Dataset Information

The Inter-rater Variability of Clinical Assessment in Post-anoxic Myoclonus.

ABSTRACT: Acute post-anoxic myoclonus (PAM) can be divided into an unfavorable (generalized/subcortical) and more favorable ((multi)focal/cortical) outcome group that could support prognostication in post-anoxic encephalopathy; however, the inter-rater variability of clinically assessing these PAM subtypes is unknown.We prospectively examined PAM patients using a standardized video protocol. Videos were rated by three neurologists who classified PAM phenotype (generalized/(multi)focal), stimulus sensitivity, localization (proximal/distal/both), and severity (Clinical Global Impression-Severity Scale (CGI-S) and Unified Myoclonus Rating Scale (UMRS)).Poor inter-rater agreement was found for phenotype and stimulus sensitivity (κ=-0.05), moderate agreement for localization (κ=0.46). Substantial agreement was obtained for the CGI-S (intraclass correlation coefficient (ICC)=0.64) and almost perfect agreement for the UMRS (ICC=0.82).Clinical assessment of PAM is not reproducible between physicians, and should therefore not be used for prognostication. PAM severity measured by the UMRS appears to be reliable; however, the relation between PAM severity and outcome is unknown.

SUBMITTER: van Zijl JC

PROVIDER: S-EPMC5618111 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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The Inter-rater Variability of Clinical Assessment in Post-anoxic Myoclonus.

van Zijl Jonathan C JC Beudel Martijn M Elting Jan-Willem J JJ de Jong Bauke M BM van der Naalt Joukje J van den Bergh Walter M WM Rossetti Andrea O AO Tijssen Marina A J MAJ Horn Janneke J

Tremor and other hyperkinetic movements (New York, N.Y.) 20170713

<h4>Background</h4>Acute post-anoxic myoclonus (PAM) can be divided into an unfavorable (generalized/subcortical) and more favorable ((multi)focal/cortical) outcome group that could support prognostication in post-anoxic encephalopathy; however, the inter-rater variability of clinically assessing these PAM subtypes is unknown.<h4>Methods</h4>We prospectively examined PAM patients using a standardized video protocol. Videos were rated by three neurologists who classified PAM phenotype (generalize ...[more]

PMID: 28966876

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Project description:ObjectivesEvaluation of the inter-rater reliability of clinical assessment methods for pelvic floor muscles and diastasis recti abdominis post partum.DesignA multicentre inter-rater reliability study.SettingThree primary care rehabilitation centres in Sweden.ParticipantsA total of 222 participants were recruited via advertising at Swedish maternity care units and social media. Eligibility for participation included female gender, ≥18 years, at maximum 3 months after childbirth. Exclusion criteria were chronic pelvic girdle pain and/or low back pain and/or pelvic floor tear grade III/IV. At each centre, 2 physiotherapists, with training and experience in pelvic floor assessment, assessed the 222 women according to a standardised protocol in random order.Outcome measuresInter-rater reliability of the assessment of pelvic floor muscle function (involuntary and voluntary contraction and voluntary relaxation) and diastasis recti abdominis (width, depth and bulging).ResultsVaginal palpation of maximal voluntary contraction revealed a kappa value of 0.69 (95% CI 0.62 to 0.76). Assessments of involuntary contraction and voluntary relaxation yielded inconsistent results, with slight-to-moderate weighted kappa values ranging from 0.10 to 0.51. After 2 months of training in applying this method, diastasis recti abdominis width measured at the umbilicus by calliper yielded an intraclass correlation coefficient value of 0.83 (95% CI 0.76 to 0.87). Assessments of diastasis recti abdominis depth and bulging showed moderate kappa values, with reservation for some inconsistency between the centres.ConclusionsVaginal palpation of pelvic floor muscle strength is a reliable method for the postpartum muscle assessment. Additional research is needed to identify reliable assessment method for other pelvic floor muscle functions like involuntary contraction and voluntary relaxation. With some training, a calliper is a reliable instrument for measuring the postpartum diastasis recti abdominis width. This study provides novel thoughts about how to measure diastasis recti abdominis depth and bulging.Trial registration numberNCT03703804.

Project description:Background:Direct clinical assessment is the mainstay of evaluation in dentistry education. An effective evaluation method in prosthodontics should be equally valid and consistent; however, this is not attained frequently. A limited number of studies have applied an analytic evaluation in prosthodontics. Objective:To compare the intra- and inter-raters' variability in two evaluation methods: glance and grade (global), and checklist and criteria (analytical). Moreover, to identify the components of the analytical evaluation system and its applicability. Methods:This cross-sectional study was carried out on outpatients attending removable prosthodontics clinics affiliated with King Abdulaziz University (Jeddah, Saudi Arabia) from December 2017 to April 2018. Two prosthodontist examiners evaluated a sample of 35 complete denture cases (20 male, 15 female) twice over a period of five months. Inter-rater and intra-rater agreement were computed using reliability test (interclass correlation coefficient ICC). Data were analyzed in IBM SPSS version 23, using paired-samples t-test, weighted kappa, and Wilcoxon signed-rank test. The level of significance was set at p≤0.05. Results:The intra-rater agreement for the first and second exposures under global and analytical evaluation methods with Examiner A was outstanding with 90.7% and 99.8% agreement respectively. While with Examiner B, global was lower but still in the acceptable range with about 78.1%, and 96.1% for the analytical evaluation. Inter-rater reliability analysis showed high agreement between the two raters in the first exposure of the analytical evaluation with 97.3%, while it was 87.5% in the global evaluation. This trend goes the same with analytical in the second exposure with 93.2%; however, the second exposure under global evaluation failed the cut off, which is only 56.6% agreement. In evaluation of inter-raters agreement, the second exposure of the global method demonstrated inconsistency between the two examiners (p=0.002), while the analytical second exposure demonstrated more homogeneity (p=0.050). Intra-rater variability between first and second exposure in analytical evaluation was (0.711 for the first rater and 0.677 for the second rater). Intra-rater variability between first and second exposure in global evaluation was (<0.001 for the first rater and 0.075 for the second rater). Conclusion:A simple objective and detailed method to evaluate complete denture insertion procedure was developed, and it showed that both intra-rater and inter-rater agreement were excellent for the analytical method that might overcome errors and subjectivity in evaluation that result from the limitations of global method. Results recommend suitability of using the analytical evaluation to improve reliability between raters.

Dataset Information

The Inter-rater Variability of Clinical Assessment in Post-anoxic Myoclonus.

Publications

The Inter-rater Variability of Clinical Assessment in Post-anoxic Myoclonus.

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