Reliability of self-measured objective functional impairment using the timed up and go test in patients with diseases of the spine.

BACKGROUND: Accurate assessment of a patient's functional status is crucial for determining the need for treatment and evaluating outcomes. Objective functional impairment (OFI) measures, alongside patient-reported outcome measures (PROMs), have been proposed for spine diseases. The Timed-Up and Go (TUG) test, typically administered by healthcare professionals, is a well-studied OFI measure. This study investigates whether patient self-measurement of TUG is similarly reliable. METHODS: In a prospective, observational study, patients with spinal diseases underwent two TUG assessments: one measured by a healthcare professional and one self-measured by the patient. Interrater reliability was assessed using the intraclass correlation coefficient (ICC) with a two-way random-effects model, considered excellent between 0.75 - 1.00. Paired t-tests directly compared both measurements. The impact of variables such as age, sex, disease type, symptom severity (via PROMs), comorbidities, and frailty on reliability was also analysed. RESULTS: Seventy-four patients were included, with a mean age of 62.9 years (SD 17.8); 29 (39.2%) were female. The majority (64.9%) were treated for degenerative disc disease. The lumbo-sacral region was most affected (71.6%), and 47.3% had previous surgeries. Patient self-measurement reliability was excellent (ICC 0.8740, p < 0.001), and the difference between healthcare professional (19.3 ± 9.4 s) and patient measurements (18.4 ± 9.7 s) was insignificant (p = 0.116). Interrater reliability remained high in patients > 65 years (ICC 0.8584, p < 0.001), patients with ASA grades 3&4 (ICC 0.7066, p < 0.001), patients considered frail (ICC 0.8799, p < 0.001), and in patients not using any walking aid (ICC 0.8012, p < 0.001). High symptom severity still showed strong reliability (ICC 0.8279, p < 0.001 for Oswestry Disability Index > 40; ICC 0.8607, p = 0.011 for Neck Disability Index > 40). CONCLUSIONS: Patients with spine diseases can reliably self-measure OFI using the TUG test. The interrater reliability between self-measurements and those by healthcare professionals was excellent across all conditions. These findings could optimize patient assessments, especially in resource-limited settings.

A Reliability Study of the Load Distribution Percentage While Walking Using Curalgia Feet Sx Smart Insoles.

Background Gait analysis has evolved through many years of research. Many methods are used to analyze the gait of a subject. Recent times have shown a high demand for wearable sensor-based insoles integrated with smartphone-based devices used for gait analysis due to ease of use. This study utilized Curalgia Feet Sx Smart Insoles and its software toolset, Gait Analysis+, designed and manufactured in India making it an accessible and cost-effective option. The Curalgia Feet Sx Smart Insoles allow for a broad range of biofeedback-based rehabilitation and recovery training for several patients and have many applications, such as sports performance enhancement and neurological disorder rehab (e.g., brain stroke rehab). The system also significantly delays the onset of neurodegenerative illnesses by providing balance and proprioceptive training. The smart insole can help the athlete, the coach, and the sports medicine team get the on-field data in real-time, which will help them understand if any technical or biomechanical alterations are required. This may help in performance enhancement. This study aimed to determine the interrater reliability of the load distribution percentage parameter of the Curalgia Feet Sx Smart Insole for both feet while walking in a controlled setting. Methodology A total of 120 subjects were enrolled in the study. In total, 90 subjects were randomly selected using Research Randomizer which included male and female students and staff at Sardar Bhagwan Singh University. The subjects were asked to come to the research lab of the physiotherapy department wearing their sports shoes. Curalgia Feet Sx insoles were inserted into the shoe firmly to fit properly. Two assessors took two readings after the smart insole was connected to the smartphone-based application, GaitAnalysis+, via Bluetooth. The dynamic analysis option was selected, and each subject's analysis was done one after another with a desirable break in between. Each subject walked for three minutes at their normal speed after pressing "Start Analysis." At the three-minute mark, the subjects were asked to press "Stop Analysis" and the investigator downloaded the report on the smartphone. The data collected was compiled as the cumulative weight in kg (load distribution) borne and the % weight (load distribution %) borne by each foot for the duration of the walk. Statistical analysis was done using Karl Pearson's test and interclass correlation calculation. Results Assessor 1 and Assessor 2 collected readings for the left foot as "L" and the right foot as "R." Assessor 1 readings were L1-R1 for load distribution and L1% and R1% for load distribution %. Assessor 2 readings were L2-R2 for load distribution and L2% and R2% for load distribution %. The r value (correlation coefficient) was calculated using the load distribution. The mean value of L1 was 337.46 (SD=94.16). The mean L2 was 313.6 (SD=104.40). The R1 mean was 229.03 (SD=112.88), and the R2 mean was 233.011 (SD=79.84). The r was 0.7171 for the left foot and 0.7502 for the right foot, suggesting an excellent correlation. The ICC was calculated for load distribution %. The means of L1% was 55.94, L2% was 57.59, R1% was 44.06, and R2% was 42.41. The ICC was found to be 0.91 for both feet, suggesting high interrater reliability for the tested parameter. Conclusions The findings confirmed that the Curalgia Feet Sx Smart Insoles presented good interrater reliability for the load distribution % parameter.

