Short-term reproducibility of cystometry in multiple sclerosis patients.

OBJECTIVE: To assess the reproducibility of detrusor activity cystometric pattern in multiple sclerosis (MS) patients, which is poorly documented in the medical literature, by means of successive filling. METHODS: We conducted a prospective study in MS patients; cystometry was repeated twice at 5minutes of interval if a detrusor overactivity before 300mL of filling was observed. Thus, 3 successive cystometries were analysed. The following characteristics were recorded: detrusor maximum pressure (Pmax), volume at the first involuntary detrusor contraction (IDC), maximum cystometric capacity (MCC), pressure at the first IDC, the existence of an overactive detrusor classified as phasic or terminal. RESULTS: We included 31 patients (19 women and 12 men); only 6 patients were naïve-treatment, the mean EDSS was: 5.3 (±1.6) and the mean age was 48.4 (±12.5) years. All the patients had an overactive detrusor for each cystometry. The reproducibility was good for all the parameters (range ICC between 0.7 and 0.83). CONCLUSION: Quantitative and qualitative cystometric data have a good reproducibility in MS patients with detrusor overactivity before 300mL of filling. LEVEL OF PROOF: 3.

[Reproducibility of bladder diary in patients with multiple sclerosis]. / Reproductibilité du calendrier mictionnel chez les patients atteints de sclérose en plaques. Étude prospective monocentrique.

INTRODUCTION: Multiple sclerosis (MS) is a neurological condition characterized by variable levels of symptoms. This variability could also affect bladder dysfunction and impact on the reproducibility or stability of bladder diary (BD). The aim of the study is to investigate the reproducibility and reliability of BD in MS, and then determine its linked factors. METHODS: The MS patient provided a 21 days BD and they documented the time of every void. The main criterion was assessed by voiding frequency, represented by the coefficient of variation (CV=average/standard deviation), expressed as a percentage. Two groups were described: stable BD group (CV≤15 %) and instable BD group (CV>15 %). Secondary criteria were completion of BD (complete or not) and the difference of voiding frequency variation between weekend and week. RESULTS: Thirty-one patients were included (mean age 51.06 years, SD 11.33) with 65 % of women. Mean CV is 23 % (SD 0.11). The mean completion of BD was 19.35 days (SD 3.99). 8 patients had a CV≤15 %. Stable group was older than instable group (P=0.03). There was no other difference between the 2 groups. There is a strong correlation between mean voiding frequency weekend and week (ρ=0.94, P<0.05). The longer duration of BD, the less reliability is notified. CONCLUSION: BD is not a stable reproducible in MS population. Both lack of compliance or variability of LUTS in MS may explain the unreliability of BD. However, BD utility should be discussed in this population. LEVEL OF EVIDENCE: 4.

[The 2015 classification of lung adenocarcinomas: Reproducibility in a Tunisian department specialised in thoracic pathology]. / La nouvelle classification 2015 des adénocarcinomes pulmonaires : reproductibilité au sein d'un service Tunisien spécialisé en pathologie thoracique.

INTRODUCTION: The new classification of lung cancer contains modifications of terminology and a new subdivision of the tumors with the most relevant modifications concerning the group of adenocarcinomas. The latter has been increasing and represents nowadays the most frequent type. Our aim was to assess the reproducibility of the new classification through the experience of a Department of Pathology specialized in thoracic pathology. METHODS: Our study included initially 106 cases diagnosed as adenocarcinomas and reviewed by 2 pathologists and 1 referee. Five cases were ruled out because they corresponded to squamous carcinoma according to the immunohistochemical findings. The same number of slides was reviewed without a limit of time. Statistical analysis was performed using the SPSS software. The Kappa index was estimated and a second coefficient: rho was analyzed. RESULTS: A total concordance was noticed in 82 cases (81.2%) and a discordance was noticed in 19 cases (18.8%). The agreement degree was good with an index Kappa estimated to 0.743 and a rho index reaching 0.763. CONCLUSION: Our study highlights the good reproducibility of the 2015 WHO classification of lung cancer among a trained team. Whereas, in order to improve the reproducibility of such a classification, even in non specialised departments, a training of the pathologists is necessary in order to highlight the prognostic impact of this classification.

Reliability of Haemophilus influenzae biofilm measurement via static method, and determinants of in vitro biofilm production.

