Showing papers on "Intra-rater reliability published in 2010"

Validity and Between-Day Reliability of the Cervical Range of Motion (CROM) Device

Abstract: Study Design Clinical measurement, validity and intrarater reliability study. Objectives (1) To confirm the validity and assess between-day test-retest reliability of cervical spine motion measurements made with the cervical range of motion (CROM) device in flexion, extension, bilateral rotation, and bilateral side flexion; (2) to provide meaningful information to clinicians about the standard error of measurement and the minimal detectable change for the CROM device. Background Range of motion is a common outcome measure used in the assessment of the cervical spine. The CROM device is one of the tools used to measure cervical range of motion in the clinical setting. However, its psychometric properties are not well established, especially for measurements taken on separate days. Methods Quasi-experimental design with 1 group comparison. Twenty healthy adults (9 men and 11 women) participated in this study. Cervical range of motion was simultaneously recorded with the CROM device and the Fastrak motion an...

Clinical measurement of the thoracic kyphosis. A study of the intra-rater reliability in subjects with and without shoulder pain

Abstract: Background: Clinical sagittal plane assessment of the thoracic kyphosis angle is considered an essential component of the postural examination of patients presenting with upper body pain syndromes. Cervical headaches and conditions involving the shoulder, such as subacromial pain syndrome, have all been associated with an increase in the thoracic kyphosis. Concomitantly a decrease in the thoracic kyphosis as a result of a stretching and strengthening rehabilitation programme is believed to be associated with a reduction in symptoms and pain and improvement in function. Clinicians generally measure the sagittal plane kyphosis angle visually. There is no certainty that this method is reliable or is capable of measuring angular changes over time or in response to intervention. As such a simple and reliable clinical method of measuring the thoracic kyphosis would enable clinicians to record this information. The aim of this investigation was to determine the intra-tester reliability of measuring the thoracic kyphosis angle using a clinical method Methods: Measurements were made in 45 subjects with and 45 subjects without upper body symptoms. Measurements were made with the subjects in relaxed standing. Two gravity dependent inclinometers were used to measure the kyphosis. The first was placed over the region of the 1 st and 2 nd thoracic spinous processes. The other, over the region of the 12 th thoracic and 1 st lumbar spinous processes. The angle produced by each inclinometer was measured 3 times in succession. Each set of 3 measurements was made on two occasions (separated by a minimum of 30 minutes and additional data collection involving 46 further measurements of posture and movement on the same and an additional subject before the thoracic kyphosis measurements were re-measured) by one rater. The reliability of the measurements was analyzed using 2-way ANOVA intraclass correlation coefficients (ICC), 95% confidence intervals (CI) and standard error of measurement (SEM) for precision, for a single measurement [ICC(single)] and the average of 3 measures [ICC(average)]. The assessor remained ‘blinded’ to data input and the measurements were staggered to reduce examiner bias. Results: The measurement of the thoracic kyphosis as used in this investigation was found to have excellent intrarater reliability for both subjects with and without symptoms. The ICC(single) results for the subjects without symptoms were, .95; (95% CI .91-.97). The corresponding ICC(average) results were; .97; (95% CI .95-.99). The results for the subjects with symptoms were; 93; (95% CI .88-.96), for ICC(single) and for ICC(average); .97; (95% CI .94-.98). The SEM results for subjects without and with symptoms were 1.0° and 1.7°, respectively. Conclusions: The findings of this immediate test-retest reliability study suggest that the clinical measurement of the thoracic kyphosis using gravity dependent inclinometers demonstrates excellent intra-rater reliability. Additional research is required to determine the inter-rater reliability of this method.