Three-dimensional anatomical analysis of the optic nerve canal with virtual model based on CBCT.

The optic nerve canal (ONC) is a fine skeletal structure that contains the optic nerve. However, it has not been thoroughly examined. This necessitates establishing a baseline knowledge of the geometrical and volumetric parameters of the ONC. The data of twenty patients who received a cone beam computed tomography examination were prepared using a voxel-based segmentation. The measurement was performed separately by two examiners on virtual skull models in stereolithography format in Geomagic Wrap®. The results showed that the volume of the ONC varied between 92.48 mm3 and 162.7 mm3 (M = 123.46 mm3, SD = 26.61 mm3). Sex-specific statistically significant differences in volume were detected only for the right side. The angle of the ONC to the skull base was independent of the diameter of the canal. Both the intrarater and interrater comparisons of the measurements showed high values of reproducibility of the results. This study showed that a virtual anatomical model provides a feasible and reliable method to investigate the ONC. The examination technique could have a wider range of application in anthropology and application in clinical medicine. Advances in the automation of radiological diagnostics and the digital analysis of X-ray images could help to reduce examination times.

The Importance of Training and Assessing Quality Control Reviewers in Technology-Enabled Abstraction of Real-World Data: A Case Study.

Accurate cancer registry data is crucial for understanding cancer prevention and treatment strategies. Proper education and training are key for successful quality control (QC) programs and an evaluation process is needed to assess effectiveness. Syapse developed a rigorous QC training program that includes a peer review process to assess data quality and an interrater review (IRR) program to evaluate the consistency of QC reviewers. In reviewing IRR cases, we found high rates of agreement in various cancer types: colon (97.74%), prostate (97.75%), ovarian (96.31%), lung (98.03%), breast (97.86%), and bladder (97.88%). A peer review experience questionnaire was also administered. Results indicated that the program facilitated the acquisition of new skills. Through the implementation of robust QC training and assessment procedures for technology-enabled data curation, our Oncology Data Specialist (ODS)-certified professionals at Syapse ensure data quality in a real-world evidence (RWE) platform. QC reviewers deserve an extensive investment in training and professional development to uphold data quality and support cancer research efforts.

Validation of Quality Assessment Measures for Inpatient Gastroenterology Consults on Oncologic Patients in Non-teaching Services at a Cancer Center: A Cross-Sectional Study.

OBJECTIVE: To develop and validate tools for measuring inpatient gastroenterology (GI) consultation quality on oncologic patients. METHODS: A total of 145 inpatient GI consults were analyzed using electronic health records in this cross-sectional study. Essential Consult Elements on oncologic-hospitalized patients (EE-COH) and Hospitalized Oncologic Patients Enhanced Quality of Consult Assessment Tool (HOPE-QCAT) were used for grading. Interrater reliability was assessed. RESULTS: Both EE-COH and HOPE-QCAT showed near-perfect interrater reliability across most measures in the validation cohort. On application of these measures for quality assessment, basic evaluation by the requesting hospitalist was partially complete in 24.8%, the request for GI consultation was inappropriate in 18.6%, while the rationale for recommended studies from the GI consultant was provided in 55.7% of cases suggesting key areas for quality improvement. CONCLUSION: We developed highly reliable quality measures for inpatient GI consults on oncology patients. The EE-COH and HOPE-QCAT tools can be utilized in future studies of inpatient GI consult quality and to form the basis for interventions to improve communication between consultants and hospitalists. Such tools could be adapted for inpatient quality assessment across other specialties and settings.