Information is lacking regarding the precision of microtitre plate (MTP) assays used to measure biofilm. This study investigated the precision of an MTP assay to measure biofilm production by nontypeable Haemophilus influenzae (NTHi) and the effects of frozen storage and inoculation technique on biofilm production. The density of bacterial final growth was determined by absorbance after 18-20 h incubation, and biofilm production was then measured by absorbance after crystal violet staining. Biofilm formation was categorised as high and low for each strain. For the high biofilm producing strains of NTHi, interday reproducibility of NTHi biofilm formation measured using the MTP assay was excellent and met the acceptance criteria, but higher variability was observed in low biofilm producers. Method of inoculum preparation was a determinant of biofilm formation with inoculum prepared directly from solid media showing increased biofilm production for at least one of the high producing strains. In general, storage of NTHi cultures at -80 °C for up to 48 weeks did not have any major effect on their ability to produce biofilm.

[The ground visual field assessment, using two methods, compared with Goldmann perimetry]. / Évaluation du champ visuel au sol, selon deux méthodes, comparée avec le champ visuel de Goldmann. Validation de l'évaluation du champ visuel au sol.

In visual rehabilitation, ground visual field assessment (GVFA) makes it possible to assess the size of scotomas in connection with locomotion and to restore the width of the patient's visual field (VF). The information obtained by these tests has never been compared with Goldmann testing. The purpose of this study was to assess the reproducibility of VF measurement under different conditions (Goldmann perimetry, manual and automated GVFA). Ten patients (51.4±14.0 years, 4 men and 6 women) with tunnel fields inferior or equal to the central 25°, performed three different versions of a binocular VF assessment: Goldmann perimetry, manual GVFA, and automated GVFA. The two versions of the GVFA were performed at 1m then 5m from the patient on the ground, and finally 5m away from the patient at eye level, facing the patient. The main outcome was the total perceived surface for each test. The reproducibility of the measurement was average or good for the test at 1m (ICC=0.685 to 0.866). Conversely, it was very poor between the tests at 5m, except for the automated and manual GVFA at 5m on the ground (ICC=0.888). This study shows good reproducibility of the GVFA measurements at 1m with less reproducibility at 5m, which can be explained by difficulties in the execution of the GVFA. Among the tests, the automated GVFA appears to be more reliable than the manual GVFA and is preferred by patients.

Validation and reproducibility of a short food frequency questionnaire for cardiovascular prevention.

BACKGROUND: Diet strongly influences cardiovascular risk. Dietary evaluation is a major issue in cardiovascular prevention, but few simple tools are available. Our team previously validated a short food frequency questionnaire; a new version of this questionnaire (Cardiovascular Dietary Questionnaire 2 [CDQ-2]) is easier to complete and more reliable. AIMS: To validate CDQ-2 in comparison with the original version, and to test its reproducibility. METHODS: CDQ-2 has 17 closed-ended questions; it provides a global dietary score that is a combination of specific scores for saturated, monounsaturated and omega-3 fatty acids, and fruit and vegetables. CDQ-2 was validated against the original version in two groups, who completed both questionnaires: 99 patients with cardiovascular risk factors and 50 healthy subjects. Reproducibility was assessed with 27 health professionals who completed the questionnaire twice, with a 1-month interval. RESULTS: The correlation coefficients of the scores between the two questionnaires ranged from 0.65 (monounsaturated fatty acids) to 0.93 (fruit and vegetables) (all P<0.001). The percentage of subjects classified in the same quartile by both questionnaires ranged from 56% (omega-3 fatty acids) to 78% (fruit and vegetables). The percentage of subjects classified in the same or adjacent quartile ranged from 91% to 99%. The intraclass correlation coefficients, which assessed reproducibility, ranged from 0.61 (fruit and vegetables) to 0.88 (saturated fatty acids) (P<0.001). CONCLUSIONS: This new version of the short dietary questionnaire shows good reproducibility and correlations with the original version; use and reliability are improved, which makes CDQ-2 a valuable tool for cardiovascular prevention.

Agreement between optical coherence and Scheimpflug tomography: Vault measurements and reproducibility after implantable collamer lens implantation.

PURPOSE: To evaluate the agreement between Scheimpflug tomography (Pentacam, Oculus) and anterior segment optical coherence tomography (AS-OCT, RTVue 100, Optovue) as well as the reproducibility of each technique in assessing the lens-ICL distance (vault) after implantable collamer lens (ICL) implantation. METHODS: The vault was measured manually with Scheimpflug tomography and AS-OCT. Intraclass correlation coefficients (ICC) and Bland-Altman plots were used to determine the reproducibility of measurements and the agreement between them. Multivariate regression analysis was performed to identify predictors of differences in vault measurements between devices. RESULTS: 80 eyes of 46 ICL patients were analyzed. Mean patient age was 33.8±7.4 years (range, 21 to 51), and 27 (59%) were women. The preoperative spherical equivalent refraction ranged from -26 to 8.5 diopters (D). The mean vault measured by AS-OCT was 558.8±240.2µm (range, 162 - 1220) vs. 430.1±215.3µm (range, 0 to 1070) by Pentacam. AS-OCT yielded vault values, on average, 128.1±64.6µm higher than the Pentacam (range, -22 to 293µm). The ICC values for consistency and absolute agreement were 0.960 and 0.928, respectively. Reproducibility of vault measurements was excellent for both devices (ICC≥0.946). Four parameters-vault, pupil diameter (PD), PD differences between devices, and preoperative spherical equivalent refraction-were significant predictors of differences in vault measurements (adjusted-R2=0.412; P<0.001). CONCLUSIONS: Agreement between AS-OCT and Pentacam for vault measurement was good. Vaults were higher when measured by AS-OCT. These differences are clinically relevant, and therefore these devices cannot be used interchangeably to measure vault.

