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INTRODUCTION: Measurement instruments are important in clinical practice and research for assessing physical function in critically ill patients in the intensive care unit (ICU).OBJECTIVE: To investigate inter-rater reliability and responsiveness of the Danish version of the CPAx (CPAx-D).METHOD: Critically ill patients from three Danish ICUs were included. Patients were assessed with CPAx-D by two blinded testers during a regular physiotherapy session. Follow-up tests were performed in patients who stayed in the ICU for more than 24 hours, were not transferred to another hospital or received palliative care. Floor and ceiling effects were examined in all assessments.Results For the reliability analysis 66 patients were included.Results Showed no significant difference between raters. For the total score, intra class correlation coefficient (ICC) was 0.996 (95% CI: 0.993; 0.997), standard error of measurement was 0.72 point and minimal detectable change 2.0 points. Bland-Altman plot revealed no heteroscedacity. The responsiveness results of 24 patients showed that the effect size was 1.2 and the standardized response mean 1.1, which was in accordance with the hypothesis. No ceiling or floor effect was revealed.CONCLUSION: The CPAx-D showed excellent inter-rater reliability and responsiveness.

OBJECTIVE The Osteoarthritis Research Society International (OARSI) recommends assessment of physical function using a performance-based test of stair negotiation, but was unable to recommend any specific test. We assessed the reliability, validity, responsiveness, measurement error, and minimum important change (MIC) of the 6-step timed Stair Climb Test (SCT). METHODS We used pooled data from 397 participants with hip or knee osteoarthritis (54% women) from four clinical trials (86% retained at 12-week follow-up). Construct validity was assessed by testing six a priori hypotheses against other OARSI-recommended physical function measures. A self-reported Global Rating of Change scale was used to classify participants as worsened, improved and stable. Participants who worsened in physical function were excluded from all analyses. Responsiveness and MIC were assessed using multiple anchor-based and distribution-based approaches. Test-retest reliability, standard error of measurement (SEM) and smallest detectable change (SDC) were assessed on stable participants. RESULTS Five of six hypotheses (83%) for construct validity were met. Test-retest reliability was excellent (intraclass correlation coefficient2,1 : 0.83; 95% confidence interval: 0.71, 0.90). The SEM and SDC values were 0.44 and 1.21 seconds respectively. We did not find adequate support for responsiveness. The MIC values ranged from 0.78 to 1.95 seconds using different approaches (median=1.37 seconds). CONCLUSION The 6-step timed SCT adequately assesses the construct of physical function in individuals with hip or knee osteoarthritis with excellent 12-week test-retest reliability. However, support for its responsiveness was inadequate to recommend its use as an outcome measure in people with osteoarthritis for research and clinical practice.

OBJECTIVE Patient-Reported Outcomes Measurement Information System® (PROMIS® ) measures can be administered via computerized adaptive testing (CAT) or fixed short forms (FSF), but the empirical benefits of CAT versus FSF are unknown in juvenile myositis (JM). This study assesses if PROMIS CAT is feasible, precise, correlated with FSF, and less prone to respondent burden and floor/ceiling effects than FSF in JM. METHODS Patients 8-17 yo (self-report and parent proxy) and parents of patients 5-7 yo (only parent proxy) completed PROMIS Fatigue, Pain Interference, Upper Extremity Function, Mobility, Anxiety and Depressive Symptoms measures. Pearson correlations, paired t-tests, and Cohen's D were calculated between PROMIS CAT and FSF. McNemar test assessed floor/ceiling effects between CAT and FSF. Precision and respondent burden were examined across the T-score range. RESULTS Data from 67 patient-parent dyads were analyzed. CAT and FSF mean scores did not significantly differ except in parent proxy Anxiety and Fatigue (effect size: 0.23 and 0.19, respectively). CAT had less pronounced floor/ceiling effects at the less symptomatic extreme in all domains except self-report Anxiety. Increased item burden and higher standard errors were seen in less symptomatic scorers for CAT. Modified stopping rules limiting CAT item administration did not decrease precision. CONCLUSION PROMIS CAT appears to be feasible and correlated with FSF. CAT had less pronounced floor/ceiling effects, allowing detection of individual differences in less symptomatic patients. Modified stopping rules for CAT may decrease respondent burden. CAT can be considered for long-term follow-up of JM patients.

To translate and validate the Identification of Functional Ankle Instability (IdFAI) into French.The IdFAI was translated according to international recommendations. Discriminative power, floor and ceiling effects, construct validity (including confirmatory factorial analysis (CFA)), internal consistency and test-retest reliability were measured. Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) were also calculated.160 participants were included. The IdFAI-F showed a very good test-retest reliability (ICC = 0.95). The SEM was 1.37 and the MDC was 3.79. The internal consistency was moderate (Cronbach's alpha coefficient = 0.68). The correlation between the IdFAI and the Cumberland Ankle Instability Tool (CAIT) was high (r = -0.75, p 0.001). No floor, nor ceiling effects were observed. The CFA analyses did not confirm the factor structure proposed by the authors of the original English version.The IdFAI-F is a valid and reliable tool to accurately identify and measure chronic ankle instability in research and clinical settings for French-speaking individuals.