Assessing expert reliability in determining intracranial EEG channel quality and introducing the automated bad channel detection algorithm.

Objective.To evaluate the inter- and intra-rater reliability for the identification of bad channels among neurologists, EEG Technologists, and naïve research personnel, and to compare their performance with the automated bad channel detection (ABCD) algorithm for detecting bad channels.Approach.Six Neurologists, ten EEG Technologists, and six naïve research personnel (22 raters in total) were asked to rate 1440 real intracranial EEG channels as good or bad. Intra- and interrater kappa statistics were calculated for each group. We then compared each group to the ABCD algorithm which uses spectral and temporal domain features to classify channels as good or bad.Main results.Analysis of channel ratings from our participants revealed variable intra-rater reliability within each group, with no significant differences across groups. Inter-rater reliability was moderate among neurologists and EEG Technologists but minimal among naïve participants. Neurologists demonstrated a slightly higher consistency in ratings than EEG Technologists. Both groups occasionally misclassified flat channels as good, and participants generally focused on low-frequency content for their assessments. The ABCD algorithm, in contrast, relied more on high-frequency content. A logistic regression model showed a linear relationship between the algorithm's ratings and user responses for predominantly good channels, but less so for channels rated as bad. Sensitivity and specificity analyses further highlighted differences in rating patterns among the groups, with neurologists showing higher sensitivity and naïve personnel higher specificity.Significance.Our study reveals the bias in human assessments of intracranial electroencephalography (iEEG) data quality and the tendency of even experienced professionals to overlook certain bad channels, highlighting the need for standardized, unbiased methods. The ABCD algorithm, outperforming human raters, suggests the potential of automated solutions for more reliable iEEG interpretation and seizure characterization, offering a reliable approach free from human biases.

Fundamental Stability Skills: Reliability Analysis Using the Alfamov Assessment Tool.

Fundamental movement skills (FMS), considered as building blocks of movement, have received growing interest due to their significant impact on both present and future health. FMS are categorized into locomotor, object control and stability skills. While there has been extensive research on assessing the proficiency and reliability of locomotor and object control skills, stability skills have received comparatively less attention. For this reason, this study aimed to assess the test-retest, intrarater and interrater reliability of five stability skills included in the Alfamov app. The performance of eighty-four healthy primary school children (60.8% girls), aged 6 to 12 years (mean ± standard deviation of 8.7 ± 1.8 years), in five stability skills was evaluated and scored by four raters, including two experts and two novices. The Alfamov tool, integrating various process-oriented tests, was used for the assessment. Reliability analyses were conducted through the computation of the intraclass correlation coefficient (ICC) along with the corresponding 95% confidence intervals. Good-to-excellent intrarater reliability, excellent interrater reliability and moderate-to-good reliability in the test-retest were achieved. The results proved that Alfamov is a robust test for evaluating stability skills and can be suitable for use by different professionals with less experience in assessing children's motor competence.

The impact of repeated item development training on the prediction of medical faculty members' item difficulty index.

BACKGROUND: Item difficulty plays a crucial role in assessing students' understanding of the concept being tested. The difficulty of each item needs to be carefully adjusted to ensure the achievement of the evaluation's objectives. Therefore, this study aimed to investigate whether repeated item development training for medical school faculty improves the accuracy of predicting item difficulty in multiple-choice questions. METHODS: A faculty development program was implemented to enhance the prediction of each item's difficulty index, ensure the absence of item defects, and maintain the general principles of item development. The interrater reliability between the predicted, actual, and corrected item difficulty was assessed before and after the training, using either the kappa index or the correlation coefficient, depending on the characteristics of the data. A total of 62 faculty members participated in the training. Their predictions of item difficulty were compared with the analysis results of 260 items taken by 119 fourth-year medical students in 2016 and 316 items taken by 125 fourth-year medical students in 2018. RESULTS: Before the training, significant agreement between the predicted and actual item difficulty indices was observed for only one medical subject, Cardiology (K = 0.106, P = 0.021). However, after the training, significant agreement was noted for four subjects: Internal Medicine (K = 0.092, P = 0.015), Cardiology (K = 0.318, P = 0.021), Neurology (K = 0.400, P = 0.043), and Preventive Medicine (r = 0.577, P = 0.039). Furthermore, a significant agreement was observed between the predicted and actual difficulty indices across all subjects when analyzing the average difficulty of all items (r = 0.144, P = 0.043). Regarding the actual difficulty index by subject, neurology exceeded the desired difficulty range of 0.45-0.75 in 2016. By 2018, however, all subjects fell within this range. CONCLUSION: Repeated item development training, which includes predicting each item's difficulty index, can enhance faculty members' ability to predict and adjust item difficulty accurately. To ensure that the difficulty of the examination aligns with its intended purpose, item development training can be beneficial. Further studies on faculty development are necessary to explore these benefits more comprehensively.