Reproducibility of SD-OCT inner macular layer thickness measurements in children with primary congenital glaucoma.

PURPOSE: To examine the reproducibility of spectral domain optical coherence tomography (SD-OCT) segmented ganglion cell complex and circumpapillary retinal nerve fiber layer (cpRNFL) measurements in children with primary congenital glaucoma (PCG) in comparison with healthy children. METHODS: 12 children with PCG (G1) and 24 healthy children (G2) were recruited. The following SD-OCT measurements (Spectralis, Heidelberg Engineering) were made in one eye per child: total macular thickness (MT), thicknesses in several subfields and volumes of the three inner macular layers, macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) and cpRNFL thickness. In a single day, an expert operator obtained 3 circumpapillary and 3 macular measurements in each participant to determine intraoperator variability. Intraoperator repeatability was defined by the coefficient of variation (CoV) and intraclass correlation (ICC). RESULTS: ICC was excellent in both groups for cpRNFL measurements (G1 ICC=0.950 and G2 ICC=0.995) and for MT was excellent in G1 (ICC=0.957) and moderate in G2 (ICC=552). For the inner macular layer measurements, all ICCs were better in PCG group (mRNFL-ICC: 0.915 vs. 0.765; ICC-GCL: 0.584 vs. 0.263 and ICC-IPL: 0.979 vs. 0.742; G1 and G2 respectively). Greater CoV were recorded for macular measurements (from 0.71% to 9.82%) compared to cpRNFL measurements (from 0.52% to 1.50%). CONCLUSION: In children with PCG, Spectralis SD-OCT showed excellent intrasession repeatability for cpRNFL, MT, mRNFL and IPL measurements and moderated for GCL measurements. For all macular measurements, ICC were higher in children with PCG than healthy children.

Generalizability of Results from Randomized Controlled Trials in Post-Stroke Physiotherapy.

Purpose: The randomized controlled trial (RCT) is considered a reliable experimental design, able to detect the effect of an intervention. However, a criticism frequently levelled at RCTs by clinicians is their lack of generalizability. This study aimed to evaluate the generalizability of findings from RCTs of physiotherapy interventions for individuals with stroke. Method: A sample of RCTs of physiotherapy interventions after stroke indexed in the PEDro database was selected, and the reported inclusion and exclusion criteria were analyzed. Results: We reviewed 100 articles, which included 7,366 participants (41.6% women, with a mean weighted age of 65.5 years). The most frequent criteria for exclusion were comorbidity (83%), cognitive impairments (69%), communication skills (55%), recurrent stroke (53%), low functional level (47%) and being elderly (25%). Conclusions: A variety of cohorts of individuals who have had a stroke are excluded from RCTs published in the field of physiotherapy. Because they represent a substantial proportion of the real-world population with stroke, and consequently treated in clinical practice, more vulnerable cohorts of participants should be included in RCTs.

Objectif : l'essai aléatoire et contrôlé (EAC) est considéré comme une méthodologie expérimentale fiable, en mesure de déterminer l'effet d'une intervention. Cependant, les cliniciens en critiquent souvent l'absence de généralisabilité. La présente étude visait à évaluer la généralisabilité des résultats des EAC sur des interventions de recherche en physiothérapie auprès de personnes ayant subi un accident vasculaire cérébral (AVC). Méthodologie : les auteurs ont sélectionné un échantillon d'EAC sur des interventions de physiothérapie après un AVC indexées dans la base de données PEDro. Ils ont analysé les critères d'inclusion et d'exclusion déclarés. Résultats : les auteurs ont examiné 100 articles, qui incluaient 7 366 participants (41,6 % de femmes, d'un âge moyen pondéré de 65,5 ans). Les critères d'exclusion les plus fréquents étaient la comorbidité (83 %), les déficiences cognitives (69 %), les aptitudes à la communication (55 %), les AVC récurrents (53 %), un faible niveau fonctionnel (47 %) et le fait d'être âgé (25 %). Conclusion : diverses cohortes de personnes qui ont subi un AVC sont exclues des EAC publiés en physiothérapie. Puisqu'elles représentent une forte proportion de la population de personnes qui subissent un AVC en situation réelle et qui sont ensuite traitées en pratique clinique, il faudrait inclure plus de cohortes de participants vulnérables dans les EAC.