Background The health benefits of diets rich in fruits and vegetables (FV) are well established. Recent observational and intervention research suggests that FV consumption may also exert a positive effect on psychological well-being. Objective This study aimed to assess changes in mean Subjective Happiness Scale (SHS) scores in response to consuming DGA recommended types and amounts of vegetables. It was hypothesized that increased vegetable consumption would increase mean SHS scores. Design This study investigated a secondary outcome of a randomized, parallel, non-blinded controlled trial with a 1:1 allocation ratio to a provided vegetable intervention or attention control group. Participants/setting Men and women (n=75) aged 18-65 years, body mass index ≥25 kg/m2, with low habitual vegetable consumption were recruited from Grand Forks, ND, December 2016 to January 2018, for this community-based study. Intervention The vegetable intervention consisted of an 8-week feeding phase during which participants were provided with vegetables in DGA recommended types and amounts. The attention control group was not provided vegetables but completed the same testing schedule as the vegetable intervention group. Main outcome measure Mean SHS scores were assessed before and after the intervention. Statistical analyses Mean SHS scores were analyzed using a 2-way factorial mixed linear model analysis of variance. Results A significant interaction between treatment and visit (P=0.015) revealed greater mean SHS scores at week 8 than at baseline in the vegetable intervention group (+0.23 ± 0.11 (mean difference ± standard error of the difference) but no change in the attention control group (-0.15 ± 0.11). Conclusions Greater mean SHS scores were observed after increasing vegetable consumption to meet DGA recommendations, suggesting that adhering to DGA vegetable guidance may help promote psychological well-being.

PURPOSE To evaluate the quality, reliability, and popularity of videos relating to glaucoma on YouTube. DESIGN Retrospective, cross-sectional study of YouTube videos about glaucoma. PARTICIPANTS One hundred YouTube videos were analyzed for this study. METHODS An online YouTube search for glaucoma videos was conducted simulating a user search using the keywords glaucoma, high eye pressure, and high intraocular pressure. The first 100 videos were analyzed, and each video was evaluated by 2 independent reviewers using the modified DISCERN (scale, 1-5), Journal of the American Medical Association (JAMA; scale, 0-4), and Global Quality (GQ; scale, 1-5) criteria to assess quality and reliability. Videos were categorized further into 3 groups depending on the source of their upload. Group 1 comprised videos uploaded by academic or government institutions, group 2 comprised videos uploaded by private medical practices, and group 3 comprised videos uploaded by independent users. MAIN OUTCOME MEASURES Modified DISCERN, JAMA, and GQ scores for quality and reliability of information and video power index (VPI) for video popularity. RESULTS No substantial difference in scoring was observed between the 2 independent reviewers. The overall mean ± standard error (SE) scores were modified DISCERN score, 3.81 ± 0.06; JAMA score, 2.93 ± 0.07; and GQ score, 3.98 ± 0.06. The overall mean ± SE VPI score was 9.9 ± 2.9. Significant positive correlations were found between video popularity and quality of information for all 3 criteria (P < 0.05). The videos in groups 1 and 2 showed higher modified DISCERN scores than those in group 3, but did not score higher with either the JAMA or GQ criteria. Videos in group 3 were the most popular when compared with videos in groups 1 or 2 (P < 0.01). CONCLUSIONS Overall, many of the videos had adequate quality and reliability scores. No difference was found among groups 1 through 3 for 2 of the 3 criteria used, suggesting a similar quality of information provided among academic, private, and independent sources.

Objective To compare the outcomes of heparin bonded expanded polytetrafluoroethylene (HePTFE) and autologous saphenous vein (ASV) in patients undergoing below-knee (BK) femoro-popliteal bypass for critical limb ischemia (CLI). Design Retrospective single-centre matched case–control study. Methods From 2003 to 2019, 275 consecutive BK bypasses for CLI were performed, 109 with the ASV and 166 with a HePTFE graft. All the baseline characteristics that were reliably measured and were potentially relevant in the decision-making process were included as confounders in a logistic regression model and the factors that were significantly different between the two groups then used to perform a propensity matching analysis. Propensity score-based matching was performed in a 1:1 ratio to compare outcomes. Arterial hypertension, hyperlipemia, the need for tibial anastomosis at the distal level and the run-off status were the covariates included in the matching. Follow-up outcomes were estimated by Kaplan–Meier methods and compared with log rank test. Results After propensity matching, 101 HePTFE bypasses were matched with 101 ASV bypasses. The median duration of follow-up was 37 months (range 1–192). The 5-year survival rate was 67.5% (standard error (SE) 0.05) in the HePTFe group and 64.5% (SE 0.06) in the ASV group (p = 0.8, log rank 0.04). Primary patency rates were 38% (SE 0.06) in the HePTFE group and 41% (SE 0.06) in the ASV group (p = 0.7, log rank 0.3). Also assisted primary patency and secondary patency rates did not differ in the two groups. Amputation-free survival was 53% (SE 0.05) in the HePTFE group and 58% (SE 0.06) in the ASF group (p = 0.6, log rank 0.2). Conclusions HePTFE provided 5-year similar results to those obtained with use of the ASV in equivalent patients with CLI undergoing below-knee or tibial bypass.

