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Inter-rater reliability of three standardized functional tests in patients with low back pain
Johan Tidstrand, Eva Horneij
BMC Musculoskeletal Disorders , 2009, DOI: 10.1186/1471-2474-10-58
Abstract: Nineteen consecutive individuals, ten men and nine women were included. (Mean age 42 years, SD ± 12 yrs). Two independent examiners assessed three tests: "single limb stance", "sitting on a Bobath ball with one leg lifted" and "unilateral pelvic lift" on the same occasion. The standardization procedure took altered positions of the spine or pelvis and compensatory movements of the free extremities into account. The inter-rater reliability was analyzed by Cohen's kappa coefficient (κ) and by percentage agreement.The inter-rater reliability for the right and the left leg respectively was: for the single limb stance very good (κ: 0.88–1.0), for sitting on a Bobath ball good (κ: 0.79) and very good (κ: 0.88) and for the unilateral pelvic lift: good (κ: 0.61) and moderate (κ: 0.47).The present study showed good to very good inter-rater reliability for two standardized tests, that is, the single-limb stance and sitting on a Bobath-ball with one leg lifted. Inter-rater reliability for the unilateral pelvic lift test was moderate to good. Validation of the tests in their ability to evaluate lumbar stability is required.Only 15% of patients with low back pain (LBP) are given a specific pathological diagnosis, the remaining 85% are diagnosed as "non-specific lumbar pain" [1]. For this latter group, treatment as well as the evaluation of treatment are considered difficult. Postural control as well as muscular coordination of the lumbar spine, are found to be impaired among patients with lumbar pain [2-5]. Muscular reactions are delayed among these patients [6-8]. This has mostly been measured and evaluated in a laboratory setting [2-4,6-8]. Traditionally, lumbar instability has been defined merely as an osteological, mechanical instability verified by x-ray, for example spondylolisthesis [9]. However, in line with a more functional and broader definition of lumbar stability, researchers have pointed out the importance of muscular and neurological functions as well as those of
Intrarater Reliability of Pain Intensity, Tissue Blood Flow, Thermal Pain Threshold, Pressure Pain Threshold and Lumbo-Pelvic Stability Tests in Subjects with Low Back Pain  [cached]
Aatit Paungmali,Patraporn Sitilertpisan,Khanittha Taneyhill,Ubon Pirunsan
Asian journal of Sports Medicine , 2012,
Abstract: Purpose: This preliminary study aimed to determine the intrarater reliability of the quantitative tests for the study of non-specific low back pain. Methods: Test-retest reliability of the measurements of ratio data was determined by an intraclass correlation coefficient (ICC),standard error of measurements (SEMs),coefficient of variation (CV), and one-way repeated measures ANOVA using the values collected from 13 young individuals (25.8 ± 6.2 years) with chronic non-specific low back pain on two occasions separated by 2 days. Percent agreement of the ordinal data was also determined by Cohen’s Kappa statistics (kappa). The measures consisted of tissue blood flow (BF), average pain visual analog scales (VAS), pressure pain threshold (PPT), cold pain threshold (CPT), heat pain threshold (HPT) and lumbo-pelvic stability test (LPST). An acceptable reliability was determined as the ICC values of greater than 0.85, SEMs less than 5%, CV less than 15%, the kappa scores of greater than 80% and no evidence of systematic error (ANOVA, P > 0.05). Results: ICC of all measures in the lumbo-sacral area were greater than 0.87. The kappa was also greater than 83%. Most measures demonstrated a minimal error of measurements and less potential of systemic error in nature. Only the SEMs and the CV of the CPT exceeded the acceptable level. Conclusions: It is concluded that most of the quantitative measurements are reliable for the study of non-specific low back pain, however the CPT should be applied with care as it has a great variation among individuals and potential of measurement error.
Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system
Annina B Schmid, Florian Brunner, Hannu Luomajoki, Ulrike Held, Lucas M Bachmann, Sabine Künzer, Michel W Coppieters
BMC Musculoskeletal Disorders , 2009, DOI: 10.1186/1471-2474-10-11
Abstract: Two experienced clinicians examined 31 patients with unilateral arm and/or neck pain. The examination included clinical tests for nerve function (sensory testing, reflexes and manual muscle testing (MMT)) and mechanosensitivity (ULNTs and palpation of the median, radial and ulnar nerve). Kappa statistics were calculated to evaluate intertester reliability. A meta-analysis determined an overall kappa for the domains with multiple kappa values (MMT, ULNT, palpation). We then compared the difference in reliability between the tests of mechanosensitivity and nerve function using a one-sample t-test.We observed moderate to substantial reliability for the tests for afferent/efferent nerve function (sensory testing: kappa = 0.53; MMT: kappa = 0.68; no kappa was calculated for reflexes due to a lack of variation). Tests to investigate mechanosensitivity demonstrated moderate reliability (ULNT: kappa = 0.45; palpation: kappa = 0.59). When compared statistically, there was no difference in reliability for tests for nerve function and mechanosensitivity (p = 0.06).This study demonstrates that clinical tests which evaluate increased nerve mechanosensitivity and afferent/efferent nerve function have comparable moderate to substantial reliability. To further investigate the clinometric properties of these tests, more studies are needed to evaluate their validity.Bedside neurological examination (sensory testing, reflexes and MMT) is used to evaluate lesions of the peripheral nervous system [1]. This assessment screens for nerve injuries characterised by changes in afferent or efferent nerve function such as changes in nerve conduction [2]. Beside these nerve lesions, various other nerve disorders do not necessarily lead to altered afferent or efferent function [3,4]. An inflamed nerve, for example, can be highly sensitive to mechanical stimuli [5], such as compression and stretch, but conduction velocity through the inflamed region can be near normal [6]. Therefore, when relying
Cost-effectiveness of minimal interventional procedures for chronic mechanical low back pain: design of four randomised controlled trials with an economic evaluation  [cached]
Maas Esther T,Juch Johan NS,Groeneweg J George,Ostelo Raymond WJG
BMC Musculoskeletal Disorders , 2012, DOI: 10.1186/1471-2474-13-260
Abstract: Background Minimal interventional procedures are frequently applied in patients with mechanical low back pain which is defined as pain presumably resulting from single sources: facet, disc, sacroiliac joint or a combination of these. Usually, these minimal interventional procedures are an integral part of a multidisciplinary pain programme. A recent systematic review issued by the Dutch Health Insurance Council showed that the effectiveness of these procedures for the total group of patients with chronic low back pain is yet unclear and cost-effectiveness unknown. The aim of the study is to evaluate whether a multidisciplinary pain programme with minimal interventional procedures is cost-effective compared to the multidisciplinary pain programme alone for patients with chronic mechanical low back pain who did not respond to conservative primary care and were referred to a pain clinic. Methods All patients with chronic low back pain who are referred to one of the 13 participating pain clinics will be asked to participate in an observational study. Patients with a suspected diagnosis of facet, disc or sacroiliac joint problems will receive a diagnostic block to confirm this diagnosis. If confirmed, they will be asked to participate in a Randomized Controlled Trial (RCT). For each single source a separate RCT will be conducted. Patients with a combination of facet, disc or sacroiliac joint problems will be invited for participation in a RCT as well. An economic evaluation from a societal perspective will be performed alongside these four RCTs. Patients will complete questionnaires at baseline, 3 and 6 weeks, 3, 6, 9 and 12 months after start of the treatment. Costs will be collected using self-completed cost questionnaires. Discussion No trials are yet available which have evaluated the cost-effectiveness of minimal interventional procedures in patients with chronic mechanical low back pain, which emphasizes the importance of this study. Trial registration number National Trial Register: NTR3531
Reliability of movement control tests in the lumbar spine
Hannu Luomajoki, Jan Kool, Eling D de Bruin, Olavi Airaksinen
BMC Musculoskeletal Disorders , 2007, DOI: 10.1186/1471-2474-8-90