Reliability and Agreement of Hip Range of Motion and Provocative Physical Examination Tests in Asymptomatic Volunteers

Abstract: Objective To: (1) report passive hip range of motion (ROM) in asymptomatic young adults, (2) report the intratester and intertester reliability of hip ROM measurements among testers of multiple disciplines, and (3) report the results of provocative hip tests and tester agreement. Design Descriptive epidemiology study. Setting Tertiary university. Participants Twenty-eight young adult volunteers without musculoskeletal symptoms, history of disorder, or surgery involving the lumbar spine or lower extremities were enrolled and completed the study. Methods Asymptomatic young adult volunteers completed questionnaires and were examined by 2 blinded examiners during a single session. The testers were physical therapists and physicians. Hip ROM and provocative tests were completed by both examiners on each hip. Main Outcome Measurements Inter-rater and intrarater reliability for ROM and agreement for provocative tests were determined. Results Twenty-eight asymptomatic adults, mean age 31 years (range, 18-51 years), with a mean modified Harris Hip Score of 99.5 ± 1.5 and UCLA activity score of 8.8 ± 1.2 completed the study. Intrarater agreement was excellent for all hip ROM measurements, with intraclass correlation coefficients (ICCs) ranging from 0.76 to 0.97, with similar agreement if the examiner was a physical therapist or a physician. Excellent inter-rater reliability was found for hip flexion ICC 0.87 (95% confidence interval [95% CI] 0.78-0.92), supine internal rotation ICC 0.75 (95% CI 0.60-0.84), and prone internal rotation ICC 0.79 (95% CI 0.66-0.87). The least reliable measurements were supine hip abduction (ICC 0.34) and supine external rotation (ICC 0.18). Agreement between examiners ranged from 96% to 100% for provocative hip tests, which included the hip impingement, resisted straight leg raise, Flexion Abduction External Rotation/Patrick, and log roll tests. Conclusions Specific hip ROM measures show excellent inter-rater reliability, and provocative hip tests show good agreement among multiple examiners and medical disciplines. Further studies are needed to assess the use of these measurements and tests as a part of a hip screening examination to assess for young adults at risk for intra-articular hip disorders before the onset of degenerative changes.

The reliability of portable fixed dynamometry during hip and knee strength assessments.

Abstract: Context: Insufficient lower extremity strength may be a risk factor for lower extremity injuries such as noncontact anterior cruciate ligament tears. Therefore, clinicians need reliable instruments to assess strength deficiencies. Objective: To assess the intrarater, interrater, intrasession, and intersession reliability of a portable fixed dynamometer in measuring the strength of the hip and knee musculature. Design: Crossover study. Setting: Sports medicine research laboratory. Patients or Other Participants: Three raters (A, B, C) participated in this 2-phase study. Raters A and B tested 11 healthy college graduate students (2 men, 9 women) in phase 1. Raters A and C tested 26 healthy college undergraduate students (7 men, 19 women) in phase 2. Main Outcome Measure(s): The dependent variables for the study were hip adductor, hip abductor, hip flexor, hip extensor, hip internal rotator, hip external rotator, knee flexor, and knee extensor peak force. Results: The phase 1 intrasession intraclass correlation coefficients for sessions 1, 2, and 3 ranged from 0.88 to 0.99 (SEM 5 0.08–3.02 N), 0.85 to 0.99 (SEM 5 0.26–3.88 N), and 0.92 to 0.96 (SEM 5 0.52–2.76 N), respectively. Intraclass correlation coefficients ranged from 0.57 to 0.95 (SEM 5 1.72– 13.15 N) for phase 1 intersession values, 0.70 to 0.94 (SEM 5 1.42–9.20 N) for phase 2 intrarater reliability values, and 0.69 to 0.88 (SEM 5 1.20–8.50 N) for phase 2 interrater values. Conclusions: The portable fixed dynamometer showed good to high intrasession and intersession reliability values for hip and knee strength. Intrarater and interrater reliability were fair to high, except for hip internal rotation, which showed poor reliability.

Telerehabilitation mediated physiotherapy assessment of ankle disorders.

