Intra-Rater and Inter-Rater Reliability Analysis of Muscle-Tone Evaluation Using a Myotonometer for Children with Developmental Disabilities

The MyotonPRO is a portable device that measures muscle tone and biomechanical muscle properties objectively. MyotonPRO has already proven to be effective in measuring muscle properties in healthy and diseased populations. However, to the best of our knowledge, it has never been tested in individuals suffering from paratonia, a form of hypertonia frequently accompanying dementia. The aims of the present study were to (1) compare muscle tone, elasticity, and stiffness between 3 different subpopulations of young and old healthy adults and individuals with paratonia, and (2) investigate the intra- and interrater reproducibility of MyotonPRO measurements of the biceps brachii (BB) muscle in each subpopulation. MyotonPRO measurements of muscle tone, elasticity, and dynamic stiffness were carried out by 2 investigators on 2 different days over the BB muscles of 54 participants (18 healthy young adults, 20 healthy older adults, and 16 older individuals with paratonia). Muscle properties were compared between subpopulations using ANOVA/Welch and post hoc tests. Reliability (intraclass correlation coefficient) and agreement parameters (standard error of measurement and the minimal detectable change) were calculated. Statistically significant differences between subpopulations were found in all parameters, except for stiffness between healthy elderly and individuals with paratonia. In the healthy subpopulations, (a) intrarater reliability was very high and intrarater agreement was good between 2 consecutive series, (b) between days intrarater reliability was low to high and intrarater agreement was variable, (c) interrater reliability was high to very high and interrater agreement was good. In individuals with paratonia, (a) intrarater reliability was moderate to high and agreement was variable between series, (b) between days intrarater reliability was poor to moderate and agreement was poor, (c) interrater reliability ranged from low to high with poor agreement. MyotonPRO measurements of the BB muscle showed good reproducibility in both healthy subpopulations, particularly for measurements performed within the same day. In individuals with paratonia, reliability and agreement were substantially lower. MyotonPRO can be used in clinical assessment and research. However, in individuals with paratonia, careful interpretation of results is required. Research in a larger sample of persons with paratonia at different stages of disease severity is recommended.

Intrarater and Inter-rater Reliability of Maximal Voluntary Neck Muscle Strength Assessment Using a Handheld Dynamometer in Women With Headache and Healthy Women

1. To assess the Inter-rater reliability and test-retest reliability of FPI-6 total score and individual scores in static foot posture evaluation among elderly female patients with knee osteoarthritis (KOA), aiming to establish the reliability of the FPI-6 scale. 2. To investigate the disparity between dominant and non-dominant quadriceps characteristics in elderly female KOA patients, as well as explore the correlation between quadriceps characteristics and abnormal foot posture, thereby offering novel insights for the prevention and treatment of KOA. The study enrolled a total of 80 lower legs of 40 participants (all female) with unilateral or bilateral KOA, who were assessed by two raters at three different time points. The inter-rater and test-retest reliability of the FPI-6 was evaluated using the intra-class correlation coefficient (ICC), while the absolute reliability of FPI-6 was examined using the standard error of measurement (SEM), minimum detectable change (MDC), and Bland-Altman analysis. The internal consistency of FPI-6 was assessed using Spearman's correlation coefficient. Additionally, MyotonPRO was employed to assess quadriceps muscle tone and stiffness in all participants, and the association between quadriceps muscle tone/stiffness and the total score of FPI-6 was analyzed. Our study found excellent inter-rater and test-retest reliability (ICC values of 0.923 and 0.931, respectively) for the FPI-6 total score, as well as good to excellent reliability (ICC values ranging from 0.680 to 0.863 and 0.739-0.883) for individual items. The SEM and MDC values for the total score of FPI-6 among our study inter-rater were 0.78 and 2.15, respectively. and the SEM and MDC values for the test-retest total score of FPI-6 were found to be 0.76 and 2.11, respectively. Furthermore, the SEM and MDC values between inter-rater and test-retest across six individual items ranged from 0.30 to 0.56 and from 0.84 to 1.56. The Bland-Altman plots and respective 95% LOA showed no evidence of systematic bias. In terms of the mechanical properties of the quadriceps on both sides, the muscle tone and stiffness of rectus femoris (RF), vastus medialis (VM), and vastus lateralis (VL) were significantly higher in the non-dominant leg compared to the dominant leg. Additionally, in the non-dominant leg, there was a significant positive correlation between the muscle tone and stiffness of VM, VL, RF and the total score of FPI-6. However, in the dominant leg, only VM's muscle tone and stiffness showed a significant positive correlation with the total score of FPI-6. The reliability of the FPI-6 total score and its six individual items was good to excellent. Our findings offer a straightforward and dependable approach for researchers to assess foot posture in elderly female patients with KOA. Furthermore, we observed significantly greater quadriceps tension and stiffness in the non-dominant leg compared to the dominant leg. The FPI-6 total score exhibited a significant correlation with changes in quadriceps muscle performance among KOA patients. These observations regarding the relationship between changes in quadriceps muscle performance and foot posture in elderly female KOA patients may provide novel insights for disease prevention, treatment, and rehabilitation.

