Accuracy and Reliability of Single-Camera Measurements of Ankle Clonus and Quadriceps Hyperreflexia.

OBJECTIVE: To evaluate the accuracy and reliability of a simple, single-camera smartphone-based method, named the Reflex Tracker (RT) system, for measuring reflex threshold angles related to ankle clonus and quadriceps hyperreflexia. DESIGN: A prospective comparison study using a high-fidelity reference standard was constructed employing a 2 × 2 × 2 factorial design, with factors of rater (tester) type (student and experienced physical therapist), joint (ankle and knee), and repetition (2 per condition). SETTING: This multicenter study was conducted at 4 outpatient rehabilitation clinics. PARTICIPANTS: A convenience sample of 14 individuals with a neurologic condition presented with 20 lower limbs that exhibited ankle clonus and/or quadriceps hyperreflexia and were included in the study. Also participating in the study were 8 student and 8 experienced physical therapist raters (testers) (N=16). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The plantar flexor reflex threshold angle (PFRTA) related to ankle clonus and the quadriceps reflex threshold angle (QRTA) related to quadriceps hyperreflexia were quantified. RESULTS: PFRTA and QRTA results were compared between the smartphone RT method and synchronous 3-dimensional inertial measurement unit (IMU) sensor motion capture. Mean difference (bias) was minimal between RT and IMU measurements for PFRTA (bias≤0.2°) and QRTA (bias≤1.2°). Intrarater reliability for PFRTA ranged from 0.85-0.90 using RT and from 0.85-0.87 using IMU; QRTA ranged from 0.97-0.98 using RT and from 0.96-0.99 using IMU. Intersensor reliability for PFRTA and QRTA was 0.97 and 0.99, respectively. Minimum detectable change for PFRTA ranged from 7.1°- 8.7° and for QRTA ranged from 6.1°-8.3°. CONCLUSIONS: RT performed comparable to IMU for accurate and reliable measurement of PFRTA and QRTA to quantify ankle clonus and quadriceps hyperreflexia in clinical settings.

Comparison of two non-invasive arterial blood pressure monitoring techniques in brown bears (Ursus arctos).

Monitoring arterial blood pressure (BP), represents a more accurate evaluation of hemodynamics than heart rate alone and is essential for preventing and treating intra- and post-operative complications in wildlife chemical immobilization. The objectives of the study were to test the correlation between standard oscillometry and Korotkoff's technique in anesthetized free-ranging brown bears in Croatia and Scandinavia and to assess the blood pressure in both locations. Five bears were snared and darted with xylazine and ketamine in Croatia, and 20 bears were darted from a helicopter with medetomidine and tiletamine-zolazepam in Scandinavia. Blood pressure was simultaneously measured with both techniques every 5 minutes. Correlation between techniques, trends of BP variation, and the factors of the capture which likely influenced BP were assessed. Successful measurements of BP were achieved in 93% of all attempts with the Korotkoff's technique but in only 29% of all attempts with oscillometry. The latter method mostly provided lower values of BP compared to Korotkoff's technique in yearlings. Most bears showed a decreasing trend in systolic and mean BP over time, consistent between the two techniques. All bears were hypertensive: the auscultatory technique detected moderate to severe systolic hypertension in 25% and 84% of bears in Croatia and in Scandinavia, respectively, with significantly higher BP in subadults and adults compared to yearlings. Only Korotkoff's method resulted in a reliable and effective tool for BP assessment in brown bears. The anesthetic protocols used in the present study in association with the capture methods produced hypertension in all animals.

Agreement and Reliability of Clinician-in-Clinic Versus Patient-at-Home Clinical and Functional Assessments: Implications for Telehealth Services.

OBJECTIVE: To compare agreement and reliability between clinician-measured and patient self-measured clinical and functional assessments for use in remote monitoring, in a home-based setting, using telehealth. DESIGN: Reliability study: repeated-measure, within-subject design. SETTING: Trained clinicians measured standard clinical and functional parameters at a face-to-face clinic appointment. Participants were instructed on how to perform the measures at home and to repeat self-assessments within 1 week. PARTICIPANTS: Liver transplant recipients (LTRs) (N=18) (52±14y, 56% men, 5.4±4.3y posttransplant] completed the home self-assessments. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The outcomes assessed were body weight, systolic and diastolic blood pressure (SBP and DBP), waist circumference, repeated chair sit-to-stand (STST), maximal push-ups, and the 6-minute walk test (6MWT). Intertester reliability and agreement between face-to-face clinician and self-reported home-based participant measures were determined by intraclass-correlation coefficients (ICCs) and Bland-Altman plots, which were compared with minimal clinically important differences (MCID) (determined a priori). RESULTS: The mean difference (95% confidence interval) and [limits of agreement] for measures (where positive values indicate lower participant value) were weight, 0.7 (0.01-1.4) kg [-2.2 to 3.6kg]; waist 0.4 (-1.2 to 2.0) cm [-5.9 to 6.8cm]; SBP 7.7 (0.6-14.7 ) mmHg [-19.4 to 34.9mmHg]; DBP 2.4 (-1.4 to 6.2 ) mmHg [-12.2 to 17.0mmHg]; 6MWT, 7.5 (-29.1 to 44.1) m [-127.3 to 142.4m]; STST 0.5 (-0.8 to 1.7) seconds [-4.3 to 5.3s]; maximal push-ups -2.2 (-4.4 to -0.1) [-10.5 to 6.0]. ICCs were all >0.75 except for STST (ICC=0.73). Mean differences indicated good agreement than MCIDs; however, wide limits of agreement indicated large individual variability in agreement. CONCLUSIONS: Overall, LTRs can reliably self-assess clinical and functional measures at home. However, there was wide individual variability in accuracy and agreement, with no functional assessment being performed within acceptable limits relative to MCIDs >80% of the time.

Evaluation of Diabetes Care parameters in capillary blood collected with a novel sampling device.

The aim of this study was to determine whether the Hem-Col method of obtaining and storing blood is an acceptable alternative to venepuncture for measuring Diabetes Care parameters. Design and methods : Hem-Col is a novel blood collection device that is designed to collect capillary blood drawn with a finger prick. Hem-Col is a microtube containing an anticoagulant and a preservation buffer to enhance analyte stability in whole blood. The Diabetes Care parameters cholesterol, creatinine, HbA1c, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, and triglycerides were measured both in blood/plasma collected via Hem-Col and blood/plasma collected with venepuncture. The results were compared to assess the agreement between the two methods. Results : HbA1c shows agreement after storage for up to 120 hours at temperatures ranging from 4 to 37 °C. Cholesterol, HDL cholesterol, LDL cholesterol, triglycerides and creatinine can be measured after 120 hours of storage in Hem-Col buffer, if high temperatures are avoided, and with the use of correction factors or adaptations to reported reference intervals. Conclusion : Hem-Col is suitable for the measurement of HbA1c after storage for up to 120 hours at temperatures ranging from 4 to 37 °C. Cholesterol, creatinine, HDL cholesterol, LDL cholesterol and triglycerides can be measured after 120 hours of storage in Hem-Col buffer, if high temperatures are avoided. Further studies are required to determine whether Hem-Col can replace the venepuncture for the Diabetes Care parameters.