[Training in fetal ultrasound biometry: Prospective assesment of Objective Structured Assessment of Ultrasound Skills (OSAUS) efficiency]. / Apprentissage de la biométrie échographique fœtale : évaluation prospective de la performance de l'Objective Structured Assessment of Ultrasound Skills (OSAUS).

BACKGROUND: Fetal biometry quality directly influences obstetrical care relevance. However, obstetrician proficiencies are heterogeneous in particular during initial training. OBJECTIVES: To assess the predictive value of OSAUS scale to identify operators with enough command to perform a valid estimation of fetal weight (EFW) (I). This study also assesses OSAUS intra-operator inter-exams variability (II) and pass/fail score relevancy (III). METHODS: Lecturers in Nancy University Hospital assessed trainees' proficiency for EWF systematically and prospectively through OSAUS scale. The trainee assessment was performed right after the one of the senior operator (reference EFW) on three consecutive patients during standard care ultrasounds. To ensure variability in proficiency within the sample, previous practice was taken into account during enrollment ("novices" and "intermediates" for<20 and 20 past exams, respectively). Correlation between mean OSAUS and validity of EFW (a valid EFW was defined by a difference with the reference EWF<0.8 Z-score) and variability between consecutive assessments were assessed. RESULTS: The study population was constituted of 8 "novice" and 8 "intermediate" trainees. Association between OSAUS and EFW validity was significant (P<0.03) (I). Intra-operator inter-exams variability was majored in the "novice" group (coefficients of variation were 25% vs. 10% in "novice" and "intermediate" group respectively) (II). Within the sample, specificity and positive predictive value of a pass/fail score OSAUS>3.5 to predict EFW validity were 77% and 71%, respectively (III). CONCLUSION: A 3.5 OSAUS pass/fail score could provide a relevant threshold to estimate operator proficiency in assessing fetal biometry in an autonomous and secure way.

Diagnostic Value of Acromiohumeral Distance in Rotator Cuff Pathology: Implications for Advanced-Practice Physiotherapists.

Purpose: The primary purpose of this study was to examine the inter-tester reliability and criterion validity of reduced acromiohumeral distance (AHD; <6 mm) visualized on plain radiographs in detecting rotator cuff (RC) pathology. The secondary objective was to examine the relationship between this radiographic feature and patient demographics and clinical examination. Method: This was a diagnostic study of patients seen in a tertiary care centre. Two advanced-practice physiotherapists measured AHD in two radiographic views. MRI was used as the gold standard. Results: A total of 150 consecutive patients (mean age 59 [SD 11] y, 57 women, 93 men) were included. AHD less than 6 millimetres was highly specific in both views for the presence of tear (99%), tear size (96%-98%), and fatty infiltration in the supraspinatus and infraspinatus muscles (93%-96%). The absence of AHD less than 6 millimetres was associated with a lack of advanced fatty infiltration in the supraspinatus and infraspinatus muscles (92%-100%). Sensitivity values were low for the presence and size of RC tear (21%-55%). We found a statistically significant positive association between the AHD categories and clinically observed muscle wasting and weakness of the RC muscles (p < 0.05). Conclusions: AHD less than 6 millimetres was reliably measured in plain radiographs and was strongly associated with important clinical and imaging features of advanced RC pathology; this may assist with clinical decision making by allowing judicious use of more costly investigations and referral for surgery.

Objectif : la présente étude avait comme objectif primaire d'examiner la fiabilité interévaluateur et la validité critérielle d'un intervalle acromio-huméral réduit (IAH < 6 mm) observé à la radiographie simple pour déceler une pathologie de la coiffe des rotateurs (CR). Son objectif secondaire consistait à examiner la relation entre cette caractéristique radiographique, la démographie des patients et l'examen clinique. Méthodologie : étude diagnostique de patients vus dans un centre de soins tertiaires. Deux physiothérapeutes en pratique avancée ont mesuré l'IAH sur deux vues radiographiques. L'imagerie par résonance magnétique servait de norme de référence. Résultats : au total, 150 patients consécutifs (âge moyen de 59 ans [ÉT 11], 57 femmes, 93 hommes) ont été inclus dans l'étude. Dans les deux vues radiographiques, l'IAH inférieur à 6 mm était hautement spécifique de la présence d'une déchirure (99 %), de la dimension de la déchirure (96 % à 98 %) et d'une infiltration graisseuse dans les muscles supra-épineux et infra-épineux (93 % à 96 %). L'absence d'IAH inférieur à 6 mm s'associait à l'absence d'infiltration graisseuse avancée dans les muscles supra-épineux et infra-épineux (92 % à 100 %). Les valeurs de sensibilité étaient faibles pour ce qui est de la présence et de la dimension d'une déchirure de la CR (21 % à 55 %). On constatait une association statistiquement significative entre les catégories d'IAH et une observation clinique d'amyotrophie et de faiblesse musculaire de la CR (p < 0,05). Conclusion : l'IAH inférieur à 6 mm était mesuré en toute fiabilité sur des radiographies simples et s'associait fortement à des caractéristiques de pathologie avancée de la CR, tant sur le plan de la clinique que de l'imagerie. Ces constatations pourraient contribuer aux prises de décision en favorisant l'utilisation judicieuse d'explorations plus coûteuses et de l'orientation en chirurgie.