Sensitivity, Specificity, and Reliability of the CTS-6 for Carpal Tunnel Syndrome Administered by Medical Assistants.

PURPOSE: The CTS-6 can be used clinically to diagnose carpal tunnel syndrome (CTS) and has demonstrated high levels of interrater reliability when administered by nonexpert clinicians. Our purpose was to assess sensitivity (Sn), specificity (Sp), and interrater reliability of the CTS-6 when administered by medical assistants (MAs). METHODS: A series of patients presenting to an academic, upper-extremity surgery clinic were screened using CTS-6 between May and June of 2023. The CTS-6 was first administered by one of seven MAs and then by one of four fellowship-trained upper-extremity surgeons. In addition to recording baseline demographics, the results of each of the six history and examination components of the CTS-6 were recorded, as was the cumulative CTS-6 score (0-26). Surgeons were blinded to the scores obtained by the MAs. Interrater reliability (Cohen's kappa) was determined between the groups with respect to the diagnosis of CTS and the individual CTS-6 items. Sensitivity/specificity was calculated for the MA-administered CTS-6, using the score obtained by the surgeon as the reference standard. A CTS-6 score >12 was considered diagnostic of CTS. RESULTS: Two hundred eighteen patients were included, and 26% had a diagnosis of CTS. The MA group demonstrated a Sn/Sp of 84%/91% for the diagnosis of CTS. Interrater reliability was substantial (Cohen's kappa: 0.72, 95% confidence interval: 0.62-0.83) for MAs compared with hand surgeons for the diagnosis of CTS. For individual CTS-6 components, agreement was lowest for the assessment of two-point discrimination (fair) and highest for the assessment of subjective numbness (near perfect). CONCLUSIONS: The CTS-6 demonstrates substantial reliability and high Sn/Sp when administrated by MAs in an upper-extremity clinic. These data may be used to inform the development of CTS screening programs and future investigations in the primary care setting. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.

Interrater reliability of the violence risk assessment checklist for youth: a case vignette study.

BACKGROUND: Facilities providing health- and social services for youth are commonly faced with the need for assessment and management of violent behavior. These providers often experience shortage of resources, compromising the feasibility of conducting comprehensive violence risk assessments. The Violence Risk Assessment Checklist for Youth aged 12-18 (V-RISK-Y) is a 12-item violence risk screening instrument developed to rapidly identify youth at high risk for violent behavior in situations requiring expedient evaluation of violence risk. The V-RISK-Y instrument was piloted in acute psychiatric units for youth, yielding positive results of predictive validity. The aim of the present study was to assess the interrater reliability of V-RISK-Y in child and adolescent psychiatric units and acute child protective services institutions. METHODS: A case vignette study design was utilized to assess interrater reliability of V-RISK-Y. Staff at youth facilities (N = 163) in Norway and Sweden scored V-RISK-Y for three vignettes, and interrater reliability was assessed with the intraclass correlation coefficient (ICC). RESULTS: Results indicate good interrater reliability for the sum score and Low-Moderate-High risk level appraisal across staff from the different facilities and professions. For single items, interrater reliability ranged from poor to excellent. CONCLUSIONS: This study is an important step in establishing the psychometric properties of V-RISK-Y. Findings support the structured professional judgment tradition the instrument is based on, with high agreement on the overall risk assessment. This study had a case vignette design, and the next step is to assess the reliability and validity of V-RISK-Y in naturalistic settings.

Development and validation of a questionnaire to assess health-related quality-of-life in cats with hyperthyroidism.

