Evaluation and Improvement of Intern Progress Note Assessments and Plans.

Background:The inter-rater reliability of the craniocervical flexion test (CCFT) has not been established.Objective:To investigate the intra-rater and inter-rater reliabilities of the CCFT in asymptomatic subjects.Methods:Sixty asymptomatic subjects were randomly selected for the study. The CCFT was measured on each subject by two testers for inter-rater reliability and by one of the testers after a gap of seven days for the intra-rater reliability. Before testing, the participants were trained for the movement and compensations were corrected.Results:The CCFT has high inter-rater reliability (intra-class correlation coefficient 0.907, standard error of mean 0.735) and high intra-rater reliability (intra-class correlation coefficient 0.986, standard error of mean 0.287). A Bland & Altman limits of agreement analysis has confirmed the high inter- and intra-rater reliabilities of the test.Conclusion:The CCFT has high inter-rater and intra-rater reliabilities in asymptomatic subjects.

Cancer is primarily a disease of older adults. About 77% of all cancers are diagnosed in persons aged 55 years and older. Cancer and its treatment can cause diverse sequelae impacting body systems underlying balance control. No study has examined the psychometric properties of balance assessment tools in older cancer survivors, presenting a significant challenge in the selection of outcome measures for clinicians treating this fast-growing population. This study aimed to determine the reliability, validity, and minimal detectable change (MDC) of the Balance Evaluation System Test (BESTest), Mini-Balance Evaluation Systems Test (Mini-BESTest), and Brief-Balance Evaluation Systems Test (Brief-BESTest) in community-dwelling older cancer survivors. This study was a cross-sectional design. Twenty breast and 8 prostate cancer survivors participated [age (SD) = 68.4 (8.13) years]. The BESTest and Activity-specific Balance Confidence (ABC) Scale were administered during the first session. Scores of Mini-BESTest and Brief-BESTest were extracted on the basis of the scores of BESTest. The BESTest was repeated within 1 to 2 weeks by the same rater to determine the test-retest reliability. For the analysis of the inter-rater reliability, 21 participants were randomly selected to be evaluated by 2 raters. A primary rater administered the test. The 2 raters independently and concurrently scored the performance of the participants. Each rater recorded the ratings separately on the scoring sheet. No discussion among the raters was allowed throughout the testing. Intraclass correlation coefficients (ICCs), standard error of measurement, minimal detectable change (MDC), and Bland-Altman plots were calculated. Concurrent validity of these balance tests with the ABC Scale was examined using the Spearman correlation. The BESTest, Mini-BESTest, and Brief-BESTest had high test-retest (ICC = 0.90-0.94) and interrater reliability (ICC = 0.86-0.96), small standard error of measurement (0.86-2.47 points), and MDC (2.39-6.86 points). The Bland-Altman plot revealed no systematic errors. The scores of BESTest, Mini-BEST, and Brief-BEST were correlated significantly with those of ABC Scale (P < .01), supporting their concurrent validity. The BESTest, Mini-BESTest, and Brief-BESTest showed high interrater and test-retest reliability, and excellent concurrent validity with the ABC Scale for community-dwelling cancer survivors aged 55 years and older who had completed cancer treatments for at least 3 months. Future studies are necessary to determine the predictive values for determining fall risks using balance assessment tools in older cancer survivors. Clinicians can utilize the BESTest and its short versions to evaluate balance problems in community-dwelling older cancer survivors and apply the established MDC to assess the intervention outcomes.

The reliability of the Wolf Motor Function Test for assessing upper extremity function after stroke

The clinical assessment of motor symptoms in Huntington's disease is usually performed with the Unified Huntington's Disease Rating Scale-Total Motor Score (UHDRS-TMS). A high interrater reliability is desirable to monitor symptom progression. Therefore, a teaching video and a system for annual online certification has been developed and implemented. The aim of this study is to investigate the interrater reliability of the UHDRS-TMS and of its subitems, and to examine the performance of raters in consecutive years. Data from the online UHDRS-TMS certification were used. The interrater reliability was assessed for all first-time participants (n = 944) between 2009 and 2016. Intraclass correlation coefficients (ICC) were calculated for each year separately and the mean was taken as the total ICC. The UHDRS-TMS (ICC = 0.847), tandem walking (0.824), pronate/supinate hands left (0.713), and retropulsion pull test (0.706) showed good interrater reliability. Poor interrater reliability was found for maximal dystonia of the left and right upper extremity (0.187 and 0.322, respectively), maximal dystonia of the left and right lower extremity (0.200 and 0.256, respectively), and maximal dystonia of the trunk (0.389), tongue protrusion (0.266), and rigidity arms left (0.390). Raters performed significantly worse on follow-up certification compared to their first certification. Our results suggest that the rating of dystonia (absent, slight, mild, moderate, or marked) is subjective and difficult to interpret, especially on video. Therefore, changing the dystonia items of the UHDRS-TMS should be explored. We also recommend that raters should watch the UHDRS-TMS teaching video before each certification.

