Dataset Information

Reproducibility of tender point examination in chronic low back pain patients as measured by intrarater and inter-rater reliability and agreement: a validation study.

ABSTRACT: To evaluate the reliability and agreement of digital tender point (TP) examination in chronic low back pain (LBP) patients.Cross-sectional study.Hospital-based validation study.Among sick-listed LBP patients referred from general practitioners for low back examination and return-to-work intervention, 43 and 39 patients, respectively (18 women, 46%) entered and completed the study.The reliability was estimated by the intraclass correlation coefficient (ICC), and agreement was calculated for up to ±3 TPs. Furthermore, the smallest detectable difference was calculated.TP examination was performed twice by two consultants in rheumatology and rehabilitation at 20 min intervals and repeated 1 week later. Intrarater reliability in the more and less experienced rater was ICC 0.84 (95% CI 0.69 to 0.98) and 0.72 (95% CI 0.49 to 0.95), respectively. The figures for inter-rater reliability were intermediate between these figures. In more than 70% of the cases, the raters agreed within ±3 TPs in both men and women and between test days. The smallest detectable difference between raters was 5, and for the more and less experienced rater it was 4 and 6 TPs, respectively.The reliability of digital TP examination ranged from acceptable to excellent, and agreement was good in both men and women. The smallest detectable differences varied from 4 to 6 TPs. Thus, TP examination in our hands was a reliable but not precise instrument. Digital TP examination may be useful in daily clinical practice, but regular use and training sessions are required to secure quality of testing.

SUBMITTER: Jensen OK

PROVIDER: S-EPMC3586147 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Reproducibility of tender point examination in chronic low back pain patients as measured by intrarater and inter-rater reliability and agreement: a validation study.

Jensen Ole Kudsk OK Callesen Jacob J Nielsen Merete Graakjaer MG Ellingsen Torkell T

BMJ open 20130226 2

<h4>Objectives</h4>To evaluate the reliability and agreement of digital tender point (TP) examination in chronic low back pain (LBP) patients.<h4>Design</h4>Cross-sectional study.<h4>Settings</h4>Hospital-based validation study.<h4>Participants</h4>Among sick-listed LBP patients referred from general practitioners for low back examination and return-to-work intervention, 43 and 39 patients, respectively (18 women, 46%) entered and completed the study.<h4>Main outcome measures</h4>The reliability ...[more]

PMID: 23444448

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Project description:Objectives To explore agreement among healthcare professionals assessing eligibility for work disability benefits.Design Systematic review and narrative synthesis of reproducibility studies.Data sources Medline, Embase, and PsycINFO searched up to 16 March 2016, without language restrictions, and review of bibliographies of included studies.Eligibility criteria Observational studies investigating reproducibility among healthcare professionals performing disability evaluations using a global rating of working capacity and reporting inter-rater reliability by a statistical measure or descriptively. Studies could be conducted in insurance settings, where decisions on ability to work include normative judgments based on legal considerations, or in research settings, where decisions on ability to work disregard normative considerations. : Teams of paired reviewers identified eligible studies, appraised their methodological quality and generalisability, and abstracted results with pretested forms. As heterogeneity of research designs and findings impeded a quantitative analysis, a descriptive synthesis stratified by setting (insurance or research) was performed.Results From 4562 references, 101 full text articles were reviewed. Of these, 16 studies conducted in an insurance setting and seven in a research setting, performed in 12 countries, met the inclusion criteria. Studies in the insurance setting were conducted with medical experts assessing claimants who were actual disability claimants or played by actors, hypothetical cases, or short written scenarios. Conditions were mental (n=6, 38%), musculoskeletal (n=4, 25%), or mixed (n=6, 38%). Applicability of findings from studies conducted in an insurance setting to real life evaluations ranged from generalisable (n=7, 44%) and probably generalisable (n=3, 19%) to probably not generalisable (n=6, 37%). Median inter-rater reliability among experts was 0.45 (range intraclass correlation coefficient 0.86 to κ-0.10). Inter-rater reliability was poor in six studies (37%) and excellent in only two (13%). This contrasts with studies conducted in the research setting, where the median inter-rater reliability was 0.76 (range 0.91-0.53), and 71% (5/7) studies achieved excellent inter-rater reliability. Reliability between assessing professionals was higher when the evaluation was guided by a standardised instrument (23 studies, P=0.006). No such association was detected for subjective or chronic health conditions or the studies' generalisability to real world evaluation of disability (P=0.46, 0.45, and 0.65, respectively).Conclusions Despite their common use and far reaching consequences for workers claiming disabling injury or illness, research on the reliability of medical evaluations of disability for work is limited and indicates high variation in judgments among assessing professionals. Standardising the evaluation process could improve reliability. Development and testing of instruments and structured approaches to improve reliability in evaluation of disability are urgently needed.