Abstract: Background and Purpose. Musculoskeletal injuries are the most common source of chronic pain and disability. The ankle joint is the most common of these injuries and without adequate rehabilitation function can be severely impaired. Access to physiotherapy rehabilitation services can be limited due to geographical remoteness and a shortage of services in rural and remote areas. Telerehabilitation is a potential solution to bridge this service delivery gap. The aim of this study was to determine the criterion validity and reliability of conducting a remote musculoskeletal assessment of the ankle joint complex using telerehabilitation technologies compared with a face-to-face assessment. Methods. This study utilized a repeated measures design to assess 15 subjects (mean age 24.5, SD 10.8 years) presenting with ankle pain. Conventional face-to-face assessments were compared with assessments performed via a telerehabilitation system. Results. A similar agreement of 93.3% in patho-anatomical diagnosis and an 80% exact agreement (chi(2) = 4.267; p < 0.04) in primary systems diagnosis was found between face-to-face and telerehabilitation assessments. Clinical observations were found to have very strong agreement (k = 0.92) for categorical data and significant agreement (93.3% agreement;chi(2) = 234.4; p < 0.001) for binary data. A high level of inter-and intrarater reliability was found for the telerehabilitation assessments. Conclusions. This study demonstrates the criterion validity and reliability of remote musculoskeletal assessments of the ankle joint complex using telerehabilitation. Copyright (C) 2010 John Wiley & Sons, Ltd.

Repeatability of ultrasonographic median nerve measures.

Abstract: In this study we investigated the reliability of ultrasound in measuring median nerve characteristics including cross-sectional area (CSA), flattening ratio (FR), swelling ratio (SR), and mean grayscale. Generalizability theory was used to assess inter- and intrarater reliability using the dependability coefficient (phi), normalized standard error of measurement, and normalized minimum detectable change (MDC(NORM)) for multiple study design protocols. Interrater reliability was generally moderate. Intrarater reliability was mostly good (phi > 0.876) when using a single image, captured on one occasion, and being read once. Intrarater MDC(NORM) ranged from 3.8% to 6.2% for all CSA measures and SR. Using multiple images and/or readings at multiple occasions did not appreciably improve reliability measures. Ultrasound is a reliable tool for measuring median nerve characteristics. We recommend that a single evaluator capture all images for protocols aimed at quantifying median nerve ultrasound measures. We believe an appropriately designed protocol can utilize ultrasound to accurately assess changes in median nerve characteristics after activity.

Interrater and intrarater reliability of finger goniometric measurements.

Abstract: Intrarater and interrater reliability were determined for middle finger range of motion (ROM) using the Rolyan finger goniometer. Seven raters measured ROM 3 times (trials) on 20 healthy adults. Intraclass reliability analysis and analysis of variance was used to assess the consistency and stability of measures. Level of significance was set at p £ .05. Significant differences (p < .05) existed between raters for metacarpophalangeal, proximal interphalangeal, and distal interphalangeal active finger ROM measurements and for metacarpophalangeal and proximal interphalangeal passive range of motion. Intrarater reliability ranged from .43 to .99 (single measure intraclass coefficient). Interrater reliability ranged from .24 to .95, with passive measures lower than active measures. These results provide clinicians with evidence for using this specific goniometer and issues associated with various therapists assessing finger ROM. Lewis, E., Fors, L., & Tharion, W. J. (2010). Interrater and intrarater reliability of finger goniometric measurements.

Reliability and Validity of Thoracolumbar Injury Classification and Severity Score (TLICS)

Abstract: Study D Design: A new classification system for throacolumbar spine injury, Thoracolumbar Injury Classification and Severity Score (TLICS) was evaluated retrospectively. Purpose: To evaluate intrarater and interrater reliability of newly proposed TLICS schemes and to estimate validity of TLICS’s final treatment recommendation. Overview oof L Literature: Despite numerous literature about thoracolumbar spine injury classifications, there is no consensus regarding the optimal system. Methods: Using plain radiographs, computed tomography scanning, magnetic resonance imaging, and medical records, 3 clssifiers, consisting of 2 spine surgeons and 1 senior orthopaedic surgery resident, reviewed 114 clinical thoracolumbar spine injury cases retrospectively to classify and calculate injury severity score according to TLICS. This process were repeated on 4 weeks intervals and the scores were then compared with type of treatment that patient ultimately received. Results: The intrarater reliability of TLICS was substantial agreement on total score and injury morphology, almost perfect agreement on integrity of the posterior ligament complex (PLC) and neurologic status. The interrater reliability was substantial agreement on injury morphology and integrity of the PLC, moderate agreement on total score, almost perfect agreement on neurologic status. The TLICS schems exhibited satisfactory overall validity in terms of clinical decision making. Conclusions: The TLICS was demonstrated acceptable intrarater and interrater reliability and satisfactory validity in terms of treatment recommendation.