BACKGROUND: Health-related quality-of-life (HRQoL) assessment tools are becoming increasingly important for the assessment of diseases in veterinary medicine. OBJECTIVES: To develop a tool to assess the HRQoL of hyperthyroid cats and their owners. ANIMALS: Cats with hyperthyroidism (n = 229) and without hyperthyroidism (n = 322). METHODS: Cross-sectional study design. A preliminary list of 28 questions relating to the HRQoL of hyperthyroid cats and the influence their cat's disease might have on owners was created. Each question consisted of 2 subquestions: (1) "how often does the item apply"; (2) "how strongly does the item affect HRQoL." The questionnaire was refined based on statistical analysis, including Mann-Whitney-U tests on each item, comparing the results from cats with and without hyperthyroidism. Internal consistency and reliability of the questions were measured by Cronbach's alpha (α). P < .05 was considered significant. RESULTS: Overall, 25/28 questions were retained within the final HRQoL tool, which had an excellent internal consistency (α = .92). The tool produced a score between 0 and 382 (lower scores meaning better HRQoL). The median HRQoL score was 87.5 (range, 2-348) for cats with hyperthyroidism, and 27 (range, 0-249) for cats without (P < .001), suggesting the HRQoL was poorer in hyperthyroid cats. CONCLUSIONS AND CLINICAL IMPORTANCE: This validated HRQoL tool is useful to reliably quantify the influence of hyperthyroidism on the quality-of-life of affected cats and their owners. In the future, it could be considered of assistance in the clinical assessment of cats with hyperthyroidism.

A Descriptive Study on the Impacts of Hyperbaric Oxygen Therapy on Autistic Individuals Using Parent Testimonies.

Introduction Hyperbaric oxygen therapy (HBOT) has been influential in treating many physical and psychological ailments, including the symptoms of autism. This current study aims to evaluate HBOT parents' goals and exit interviews describing the positive, negative, or no impacts experienced from the HBOT dives, asking the question, "Are your child's symptoms improving?" Methods Between January 2020 and July 2023, a Class B monoplace hyperbaric chamber (Sechrist 3300H, Sechrist Industries, Inc., Anaheim, California, United States) was used to administer HBOT sessions to patients with autism. Medical-grade oxygen was pressurized to 1.5-2.0 atmospheres absolute at a rate of 1-2 psi/min, with an average oxygen percentage of 100%, for up to five sessions per week. Retrospective descriptive data and patient information through parent testimonials were collected through a chart review of 30 children and one adult with autism who experienced HBOT sessions. Data were presented through exit interviews describing how parents felt about their child's progress toward goals. Four raters rated parent testimonies on a 5-point Likert scale (1 = Much worse, 2 = Somewhat worse, 3 = Stayed the same, 4 = Somewhat improved, and 5 = Much improved), and an inter-rater reliability estimate using interclass correlation (2) (r = 0.831) was derived, indicating excellent agreement between raters. Results Parents/caregivers provided testimony in an exit interview with a registered nurse after the individual with autism received an entire course of HBOT dives. Descriptive statistics resulted in Rater #1 (M = 4.19, median = 4, SD = 0.654): 87.1% of Rater #1 ratings were Somewhat improved and Much improved; Rater #2 (M = 4.23, median = 4, SD = 0.717): 83.9% of Rater #2 ratings were Somewhat improved and Much improved; Rater #3 (M = 4.23, median = 4, SD = 0.560): 93.5% of Rater #3 ratings were Somewhat improved and Much improved; and Rater #4 (M = 4.26, median = 4, SD = 0.631): 90.3% of Rater #4 ratings were Somewhat improved and Much improved. One-way ANOVA resulted in F (3,123) = 0.052, p = 0.984, which indicated a nonstatistically significant mean difference between rater groups. Conclusions The current study assessed HBOT parents'/caregivers' goals and exit interviews, describing the effects experienced from the complete course of HBOT dives on their children/individuals. A majority of parents/caregivers declared that their condition had "Much improved" or "Somewhat improved," based on the 5-point Likert scale. Based on parents'/caregivers' testimonies, HBOT was demonstrated as a safe and effective intervention, and side effects were primarily mild and did not lead to treatment discontinuation. As a result of this analysis, we recommend continued use of HBOT for treatment.

Personality disorder coverage, prevalence, and convergence: do the DSM-5's two models of personality disorder identify the same patients?