[Borderline ovarian tumours: CNGOF Guidelines for clinical practice - Biopathology of ovarian borderline tumors]. / Tumeurs frontières de l'ovaire. Recommandations pour la pratique clinique du CNGOF ­ Biopathologie des tumeurs frontières de l'ovaire.

OBJECTIVES: Ovarian borderline tumors (OBT) represent a heterogeneous group of lesions with specific management for each histological subtype. Thus, the correct histological diagnosis is mandatory. MATERIAL AND METHODS: References were searched by PubMed from January 2000 to January 2018 and original articles in French and English literature were selected. RESULTS AND CONCLUSIONS: OBT should be classified according to the last WHO classification. Any micro-invasion (foci<5mm) or microcarcinoma (foci<5mm with nuclear atypia and desmoplastic stromal reaction) should be indicated in the pathology report. In case of serous OBT, variants (classical or the micropapillary/cribriform) should be indicated (grade C). The peritoneal implants associated with OBT, should be classified as invasive or noninvasive, according to the extension into the underlying adipous tissue. If no adipous tissue is seen the term undetermined should be used (grade B). In case of mucinous OBT bilateral and/or with peritoneal implants or peritoneal pseudomyxoma a search for primitive gastrointestinal, appendiceal or biliopancreatic tumor should be performed (grade C). In case of OBT, a thorough sampling of the tumor is recommended, with 1 block/cm and 2 blocks/cm in case of mucinous OBT, serous OBT micropapillary variant, OBT with intraepithelial carcinoma or/and micro-invasion. Peritoneal implants should be examined in toto. Omentum without macroscopic lesion should be sampled in 4 to 6 blocks (grade C). In case of ovarian cyst suspicious for OBT, fine needle aspiration is not recommended (grade C). In case of ovarian tumor suspicious for OBT, intraoperative examination should be performed by a gynecological pathologist (grade C).

How to Optimize Measurement Protocols: An Example of Assessing Measurement Reliability Using Generalizability Theory.

Purpose: This article identifies how to assess multiple sources of measurement error and identify optimal measurement strategies for obtaining clinical outcomes. Method: Obtaining, interpreting, and using information gained from measurements is instrumental in physiotherapy. To be useful, measurements must have a sufficiently small measurement error. Traditional expressions of reliability include relative reliability in the form of an intra-class correlation coefficient and absolute reliability in the form of the standard error of measurement. Traditional metrics are limited to assessing one source of error; however, real-world measurements consist of many sources of error. The measurement framework generalizability theory (GT) allows researchers to partition measurement errors into multiple sources. GT further allows them to calculate the relative and absolute reliability of any measurement strategy, thereby allowing them to identify the optimal strategy. We provide a brief comparison of classical test theory and GT, followed by an overview of the terminology and methodology used in GT, and then an example showing how GT can be used to minimize error associated with measuring knee extension power. Conclusion: The methodology described provides tools for researchers and clinicians that enable detailed interpretation and understanding of the error associated with their measurements.

Objectif : décrire comment évaluer de multiples sources d'erreur de mesure et les stratégies de mesures optimales pour obtenir des résultats cliniques. Méthodologie : il est important d'obtenir, d'interpréter et d'utiliser l'information tirée des mesures en physiothérapie. Pour que ces mesures soient utiles, leur écart-type doit être suffisamment petit. Les expressions habituelles de fiabilité incluent la fiabilité relative sous forme de coefficient de corrélation intraclasse et la fiabilité absolue sous forme d'écart-type des mesures. Les mesures habituelles sont limitées à l'évaluation d'une source d'erreur. Cependant, les mesures réelles s'associent à plusieurs sources d'erreur. La théorie de généralisabilité (TG) du cadre de mesure permet aux chercheurs de diviser les erreurs de mesure selon de multiples sources. Elle leur permet également de calculer la fiabilité relative et absolue de toute stratégie de mesure, pour parvenir à une stratégie optimale. Le présent article fournit une brève comparaison entre la théorie du test classique et la TG, puis un aperçu de la terminologie et de la méthodologie utilisées en TG. Enfin, les auteurs présentent un exemple démontrant comment utiliser la TG pour limiter l'erreur associée à la mesure de la puissance d'extension du genou. Conclusion : la méthodologie décrite fournit des outils pour les chercheurs et les cliniciens afin de parvenir à une interprétation et une compréhension détaillées des erreurs de mesure.