Objective To evaluate the reliability, standard error of measurement, minimum detectable change, and item-level consistency of the Transfer Assessment Instrument (TAI) version 4.0 when used to evaluate transfer quality remotely. Design Participants transferred from their wheelchair to a mat table (transfer 1), repeated this after a 10-minute delay to assess intrarater reliability (transfer 2), and repeated this 1-2 days later to assess test-retest reliability (transfer 3). Each transfer was scored in person by 4 raters and asynchronously by a remote clinician rater. Setting 2017 National Veterans Wheelchair Games. Participants Convenience sample of 44 full-time wheelchair users (N=44). Interventions Not applicable. Main Outcome Measures TAI total score, subscores (wheelchair setup, body setup, flight/landing), and item scores (15 items). Results Moderate to excellent reliability was found when scoring remotely for TAI total and subscores for intrarater (intraclass correlation coefficient (ICC(3,1)=0.687-0.854), test-retest (ICC(3,1)=0.695-0.836), and interrater reliability (ICC(3,5)=0.746-0.962). Remote rater total score and flight/landing subscore were greater (indicating higher transfer quality) compared to the average in-person raters (P=.021 and P=.005, respectively). There were no differences between transfers 1-3 in remote rater scores. Item-level percentage agreement between the remote rater and in-person exceeded the 75% cutoff for clinical utility for all items. Conclusions The TAI is a reliable outcome measure for assessing transfer technique remotely.

Background The detection of islet autoantibodies is essential for the accurate classification and diagnosis of diabetes mellitus (DM). The islet autoantibody distribution varies by age. However, screening strategies for DM patients with different onset ages remain lacking. Methods This cross-sectional study included 17 536 DM patients from 46 medical centers across China. The seroprevalence of glutamic acid decarboxylase autoantibody (GADA), insulinoma-associated-2 autoantibody (IA-2A), zinc transporter 8 autoantibody (ZnT8A) and insulin autoantibody (IAA) was determined in younger and older patients with type 1 DM (T1DM) (n=287 and 285, respectively), younger and older patients with latent autoimmune diabetes (LAD) (n=140 and 121, respectively), and younger and older patients with type 2 DM (T2DM) (n=200 in each group). Results The cutoff age between younger and older patients was 35 years using restricted cubic spline method (n = 17 536, adjusted R2 = 0.97, residual standard error = 1.32; P < 0.001). The seroprevalence rates of four islet autoantibodies were higher in patients aged 15-35 years than in those ≥ 35 years (GADA: 17% vs. 5.6%, IA-2A: 8.5% vs. 1.3%, ZnT8A: 6.3% vs. 2.3%, IAA: 2.2% vs. 1.0%). The prevalence of ZnT8A was higher in LAD patients than in T1DM patients, especially in older LAD patients. The results indicated that ZnT8A detection can increase the detection rate of older LAD patients from 70.2% (based on GADA detection alone) to 91.7%. Conclusions In patients stratified according to the cutoff age of 35 years, the optimal detection sequence should be GADA, IA-2A, and ZnT8A in younger patients and GADA, ZnT8A, and IA-2A in older patients, so as to reduce the screening cost while improving the detection rate. Particularly, the ZnT8A test is recommended in older patients to avoid a missed LAD diagnosis.

Background Facial involvement of vitiligo is an important factor in patient’s life and has often been evaluated separately from body surface area in clinical trials. However, no reliable measurement tools to measure facial vitiligo specifically are available thus far. Objective To develop and validate a practical instrument for assessing facial vitiligo Methods The ratios of a hand to a fingertip unit (FTU) of 98 healthy volunteers (age range: 2-69 years) were calculated to define the FTU. Facial Vitiligo Area Scoring Index (F–VASI) was measured as the sum of all FTUs of each vitiligo lesion on the face (range: 0-112 FTU). In the validation study, 6 raters evaluated 11 patients with facial vitiligo twice at an interval of 2 weeks. Results One hand was measured at 32.1±1.3 FTU, and it was highly consistent among subjects across different age groups, genders, and races. F−VASI showed remarkably high accuracy (concordance correlation coefficient: 0.946, smallest detectable change: 2.2 FTU) as well as high intra-rater reliability (intraclass correlation coefficient: 0.903) and inter-rater reliability (0.903). Limitations Lack of dynamic validation of responsiveness Conclusion F−VASI using the FTU is an intuitive, precise, and reliable instrument for assessing the extent of facial involvement in vitiligo patients.