BACKGROUND: Research on the Alternative DSM-5 Model for Personality Disorders (AMPD) in DSM-5's Section-III has demonstrated acceptable interrater reliability, a largely consistent latent structure, substantial correlations with theoretically and clinically relevant measures, and evidence for incremental concurrent and predictive validity after controlling for DSM-5's Section II categorical personality disorders (PDs). However, the AMPD is not yet widely used clinically. One clinician concern may be caseness - that the new model will diagnose a different set of PD patients from that with which they are familiar. The primary aim of this study is to determine whether this concern is valid, by testing how well the two models converge in terms of prevalence and coverage. METHOD: Participants were 305 psychiatric outpatients and 302 community residents not currently in mental-health treatment who scored above threshold on the Iowa Personality Disorder Screen (Langbehn et al., ). Participants were administered a semi-structured interview for DSM-5 PD, which was scored for both Section II and III PDs. RESULTS: Convergence across the two PD models was variable for specific PDs, Good when specific PDs were aggregated, and Very Good for 'any PD.' CONCLUSIONS: Results provide strong evidence that the AMPD yields the same overall prevalence of PD as the current model and, further, identifies largely the same overall population. It also addresses well-known problems of the current model, is more consistent with the ICD-11 PD model, and provides more complete, individualized characterizations of persons with PD, thereby offering multiple reasons for its implementation in clinical settings.

Can surgeons accurately identify mesh type when interpreting computed tomography scans after ventral hernia repair?

BACKGROUND: Recurrent ventral hernia repair can be challenging due to scarred tissue planes and the increasing complexity of disease related to multiple recurrences. Given the challenges of acquiring complete and accurate prior operative reports, surgeons often rely on computed tomography (CT) scans to obtain information and plan for re-operation. Still, the contribution of CT scans and the ability of surgeons to interpret them is controversial. Previously, we examined the ability of surgeons to determine prior operative techniques based on CT scans. Here, we assessed the accuracy of expert abdominal wall reconstruction (AWR) surgeons in identifying the type of prior mesh using CT imaging. METHODS: A total of 22 highly experienced AWR surgeons were asked to evaluate 21 CT scans of patients who had undergone open ventral hernia repair with bilateral transversus abdominis release utilizing mesh. The surgeons were required to identify the mesh type from a multiple-choice selection. Additionally, negative controls (patients without a history of prior laparotomy) and positive controls (patients with laparotomy but no ventral hernia repair) were incorporated. The accuracy of the surgeons and interrater reliability was calculated. RESULTS: The accuracy rate of the surgeons in correctly identifying the mesh type was 46%, with heavy-weight synthetic mesh (HWSM) being identified only 35.4% of the time, Strattice mesh and medium-weight synthetic mesh (MWSM) were identified at 46.3%, and 51.8%, respectively. The interrater reliability analysis found a moderate level of agreement 0.428 (95% CI 0.356-0.503), and the repeatability measure was poor-0.053 (95% CI 0-0.119); this indicates that surgeons cannot reliably replicate the identification process. CONCLUSIONS: Surgeons' ability to accurately identify the type of previous mesh using CT scans is poor. This study underscores the importance of documenting the type of mesh used in the operative report and the need for standardized operative notes to improve the accuracy and consistency of documentation.

Reliability and validity of the Estonian version of the Clinical Institute of Withdrawal Assessment for Alcohol scale.

AIMS: Our aim was to adapt the Clinical Institute of Withdrawal Assessment for Alcohol scale (CIWA-Ar) into Estonian and test its reliability and validity. METHODS: A total of 72 patients with alcohol withdrawal syndrome participated in the study. In order to assess the interrater reliability, at first assessment the CIWA-Ar was simultaneously completed by two nurses. In order to assess the sensitivity of the CIWA-Ar to the changes in the severity of the withdrawal syndrome, as well as its correlations to several indices characterizing the subjects' current condition, the CIWA-Ar, the Clinical Global Impression Severity subscale (CGI-S), the visual analogue scales for the assessment of the general feeling of malaise, anxiety and depression were filled in and the vital signs were measured at inclusion, in 4 h and after the withdrawal syndrome had been resolved. RESULTS: The intraclass correlation coefficient (ICC) for the Estonian version of the CIWA-Ar total score, used as an indicator of interrater reliability, was excellent. The CIWA-Ar had significant correlations with the psychiatrists' CGI-S ratings of the severity of the patient's condition at all assessment points. Significant correlations were also found between CIWA-Ar and patients' self-ratings, the highest correlations found with self-rated anxiety and general feeling of malaise. CIWA-Ar total score did not correlate with simultaneously measured heart rate, systolic and diastolic blood pressure at the first assessment. At the second assessment, heart rate had a significant correlation with the CIWA-Ar total score. CONCLUSION: Our study provides confirmation that the CIWA-Ar tool is well applicable in the Estonian language and culture setting.