Does the number of trials affect the reliability of handgrip strength measurement in individuals with intellectual disabilities?

The main objectives of this study were to examine which testing protocol (one/two/three trials) and method (best/average value) used for determining maximal handgrip strength is more reliable for individuals with intellectual disabilities (ID) and to compare the reliability and variability of maximal handgrip strength measurement between individuals with ID and healthy individuals. Twenty individuals with ID (18.7±3.3 years) and 20 healthy individuals (18.5±3.4 years) performed six separate sessions. During these sessions, the participants' maximal handgrip strength was evaluated using three protocols with different number of trials (one/two/three). In individuals with ID, the protocols with one and two trials were less reliable (ICC=0.78-0.95; SEM%=9-21) than the protocol with three trials (ICC=0.94-0.96; SEM%=8-10) whereas in healthy individuals all protocols were equally reliable (ICC=0.95-0.99; SEM%=1.9-4.9). In individuals with ID, the mean of three trials (ICC=0.96, SEM=1.19-1.35kg, SEM%=8.2-8.7) had slightly higher reliability than the best of three trials (ICC=0.94, SEM=1.47-1.75kg, SEM%=9.2-10.1). Furthermore, the variability of maximal handgrip strength measurement was about twofold higher in individuals with ID (CV=37-45%) vs. healthy individuals (CV=21-23%). Maximal handgrip strength can be measured reliably in young individuals with ID using the mean of three trials as the most reliable approach for the determination of maximal handgrip strength.

Reliability of objective ocular torsion assessment using fundus photography in infantile esotropia.

PURPOSE: To evaluate the interobserver reproducibility of objective ocular torsion measurements in infantile esotropia using fundus photography analysis. MATERIALS AND METHODS: This retrospective observational study was conducted in our ophthalmology department at the University Hospital in Tours from 2009 to 2015. OBJECTIVE: Ocular torsion was assessed using fundus photography and analysed on Adobe Photoshop software within a population of children with infantile esotropia. Two observers, an orthoptist and an ophthalmologist, carried out the evaluation separately. The interobserver agreement was calculated for quantitative measurement by the interclass correlation coefficient (ICC) and by Cohen's Kappa coefficient for qualitative assessment. RESULTS: A total of 200 eyes (100 subjects, mean age: 6.88 years) were assessed. Statistical analyses for quantitative measurements resulted in an ICC of 0.98 (95% CI, 0.97-0.99) for right eyes, 0.96 (95% CI, 0.95-0.97) for left eyes, 0.98 (CI 95%, 0.97-0.98) for pre- operative eyes and 0.96 (95% CI, 0.95-0.97) for postoperative eyes. The ICC calculated on all four hundred fundus photographs was 0.97 (95% CI, 0.97-0.98). The interobserver agreement for qualitative measurements resulted in a Kappa coefficient of 0.91 for right eyes, 0.85 for left eyes, 0.90 for preoperative eyes and 0.86 for postoperative eyes. The analysis of all four hundred eyes returned a Kappa coefficient of 0.88. CONCLUSIONS: Objective ocular torsion assessment using our procedure, whether by an orthoptist or ophthalmologist, is a reliable and reproducible method for the management of infantile esotropia.

Reliability and Validity of the Four-Point Pusher Score: An Assessment Tool for Measuring Lateropulsion and Pusher Behaviour in Adults after Stroke.

Purpose: The authors determined the reliability and validity of the Four-Point Pusher Score (4PPS) among stroke survivors. Method: Stroke survivors were invited to participate within 48 hours of admission to a stroke rehabilitation unit in a tertiary hospital. Intrarater reliability was determined by examining scores assigned to the same patient by the same physiotherapist. Interrater reliability was determined by examining scores assigned to the same patient by two other physiotherapists. Validity was determined by examining associations with the Burke Lateropulsion Scale (BLS), Scale for Contraversive Pushing (SCP), and functional scales. Results: A total of 85 participants who were a median of 13 (interquartile range 9-21) days post-stroke completed this study. The weighted κ statistic for 4PPS intra- and interrater reliability was 0.97 (p < 0.001). Scores on the 4PPS were very strongly associated with scores on the BLS (r s = 0.95) and the SCP (r s = 0.86). Strong associations were evident between the 4PPS and the Berg Balance Scale (r s = -0.77), Chedoke-McMaster Stroke Assessment postural control scale (r s = -0.76), and FIM Motor sub-scale (r s = -0.64; all ps < 0.001). Conclusion: The 4PPS is a reliable and valid scale to assess lateropulsion and pusher behaviour in stroke survivors in an in-patient rehabilitation setting.