Inter- and intra-rater reliability of handpump functionality field tests

Health-Related Quality of Life (HRQOL) is an essential domain for evaluating the true success of rehabilitation. The EuroQol 5-dimension 5-level (EQ-5D-5L) is a brief and widely used HRQOL measure. However, evidence is currently lacking regarding its responsiveness following rehabilitation for musculoskeletal disorder, particularly in Japan. Assessment of HRQOL is challenging for older patients with musculoskeletal disorders, particularly those with cognitive impairments or frailty, who may have difficulty self-reporting. Therefore, evaluating the reliability of proxy assessments is crucial in this population. Furthermore, the agreement between self-ratings and proxy-ratings is generally reported to be low. In contrast, a previous Japanese study reported high agreement when an Occupational Therapist (OT) acted as a proxy for stroke patients. This study therefore aimed to clarify the change (responsiveness) in HRQOL and investigate the inter-rater reliability between patient self-responses and OT proxy responses using the EQ-5D-5L in patients with musculoskeletal disorders in a Japanese convalescent rehabilitation ward. This was a multicenter, collaborative longitudinal study conducted across five hospitals in Japan. We enrolled 77 participants with musculoskeletal disorders who were capable of self-reporting. The mean age was 77.7 years. Evaluations were conducted at initial assessment (within one week of admission) and re-evaluation (one month later). HRQOL was measured using the EQ-5D-5L. Proxies were clinical OT who were blinded to patient responses during concurrent assessment. Responsiveness was assessed using the Standardized Response Mean (SRM). Inter-rater reliability for the QOL score was assessed using the Intraclass Correlation Coefficient (ICC), and the sub-items were assessed using weighted Kappa. Significant improvement was observed in all outcome measures post-rehabilitation (p < 0.01). The SRM for the QOL score indicated a large effect size for both self-reported (0.90) and proxy-reported (0.95) responses. Inter-rater reliability for the QOL score showed substantial agreement, with the ICC at re-evaluation was 0.72 (95%CI: 0.59; 0.81), which met the threshold for “good measurement properties” (≥ 0.70) as defined by the COSMIN criteria. The kappa coefficients for the five sub-items ranged from 0.31 (95%CI: 0.17; 0.45) to 0.56 (95%CI: 0.40; 0.72) (fair to moderate agreement). The EQ-5D-5L demonstrates high responsiveness and good inter-rater reliability when administered by an OT proxy at the one-month re-evaluation in this patient population. These findings support the use of OT proxy-responses to reliably estimate the HRQOL of patients with musculoskeletal disorders in the convalescent setting, particularly when self-reporting is difficult, providing evidence that proxy assessments can reliably complement patient reports in musculoskeletal rehabilitation settings.

ABSTRACTAims: To develop a revised edition of the Bimanual Fine Motor Function (BFMF 2), as a classification of fine motor capacity in children with cerebral palsy (CP), and establish intra- and interrater reliability of this edition. Methods: The content of the original BFMF was discussed by an expert panel, resulting in a revised edition comprising the original description of the classification levels, but in addition including figures with specific explanatory text. Four professionals classified fine motor function of 79 children (3–17 years; 45 boys) who represented all subtypes of CP and Manual Ability Classification levels (I-V). Intra- and inter-rater reliability was assessed using overall intra-class correlation coefficient (ICC), and Cohen's quadratic weighted kappa. Results: The overall ICC was 0.86. Cohen's weighted kappa indicated high intra-rater (кw: >0.90) and inter-rater (кw: >0.85) reliability. Conclusions: The revised BFMF 2 had high intra- and interrater reliability. The classification levels could be determined from short video recordings (<5 minutes), using the figures and precise descriptions of the fine motor function levels included in the BFMF 2. Thus, the BFMF 2 may be a feasible and useful classification of fine motor capacity both in research and in clinical practice.