Inter- and intra-rater reliability in fibroptic endoscopic evaluation of swallowing.

Abstract: Fibroptic endoscopic evaluation of swallowing (FEES) is a useful way for dentists to evaluate oropharyngeal dysfunction. However, no study has paid attention to inter- and intra-rater reliability of FEES evaluation about oropharyngeal dysfunction. The purpose of this study is to verify whether dentist who trained and experienced for evaluation of dysphagia could diagnose oropharyngeal function with FEES. Nine dentists independently evaluated FEES images of 10 cases four times each. At first, evaluators performed the first evaluation without consulting the evaluative criteria. Subsequently, evaluators independently re-evaluated at 1-week intervals for three consecutive weeks, consulting the evaluative criteria. And then, inter- and intra-rater reliability was calculated. Cohen's Kappa was used to assess reliability. The results found that overall inter-rater reliability was 0·35±0·04 (first evaluation), 0·45±0·05 (s), 0·44±0·05 (third) and 0·46±0·04 (fourth). Most of inter-rater reliability related to aspiration was moderate to high, but lower for categories that evaluated timing of swallowing and mastication. In contrast, intra-rater reliability was moderate to high for overall categories, at 0·53±0·04 (first vs. second evaluation), 0·55±0·04 (first vs. third), 0·53±0·04 (first vs. fourth), 0·55±0·03 (second vs. third), 0·60±0·03 (second vs. fourth) and 0·78±0·03 (third vs. fourth). FEES is reliable for experienced dentists to diagnose oropharyngeal function. Moreover, repeated evaluation with the aids of evaluative criteria is useful to improve the reliability of FEES.

Reliability of Shoulder Internal Rotation Passive Range of Motion Measurements in the Supine Versus Sidelying Position

Abstract: Study Design Clinical measurement, reliability. Objective To compare intrarater and interrater reliability of shoulder internal rotation (IR) passive range of motion measurements utilizing a standard supine position and a sidelying position. Background Glenohumeral IR range of motion deficits are often noted in patients with shoulder pathology. Excellent intrarater reliability has been found when measuring this motion. However, interrater reliability has been reported as poor to fair. Some clinicians currently use a sidelying position for IR stretching with patients who have shoulder pathology. However, no objective data exist for IR passive range of motion measured in this sidelying position, either in terms of reliability or normative values. Methods Seventy subjects (mean age, 36.8 years), with (n = 19) and without (n = 51) shoulder pathology, were included in this study. Shoulder IR passive range of motion of the dominant shoulder or involved shoulder was measured by 2 investigators in 2 positions: (1...

Assessment of postural muscle strength in sitting: reliability of measures obtained with hand-held dynamometry in individuals with spinal cord injury.

