PURPOSE: The Nasality Severity Index 2.0 (NSI 2.0) forms a new, multiparametric approach in the assessment of hypernasality. To enable clinical implementation of this index, the short- and long-term test-retest reliability of this index was explored. METHODS: In 40 normal-speaking adults (mean age 32y, SD 11, 18-56y) and 29 normal-speaking children (mean age 8y, SD 2, 4-12y), the acoustic parameters included in the NSI 2.0 (i.e. nasalance of the vowel /u/ and an oral text, and the voice low tone to high tone ratio (VLHR) of the vowel /i/) were obtained twice at the same test moment and during a second assessment two weeks later. After determination of the NSI 2.0, a comprehensive set of statistical measures was applied to determine its reliability. RESULTS: Long-term variability of the NSI 2.0 and its parameters was slightly higher compared to the short-term variability, both in adults and in children. Overall, a difference of 2.82 for adults and 2.68 for children between the results of two consecutive measurements can be interpreted as a genuine change. With an ICC of 0.84 in adults and 0.77 in children, the NSI 2.0 additionally shows an excellent relative consistency. No statistically significant difference was withheld in the reliability of test-retest measurements between adults and children. CONCLUSION: Reliable test-retest measurements of the NSI 2.0 can be performed. Consequently, the NSI 2.0 can be applied in clinical practice, in which successive NSI 2.0 scores can be reliably compared and interpreted. LEARNING OUTCOMES: The reader will be able to describe and discuss both the short-term and long-term test-retest reliability of the Nasality Severity Index 2.0, a new multiparametric approach to hypernasality, and its parameters. Based on this information, the NSI 2.0 can be applied in clinical practice, in which successive NSI 2.0 scores, e.g. before and after surgery or speech therapy, can be compared and interpreted.
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Literature highlights the need for research on changes in lumbar movement patterns, as potential mechanisms underlying the persistence of low-back pain. Variability and local dynamic stability are frequently used to characterize movement patterns. In view of a lack of information on reliability of these measures, we determined their within- and between-session reliability in repeated seated reaching. Thirty-six participants (21 healthy, 15 LBP) executed three trials of repeated seated reaching on two days. An optical motion capture system recorded positions of cluster markers, located on the spinous processes of S1 and T8. Movement patterns were characterized by the spatial variability (meanSD) of the lumbar Euler angles: flexion–extension, lateral bending, axial rotation, temporal variability (CyclSD) and local dynamic stability (LDE). Reliability was evaluated using intraclass correlation coefficients (ICC), coefficients of variation (CV) and Bland-Altman plots. Sufficient reliability was defined as an ICC ≥ 0.5 and a CV < 20%. To determine the effect of number of repetitions on reliability, analyses were performed for the first 10, 20, 30, and 40 repetitions of each time series. MeanSD, CyclSD, and the LDE had moderate within-session reliability; meanSD: ICC = 0.60–0.73 (CV = 14–17%); CyclSD: ICC = 0.68 (CV = 17%); LDE: ICC = 0.62 (CV = 5%). Between-session reliability was somewhat lower; meanSD: ICC = 0.44–0.73 (CV = 17–19%); CyclSD: ICC = 0.45–0.56 (CV = 19–22%); LDE: ICC = 0.25–0.54 (CV = 5–6%). MeanSD, CyclSD and the LDE are sufficiently reliable to assess lumbar movement patterns in single-session experiments, and at best sufficiently reliable in multi-session experiments. Within-session, a plateau in reliability appears to be reached at 40 repetitions for meanSD (flexion–extension), meanSD (axial-rotation) and CyclSD.
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Objective. There are no Dutch language disease-specific questionnaires for patients with patellofemoral pain syndrome available that could help Dutch physiotherapists to assess and monitor these symptoms and functional limitations. The aim of this study was to translate the original disease-specific Kujala Patellofemoral Score into Dutch and evaluate its reliability. Methods. The questionnaire was translated from English into Dutch in accordance with internationally recommended guidelines. Reliability was determined in 50 stable subjects with an interval of 1 week. The patient inclusion criteria were age between 14 and 60 years; knowledge of the Dutch language; and the presence of at least three of the following symptoms: pain while taking the stairs, pain when squatting, pain when running, pain when cycling, pain when sitting with knees flexed for a prolonged period, grinding of the patella and a positive clinical patella test. The internal consistency, test–retest reliability, measurement error and limits of agreement were calculated. Results. Internal consistency was 0.78 for the first assessment and 0.80 for the second assessment. The intraclass correlation coefficient (ICCagreement) between the first and second assessments was 0.98. The mean difference between the first and second measurements was 0.64, and standard deviation was 5.51. The standard error measurement was 3.9, and the smallest detectable change was 11. The Bland and Altman plot shows that the limits of agreement are 10.37 and 11.65. Conclusions. The results of the present study indicated that the test–retest reliability translated Dutch version of the Kujala Patellofemoral Score questionnaire is equivalent of the test– retest original English language version and has good internal consistency. Trial registration NTR (TC = 3258). Copyright © 2015 John Wiley & Sons, Ltd.