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. 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). 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. 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.

Validated Assessment Tools for Pediatric Airway Endoscopy Simulation

Global longitudinal strain (GLS) analysis via speckle tracking echocardiography is a relatively new and promising imaging technology for the assessment of structural and functional abnormalities in the heart. GLS can be used in conjunction with left ventricular ejection fraction (LVEF) as a valuable predictor of left ventricular function. In fact, current data suggest strain to be a more effective indicator for ventricular dysfunction than LVEF. Despite its promise, the use of speckle tracking echocardiography has been limited to robust academic and research institutions due to concerns of reliability in clinical settings. Therefore, the hypothesis of this study is that high inter-rater reliability can be obtained in the measurement of mean global longitudinal strain in a non-academic, rural setting. GLS and LVEF were evaluated on twenty-one patients undergoing chemotherapeutic treatment during routine standard-of-care visits. The echocardiograms were performed on each patient by two separate technologists on the same day and the measurements were compared via intra-class correlation coefficient (ICC) values. Briefly, higher inter-rater reliability was observed in GLS (ICC 0.895) compared to LVEF (ICC 0.569), suggesting GLS is a reliable and reproducible measure of systolic function.

Aims:To describe the development and test reliability of a new assessment scale for measuring basic mobility and self-care: the Traffic Light System-BasicADL (TLS-BasicADL).Subjects:Eighteen occupational and physiotherapists took part in inter-rater, and 25 in intra-rater, reliability testing. Thirty inpatients admitted to an acute geriatric/orthopaedic unit, aged ≥70 years participated in inter-rater testing, 5 of whom were included in intra-rater testing.Methods:TLS-BasicADL was constructed by members of the interdisciplinary team at a geriatric unit. Items were generated from existing instruments, pilot testing and consensus meetings. Inter-rater testing was performed by two therapists simultaneously. Intra-rater reliability was examined using video-taped films of 5 patients. Therapists viewed and assessed 5 patients, then retested 4 weeks later. For inter-rater testing percentage agreement (PA) and intra-class correlation coefficient (ICC) were used, and for intra-rater reliability, PA.Results:Analysis of reliability showed high inter-rater (PA=86%; ICC=0.90) and fair intra-rater reliability (PA=≥72%) for mobility items.Conclusion:The new interdisciplinary assessment, TLS-BasicADL for measuring function in older persons in the acute hospital setting is shown to have high inter-rater and fair intra-rater reliability.

The Stroke Rehabilitation Assessment of Movement (STREAM) instrument is used to measure motor and mobility problems in patients who have experienced a stroke. The purposes of the study were to examine the interrater reliability, concurrent and convergent validity of the STREAM instrument in stroke patients. Fifty-four stroke patients participated in the study. For the purpose of interrater reliability, the STREAM instrument was administered by two raters on each patient within a 2-day period. Validity was assessed by comparing the patients' scores on the STREAM instrument with those obtained from the other well-established measures. Weighted kappa statistics for inter-rater agreement on scores for individual items ranged from 0.55 to 0.94. The intraclass correlation coefficient for the total score was 0.96 indicating very high inter-rater reliability. The intraclass correlation coefficients were also very high in each of the subscales. The total STREAM score was moderately to highly associated with the score of the Barthel Index and Fugl-Meyer motor assessment scale, rho = 0.67, and 0.95, respectively. The STREAM subscale scores were closely associated with scores of the other well-validated measures. Our results demonstrate that consistent and valid information can be obtained from the STREAM instrument and support its use in the value of the STREAM evaluation of motor and mobility recovery in persons who have experienced a stroke.