Abstract: We videoed patients performing a standardized test battery consisting of 10 active movement tests for motor control in 27 patients with non specific low back pain and 13 patients with other diagnoses but without back pain. Four physiotherapists independently rated test performances as correct or incorrect per observation, blinded to all other patient information and to each other. The study was conducted in a private physiotherapy outpatient practice in Reinach, Switzerland. Kappa coefficients, percentage agreements and confidence intervals for inter- and intra-rater results were calculated.The kappa values for inter-tester reliability ranged between 0.24 – 0.71. Six tests out of ten showed a substantial reliability [k > 0.6]. Intra-tester reliability was between 0.51 – 0.96, all tests but one showed substantial reliability [k > 0.6].Physiotherapists were able to reliably rate most of the tests in this series of motor control tasks as being performed correctly or not, by viewing films of patients with and without back pain performing the task.Low back pain [LBP] is a huge social and financial problem for all western societies [1]. According to evidence based guidelines [2] up to 90% of all LBP is classified as non specific low back pain [NSLBP]. This means that in a medical sense, the cause of the back pain is not clear. Although LBP classification systems have been proposed, it is still unclear which clinical tests can be reliably used to allow subgroup categorization. The identification of subgroups of LBP has been identified as a major future research topic [2]. Several authors suggest that because NSLBP is a benign problem, the emphasis should be on clinical tests and assessments [1-5].An earlier systematic review of treatments used for NSLBP revealed that few studies had addressed the issue of clinical subgroups [6]. Widely used synonyms for the movement control dysfunctions are movement impairment syndromes, relative flexibility [7] motor control dysfunctions
On the reliability of microvariability tests in quasars  [PDF]
José A. de Diego
Physics , 2014, DOI: 10.1088/0004-6256/148/5/93
Abstract: Microvariations probe the physics and internal structure of quasars. Unpredictability and small flux variations make this phenomenon elusive and difficult to detect. Variance based probes such as the C and F tests, or a combination of both, are popular methods to compare the light-curves of the quasar and a comparison star. Recently, detection claims in some studies depend on the agreement of the results of the C and F tests, or of two instances of the F-test, in rejecting the non-variation null hypothesis. However, the C-test is a non-reliable statistical procedure, the F-test is not robust, and the combination of tests with concurrent results is anything but a straightforward methodology. A priori Power Analysis calculations and post hoc analysis of Monte-Carlo simulations show excellent agreement for the Analysis of Variance test to detect microvariations, as well as the limitations of the F-test. Additionally, combined tests yield correlated probabilities that make the assessment of statistical significance unworkable. However, it is possible to include data from several field stars to enhance the power in a single F-test, increasing the reliability of the statistical analysis. This would be the preferred methodology when several comparison stars are available. An example using two stars and the enhanced F-test is presented. These results show the importance of using adequate methodologies, and avoid inappropriate procedures that can jeopardize microvariability detections. Power analysis and Monte-Carlo simulations are useful tools for research planning, as they can reveal the robustness and reliability of different research approaches.
Adrian Stere PARIS
Revista Fiabilitate si Durabilitate , 2010,
Abstract: The mechanical reliability uses many statistical models to fit experimental data. The state-of-the-art in the domain implies extended use of specialised software, from simple freeware to complex, expensive ones; the paper proposes an investigation of the capabilities of some useful software, mainly applying the regression analysis of experimental data and some numerical examples and extends the discussion to dependability and performability.
A Preliminary Study of the Development, Validity, and Reliability of A Caregiver Questionnaire for the Health-related Quality of Life in Children with Cerebral Palsy  [PDF]
Wen-Yu Liu,Yu-Jen Hou,Hua-Fang Liao,Yang-Hua Lin
Chang Gung Medical Journal , 2010,
Abstract: Background: In Taiwan, there is no disease-specific instrument to measure the health-relatedquality of life (HRQL) in children with cerebral palsy (CP). The goal ofthis preliminary study was to develop and test the validity and reliability of acaregiver questionnaire for HRQL in children with CP (CQ-HRQL-CP).Methods: The CQ-HRQL-CP included 4 dimensions, motor ability, pain and emotion,interaction and participation, and satisfaction and expectation. The questionswere modified based on the content validity index (CVI). A purposive samplingof 45 parents of children with CP completed tests of the item discriminantvalidity and internal consistency. Twenty of these parents were randomlyrecruited for further testing of the test-retest reliability.Results: The CVI of individual items and dimensions was 0.86~1. With regard to theitem discriminant validity, items which correlated more strongly with otherdimensions than with their own dimensions were deleted. The adjustedCronbach’s coefficient value was 0.87~0.99. The test-retest reliability, evaluatedusing an intraclass correlation coefficient (ICC(3,1)), was 0.86~0.99 foreach dimension.Conclusions: The content validity, item discriminant validity, internal consistency, andtest-retest reliability of this new CQ-HRQL-CP were acceptable. Furtherstudy of the concurrent validity of the CQ-HRQL-CP is needed.