PURPOSE To compare Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) with traditional ("legacy") patient-reported outcome measures (PROMs) in regard to correlations, ease of use, and quality criteria for upper (UE) and lower extremity (LE) orthopaedic conditions. METHODS A systematic search of the PubMed/MEDLINE database was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify published articles that referenced the various PROMIS PF measures. Two authors independently reviewed selected studies. The search returned 857 studies, 85 of which were selected for independent review by 2 authors. Of these, 54 were selected for inclusion. Mixed linear models were performed to assess for differences between legacy PROMs and PROMIS measures. RESULTS The combined sample size of all included studies yielded 6,074 UE and 9,366 LE patients. Overall, PROMIS PF measures demonstrated strong correlations with legacy PROMs among UE (weighted Pearson correlation, 0.624, standard error [SE] = 0.042; weighted Spearman correlation, 0.566, SE = 0.042) and LE patients (weighted Pearson correlation, 0.645, SE = 0.062; weighted Spearman correlation, 0.631, SE = 0.041). PROMIS PF questionnaires completed by UE patients had fewer questions than legacy PROMs (5.9 vs 17.7, P = .0093) and were completed in less time (90.5 vs 223.8 seconds, P = .084). PROMIS PF questionnaires completed by LE patients had fewer questions than legacy PROMs (4.81 vs 15.33, P < .001) and were completed in less time (63.6 vs 203.2 seconds, P = .0063). The differences for the reliability measures were not significant. CONCLUSIONS PROMIS PF scores correlate strongly with commonly used legacy PROMs in orthopaedics, particularly in UE and LE patients. PROMIS PF forms can be administered efficiently and to a broad patient population while remaining highly reliable. Therefore, they can be justified for standardized use among orthopaedic patients with UE and LE conditions, improving the ability to aggregate and compare outcomes in orthopaedic research. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV evidence.

Background: Coronary computed tomography angiography (CCTA) is used to assess plaque characteristics, remodelling, and progression and regression. Few papers address standard operating procedures that ensure achievement of high interobserver reproducibility. Moreover, assessment of coronary artery bypass grafts has not been reported. Methods: A training set of images was created of native coronary segments, spanning the full range of atheromatous disease from normal to severe, excluding totally occluded segments, and including segments with or without calcification (n = 24) and completely normal-appearing bypass grafts (n = 16). Three observers used a validated software program during a training phase to establish standard operating procedures and then to achieve high intraobserver performance based on Pearson’s correlation coefficient. Subsequently, interobserver variability for the laboratory as a whole was determined with a focus on measures of plaque volume, low- attenuation plaque (LAP), mixed plaque (MP), and calcified plaque (CP). Results: We found no substantive differences in analytical issues between grafts and native vessels and emphasize the aggregated data. The range of mean total plaque percent was approximately 55% of total vessel volume with maximal interobserver mean absolute differences of 2% or less. Percent of LAP, MP, and CP demonstrated interobserver standard errors of 1% to 2% and interobserver mean absolute differences of 0% to 1%. Pearson’s correlations were all highly significant and ranged from 0.969 to 0.999. Conclusions: CCTA provides a rich diversity of measures of atherosclerosis in coronary and bypass segments that are highly reproducible with experience and adherence to standard operating procedures. Résumé: Introduction: L’angiographie cardiaque par tomodensitométrie (TDM) est utilisée pour évaluer les caractéristiques, le remodelage, la progression et la régression de la plaque. Peu d’articles portent sur les procédures opérationnelles normalisées qui permettent d’atteindre une reproductibilité inter-observateurs élevée. De plus, les greffons de pontage aorto-coronarien n’ont pas fait l’objet d’évaluation. Méthodologie: Un ensemble de formation composé d’images de segments d’artères coronaires natives couvrant l’ensemble de la maladie athéromateuse, c’est-à-dire de normale à sérieuse, à l’exclusion des segments totalement obstrués, mais y compris les segments calcifiés ou non (n = 24) et les greffons de pontage qui apparaissent complètement normaux (n = 16) a été créé. Trois observateurs ont utilisé un programme informatique validé durant la phase de formation pour établir des procédures opérationnelles normalisées et ensuite pour atteindre une performance intra-observateurs élevée en fonction du coefficient de corrélation de Pearson. Subséquemment, la variabilité inter-observateurs du laboratoire dans son ensemble a été déterminée plus particulièrement par les mesures du volume de la plaque, la plaque de faible atténuation (PFA), la plaque mixte (PM) et la plaque calcifiée (PC). Résultats: Nous n’avons constaté aucune différence dans les difficultés analytiques entre les greffons et les vaisseaux natifs et faisons valoir les données regroupées. La fourchette du pourcentage total moyen de la plaque était approximativement de 55 % du volume total du vaisseau avec des différences inter-observateurs absolues moyennes maximales de 2 % ou moins. Le pourcentage de la PFA, de la PM et de la PC a démontré des erreurs types inter-observateurs de 1 % à 2 % et des différences absolues moyennes inter-observateurs de 0 % à 1 %. Les corrélations de Pearson étaient toutes hautement significatives et allaient de 0,969 à 0,999. Conclusions: La TDM offre une riche diversité de mesures de l’athérosclérose dans les segments d’artères coronaires et de pontage qui, avec l’expérience et le respect des procédures opérationnelles normalisées, sont très reproductibles.