Objectif : déterminer la fiabilité et la validité du score du pousseur en quatre points (SP4P) chez les survivants d'un accident vasculaire cérébral (AVC). Méthodologie : des survivants d'un AVC hospitalisés dans l'unité d'un hôpital de soins tertiaires depuis moins de 48 heures ont été invités à participer à une réadaptation après un AVC. Les chercheurs ont déterminé la fiabilité intraévaluateur en examinant les scores attribués par un même physiothérapeute au même patient, et la fiabilité interévaluateur en examinant les scores attribués par deux autres physiothérapeutes au même patient. Ils ont établi la validité en examinant les associations avec l'échelle de latéropulsion de Burke (ÉLB), l'échelle de poussée contralésionnelle (ÉPC) et les échelles fonctionnelles. Résultats : au total, 85 participants qui avaient subi leur AVC une médiane de 13 jours auparavant (plage interquartile de 9 à 21 jours) ont terminé l'étude. Le test de concordance pondéré de kappa pour déterminer la fiabilité intraévaluateur et interévaluateur des SP4P s'élevait à 0,97 (p < 0,001). Les SP4P s'associaient très fortement à ceux de l'ÉLB (r s = 0,95) et de l'ÉPC (r s = 0,86). Des associations solides étaient évidentes entre les SP4P et l'échelle d'évaluation de l'équilibre de Berg (r s = ­0,77), l'échelle de contrôle postural de Chedoke-McMaster (r s = ­0,76) et le sous-score moteur de mesure de l'autonomie fonctionnelle (r s = ­0,64; p < 0,001 dans tous les cas). Conclusion : le SP4P est fiable et valide pour évaluer le comportement de la latéropulsion et du pousseur des survivants d'un AVC dans un contexte de réadaptation hospitalière.

Measurement Properties of the Return-to-Work Self-Efficacy Scale in Workers with Shoulder Injuries.

Purpose: The objective of this study was to investigate the measurement properties of the Return-To-Work Self-Efficacy (RTWSE) scale in injured Canadian workers. Method: We assessed internal consistency, construct-convergent, and known-groups validity of the RTWSE scale's total score and the pain management and re-injury self-efficacy (PRSE), supervisor support self-efficacy (SSE), and coworkers support self-efficacy (CWSE) domains in workers who had participated in a multidisciplinary rehabilitation program. Disability was measured by using the Disabilities of the Arm, Shoulder and Hand (DASH) scale. Spearman's ρ, odds ratios, and the area under the receiver operating characteristic curve (AUC) were used to examine the strength of the associations. Results: The data of 57 injured workers (43 men [75%], mean age 52 [11] y) were used for analysis. Internal consistency of the domains was satisfactory, with Cronbach's αs of 0.81, 0.87, and 0.92 for the CWSE, PRSE, and SSE, respectively. The PRSE domain correlated with the DASH (r = 0.39) and relevant domains of the RTWSE scale (rs = 0.47-0.78). The PRSE was able to differentiate between working and non-working people (AUC = 0.72). Satisfaction with the actual support received at work and overall job satisfaction correlated significantly with the total score and CWSE and SSE domains (AUCs ≥ 0.70). Conclusions: The RTWSE showed satisfactory internal consistency and construct convergent and known-groups validity in workers with shoulder injuries.

Objectif : explorer les propriétés de mesure de l'échelle d'efficacité personnelle liée au retour au travail (EPRT) chez des travailleurs canadiens blessés. Méthodologie : les chercheurs ont évalué la cohérence interne, la validité du construit convergent et la validité du groupe connu du score total de l'EPRT, ainsi que les domaines de l'efficacité personnelle de la gestion de la douleur et des nouvelles blessures (EPGDNB), de l'efficacité personnelle du soutien du superviseur (EPSS) et de l'efficacité personnelle du soutien des collègues de travail (EPSC) chez les travailleurs qui avaient participé à un programme de réadaptation multidisciplinaire. Les chercheurs ont mesuré l'incapacité à l'aide de l'échelle des incapacités du bras, de l'épaule et de la main (DASH, d'après l'acronyme anglais). Ils ont examiné la force des associations au moyen de la corrélation de Spearman, des rapports de cotes et de l'aire sous la courbe (ASC) de la fonction d'efficacité du récepteur. Résultats : les chercheurs ont analysé les données relatives à 57 travailleurs blessés 43 hommes [75 %], âge moyen de 52 ans [11]). La cohérence interne des domaines était satisfaisante : le coefficient alpha de Cronbach était de 0,81 pour l'EPSC, de 0,87 pour l'EPGDNB et de 0,92 pour l'EPSS. Le domaine de l'EPGDNB était corrélé avec l'échelle DASH (r = 0,39) et les domaines pertinents de l'EPRT (r s = 0,47 à 0,78). L'EPGDNB a pu distinguer les personnes qui travaillent de celles qui ne travaillent pas (ASC = 0,72). La satisfaction à l'égard du soutien réel reçu au travail et à l'égard du travail global avait une corrélation significative avec le score total et avec les domaines d'EPSC et d'EPSS (ASC ≥ 0,70). Conclusion : L'EPRT démontrait une cohérence interne, une validité du construit convergent et une validité des groupes connus satisfaisantes chez les travailleurs victimes d'une blessure à l'épaule.