Reliability of Markerless Motion Capture Systems for Assessing Movement Screenings.

Background: Movement screenings are commonly used to detect unfavorable movement patterns. Markerless motion capture systems have been developed to track 3-dimensional motion. Purpose: To determine the reliability of movement screenings assessed using a markerless motion capture system when comparing the results of multiple systems and multiple collection periods. Study Design: Descriptive laboratory study. Methods: The inter- and intrarater reliability of a commercially available markerless motion capture system were investigated in 21 recreationally active participants aged between 18 and 22 years. A total of 39 kinematic variables arising from 10 fundamental upper and lower body movements typical of a screening procedure in sports performance were considered. The data were statistically analyzed in terms of relative error via the intraclass correlation coefficient (ICC) and absolute error via the residual standard error (RSE). Results: Both inter- and intrarater reliability ICCs were at least moderate across all variables (ICC, >0.50), with most movements and corresponding variables having excellent reliability (ICC, >0.90). Although maximum knee valgus angles were the kinematic variables with the lowest interrater reliability (ICCs, 0.59-0.82) and moderate relative agreement, there was agreement in absolute terms with an RSE of <1.3°. Conclusion: Findings indicated that markerless motion capture provides reliable measurements of joint position during a movement screen, which allows for a more objective evaluation of the direction and subsequent success of interventions. However, practitioners should consider relative and absolute agreements when applying information provided by these systems. Clinical Relevance: Markerless motion capture systems may assist clinicians by reliably assessing movement screenings using different systems over different collection periods.

GripAble: Interrater reliability and normative grip strength of UK population.

BACKGROUND: Hand grip strength is an established indicator of individual health status and is used as a biomarker for predicting mortality, disability, and disease risks. GripAble hand grip dynamometer offers a modernized approach to measuring grip strength with its digital and high-accuracy measurement system. PURPOSE: This study aimed to (1) assess the interrater reliability of maximum grip strength (MGS) measurement and (2) establish GripAble's own gender-, age group- and hand-stratified normative MGS reference values of the adult UK population. STUDY DESIGN: Cross-sectional study design. METHODS: Interrater reliability among three raters assessing 30 participants across diverse age groups was measured using the intraclass correlation. In the second study, 11 investigators gathered MGS data from 907 participants across diverse age groups and gender. The average, standard deviation, minimum, median, maximum, and percentiles of MGS were computed for each gender, age group, and hand (L/R). The relationship between MGS and age was examined using quantile regression analysis. Additionally, generalized linear model regression analysis was conducted to explore the influence of participants' demographics (gender, hand [L/R], hand length, hand circumference, age, weight, and height) on MGS. RESULTS: MGS measurements between raters showed excellent agreement (ICC(2,1) = 0.991, 95% confidence interval [0.98, 1.0]). The MGS and age relationship follows a curvilinear pattern, reaching a peak median MGS values of up to 20 kg between 30 and 49 years for females and up to 35 kg between 30 and 59 years for males. Subsequently, MGS declined as age advanced. Gender and hand (L/R) emerged as the primary factors influencing MGS, followed by hand length, hand circumference, age, weight, and height. CONCLUSIONS: The presented normative MGS reference values can be used for interpreting MGS measurements obtained from adults in the United Kingdom using GripAble. This study, along with previous studies on GripAble devices, confirms GripAble as a reliable and valid tool for measuring MGS.

Predictive value and interrater reliability of mental status and mobility assessment in the emergency department.