Project description:There is a shortage of agreement studies relevant for measuring changes over time in lumbar intervertebral disc structures. The objectives of this study were: 1) to develop a method for measurement of intervertebral disc height, anterior and posterior disc material and dural sac diameter using MRI, 2) to evaluate intra- and inter-rater agreement and reliability for the measurements included, and 3) to identify factors compromising agreement.Measurements were performed on MRIs from 16 people with and 16 without lumbar disc herniation, purposefully chosen to represent all possible disc contours among participants in a general population study cohort. Using the new method, MRIs were measured twice by one rater and once by a second rater. Agreement on the sagittal start- and end-slice was evaluated using weighted Kappa. Length and volume measurements were conducted on available slices between intervertebral foramens, and cross-sectional areas (CSA) were calculated from length measurements and slice thickness. Results were reported as Bland and Altman's limits of agreement (LOA) and intraclass correlation coefficients (ICC).Weighted Kappa (Kw (95% CI)) for start- and end-slice were: intra-: 0.82(0.60;0.97) & 0.71(0.43;0.93); inter-rater: 0.56(0.29;0.78) & 0.60(0.35;0.81). For length measurements, LOA ranged from [-1.0;1.0] mm to [-2.0;2.3] mm for intra-; and from [-1.1; 1.4] mm to [-2.6;2.0] mm for inter-rater. For volume measurements, LOA ranged from [-293;199] mm3 to [-582;382] mm3 for intra-, and from [-17;801] mm3 to [-450;713] mm3 for inter-rater. For CSAs, LOA ranged between [-21.3; 18.8] mm2 and [-31.2; 43.7] mm2 for intra-, and between [-10.8; 16.4] mm2 and [-64.6; 27.1] mm2 for inter-rater. In general, LOA as a proportion of mean values gradually decreased with increasing size of the measured structures. Agreement was compromised by difficulties in identifying the vertebral corners, the anterior and posterior boundaries of the intervertebral disc and the dural sac posterior boundary. With two exceptions, ICCs were above 0.81.Length measurements and calculated CSAs of disc morphology and dural sac diameter from MRIs showed acceptable intra- and inter-rater agreement and reliability. However, caution should be taken when measuring very small structures and defining anatomical landmarks.

Project description:BackgroundInfectious disease computational modeling studies have been widely published during the coronavirus disease 2019 (COVID-19) pandemic, yet they have limited reproducibility. Developed through an iterative testing process with multiple reviewers, the Infectious Disease Modeling Reproducibility Checklist (IDMRC) enumerates the minimal elements necessary to support reproducible infectious disease computational modeling publications. The primary objective of this study was to assess the reliability of the IDMRC and to identify which reproducibility elements were unreported in a sample of COVID-19 computational modeling publications.MethodsFour reviewers used the IDMRC to assess 46 preprint and peer reviewed COVID-19 modeling studies published between March 13th, 2020, and July 30th, 2020. The inter-rater reliability was evaluated by mean percent agreement and Fleiss' kappa coefficients (κ). Papers were ranked based on the average number of reported reproducibility elements, and average proportion of papers that reported each checklist item were tabulated.ResultsQuestions related to the computational environment (mean κ = 0.90, range = 0.90-0.90), analytical software (mean κ = 0.74, range = 0.68-0.82), model description (mean κ = 0.71, range = 0.58-0.84), model implementation (mean κ = 0.68, range = 0.39-0.86), and experimental protocol (mean κ = 0.63, range = 0.58-0.69) had moderate or greater (κ > 0.41) inter-rater reliability. Questions related to data had the lowest values (mean κ = 0.37, range = 0.23-0.59). Reviewers ranked similar papers in the upper and lower quartiles based on the proportion of reproducibility elements each paper reported. While over 70% of the publications provided data used in their models, less than 30% provided the model implementation.ConclusionsThe IDMRC is the first comprehensive, quality-assessed tool for guiding researchers in reporting reproducible infectious disease computational modeling studies. The inter-rater reliability assessment found that most scores were characterized by moderate or greater agreement. These results suggest that the IDMRC might be used to provide reliable assessments of the potential for reproducibility of published infectious disease modeling publications. Results of this evaluation identified opportunities for improvement to the model implementation and data questions that can further improve the reliability of the checklist.

Dataset Information

Reproducibility of tender point examination in chronic low back pain patients as measured by intrarater and inter-rater reliability and agreement: a validation study.

Publications

Reproducibility of tender point examination in chronic low back pain patients as measured by intrarater and inter-rater reliability and agreement: a validation study.

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