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In The Netherlands, the 4-Skills Scan is an instrument for physical education teachers to assess gross motor skills of elementary school children. Little is known about its reliability. Therefore, in this study the test–retest and inter-rater reliability was determined. Respectively, 624 and 557 Dutch 6- to 12-year-old children were analyzed for test re-test and inter-rater reliability. All tests took place within the school setting. The outcome measure was age-expected motor performance (in years). Results showed a small practice effect of .24 years for re-test sessions and assessment of motor skills was possible with acceptable precision (standard error of measurement = .67 years). Overall, intraclass correlation coefficient (ICC) was .93 (95% confidence interval: .92–.95) for test–retest reliability and .97 for inter-rater reliability. For the repeated measures, the smallest detectable change (SDC) was 1.84 and limits of agreement were –1.60 and 2.08 years. It can be concluded that the 4-Skills Scan is a reliable instrument to assess gross motor skills in elementary school children.
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Caregivers of persons with profound intellectual and multiple disabilities (PIMD) often describe the quality of the daily movements of these persons in terms of flexibility or stiffness. Objective outcome measures for flexibility and stiffness are muscle tone or level of spasticity. Two instruments used to grade muscle tone and spasticity are the Modified Ashworth Scale (MAS) and the Modified Tardieu Scale (MTS). To date, however, no research has been performed to determine the psychometric properties of the MAS and MTS in persons with PIMD. Therefore, the purpose of this study was to determine the feasibility, test-retest reliability, and interrater reliability of the MAS and MTS in persons with PIMD. We assessed 35 participants on the MAS and MTS twice, first for the test and second a week later for the retest. Two observers performed the measurements. Feasibility was assessed based on the percentage of successful measurements. Test-retest and interrater reliability were determined by using the Wilcoxon signed rank test, intraclass correlation coefficients (ICC), Spearman's correlation, and either limits of agreement (LOA) or quadratically weighted kappa. The feasibility of the measurements was good, because an acceptable percentage of successful measurements were performed. MAS measurements had substantial to almost perfect quadratically weighted kappa (>0.8) and an acceptable ICC (>0.8) for both inter- and intrarater reliability. However, MTS measurements had insufficient ICCs, Spearman's correlations, and LOAs for both inter- and interrater reliability. Our data indicated that the feasibility of the MAS and MTS for measuring muscle tone in persons with PIMD was good. The MAS had sufficient test-retest and interrater reliability; however, the MTS had an insufficient test-retest and interrater reliability in persons with PIMD. Thus, the MAS may be a good method for evaluating the quality of daily movements in persons with PIMD. Providing test administrators with training and clear instructions will improve test reliability.
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Background: Lymphedema measurement is vital to select appropriate treatment and monitor its progress. Quantifying lymphedema in the head and neck area is challenging. The use of tissue dielectric constant (TDC) measurements has shown promising results in other body areas. This study aims to determine the test-retest reliability of a TDC measurement protocol developed for the head and neck area. Methods and Results: A detailed measurement protocol, including eight measurement points per side, was developed. Subsequently, the reliability of the protocol was tested in a sample of healthy participants (n = 50, 28 males). Using the LymphScanner (Delfin, Finland), participants were subjected to two measurement sessions. Each measurement point was measured three times per session. Test-retest reliability for each point was evaluated using intraclass correlation coefficients (ICCs) and standard errors of measurement (SEMs). Using the average of three measurements, reliability was good to excellent for all points (ICCs 0.81–0.95), with small measurement errors (SEMs 1.51–2.86). The reliability of a single measurement was moderate to excellent for all measurement points (ICCs 0.58–0.87), with larger, but still small, measurement errors (SEMs 1.65–3.39). When using single measurements, the lowest ICCs were found for the temporal (left 0.73 and right 0.67) and submandibular (left 0.58 and right 0.77) locations. Conclusion: Measurements with the LymphScanner, taken according to the developed protocol, are reliable in healthy participants. We recommend using the average of three measurements to optimize reliability. The protocol is fit for further testing in patient populations and for determining normal values in a larger scale study with healthy subjects.