BackgroundOsteoarthritis (OA) of the hip affects the entire joint structure and function and leads joint capsular changes which result limitation in range of motion (ROM). Therefore, measuring ROM is an...

Vaginal birth is a risk factor for weakening of the pelvic floor muscles (PFM) and development of pelvic floor dysfunction (PFD). Perineal tears may decrease PFM function. PFM tone can be assessed with surface EMG (sEMG), but reliability studies of sEMG in women with perineal tears are lacking. The aims of this study were to evaluate test-retest and intrarater reliability of sEMG and compare PFM activation between nulliparous and primiparous. A sEMG test-retest was performed in 21 women (12 nulliparous and 9 primiparous with grade II tears) to assess intra-rater reliability during rest and maximal voluntary contraction (MVC) of the PFM. Intraclass Correlation Coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) were tested. A comparison between nulliparous'and primiparous'PFM activation during rest and MVC was performed. sEMG demonstrated fair reliability in nulliparous (ICC: 0.239; SEM: 5.2; MDC: 14.5) and moderate reliability in primiparous (ICC: 0.409; SEM: 1.5; MDC: 4.2) during rest. For peak MVC very good intrarater reliability was found in nulliparous (ICC: 0.92; SEM: 8.0; MDC: 22.2) and in primiparous (ICC: 0.823; SEM: 8.0; MDC: 22.2). Statistically significant lower PFM activation was found in primiparous women with perineal tear grade II than in nulliparous at rest (mean difference 9.1 µV, 95% confidence interval[CI] 3.0-19.0, p = 0.001), and during MVCpeak (mean difference 50.0 µV, 95% CI 10.0-120.0 p = 0.021). sEMG is reliable when measuring PFM activation in primiparous women with perineal tears grade II. Women with perineal tears grade II have lower PFM activation both during rest and MVC.

Muscle length is a common component of the physical therapy examination, which may include the prone knee flexion (Ely) and active knee extension (AKE) tests. Clinicians using these tests should understand the clinimetric properties. To investigate the reliability and minimal detectable change (MDC95) of the Ely and AKE tests. Reliability analysis. Seventy-one asymptomatic adults (mean age 24.6 + /- 2.8 years) were recruited based on a convenience sample. Two examiners each performed the Ely and AKE test one time each in an intrasession design for the interrater reliability component, with one examiner repeating the tests one time 48 hours later to determine the intra-rater reliability. Results were recorded based on one trial per test and utilized a pelvic strap for the Ely test and an adjustable bolster for the AKE test. A separate researcher recorded measurements and results were blinded from the examiners. The Ely test had excellent intra-rater and inter-rater reliability with an intraclass correlation coefficient (ICC) (3,1) of 0.900 and ICC (2,1) of 0.914 respectively. The intra-rater and inter-rater reliability of the AKE test was good with ICC (3,1) of 0.882 and ICC (2,1) 0.886 respectively. The MDC95 indicated that a change greater than or equal to 8° and 12° is required to exceed the threshold of error for the Ely and AKE test respectively. The Ely and AKE tests have good to excellent inter-rater and intra-rater reliability for measuring rectus femoris and hamstring muscle length when stabilization of the pelvis and hip is accounted for. The MDC should be considered as a threshold for true change in the asymptomatic adult population. 2b.