AIM: To investigate the predictive value of both mental status, assessed with the AVPUC (Alert, responds to Voice, responds to Pain, Unresponsive, and new Confusion) scale, and mobility assessments, and their interrater reliability (IRR) between triage clinicians and a research team. METHOD: Prospective study of consecutive patients who presented to an ED. Mental status and mobility were assessed by triage clinicians and by a dedicated research team. RESULTS: 4,191 patients were included. After adjustment for age and sex, patients with altered mental status have an odds ratio of 6.55 [4.09-10.24] to be admitted in the ICU and an odds ratio of 21.16 [12.06-37.01] to die within 30 days; patients with impaired mobility have an odds ratio of 7.08 [4.60-11.12] to be admitted in the ICU and an odds ratio of 12.87 [5.93-32.30] to die within 30 days. The kappa coefficient between triage clinicians and the research team for mental status assessment was 0.75, and 0.80 for mobility. CONCLUSION: Assessment of mental status by the AVPUC scale, and mobility by a simple dichotomous scale are suitable for ED triage. Both altered mental status and impaired mobility are associated with adverse outcomes. Mental status and mobility assessment have good interrater reliability.

Assessment of pressure injury risk in intensive care using the COMHON index: An interrater reliability study.

OBJECTIVES: To assess the interrater reliability of the COMHON (level of COnciousness, Mobility, Haemodynamics, Oxygenation, Nutrition) Index pressure injury risk assessment tool. DESIGN: Interrater reliability was tested. Twenty-five intensive care patients were each assessed by five different nurse-raters from a pool of intensive care nurses who were available on the days of assessment. In total, 25 nurses participated. SETTING: Two general and one cardiovascular surgery intensive care units in Istanbul, Turkey. MAIN OUTCOME MEASURES: Interrater reliability was analysed using intraclass correlations, and standard errors of measurement (SEM) were calculated for sum scores, risk level and item scores. Minimally detectable change (MDC) was also calculated for sum score. Consistency between paired raters was analysed using Pearson's Product Moment Correlation (r) for sum score and Spearman's rho (rs) for ordinal variables. RESULTS: All assessments were completed in ≤5 min. Interrater reliability was very high [ICC (1,1) = 0.998 (95 % CI 0.996 - 0.999)] with a SEM of 0.14 and MDC of 0.39. Consistency between paired raters was strong for sum and item scores and risk levels (coefficients >0.6). All scale items showed correlations of >.3 with the sum score. CONCLUSION: The results demonstrate near-perfect interrater reliability. Further research into the psychometric properties of the COMHON Index and its impact on preventative intervention use is warranted. IMPLICATIONS FOR CLINICAL PRACTICE: Pressure injury risk assessment within intensive care should be setting-specific due to the unique risk factors inherent to the patient population, which are not considered by general pressure injury risk assessment tools. An intensive care-specific pressure injury risk assessment tool was tested and demonstrated high reliability between intensive care nurses. Further research is needed to understand how its use in practice affects preventative intervention implementation and, in turn, how it impacts pressure injury outcomes.

[The Operationalized Psychodynamic Diagnostic of Children and Adolescents (OPD-KJ-2) in Everyday Clinical Practice with the Plämobox: Applicability and Interrater Reliability]. / Die Operationalisierte Psychodynamische Diagnostik des Kindes- und Jugendalters (OPD-KJ-2) im klinischen Alltag mit dem Plämokasten.

The Operationalized Psychodynamic Diagnostic of Children and Adolescents (OPD-KJ-2) in Everyday Clinical Practice with the Plämobox: Applicability and Interrater Reliability Abstract: Objective: The OPD-CA2 manual for assessing psychodynamic aspects in children and adolescents is well established in clinical practice. However, publications regarding its reliability and validity are limited to (1) adolescents, (2) the structure of the first version of the manual and not to the comprehensive revision of the OPD-CA2, (3) the axes "structure" and (partly) "conflict" but not the axis "relationship," and (4) missing applicability in everyday clinical practice. Methodology: The present study comprised 42 children aged 6-12 years (age level 2 of the OPD-CA2), with and without mental illness, and assessed them using two randomly assigned raters. We assessed them using a low-structured diagnostic symbol game with miniature figurines and objects based on videotapes. We also tested the interrater reliability of the OPD-CA2 axes. Results: The overall assessment of structure and the assessment of the four subdimensions succeeded with good to very good agreement. We could also determine the presence of relevant conflict dynamics with very high agreement, while not recognizing specific conflicts in the clinical sample. Our assessment of the items of the relationship axis shows a low level of agreement. Conclusions: Overall, we can confirm the reliability of the OPD-CA2 for everyday clinical assessment in the younger age groups. Finally, we discuss which factors contribute to the heterogeneous picture.