Background Body weight scales to height with a power of ≈2 (weight/height2 ), forming the basis of body mass index (BMI). The corresponding scaling of body composition measured by abdominal computed tomography (CT) to height has not been established. The objective of this analysis was to quantify the scaling of body composition measured by a single-slice axial abdominal CT image (skeletal muscle, and visceral, subcutaneous, and total adipose tissue) to height in patients with colorectal cancer (CRC). Methods This cross-sectional study included non-Hispanic white males and females, aged 18-80 years, who were diagnosed with stage I-III CRC at an integrated health care system in North America between January 2006 and December 2011. Body composition was measured by a single-slice axial CT image of the third lumbar vertebra and analysed with a semi-automated threshold segmentation procedure. Allometric regression models were used to quantify height scaling powers (β ± standard error) for each body composition measure, adjusted for age, for males and females. An interaction test was used to determine if height scaling powers were statistically significantly different between males and females. Results Among 2036 subjects, the mean (standard deviation) age was 64 ± 11 years, 1008 (49.5%) were female, and the mean (standard deviation) BMI was 27.9 ± 5.4 kg/m2 . Powers for skeletal muscle area were 1.06 ± 0.12 for males and 0.80 ± 0.12 for females (P = 0.049). Powers for visceral adipose tissue area were 1.81 ± 0.64 for males and 0.57 ± 0.79 for females (P = 0.16). Powers for subcutaneous adipose tissue area were 2.04 ± 0.42 for males and 0.81 ± 0.45 for females (P = 0.056). Powers for total abdominal adipose tissue area were 1.80 ± 0.46 for males and 0.76 ± 0.50 for females (P = 0.20). Conclusions Body composition measured by single-slice axial abdominal CT, particularly muscle area, scales to height with age-adjusted powers that are different than 2 and are distinct between males and females. These observations may have implications for the development of height-adjusted body composition indices in patients with cancer.

Purpose We estimated the minimal clinically important difference (MCID) for the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) computer adaptive tests (CATs) following surgical treatment of distal radius fracture (DRF). Methods Adult patients surgically treated between November 2017 and November 2020 for isolated DRF were identified. Demographic and patient-reported outcome data were extracted from the electronic health record . Outcomes of interest were the PROMIS PF and PI CATs. Inclusion criteria were met if: (1) PROMIS PF and PI scores were available at preoperative and postoperative visits; and (2) a postoperative clinical anchor question asking about overall response to treatment was answered. An anchor-based MCID estimate was determined by calculating the average absolute score change in PROMIS PF and PI for patients who indicated a mild change to the anchor question. A distribution-based MCID estimate was also calculated using the standard error of measurement and effect sizes of change. Results The changes in PROMIS PF and PI scores were significantly different between patients who gave responses of much change (n = 73), mild change (n = 51), and no change (n = 19) to the clinical anchor question. The average score changes in the mild change group for PROMIS PF and PI were 5.2 (SD, 3.7) and 6.8 (SD, 4.3) points, respectively, representing the anchor-based MCID estimates. The PROMIS PI anchor-based estimate was moderately correlated with the preoperative score (r = −0.41), time between visits (r = −0.39), and age (r = 0.30). The distribution-based MCID estimates were 3.8 (SD, 1.3) and 3.7 (SD, 1.3) points for the PROMIS PF and PI, respectively. Conclusions The MCIDs were estimated as 5.2 and 6.8 for the PROMIS PF and PI CATs, respectively, following surgery for DRF. Clinical relevance As reports continue to publish a consistent range of MCID values, researchers can be confident in these values and begin using them across a broader spectrum of conditions treated by hand surgeons.

Objective: There is strong evidence regarding impaired knee self-perception in patients with chronic knee osteoarthritis (OA). Currently, the Fremantle Knee Awareness Questionnaire (FreKAQ) has been developed to evaluate knee self-perception. This study aimed to evaluate validity and reliability of the Persian version of FreKAQ in patients with chronic knee OA.The FreKAQ was translated via forward-backward translation. In total, 312 patients with chronic knee OA completed the questionnaire, and the construct validity of the instrument was evaluated using exploratory and confirmatory factor analyses (EFA and CFA). Moreover, its reliability was confirmed using internal consistency and Cronbach's alpha coefficient. In addition, intra-class correlation coefficient and standard error measurement (SEM) and minimal detectable change (MDC) were used to assess its relative and absolute consistency. Therefore 50 patients, completed the questionnaire twice at one-week intervals.In EFA, Kaiser-Meyer-Olkin (0.705) and Bartlett's tests were significant (P 0.001), and CFA also indicated acceptable fitting with three factors. Moreover, the indices of PNFI = 0.57, PCFI = 0.60, χ2/DF = 1.14, AGFI = 0.95, GFI = 0.97, and RMSEA = 0.027 confirmed the goodness of fit of the model. The Cronbach's alpha and repeatability were estimated at 0.817 and 0.874, respectively, and the SEM and MDC was 2.13, 4.91.According to the results, the Persian version of FreKAQ had proper construct validity and reliability to evaluate the impairment of knee self-perception in patients with chronic knee OA.