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Objective: The most common methods to calculate energy costs are based on measured oxygen uptake during walking a standardized distance or time. Unfortunately, it is unclear which method is most reliable to determine energy cost of walking in stroke survivors. The objective of this study was to evaluate the 3 most commonly used methods for calculating oxygen consumption and -cost by assessing test-retest reliability and measurement error in community dwelling chronic stroke survivors during a 6 Minute Walk Test. Methods: In this secondary analysis of a longitudinal study, reproducibility of the outcome of walking distance, walking speed, oxygen consumption and oxygen cost from 3 methods (Kendall's tau, assumed steady-state and total walking time oxygen consumption) were determined using Intraclass Correlation Coefficient, Standard Error of Measurement and Smallest Detectable Change. Results: 20 from the 31 participants successfully performed the 6 minute walk test-retest within a timeframe of 1 month. Within the 2 tests the reproducibility of walking distance and walking speed was high. The 3 methods to determine reproducibility for oxygen cost and oxygen consumption were considered good (Kendall's tau), good (assumed steady-state) and excellent (total walking time). Conclusions: The method using oxygen consumption and -cost over the total walking time resulted in the highest reproducibility considering the Intraclass Correlation Coefficient, its 95% Confidence Interval, and smaller absolute differences.
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Objective: Psychophysical lift capacity tests are lifting tests in which the performance, expressed in Newtons, is divided by the perceived exertion, expressed on a Borg scale. The aim of this study was to analyse test-retest reliability of psychophysical lift capacity tests.Subjects: Patients with non-specific chronic low back pain (n=20) and healthy subjects (n=20).Methods: Psychophysical lift capacity tests were assessed during a back school intake at the Centre for Rehabilitation of the University Medical Centre Groningen. Patients on the waiting list and healthy subjects were assessed twice, with a 2-week interval between assessments. Intra-class correlation (ICC) was calculated as a measure of reliability. An ICC ≥0.75 was considered as an acceptable reliability. Limits of agreement as a measure for natural variation were calculated.Results: The psychophysical static and dynamic lift capacity tests showed good reliability (ICC ≥0.75). The limits of agreement are substantial, indicating a considerable natural variation between test-sessions for all psychophysical tests.Conclusion: The psychophysical static lift capacity and dynamic lifting capacity are reliable instruments for patients with non-specific chronic low back pain and healthy subjects. However, a substantial amount of natural variation should be taken into account between 2 test sessions when interpreting the test results clinically.
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The current study determined the test-retest reliability and concurrent validity of the Adapted Short QUestionnaire to ASsess Health-enhancing physical activity (Adapted-SQUASH) in adults with disabilities. Before filling in the Adapted-SQUASH twice with a recall period of 2 weeks, participants wore the Actiheart activity monitor up to 1 week. For the test-retest reliability (N = 68), Intraclass correlation coefficients (ICCs) were 0.67 (p < 0.001) for the total activity score (min x intensity/week) and 0.76 (p < 0.001) for the total minutes of activity (min/week). For the concurrent validity (N = 58), the Spearman correlation coefficient was 0.40 (p = 0.002) between the total activity score of the first administration of the Adapted-SQUASH and activity energy expenditure from the Actiheart (kcals kg-1 min-1). The ICC was 0.22 (p = 0.027) between the total minutes of activity assessed with the first administration of the Adapted-SQUASH and Actiheart. The Adapted-SQUASH is an acceptable measure to assess self-reported physical activity in large populations of adults with disabilities but is not applicable at the individual level due to wide limits of agreement. Self-reported physical activity assessed with the Adapted-SQUASH does not accurately represent physical activity assessed with the Actiheart in adults with disabilities, as indicated with a systematic bias between both instruments in the Bland-Altman analysis.
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The effect of alterations in the processing of proprioceptive signals, on postural control, has been studied using muscle vibration effects. However, reliability and agreement of muscle vibration have still to be addressed.This study aimed to assess intra- and interday reliability and agreement of vibration effects of lumbar paraspinal and triceps surae muscles in a non-selected sample of 20 subjects, standing on solid surface and on foam. We used mean position and velocity of Centre of Pressure (CoP), during and after vibration to quantify the effect of muscle vibration. We also calculated the ratio of vibration effects on the lumbar paraspinal and triceps surae muscles (proprioceptive weighting).Displacement of the CoP during vibration showed good reliability (ICCs. >. 0.6), and proprioceptive weighting of displacement fair to good reliability (0.52-0.73). Agreement measures were poor, with most CV's ranging between 18% and 36%. Change in CoP velocity appeared not to be reliable. Balance recovery, when based on CoP position and calculated a short period after cessation of vibration, showed good reliability. According to this study, displacement during vibration, proprioceptive weighting and selected recovery variables are the most reliable indicators of the response to muscle vibration.
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