Abstract: Background and purpose Muscle weakness frequently impairs the ability to maintain upright sitting in individuals with spinal cord injury (SCI). The primary purpose of this study was to examine the intrarater and interrater reliability of hand-held dynamometry to assess postural muscle strength for maintaining upright sitting in individuals with SCI. We also assessed reliability of forces measured in four directions of force application and of measures obtained by experienced versus student physical therapist examiners. Methods Twenty-nine individuals with SCI (mean age, 32.4 +/- 11.0 years; injury level C4-L1; American Spinal Injury Association Impairment Scale (AIS) classification A-D) participated in this study. The raters were two experienced physical therapists and two student physical therapists. Force was applied to the anterior, posterior, and right and left lateral trunk. Values were acquired in a group of participants who did not require upper extremity support for sitting (n = 22) and a group who did require upper extremity support (n = 7). Results Intrarater reliability was good to excellent (intraclass correlation coefficients, 0.80-0.98 [unsupported]; 0.79-0.99 [supported]) for all raters in the four directions of force application. Interrater reliability was excellent (intraclass correlation coefficients, 0.97-0.99 [unsupported]; 0.96-0.98 [supported]) for all directions. There were no significant differences among peak forces obtained among the four directions of force application or by experienced raters compared with student raters. Discussion and conclusion The use of hand-held dynamometry to assess postural muscle strength for maintaining upright sitting in individuals with SCI has high intrarater and interrater reliability. The direction of force application and experience of the rater did not influence the level of reliability. Future research is needed to identify the minimum muscle strength required to maintain the seated posture and to understand how this measure relates to seated postural control and balance.

Reliability and validity of an Italian four-level emergency triage system

Abstract: Objectives To measure the reliability and predictive validity of a four-level triage system (I-4L). Methods This observational study was conducted in an urban hospital. Five nurses were randomly selected to assign a triage level to 246 paper scenarios, using the I-4L model. The I-4L model is a four-level triage system: urgency category (UC) 1 requires immediate response; UCs 2, 3 and 4 require assessment within 20, 60 and 120 min, respectively. Weighted κ statistics were used to measure the inter-rater and intrarater reliability of the triage tool and the validity of the model was assessed based on the accuracy in predicting admission and in predicting a reference standard9s triage code. Results The I-4L model9s inter-rater reliability was κ=0.73 (95% CI 0.67 to 0.79), and the intrarater reliability was κ=0.82 (95% CI 0.67 to 0.96). Its accuracy of triage rating for admission and for prediction of a reference standard9s triage code was good: 79% (95% CI 73% to 86%) and 93% (95% CI 89% to 96%), respectively. The percentages of patients admitted per triage level using the I-4L model was: 100% UC 1; 42% UC 2; 6% UC 3; and 2% UC 4. Conclusions The I-4L triage model shows a good inter-rater and intrarater reliability for rating triage acuity and for accuracy in patient admission and prediction of a reference standard9s triage code.

Within-day and day-to-day intrarater reliability of ultrasonographic measurements of acromion-greater tuberosity distance in healthy people.

Abstract: Shoulder subluxation is subjectively assessed by a palpable increase in the distance between the acromion and the humerus. Diagnostic ultrasound has potential for objective assessment of this distance. We used portable ultrasound to measure the distance between the acromion and greater tuberosity (acromion-greater tuberosity [AGT] distance) and tested the intrarater reliability in healthy individuals prior to testing on stroke patients. Thirty-two healthy participants aged 51–85 years (mean 64.2±10.5) were recruited. Seated participants were scanned by a physiotherapist trained in shoulder ultrasound. Measurements were recorded on day 1 and again within 2 weeks. Reliability was assessed by intraclass correlation coefficients. The mean AGT distance was 1.68±0.41 cm for the left and 1.78±0.40 cm for the right shoulder. Within-day intrarater reliability coefficients were 0.99 and 0.98 for the left and right shoulders, respectively. Corresponding values for day-to-day reliability were 0.96 and 0.97. Portable ...

Confiabilidade interavaliadores e intra- avaliador do escoliômetro Inter and intra-rater reliability of the scoliometer