Summary Background and aims Lean muscle and fat mass in the human body are important indicators of the risk of cardiovascular and metabolic diseases. Techniques such as dual-energy X-ray absorptiometry (DXA) accurately measure body composition, but they are costly and not easily accessible. Multiple linear regression (MLR) models have been developed to estimate body composition using simple demographic and anthropometric measures instead of expensive techniques, but MLR models do not explore nonlinear interactions between inputs. In this study, we developed simple demographic and anthropometric measure-driven artificial neural network (ANN) models that can estimate lean muscle and fat mass more effectively than MLR models. Methods We extracted the demographic, anthropometric, and body composition measures of 20,137 participants from the National Health and Nutrition Examination Survey conducted between 1999 and 2006. We included 13 demographic and anthropometric measures as inputs for the ANN models and divided the dataset into training and validation sets (70:30 ratio) to build and cross-validate the models that estimate lean muscle and fat mass, which were originally measured using DXA. This process was repeated 100 times by randomly dividing the training and validation sets to eliminate any effect of data division on model performance. We built additional models separately for each sex and ethnicity, older individuals, and people with underlying diseases. The coefficient of determination (R2) and standard error of estimate (SEE) were used to quantify the goodness of fit. Results The ANN models yielded high R2 values between 0.923 and 0.981. These values were significantly higher than those of the MLR models (p Conclusions We developed and validated an inexpensive but effective method for estimating body composition using easily obtainable demographic and anthropometric data.

The aim of this study was to determine the intra- and inter-rater reliability of a new semi-automatic image analysis method for quantification of the shape of the Doppler signal and the intratendinous vascular resistance in patellar tendinopathy. Thirty athletes (27.4 y, standard deviation = 8.57 y) with patellar intratendinous vascularity were included in a cross-sectional study (42 tendons analyzed). The intratendinous blood flow was assessed with power Doppler and ImageJ (Version 1.50b, National Institutes of Health, Bethesda, MD, USA) quantification software over a manually selected region of interest. Two blinded observers performed the analysis of the Doppler signal (vascular resistance) and shape descriptors (number of signals, pixel intensity, area, perimeter, major diameter, minor diameter, circularity and solidity). The intraclass correlation coefficient (ICC) was calculated, and the Bland–Altman mean of differences (MoD) and 95% limits of agreement (LoA) were determined. Also, small real differences (SRDs) and the standard error of measurement (SEM) were calculated. Intra-rater reliability was at a maximum for area (ICC = 0.999, 95% confidence interval [CI] = 0.998–0.999) and at a minimum for solidity (ICC = 0.782, 95% CI: 0.682–0.853). The MoD and 95% LoA were very low, and the relative SRD and SEM were below 5.3% and 2%, respectively. The inter-rater reliability was the maximum for area (ICC = 0.993, 95% CI = 0.989–0.996) and the minimum for circularity (ICC = 0.73; 95% CI=0.611–0.817). The MoD and 95% LoA were low, with the SRD and SEM below 6% and 2.2%. The proposed quantitative method for studying the intratendinous Doppler signal in the patellar tendon is reliable and reproducible.

Purpose: Given the potential anti-ischemic effects of allopurinol, we aimed to assess whether allopurinol administration may reduce myocardial injury following non-ST elevation myocardial infarction (NSTEMI). Methods: A randomized clinical trial (RCT) was conducted on 100 individuals with NSTEMI. The intervention group (n=50) received 600 mg oral allopurinol at the time of diagnosis of NSTEMI, followed by 300 mg every day for two next days and the standard treatment of NSTEMI, while the control group (n=50) received only the standard treatment. Serum concentrations of cardiac troponin I (cTnI) were measured at baseline, and 8, 16, 24, and 32 hours after the treatment. Results: The baseline demographic and clinical data of the patients were not statistically different between the intervention and control groups (all P > 0.05). The comparing estimated marginal mean ± standard error for cardiac troponin I (cTnI) levels revealed no significant difference between the study groups (2.93 ± .27, 2.25 ± .27; P=0.082). The linear mixed model results showed that the interaction of time and group was not statistically different (P=0.751). Moreover, there was a decreasing trend over time for cTnI in both groups (P=0.039). Conclusion: The present pilot RCT did not support the potential cardio-protective benefits of allopurinol administration on decreasing myocardial injury following NSTEMI.