Diagnostic ultrasound has accurately and reliably been utilized by clinicians to determine ACL morphology at the tibial insertion site, specifically measuring the entire ACL diameter, the anteromedial bundle (AM), and the posterolateral bundle. However, intra- and inter-rater reliability of these measures in a research setting is unknown. The purpose of this study was to determine intra- and inter-rater reliability of ultrasound measures of ACL diameter and AM diameter in researchers with low-to-moderate ultrasound experience. We hypothesized that intra- and inter-rater reliability of ACL and AM diameters would reach acceptable levels, a minimal intraclass correlation (ICC) of 0.6 and a desired ICC of 0.8 with an α of 0.05 and β of 0.20. Fourteen volunteers participated in this study. During the ACL ultrasound measures, participants were seated with their knee flexed to at least 90°. Each rater recorded two images of both the right and left ACL and AM bundles. Next, participants were re-examined by rater one for intra-rater reliability analyses. Two-way random ICCs were conducted for intra-rater (between sessions) and inter-rater reliability for both the full ACL and the AM bundle diameters. Standard errors between sessions for Rater 1's AM bundle and ACL diameters were less than 0.03cm. Intra-rater reliability was higher in AM bundles compared to full ACL, 0.76 versus 0.59, respectively. Standard errors between Rater 1 and Rater 2 were less than 0.03cm. Inter-rater reliability was higher in AM bundles compared to full ACL, 0.71 versus 0.41, respectively. The results of the study indicate researchers with low-to-moderate training with ultrasound measures can locate and measure the ACL, but with greater reliability using the AM.

Introduction: Ultrasonography (USG) is a widely recognised, non-invasive imaging technique extensively applied in musculoskeletal diagnostics. Its capacity to provide real-time visualisation of muscle structure and function underpins its utility in clinical practice and scientific research. Nevertheless, the reliability and accuracy of USG measurements remain pivotal concerns influencing its efficacy in muscle assessment.Objective: The of this study is to evaluate the reliability and accuracy of USG-based muscle thickness measurements for four critical postural stabilisers: longus colli, serratus anterior, transversus abdominis and multifidus. These muscles play essential roles in postural stability due to their tonic characteristics, making them central to rehabilitation interventions.Methods: Twenty healthy participants were recruited for this investigation. Muscle thickness of the four target muscles was assessed in a resting state using standardised USG protocols. Both intra- and inter-rater reliability were analysed using Intraclass Correlation Coefficients (ICC). Measurement precision was quantified through Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC), ensuring a robust evaluation of reliability metrics.Results: The analysis revealed excellent intra-rater reliability for all muscles, with ICC values ranging from 0.97 to 0.99. Inter-rater reliability was highest for the serratus anterior (ICC = 0.89-0.95) and transversus abdominis (ICC = 0.79-0.85), while moderate agreement was observed for the longus colli (ICC = 0.52-0.89). The transversus abdominis demonstrated the highest measurement precision, with the lowest Standard Error of Measurement (SEM = 0.79-1.05 mm) and Minimal Detectable Change (MDC = 2.19-2.91 mm). In contrast, the multifidus exhibited greater variability (SEM > 2.1 mm; MDC > 6.0 mm), reflecting the inherent challenges in ultrasonographic assessment of deep spinal musculature. Despite these differences, all assessed muscles achieved acceptable reliability levels, supporting the clinical utility of ultrasonography in rehabilitation monitoring.Conclusion: Ultrasonography proves to be a reliable and precise modality for assessing muscle thickness in a resting state, particularly for the transversus abdominis and serratus anterior. These findings substantiate the utility of USG in evaluating key postural stabilisers within rehabilitation settings. Standardising measurement protocols and enhancing operator training are recommended to further optimise their application and ensure consistent results.

Objective: This study aimed to determine the intra-rater and inter-rater reliability and validity of a hybrid device, combining virtual reality goggles, a magnetometer and an inclinometer application for smartphones, to measure craniocervical range. Summary of Background Data: Accurate evaluation of craniocervical range of motion is important for early detection of certain diseased conditions and monitoring the progress of interventions. The universal goniometer is widely used for the measurement but it requires experienced practitioners. Whether a combination of virtual reality goggles and smartphone applications can provide the same or better performance compared with the goniometer is still unknown. Methods: Forty-one healthy adults from the department of physical medicine and rehabilitation were recruited for craniocervical range examination (flexion, extension, side-bending to the right or left and rotating to the right or left) by using the hybrid device and universal goniometer. Using the hybrid device, repeated measurements were performed twice by a primary rater and once by a second rater. The primary rater also conducted a measurement using the universal goniometer in the same cohort. The intra-rater and inter-rater reliability (intra-class correlation coefficient (ICC)) were calculated using the two-way random effect model, whereas the validity was examined by the Pearson correlation coefficient and Bland-and-Altman plot. The interval between the first and second sessions of the measurement for intra-rater reliability was set at 30 min. Results: Excellent intra-rater (ICC ≥ 0.925) and inter-rater (ICC ≥ 0.880) reliability was noted for the hybrid device. The minimal detectable changes from intra-observer and inter-observer comparisons ranged between 4.12° and 7.42° in all six directions. The Bland-and-Altman plot revealed small mean differences (≤1.68°) between the hybrid device and universal goniometer. Both instruments had highly correlated measurements of craniocervical motion (r values ≥ 0.918). Conclusion: For healthy participants, excellent intra-rater and inter-rater reliability was noted for the hybrid device, and the measurements were consistent with the universal goniometer measurements. Future studies are needed to examine whether the device can perform similarly for patients with neck disorders.