Abstract: Background:The scoliometer was developed to analyze the axial rotation of the trunk in patients with idiopathic scoliosis. However, there is controversy regarding the reliability of the measures obtained with this device. Objective: To test the intra-rater and inter-rater reliability of the scoliometer in patients with scoliosis. Methods: 24 volunteers of both sex with idiopathic scoliosis diagnostic (18±4 years-old) and curvatures with mean and standard deviation of 24.8±12.7° Cobb. The measurement procedure was accomplished in one day by two trained examiners. The palpation and determination of each spinal level was accomplished by just one examiner. Each examiner obtained one measure with the device for each vertebra from the thoracic and lumbar levels in each evaluation. For statistical analysis the measurements were divided by spinal levels into upper thorax, medium thorax, lower thorax and lumbar segments. The Intraclass Correlation Coefficient type 1,1 (ICC 1,1 ) was used to determine the intra-rater reliability while the ICC 3,1 was used to determine the inter-rater reliability. Results: The observed intra-rater reliability values for the medium and lower thorax and lumbar segments of the subjects ranged from very good to excellent. The inter-rater reliability of the measures of axial trunk rotations was considered good to the upper thorax and excellent for the medium and lower thorax and lumbar spine. Conclusion: The scoliometer is a device that has intra-rater reliability estimates ranging from very good to excellent. The inter- rater reliability for the upper and low thorax and for the lumbar spine is relatively lower than the intra-rater values for the same spinal segments, even when the errors from palpation and positioning of the instrument were eliminated.

Measuring mobility limitations in children with cerebral palsy: interrater and intrarater reliability of a mobility questionnaire (MobQues)

Abstract: Aim The objective of this study was to assess the reliability of a mobility questionnaire (MobQues) that was developed to measure the mobility limitations of children with cerebral palsy (CP) as rated by their parents. A clinical version of the questionnaire, consisting of 47 items (MobQues47), is available, as well as a research version with 28 items for a specific population (MobQues28). Total scores are expressed on a scale of 0 to 100. Method We assessed the interrater reliability between both parents of 289 children with CP (168 males, 121 females, age range 2–13y, Gross Motor Function Classification System levels I–IV) and the intrarater reliability within a subgroup of 38 parents (of 23 children) who completed the MobQues twice. Results For the interrater reliability, high intraclass correlation coefficients (ICCs) were found for the MobQues47 (ICC 0.92) and MobQues28 (ICC 0.87). The standard error of measurement (SEM) was 7.8 and 8.9 respectively. As expected, the intrarater reliability was higher, as represented by higher ICCs (0.96–0.99) and lower SEMs (3.5–4.9) for both MobQues versions. Interpretation The results of this study indicate that the MobQues is a reliable instrument to measure the mobility limitations of children with CP.

Thickness of the middle trapezius muscle measured by rehabilitative ultrasound imaging: description of the technique and reliability study

Abstract: A technique is described for measuring the thickness of the middle trapezius muscle using rehabilitative ultrasound imaging (RUSI). A test–retest study was employed to investigate the reliability of the technique in a convenience sample of 16 asymptomatic participants aged 20–41 (12 women). The middle trapezius muscle was imaged using RUSI with participants in a standardized sitting position. The principal investigator took measurements on two consecutive days to examine intrarater reliability, and two additional investigators took measurements on the second day to investigate inter-rater reliability of the measurement technique. Reliability was examined using intra-class correlation coefficients (ICC), standard error of measurement (SEM), and Bland and Altman plots. The results demonstrated that inter-rater reliability was good between raters (ICC2,3 = 0AE81, SEM = 0AE94 mm) and was moderate for the same rater between days (ICC3,2 = 0AE67, SEM = 1AE0 mm). This study demonstrates that RUSI can be used reliably to measure muscle thickness of the middle trapezius muscle following the procedure described.

Clinimetric properties of the alberta infant motor scale in infants born preterm.

Abstract: Purpose The Alberta Infant Motor Scale (AIMS) is a standardized motor assessment for young infants. This study aimed to examine the reliability of the AIMS in a group of infants born at or before 29 weeks of gestation. Methods Fifty-nine infants born preterm were recruited. Two experienced pediatric physical therapists participated in this reliability study. Infants were assessed at 4, 8, 12, and 18 months corrected age (CA). Results Intrarater reliability was high (intraclass correlation coefficient [ICC] > or =0.99). The ICC for interrater reliability varied from 0.85 to 0.97. The ICC was low at 4 and 18 months CA. Conclusions The AIMS is reliable in evaluating motor development in infants born preterm. Clinicians should be cautious about using the AIMS in infants at very young ages and those approaching independent ambulation. Accurate placement of the window on a movement repertoire is crucial. Attention is required when using the AIMS in infants developing atypically.