Objective This systematic review and meta-analysis was undertaken to estimate the effectiveness of motorcycle safety campaigns for increasing helmet use among motorcycle riders and passengers. Methods PubMed, Scopus, EMBASE, and the Web of Science (WOS) databases were systematically searched up June 2020 for all relevant studies. The National Institute of Health (NIH) tool was used to assess the quality of all included studies. Inter-study heterogeneity was measured using the Chi-Squared and I2 statistics, with the odds ratio (OR) being used as a measure of the pooled effect size. Results Out of the 561 records identified from the literature searches, eight articles (or 11 studies) were eligible for inclusion in the present meta-analysis. Using a random effects model, the results of the meta-analysis demonstrated statistically significant increases in helmet use among motorcycle riders (OR = 4.52, 95% CI: 1.01–20.14, I2 = 99.9%) and passengers (OR = 6.57, 95% CI: 1.41–30.56, I2 = 99.9%). The findings of sensitivity analyses, based on alternative levels of r for imputing the standard error (SE) of the ORs, showed the pooled OR of helmet use among motorcycle riders (r = 0.7; 3.49; 95% CI: 0.78, 16.44; r = 0.9; 3.49; 95% CI: 0.76, 16.11) was sensitive to different levels of r. However, no significant effect was detected on the pooled effect size for different correlation coefficients for motorcycle passengers (r = 0.7; 6.56; 95% CI: 1.59, 27.00; r = 0.9; 6.56; 95% CI: 2.25, 19.13). Increases in helmet use among motorcycle passengers were found in studies that: monitored pre and post campaign periods for longer than one year and were conducted in Thailand or Vietnam. However, the effect of motorcycle safety campaigns on helmet use among motorcycle riders remained significant for all of the different strata included. Conclusion The present meta-analysis found that motorcycle safety campaigns can lead to a significant increase in helmet use among both motorcycle riders and passengers. Due to the high degree of inter study heterogeneity, these findings should be interpreted with some caution. Despite the apparent favourable influence of motorcycle safety campaigns, more robust research is required.

STUDY DESIGN Cross-cultural reliability and validity. OBJECTIVES To develop and validate the Korean version of the Sitting Balance Measure (SBM-K) in Korean persons with incomplete spinal cord injury (ISCI). SETTING Tertiary care center. METHODS Twenty-nine persons with ISCI were evaluated using SBM-K, which was validated using the kappa coefficient and intraclass coefficient (ICC). The correlation between SBM-K individual items and total score was analyzed using Spearman's correlation, and the internal consistency of test items was measured using Cronbach's alpha. Additionally, the standard error measurement (SEM) and minimal detectable change (MDC) were measured. For the clinical validity of SBM-K, the correlation of SBM-K with the modified Sitting Balance Scale (mSBS) and the Korean-Spinal Cord Independence Measure-III (KSCIM-III) was determined via Spearman's correlation. Linear regression was performed to determine whether SBM-K could predict KSCIM-III. RESULTS The weighted kappa score of the SBM-K individual items and ICC of SBM-K total score were 0.76-0.83 (good-very good) and 0.98 (0.95-0.99), respectively. The correlation between the SBM-K total score and individual items was notable (r = 0.78-0.98). Cronbach's alpha, SEM, and MDC of SBM-K were 0.98, 0.59, and 1.64, respectively. The clinical validity of SBM-K correlated with mSBS (r = 0.88) and KSCIM-III (r = 0.65-0.89). SBM-K accounted for 17-72% of the variance in predicting KSCIM-III. CONCLUSIONS SBM-K showed sufficient test-retest reliability, validity, and marginal measurement errors. SBM-K can serve as an optimal clinical assessment tool for Korean ISCI patients and may provide clinicians with reliable sitting balance assessment in Korean clinical settings.

The aim of this study was to establish the reproducibility of tongue strength measurements in healthy women and men during maximum anterior isometric pressure (MAIP) and regular effort saliva swallows (RESS). In this cross-sectional study, 30 healthy young adults were required to push with the tip of the tongue on a piezo-resistive sensor glued to the hard palate, immediately above the central incisor line. Tongue pressures exerted on the sensor during MAIP and spontaneous RESS were recorded. Participants underwent a retest procedure within the same session to verify the reproducibility of measurements, as determined by intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (MDC). Complete data were obtained from 30 subjects (15 women, 15 men; mean age 31.4 ± 7.8 years; mean weight 61.3 ± 9.4 kg). Compared to women, men showed a trend for generating larger MAIP (p = 0.06; d = 0.71) and RESS (p = 0.07; d = 0.69). After normalizing to body weight, height, and body mass index (BMI), such trends disappeared. At retest, MAIP and RESS proved stable and highly reliable (all ICCs ≥ 0.93) in men and women but associated to moderate variability as for SEM and MDC, with MAIP estimates associated to smaller SEM and MDC (SEM ranging 7.4-14.2%; MDC 18.6-20.9%) than RESS (SEM ranging 20.4-38.5%; MDC 52.5-55.6%). Piezo-resistive pressure sensors allow clinicians and researchers to perform reproducible measurements of tongue muscle performance. However, if therapeutic interventions are administered, measurement variability in tongue performance should be considered when appraising their clinical efficacy, especially for those populations who display impaired performance and may not be capable to generate high and stable forces. No gender-based differences emerged in the motor tasks tested.

PURPOSE To determine differences in cycloplegic vs. non-cycloplegic refractive error and factors associated with these differences in Chinese school students. METHOD In this cross-sectional school-based study, refractive error was measured in school students using a NIDEK autorefractor before and after administration of 0.5% tropicamide. Spherical equivalent (SER) in diopters (D) was calculated as sphere plus half cylinder. SER differences before vs. after cycloplegia were evaluated using mean, standard deviation (SD), 95% limits of agreement. Univariable and multivariable regression models were used to determine factors associated with SER differences. RESULTS Among 3604 students, 3450 (95.7%) provided data for analysis. Mean age (SD) was 9.7 (3.6) years. The mean SER (SD) was -1.12 (1.97) D before cycloplegia, and -0.20 (2.19) D after cycloplegia, with a mean difference of 0.92 D (95% limits of agreement: -0.93 to 2.78 D). Among 196 eyes with non-cycloplegic SER -6.0 D or worse (e.g., met high myopia definition), 71.4% had cycloplegic SER -6.0 D or worse, and among 3607 eyes with non-cycloplegic SER -0.5 D or worse (e.g., met myopia definition), 62.1% eyes had cycloplegic SER -0.5 D or worse. Cycloplegic SER was more correlated with axial length than non-cycloplegic SER (Pearson r = 0.82 vs. 0.72, p