Cardiac autonomic function during hypothermia and its measurement repeatability.

This study examined the effect of mild hypothermia (a 0.5 °C decrease in rectal temperature) on heart rate variability (HRV), with the identical hypothermia protocol performed twice and compared using intraclass correlation coefficient (r) analysis to study the repeatability. Twelve healthy males each completed 1 neutral (23 °C) and 2 cold (0 °C) trials. In the neutral trial, participants sat quietly for 30 min. In the cold trials, baseline data were obtained from a 5-min sample following 30 min of quiet sitting at 23 °C, followed by passive exposure to 0 °C; hypothermic measures were taken from a 5-min period immediately prior to rectal temperature decreasing by 0.5 °C. HRV was obtained from a 3-lead electrocardiogram. There were no differences (all p > 0.05) in baseline measures between the neutral and the 2 cold trials, suggesting no precooling anxiety related to the cold trials. Heart rate, together with HRV measures (i.e., root mean square difference of successive normal RR intervals, triangular interpolation of NN interval histogram, low-frequency oscillations (LF), and high-frequency oscillations (HF)), increased (all p < 0.05) with mild hypothermia and showed excellent reliability between the 2 cold trials (all r ≥ 0.81). In contrast, the LF/HF ratio decreased (p < 0.05) and had only fair reliability between the 2 cold trials (r = 0.551). In general, hypothermia led to increases in heart rate, together with most measures of HRV. Although it was counterintuitive that both sympathetic and vagal influences would increase simultaneously, these changes likely reflected increased stress from whole-body cooling, together with marked cardiovascular strain and sympathetic nervous system activity from shivering to defend core body temperature. An important methodological consideration for future studies is the consistent and repeatable HRV responses to hypothermia.

[TIMMA: Ultrasonographic scale of carotid atherosclerosis by vascular neurologists]. / TIMMA : échelle échographique de la surcharge athéromateuse en carotide pratiquée par des neurologues vasculaires.

BACKGROUND: Carotid atherosclerosis is a powerful predictive factor of vascular risk at the individual patient level. Ultrasonography is a reference technique for the evaluation of this condition. However, its use in common practice remains difficult due to a lack of standardization and inter-operator variability. We present a new and simple technique for the assessment of carotid atherosclerosis; and evaluate the ability of vascular neurologists to obtain results consistent with those of an expert in vascular ultrasound. MATERIAL AND METHODS: The TIMMA scale is an acronym for the five classes of carotid atherosclerosis in French, VIMMA in English: very important, important, moderate, minimal and absent. Combined, the first two classes make up the group "significant atheroma" and the last three classes make up the group "no significant atheroma". This scale was evaluated in 38 patients (76 carotid arteries) suffering from ischemic stroke or transient ischemic attack by five operators who are competent in carotid echocardiography: one TIMMA-trained (40 hours of training) vascular neurologist physician (VNP), three VNPs informed on the measurement method (1 hour of information) and one specialized vascular physician (SVP) who was considered to be the reference examiner. We evaluated the concordance between the VNPs and the SVP in classifying patients, firstly into the significant or not atheroma group and, secondly, into the five TIMMA classes. RESULTS: The evaluation of the two-group clustering scale found a concordance between the informed VNPs and the SVP on 76 carotid arteries of 86% (kappa=0.7) and between the trained VNP and the SVP on 58 carotid arteries of 90% (kappa=0.8). The positive and negative predictive values for significant atheroma diagnosis were 100% and 81%, respectively, for the informed VNPs, and 100% and 80% for the trained VNP. The evaluation of the Five-Class Scale showed a concordance between the informed VNPs and the SVP of 46% (kappa=0.3), and between the trained VNP and the SVP of 74% (kappa=0.7). CONCLUSION: TIMMA allows VNPs who are competent in carotid ultrasonography to reproducibly identify subjects with significant carotid atheroma. The contribution of this scale to the determination of cardiovascular risk should be evaluated.