P.33Quantified muscle testing: the right way to assess muscle strength impairments in DM1

ObjectivesThe reliability of ultrasonic strain elastography (SEL) used to detect abnormalities in the supraspinatus tendon is unclear. Thus, the aim of this study was to investigate the reliability of SEL...

Reduced shear strain and deformability of the thoracolumbar fascia has been linked to low back pain. A number of ultrasound examination methods have been developed for laboratory rather than clinical practice. The aim of this study was to examine the reliability and discriminative validity (patients vs. healthy individuals) of an ultrasound (US) measurement method for the quantification of thoracolumbar fascia deformation (TLFD). A cross-sectional study with US assessment and rater blinding was conducted in a manual therapy clinic and a university laboratory. 16 acute low back pain (aLBP) patients and 15 healthy individuals performed a standardized trunk extension task. US measurements of TLFD were carried out independently by two raters by imaging the TLF in the starting and ending positions of the movement. Intra-rater and inter-rater reliability were calculated using intraclass correlation coefficients (ICCs) and minimal detectable changes (MDC) were calculated. Receiver operating characteristic (ROC) curve analysis was used to determine the cut-off for TLFD to discriminate the study groups. Kappa statistics were performed to assess rater agreement in discrimination. Intra-rater reliability was excellent (ICC: .92, MDC: 5.54 mm, p < .001) and inter-rater reliability was good (ICC: .78, MDC: 8.70 mm, p < .001). The cut-off for TLFD was 6 mm with a sensitivity of 100% and a specificity of 93.75% and the raters agreed moderately (κ = 0.74, p < .001) when distinguishing patients and controls. The reliability of the US method for assessing TLFD is moderate to excellent, and the ability to discriminate aLBP patients from healthy individuals is moderate. The method could be used to capture an additional parameter in morphological aLBP screenings.

Muscle thickness and echo intensity measurements of the rectus femoris muscle of healthy subjects: Intra and interrater reliability of transducer tilt during ultrasound

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 Physical Therapy Competence Assessment for Airway Suctioning (PT-CAAS) is a recently developed measure to assess the clinical competence of physiotherapists who perform airway suctioning with adults. The purpose of this study was to assess the inter-rater and intra-rater reliability of the PT-CAAS. Scoring rules were developed through expert consultation. Reliability was then assessed using nine videos of suctioning performed in a simulated learning environment. A repeated measures design was used, with two replicate sets of measurements made by each participant for all videos. Data were analyzed using a repeated measures model for the concurrent assessment of inter-rater and intra-rater reliability. Participants were physiotherapists with suctioning experience. Twenty physiotherapists completed initial scoring and re-scoring for all nine videos; their data were included in the analysis. Intraclass correlation coefficients (ICCs) for inter-rater reliability ranged from 0.569 [lower one-sided 95% confidence interval (CI): 0.395; standard error of measurement (SEM): 0.963] for infection control to 0.759 (lower one-sided 95% CI: 0.612; SEM: 0.722) for post-suctioning assessment and care. The inter-rater ICC for overall performance was 0.752 (lower one-sided 95% CI: 0.602; SEM: 0.660). ICCs for intra-rater reliability ranged from 0.759 (lower one-sided 95% CI: 0.197; SEM 0.721) for infection control to 0.860 (lower one-sided 95% CI: 0.544; SEM: 0.550) for post-suctioning assessment and care. The intra-rater ICC for overall performance was 0.867 (lower one-sided 95% CI: 0.559; SEM: 0.483). Evidence of moderate to good inter-rater and good intra-rater reliability was found; however, the results should be interpreted with caution given the wide CIs and relatively large SEMs. Improved assessor training and assessments of reliability using a larger sample size are recommended.