Connotation and Development of Mechanical Reliability-based Design

Abstract: Based on the reliability test and statistical analysis of the failure data,the basic task of mechanical reliability design is to propose mathematical-mechanical models and methods for engineering practice.In this way the working state and life of the mechanical product under the prescriptive working condition can be predicted in the design stage.The connotation and development of mechanical reliability-based design is expounded by integrating modern mathematical-mechanical theories.A series of theories and approaches,such as the mechanical reliability-based design,dynamic reliability-based design,reliability-based optimization design,reliability-based sensitivity design,reliability-based robust design,are explained clearly and systematically.The route and way are pointed out to solve the problem of lack of kernel technologies for reliability-based design in the field of mechanical engineering.The reliability technique service and reserve for independent research and development are provided,and the systemic and unitized theories and methods for reliability-based design of mechanical products in practical engineering are given.

Reliability of the Respiratory Movement Measuring Instrument, RMMI.

Abstract: Summary Introduction: A new instrument to measure breathing movements, Respiratory Movement Measuring Instrument (RMMI), has been developed. There is still a lack of knowledge about the reliability of the instrument. Objectives: The aim was to investigate reliability of the RMMI. Methods: In this trial, RMMI (ReMo Inc. Keldnaholt, Reykjavik, Iceland) was used. Inter- and intrarater reliability was performed on 30 volunteers who were tested three times in the supine position. Two of the tests were performed by one of the authors and the third test by the other. Intrasubject reliability was tested on 10 volunteers 12 times randomly during 1 h. Intra-instrument reliability was performed by measuring 12 solid surfaces where the instrument was placed horizontally against a couch or vertically against a chair. Results: Intra-rater reliability: The correlations were moderate to strong (r = 0·54–0·94) except for the left lower thoracic position r = 0·35. Inter-rater reliability: The correlations were strong (r = 0·71–0·99) except for the left lower thoracic position r = 0·35. The strongest correlations were seen on the tests on abdominal breathing movements. Intra subject reliability: The over-all difference within and between the participants and test was non-significant (P = 0·98). The average difference between the tests was 1·4 mm. Intra instrument: The differences between the measurements were small (mean 0·15 mm). The over-all difference was non-significant (P = 0·79). Conclusion: The RMMI is a reliable instrument and usable in both clinical practice and research.

New Assessment of Forearm Strength: Reliability and Validity

Abstract: OBJECTIVE. The objective was to determine the reliability of a portable forearm strength hydraulic dynamometer with a doorknob handle and assess its validity compared with a Cybex 6000 (Cybex International, Inc., Medway, MA) isometric torque assessment. METHOD. Eighteen volunteers (with a total of 30 forearms) participated in this one-session methodological study to determine the intra- and interrater reliability and criterion validity of a forearm dynamometer. RESULTS. Intrarater reliability for both assessors for pronation was (intraclass correlation coefficient [ICC]3,1 = .937�.961) and for supination was (ICC3,1 = .923�.968). Interrater reliability for pronation was ICC3,2 = .927 and for supination was ICC3,2 = .847. Criterion validity of the Baseline hydraulic dynamometer (Fabrication Enterprises Inc., White Plains, NY) compared with the Cybex 6000 was .574�.664 for pronation and .749�.750 for supination. CONCLUSION. The Baseline hydraulic dynamometer with a more functional doorknob handle had good intra- and interrater reliability and demonstrated moderate validity compared with Cybex 6000 strength testing

Validation of a new device to measure postsurgical scar adherence.

