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Measurement of range-of-motion in infants with indications of upper cervical dysfunction using the Flexion-Rotation-Test and Lateral-Flexion-Test: a blinded inter-rater reliability study in a clinical practice setting.

ABSTRACT: Background: In infants with indications of upper cervical dysfunction, the Flexion-Rotation-Test and Lateral-Flexion-Test are used to indicate reduced upper cervical range-of-motion (ROM). In infants, the inter-rater reliability of these tests is unknown. Objective: To assess the inter-rater reliability of subjectively and objectively measured ROM by using the Flexion-Rotation-Test and Lateral-Flexion-Test. Methods: 36 infants (<6 months) and three manual therapists participated in this cross-sectional observational study. Pairs of two manual therapists independently assessed infants' upper cervical ROM using the Flexion-Rotation-Test and Lateral-Flexion-Test, blinded for each other's outcomes. Two inertial motion sensors objectively measured cervical ROM. Inter-rater reliability was determined between each pair of manual therapists. For subjective outcomes, Cohen's kappa (ĸ) and the proportion of agreement (Pra) were calculated. For objectively measured ROM, Bland Altman plots were conducted and Limits of Agreement and Intraclass Correlation Coefficients (ICC) were calculated. Results: The inter-rater reliability of the Flexion-Rotation-Test and Lateral-Flexion-Test for subjective (ĸ: 0.077-0.727; Pra: 0.46-0.86) and objective outcomes (ICC: 0.019-0.496) varied between pairs of manual therapists. Conclusion: Assessed ROM largely depends on the performance of the assessment and its interpretation by manual therapists, leading to high variation in outcomes. Therefore, the Flexion-Rotation-Test and Lateral-Flexion-Test cannot be used solely as a reliable outcome measure in clinical practice and research context.

SUBMITTER: Driehuis F

PROVIDER: S-EPMC7889092 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Measurement of range-of-motion in infants with indications of upper cervical dysfunction using the Flexion-Rotation-Test and Lateral-Flexion-Test: a blinded inter-rater reliability study in a clinical practice setting.

Driehuis Femke F Keijsers Noël L W NLW Nijhuis-van der Sanden Maria W G MWG De Bie Rob A RA Staal J Bart JB Hoogeboom Thomas J TJ

The Journal of manual & manipulative therapy 20200413 1

Background: In infants with indications of upper cervical dysfunction, the Flexion-Rotation-Test and Lateral-Flexion-Test are used to indicate reduced upper cervical range-of-motion (ROM). In infants, the inter-rater reliability of these tests is unknown. Objective: To assess the inter-rater reliability of subjectively and objectively measured ROM by using the Flexion-Rotation-Test and Lateral-Flexion-Test. Methods: 36 infants (<6 months) and three manual therapists particip ...[more]

PMID: 32282288

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Project description:BackgroundRange of motion (ROM) is an important aspect of orthopaedic patient assessment. It can be measured at the knee joint by determining the knee flexion angle (KFA) a patient can achieve at extremes of flexion and extension. As with any measurement, the accuracy and reliability of the method used determine its validity. The consistency of magnetic resonance imaging (MRI) scans as compared to the current gold standard of X-ray remains unknown in terms of KFA evaluation. The aim of this study was to assess and compare the reliability of measuring KFA between X-ray and MRI scans.MethodsThis study included 80 patients (94 knees) who had attended a specialist knee clinic due to varying knee pathologies and undergone both X-ray and MRI scans. Lateral and T1-weighted sagittal imaging views (respectively) were used to measure KFA by two trained observers independently at two separate time points, 8 weeks apart. The data was then statistically analysed and intra- and inter-observer reliability calculated using the intraclass correlation coefficient (ICC).ResultsThe intra-observer reliability for X-ray was 0.96 (P<0.001) and that for MRI was 0.83 (P<0.001). The inter-observer reliability for X-ray was 0.99 (P<0.001) and that for MRI was 0.81 (P<0.001). All the intra-class correlation coefficients were graded as excellent in both the intra- and inter-observer reliability analysis. Overall, the mean KFA was notably higher on X-ray measurements than that on MRI scans. There was a statistically significant difference between Time 1 and Time 2 measurements (17.7° vs. 16.8°) for MRI data (P=0.022). No significant difference was found for X-ray measurements (46.4° vs. 45.6°) in this regard (P=0.182).ConclusionsBoth X-ray and MRI allow KFA to be measured with an excellent degree of reliability. However, X-ray measurements were overall superior to that of MRI mainly due to the larger field of view of the visible on-screen image which more readily identifies the anatomical landmarks required to measure KFA.

Project description:Behavioral development in domestic dogs has been investigated for predicting suitability for service dog work or for matching with the "right" families as well as for identifying predispositions to behavioral problems. Findings from the scientific literature seem to confirm that conducting behavioral tests at 7 weeks of age is too early to reliably predict the temperament and personality of a dog. However, this period for domestic dogs is sensitive for early life learning and conditions during this time could have important consequences in adulthood. The aims of this study were to evaluate inter-rater reliability of a simple standardized test and to investigate which factors influence the behavioral reaction of puppies. 105 seven-week old puppies were exposed to five subtests: social attraction, following, retrieving, sudden appearance, noise. During each task, the behaviour of each pup was scored on a 3-5 point scale that reflected the suitability of the pup's reaction to the task. Scores were evaluated for a single subtest and for two aggregate indicators (i.e. response to a person: social attraction subtest and following subtest and response to object and noise: retrieving subtest, sudden appearance subtest and noise subtest). Three assessors independently scored the dogs' reactions for each task. Inter-rater reliability of the three assessors were analyzed with Fleiss' Kappa and Kendall's coefficient, which showed a high inter-rater reliability in 4 of 5 tasks. The ordered logistic regression was carried out to obtain a proportional odds model that was used to model the relationship between sex, litter size, stimulating environment, parity of mother, adequate maternal behavior and high scores. Litter size and maternal parity were associated with test performance in response to a person. The variance of effect of litter was high in response to object and noise. Taken together, our results suggest that using this scoring system there is sufficient inter-rater reliability in the test and litter size and mother experience influences task performances related to dog-human interaction.

Dataset Information

Measurement of range-of-motion in infants with indications of upper cervical dysfunction using the Flexion-Rotation-Test and Lateral-Flexion-Test: a blinded inter-rater reliability study in a clinical practice setting.

Publications

Measurement of range-of-motion in infants with indications of upper cervical dysfunction using the Flexion-Rotation-Test and Lateral-Flexion-Test: a blinded inter-rater reliability study in a clinical practice setting.

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