acceptable Noise Level ◽  
Quasi Experimental

Background: The acceptable noise level (ANL) serves to accurately predict the listener's likelihood of success with amplification. It has been proposed as a pre–hearing aid fitting protocol for hearing aid selection and counseling purposes. The ANL is a subjective measure of the listener's ability to accept background noise. Measurement of ANL relies on the tester and listener to follow the instructions set forth. To date, no research has explored the reliability of ANL as measured across clinicians or testers. Purpose: To examine the intertester reliability of ANL. Research Design: A descriptive quasi-experimental reliability study was completed. ANL was measured for one group of listeners by three testers. Study Sample: Three participants served as testers. Each tester was familiar with basic audiometry. Twenty-five young adults with normal hearing served as listeners. Data Collection/Analysis: Each tester was stationed in a laboratory with the needed equipment. Listeners were instructed to report to these laboratories in a random order provided by the experimenters. The testers assessed most comfortable listening level (MCL) and background noise level (BNL) for all 25 listeners. Results: Intraclass correlation coefficients were significant and revealed that MCL, BNL, and ANLs are reliable across testers. Additionally, one-way ANOVAs for MCL, BNL, and ANL were not significant. These findings indicate that MCL, BNL, and ANL do not differ significantly when measured by different testers. Conclusions: If the ANL instruction set is accurately followed, ANL can be reliably measured across testers, laboratories, and clinics. Intertester reliability of ANL allows for comparison across ANLs measured by different individuals. Findings of the present study indicate that tester reliability can be ruled out as a factor contributing to the disparity of mean ANLs reported in the literature.

scholarly journals EXCELLENT RELIABILITY OF SEMI-QUANTITATIVE NAILFOLD CAPILLAROSCOPY IN PATIENTS WITH SYSTEMIC SCLEROSIS – A PILOT STUDY

2016 ◽  
Vol 25 (4) ◽  
pp. 194-198
Author(s):  
Ana Maria Gheorghiu ◽  
◽  
Raida Oneata ◽  
Mihai Bojinca ◽  
Rucsandra Dobrota ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Pilot Study ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Nailfold Capillaroscopy ◽  
Qualitative Assessment ◽  
Rater Agreement ◽  
Quality Of Data ◽  
Good Test ◽  
Good Reliability

Background. Semi-quantitative nailfold capillaroscopy (NFC) scoring represents a promising tool for assessing disease activity, severity and change in systemic sclerosis (SSc), however there is no consensus yet over which capillaroscopy abnormalities should be analyzed and how. Objective. Investigation of the reliability of the qualitative and semi-quantitative scoring of NFC assessment between two raters and test-retest for each rater in a SSc cohort. Methods. This is a single-center pilot study where 2 raters assessed the NFC images of 48 consecutive patients with SSc. Data were analyzed in 3 ways: 1. qualitatively by “normal”/“abnormal” category; 2. qualitatively by the following categories: “early”, “active”, “late” SSc patterns, “normal”, and unclassifiable in any pattern, and step; 3. Semi-quantitatively by calculating the mean score for capillary loss, disorganization of the microvascular array, giant capillaries, microhaemorrhages and capillary ramifications and combinations of giant capillaries and microhaemorrhages (as a surrogate for vascular activity). Disorganization and ramifications (surrogate for vascular damage) were also assessed. Variables for all steps were calculated for all fingers and for each finger. Inter-rater/intra-rater agreement was assessed by Cohen’s kappa coefficients for qualitative variables and by intraclass correlation coefficients (ICC) for mean score values of abnormalities. Results. Inter-rater reliability ranged from good to excellent agreement for mean score values of abnormalities in all fingers (ICC coefficients 0.745 to 0.897) and was excellent for activity (ICC coefficient of 0.923) and damage combinations (ICC coefficient of 0.918). Assessment of abnormalities in a qualitative manner (normal/abnormal or with capillaroscopy patterns) showed weaker inter-rater agreement than the semi-quantitative assessment (k coefficient <0.7). Intra-rater variability was good to excellent for mean score values of abnormalities and activity and damage combinations in all fingers and separate fingers for both raters; for qualitative assessment, only one of the raters had good test-retest reliability. Conclusion. Reliability of NFC assessment is essential in SSc trials/clinical practice to ensure quality of data. This pilot study demonstrates very good reliability between raters of the semi-quantitative NFC assessment in a SSc cohort. Combinations of NFC abnormalities had very good reliability and might be preferred because they are less time consuming.

scholarly journals Assessment of spatiotemporal gait parameters using a deep learning algorithm-based markerless motion capture system

2020 ◽  
Author(s):  
Robert Kanko ◽  
Gerda Strutzenberger ◽  
Marcus Brown ◽  
Scott Selbie ◽  
Kevin Deluzio
Keyword(s):  
Motion Capture ◽  
Learning Algorithm ◽  
Pearson Correlation ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Healthy Adults ◽  
Video Data ◽  
Heel Strike ◽  
Markerless Motion Capture ◽  
Gait Parameters