Inter- and intra-observer reliability of clinical movement-control tests for marines
Monnier Andreas,Heuer Joachim,Norman Kjell,?ng Bj?rn O
BMC Musculoskeletal Disorders , 2012, DOI: 10.1186/1471-2474-13-263
Abstract: Background Musculoskeletal disorders particularly in the back and lower extremities are common among marines. Here, movement-control tests are considered clinically useful for screening and follow-up evaluation. However, few studies have addressed the reliability of clinical tests, and no such published data exists for marines. The present aim was therefore to determine the inter- and intra-observer reliability of clinically convenient tests emphasizing movement control of the back and hip among marines. A secondary aim was to investigate the sensitivity and specificity of these clinical tests for discriminating musculoskeletal pain disorders in this group of military personnel. Methods This inter- and intra-observer reliability study used a test-retest approach with six standardized clinical tests focusing on movement control for back and hip. Thirty-three marines (age 28.7 yrs, SD 5.9) on active duty volunteered and were recruited. They followed an in-vivo observation test procedure that covered both low- and high-load (threshold) tasks relevant for marines on operational duty. Two independent observers simultaneously rated performance as “correct” or “incorrect” following a standardized assessment protocol. Re-testing followed 7–10 days thereafter. Reliability was analysed using kappa (κ) coefficients, while discriminative power of the best-fitting tests for back- and lower-extremity pain was assessed using a multiple-variable regression model. Results Inter-observer reliability for the six tests was moderate to almost perfect with κ-coefficients ranging between 0.56-0.95. Three tests reached almost perfect inter-observer reliability with mean κ-coefficients > 0.81. However, intra-observer reliability was fair-to-moderate with mean κ-coefficients between 0.22-0.58. Three tests achieved moderate intra-observer reliability with κ-coefficients > 0.41. Combinations of one low- and one high-threshold test best discriminated prior back pain, but results were inconsistent for lower-extremity pain. Conclusions Our results suggest that clinical tests of movement control of back and hip are reliable for use in screening protocols using several observers with marines. However, test-retest reproducibility was less accurate, which should be considered in follow-up evaluations. The results also indicate that combinations of low- and high-threshold tests have discriminative validity for prior back pain, but were inconclusive for lower-extremity pain.
Mechanical Properties for Reliability Analysis of Structures in Glassy Carbon  [PDF]
Cédric Garion
World Journal of Mechanics (WJM) , 2014, DOI: 10.4236/wjm.2014.43009

Despite its good physical properties, the glassy carbon material is not widely used, especially for structural applications. Nevertheless, its transparency to particles and temperature resistance are interesting properties for the applications to vacuum chambers and components in high energy physics. For example, it has been proposed for fast shutter valve in particle accelerator [1] [2]. The mechanical properties have to be carefully determined to assess the reliability of structures in such a material. In this paper, mechanical tests have been carried out to determine the elastic parameters, the strength and toughness on commercial grades. A statistical approach, based on the Weibull’s distribution, is used to characterize the material both in tension and compression. The results are compared to the literature and the difference of properties for these two loading cases is shown. Based on a Finite Element analysis, a statistical approach is applied to define the reliability of a structural component in glassy carbon. In this paper, the determination of the mechanical properties of glassy carbon allows the analysis of reliability of structures in glassy carbon.

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