Abstract: Background and Purpose Scarring after surgery can lead to a wide range of disorders. At present, the degree of scar adhesion is assessed manually and by ordinal scales. This article describes a new device (the Adheremeter) to measure scar adhesion and assesses its validity, reliability, and sensitivity to change. Design This was a reliability and validity study. Setting The study was conducted at the Scientific Institute of Veruno. Participants and Methods Two independent raters, a physical therapist and a physical therapist student, used the Adheremeter to measure scar mobility and contralateral normal skin in a sample of 25 patients with adherent postsurgical scars before (T1) and after (T2) physical therapy. Two indexes of scar mobility, the adherence's surface mobility index (SMA) and the adherence severity index (AS), were calculated. Their correlation with the Vancouver Scar Scale (VSS) and its pliability subscale (PL-VSS) was assessed for the validity analysis. Results Both the SMA and the AS showed good-to-excellent intrarater reliability (intraclass correlation coefficient [ICC]=.96) and interrater reliability (SMA: ICC=.97 and .99; AS: ICC=.87 and .87, respectively, at T1 and T2), correlated moderately with the VSS and PL-VSS only at T1 ( r s=−.58 to −.66), and were able to detect changes (physical therapist/physical therapist student): z score=−4.09/−3.88 for the SMA and −4.32/−4.24 for the AS; effect size=0.6/0.4 for the SMA and 1.4/1.2 for the AS; standard error of measurement=4.59/4.79 mm2 for the SMA and 0.05/0.06 for the AS; and minimum detectable change=12.68/13.23 mm2 for the SMA and 0.14/0.17 for the AS. Limitations The measurement is based on the rater's evaluation of force to stretch the skin and on the patient's judgment of comfort. Discussion and Conclusions The Adheremeter showed a good level of reliability, validity, and sensitivity to change. Further studies are needed to confirm these results in larger cohorts and to assess the device's validity for other types of scars.

Measuring disease activity and damage in discoid lupus erythematosus

Abstract: Summary Background Discoid lupus erythematosus (DLE) is a disfiguring inflammatory skin disease. There is no specific tool for measuring disease severity. Objectives To determine the features needed in a score measuring activity and damage in DLE and to investigate the score’s reliability and its correlation with the physician’s global assessment of disease severity and the patient-reported Dermatology Quality of Life Index (DLQI). Methods The content of the score was determined following a peer review, pilot work in patients and a preliminary inter-rater reliability study. The Score of Activity and Damage in DLE (SADDLE) measures severity of activity (erythema, scale, induration) and damage (scarring/atrophy and dyspigmentation) attributable to DLE. Summed scores range between 0 and 195. Inter- and intrarater reliability of the score was tested using six assessors and nine patients with DLE. Intraclass correlation coefficients (ICCs) > 0·7 were considered evidence of good inter- and intrarater agreement. Results The mean ± SD SADDLE score of nine patients in the inter-rater reliability study was 47 ± 22 (range 14–102). There was good inter-rater agreement for the total score [ICC 0·82; 95% confidence interval (CI) 0·61–0·95] and for the activity and damage scales, the individual physical signs and the total scores at individual body sites. The total score demonstrated excellent intrarater reliability (ICC 0·98; 95% CI 0·86–1·00). Although there was poor inter-rater agreement for global assessments (ICC 0·28; 95% CI 0·06–0·66), a good correlation was demonstrated between total scores and global assessments (r = 0·7). A weaker positive correlation was observed between disease activity scores and DLQI (r = 0·4). Conclusions The SADDLE measures activity and damage in patients with DLE. It demonstrates good inter- and excellent intrarater agreement, over and above that for global assessment. It correlates well with global assessment scores. Further studies are required to investigate SADDLE’s responsiveness to change with therapy.

Design for Reliability: Overview of the Process and Applicable Techniques

Abstract: Design for Reliability (DFR) is not a new concept, but it has begun to receive a great deal of attention in recent years. What is DFR? What are the ingredients for designing for reliability, and what is involved in implementing DFR? Should DFR be part of a Design for Six Sigma (DFSS) program, and is DFR the same as DFSS? In this paper, we will try to answer these questions and, at the same time, we will propose a general DFR process that can be adopted and deployed with a few modifications across different industries in a way that will fit well into the overall Product Development Process.