Spatiotemporal parameters can characterize the gait patterns of individuals, allowing assessment of their health status and detection of clinically meaningful changes in their gait. Video-based markerless motion capture is a user-friendly, inexpensive, and widely applicable technology that could reduce the barriers to measuring spatiotemporal gait parameters in clinical and more diverse settings. Two studies were performed to determine whether gait parameters measured using markerless motion capture demonstrate concurrent validity with those measured using marker-based motion capture and pressure sensitive gait mats. For the first study, thirty healthy adults performed treadmill gait at self-selected speeds while marker-based motion capture and synchronized video data were recorded simultaneously. For the second study, twenty-five healthy adults performed over-ground gait at self-selected speeds while footfalls were recorded using a gait mat and synchronized video data were recorded simultaneously. Kinematic heel-strike and toe-off gait events were used to identify the same gait cycles between systems. Nine spatiotemporal gait parameters were measured by each system and directly compared between systems. Measurements were compared using Bland-Altman methods, mean differences, Pearson correlation coefficients, and intraclass correlation coefficients. The results indicate that markerless measurements of spatiotemporal gait parameters have good to excellent agreement with marker-based motion capture and gait mat systems, except for stance time and double limb support time relative to both systems and stride width relative to the gait mat. These findings indicate that markerless motion capture can adequately measure spatiotemporal gait parameters during treadmill and overground gait.

scholarly journals How Important Is Randomization of Swallows During Kinematic Analyses of Swallow Function?

2020 ◽  
Vol 29 (3) ◽  
pp. 1650-1654
Author(s):  
Cara Donohue ◽  
James L. Coyle
Keyword(s):  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Random Order ◽  
Preliminary Evidence ◽  
Intrarater Reliability ◽  
Kinematic Data ◽  
Intraclass Correlation Coefficients ◽  
Exact Agreement ◽  
Kinematic Analyses ◽  
Swallow Function

Purpose In dysphagia research involving kinematic analyses on individual swallow parameters, randomization is used to ensure judges are not influenced by judgments made for other parameters within the same swallow or by judgments made for other swallows from the same participant. Yet, the necessity of randomizing swallows to avoid bias during kinematic analyses is largely assumed and untested. This study investigated whether randomization of the order of swallows presented to judges impacts analyses of temporal kinematic events from videofluoroscopic swallow studies. Method One hundred twenty-seven swallows were analyzed from 18 healthy adults who underwent standardized videofluoroscopic swallow studies. Swallows were first analyzed by two trained raters sequentially, analyzing all kinematic events within each swallow, and then a second time in random order, measuring one kinematic event at a time. Intrarater reliability measurements were calculated between random and sequential swallow judgments for all kinematic events using intraclass correlation coefficient and percent exact agreement within a three-frame tolerance. Results Intraclass correlation coefficients (1.00) and percent exact agreement (89%) were excellent for all kinematic events between analyses methods, indicating there were no significant differences in measurements performed in random or sequential order. Conclusions This study provides preliminary evidence that randomization may be unnecessary during temporal swallow kinematic data analyses for research, which may lead to more efficient analyses and dissemination of findings, and alignment of findings with clinical interpretations. Replication of this design with swallows from people with dysphagia would strengthen the generalizability of the results.

A Randomized Controlled Trial of Dexamethasone as a Prophylactic Treatment for Subglottic Stenosis in a Rabbit Model

2020 ◽  
pp. 000348942094677
Author(s):  
Paul Wistermayer ◽  
Derek Escalante ◽  
Wesley McIlwain ◽  
Derek J. Rogers
Keyword(s):  
Controlled Trial ◽  
Intraclass Correlation ◽  
Rabbit Model ◽  
Preventive Treatment ◽  
Subglottic Stenosis ◽  
Control Group ◽  
Rater Agreement ◽  
Post Injury ◽  
Cross Sectional

Objective: Iatrogenic injury is a common cause of subglottic stenosis (SGS). We investigated the role of pre-injury dexamethasone as a preventive treatment for iatrogenic subglottic stenosis. Methods: 16 New Zealand White rabbits were used in an IACUC approved study. Subjects were divided into two groups: intramuscular dexamethasone (DEX) at a dose of 2 mg/kg 15 minutes prior to an endoscopic injury to create SGS, and the same injury creation with a preoperative intramuscular saline (SAL) injection. Three independent, blinded raters evaluated endoscopic images to obtain cross sectional area (CSA) airway measurements. Rabbit airways were measured just prior to injury and at one week post-injury. All subjects were provided as-needed postoperative steroids and buprenorphine for symptoms of respiratory distress. Data analysis was performed using Student t-test. Intraclass correlation coefficients were used to assess inter-rater agreement. Results: All subjects survived to the one-week post-injury airway evaluation. There was no difference in airway size between groups prior to injury ( P = .28). Subjects in the DEX group demonstrated an average stenosis of 20.3% (95% CI 10.2-30.5) at one week compared to 60.6% (95% CI 40.3-80.9) in the SAL group ( P = .01). Subjects in the control group required significantly more doses of postoperative dexamethasone ( P = .02). Inter-rater agreement for between raters was excellent (ICC = .88). Conclusion: This is the first study to examine the role of pre-injury glucocorticoids in preventing iatrogenic subglottic stenosis. In our model, a single dose of intramuscular dexamethasone given prior to a subglottic injury resulted in a statistically significant reduction in airway stenosis. This research suggests that administering systemic dexamethasone should be considered prior to any procedure that may injure the subglottis, including traumatic intubation, to prevent iatrogenic subglottic stenosis.

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