AimDivergent thinking and executive function are critical components of cognitive performance, necessitating reliable assessment tools to guide clinical decision‐making and research on cognitive deficits. This study aimed to evaluate the interrater reliability of the modified Tinkertoy test (m‐TTT), a neuropsychological tool designed to assess these functions, particularly in individuals with schizophrenia.MethodsThe interrater reliability of the m‐TTT was assessed in a sample of 40 Japanese participants, including 20 individuals with schizophrenia (12 males, eight females; mean age = 42.4 [standard deviation, 12.6] years) and 20 healthy controls (12 males, eight females; mean age = 40.0 [standard deviation, 9.6] years). Performances were independently scored by two occupational therapists using a standardized framework. Relative reliability was evaluated using intraclass correlation coefficients (ICCs), and absolute reliability was examined using Bland–Altman analysis.ResultsIn the schizophrenia group, ICC values indicated high interrater reliability for complexity (0.979), creation process (0.881), and total (0.969) scores. Similarly, in the control group, ICC values were high for complexity (0.969), creation process (0.790), and total (0.934) scores. Bland–Altman analysis demonstrated no fixed or proportional bias; however, greater variability was observed at higher creation process scores in the control group.ConclusionThe results confirm the high interrater reliability of the m‐TTT, supporting its utility as a robust tool for assessing cognitive deficits and guiding rehabilitation strategies in psychiatric contexts. However, the study's generalizability is limited by its Japanese‐only sample, necessitating further validation across diverse populations and cultural settings.

Objective: To investigate the intra – rater and inter – rater reliability of cranio cervical flexion test in symptomatic subjects. Background of study: Neck flexor muscles endurance was negatively correlated with cervical pain and dysfunction. Cranio cervical flexion test protocol has been advocated to train cranio cervical flexor muscle performance at present there is no consensus to the most effective method. The CCFT is a clinical test of neuromotor control of deep flexor of the cervical spine. Methodology: This was an observational study design with test-retest type and conducted in the ACS medical college and hospital. 50 samples were selected based on inclusion criteria. The CCFT was measured by one tester twice for intra rater reliability and two testers for inter-rater reliability were again tested after 24 Hours (Next day) by keeping time and environment optimal. In this CCFT, the activation pressure score and highest-pressure score was measured using Pressure Biofeedback unit. Result: The mean score for Activation Pressure by intra-rater tester one was found to be 2.24 (1.69) and 2.64 (1.48) in retest. The ICC intrarater score for Highest pressure value by tester one was 23.92 (2.17) and 24.32 (1.99) in retest. The mean score for activation pressure by Inter – rater examiners was found to be 2.92(1.15) by examiner - 1 and 2.72(1.19) by examiner - 2. The ICC Inter – rater score for highest pressure value by examiner - 1 was 24.32(1.95) and 24.4(2.33) by examiner - 2. The ICC value of the study indicated high reliability of the activation pressure and highest-pressure value among the intra and inter-raters. Conclusion: The CCFT has high inter-rater and intra-rater reliabilities in symptomatic subjects. Bangladesh Journal of Medical Science Vol. 22 No. 03 July’23 Page : 617-622

The aim of the study was to develop a cross-cultural adaptation and to evaluate the validity and reliability of a Spanish version of the Quality of Life in Late-Stage Dementia (QUALID) scale. Observational and cross-sectional validation study. The QUALID was translated according to standardised procedures. Internal consistency was assessed using Cronbach's alpha. The QUALID structure was assessed using a Principal Component Analysis (PCA). Inter-respondent (one rater asking two respondents) and inter-rater (two raters asking one respondent) reliability was assessed using the Intraclass Correlation Coefficient (ICC). The criterion validity (concurrent) was assessed by Spearman's correlation between the QUALID score and the QoL-Visual Analogue Scale (QoL-VAS) score. The construct validity (convergent) was assessed by Spearman's correlations between QUALID score and scores on the Pain-Visual Analogue Scale (Pain-VAS), on the Mini-Mental State Examination (MMSE) and on the Neuropsychiatric Inventory-Nursing Home (NPI-NH). A total of 160 elderly residents and 152 respondents at 8 long-term care centres in the province of Girona (Spain) participated in the study. Results showed satisfactory levels of internal consistency (Cronbach's alpha coefficients 0.74) and evidenced the multidimensionality of the scale. Three factors were identified (behavioural signs of discomfort, behavioural signs of social interaction and signs of negative affective mood). Acceptable inter-respondent reliability (ICC = 0.74) and high inter-rater reliability (ICC = 0.95) were found. The QUALID score was associated with the QoL-VAS score, suggesting a good concurrent criterion validity, and also with the Pain-VAS, the MMSE and the NPI-NH scores, suggesting good construct validity. Our evaluation of the psychometric properties of the Spanish version of the QUALID indicates that it is a reliable and valid instrument with an adequate capacity to distinguish between different clinical status.