Bangladesh has experienced a rising trend in hypertension in recent years and women are suffering from this non-communicable disease more than men. About one-fifth of the adult population is suffering from hypertension and almost three-fifth of them are undiagnosed. This study aims to assess the prevalence and determinants of undiagnosed hypertension and to examine the extent of socioeconomic inequalities in undiagnosed hypertension among adult Bangladeshi population (≥ 18 years). This study used nationally representative Bangladesh Demographic and Health Survey 2017–18 data. Undiagnosed hypertension was defined as having systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg and was never told by the health professionals to lower/control blood pressure. Multiple logistic regression analysis was performed to assess factors associated with undiagnosed hypertension. Further, socioeconomic inequalities in the prevalence of undiagnosed hypertension were estimated using Concentration Index. Out of total 3196 hypertensive adults, half (50.1%) were undiagnosed. In the adjusted model, older age, overweight/obesity, female gender, richest wealth quintiles had lower odds of being undiagnosed. Overall concentration index showed that poor patients were disproportionately affected by undiagnosed hypertension (Concentration Index: − 0.103, Standard Error (SE) of Concentration Index: 0.024; P value < 0.001). The poor(Q1)-to-rich(Q5) ratio of 1.3 also demonstrates that poorest hypertensive Bangladeshi adults have higher prevalence of undiagnosed hypertension than their richest counterparts. Awareness building program should be targeted towards adults belong to poor wealth quintiles for checking blood pressure regularly. Hypertension should be diagnosed and treated to prevent further complications.

In recent years, the incidence of hypertension diseases has increased dramatically, not only among the elderly but also among young people. In this regard, the use of machine learning methods to diagnose the causes of hypertension diseases has increased in recent years. In this article, we have improved the prediction of hypertension detection using Mahalanobis distance-based multivariate outlier removing of Korean national health data named by the KNHANES database. The study identified a variety of risk factors associated with chronic hypertension. Chronic disease is often caused by many factors, not just one. Therefore, it is necessary to study the detection of the disease taking into account complex factors. The paper is divided into two modules. Initially, the data preprocessing step that uses a tree classifier-based feature selection, and to remove multivariate outlier using Mahalanobis distance from KNHANES data. The next module applies the predictive analysis step to detect and prediction of hypertension. In this study, we compare the accuracy, mean standard error (MSE), F1-score, and area under the ROC curve (AUC) for each classification model. The test results show that the proposed RF-MAH algorithm has an accuracy, F1-score, MSE and AUC outcomes of 99.48%, 99.62%, 0.0025 and 99.61%, respectively. Following these, the second-best outcomes of an accuracy rate of 99.51%, MSE of 0.0028, F1-score of 99.58%, and AUC of 99.65% were achieved by XGBoost with the MAH model. The proposed method can be used not only for hypertension but also for the detection of various diseases, such as stroke and cardiovascular disease. It is planned to support the identification and decision-making of high-risk patients with various diseases.

The soil acidity level is a key soil characteristic that determines soil nutrient availability, soil microbial activities and crop growth. However, studies on distribution and extent of soil acidity in Ethiopia are not available. This study was carried out to predict the extent and severity of soil acidity. The study used 88,265 soil pH samples collected from soil laboratories and 21,439 samples compiled from studies. Rainfall, altitude, slope gradient, soil, and land cover were considered to generate spatial autocorrelation and integrated into geospatial analysis to predict the soil pH. The performance of the kriging model was found to be satisfactory with a standard error of 0.77, RMSE of 0.51, and R2 of 0.74. The model estimates showed that 47% and 30.2% of the country’s total area and rainfed areas were acidic (pH

Right ventricular (RV) strain measurements from ultrasound via speckle-tracking techniques are being used more frequently as a non-invasive diagnostic tool for a variety of cardiopulmonary pathologies. However, despite the clinical utility of ultrasound RV strain measurements, quantification of RV strain in rodents remains difficult owing to unique image artifacts and non-standardized methodologies. We demonstrate here a simple approach for measuring RV strain in both mice and rats using high-frequency ultrasound and automated speckle tracking. Our results show estimated peak RV free-wall longitudinal strain values (mean ± standard error of the mean) in mice (n = 15) and rats (n = 5) of, respectively, −10.38% ± 0.4% and −4.85% ± 0.42%. We further estimated the 2-D Green–Lagrange strain within the RV free wall, with longitudinal components estimated at −5.7% ± 0.48% in mice and −2.1% ± 0.28% in rats. These methods and data may provide a foundation for future work aimed at evaluating murine RV strain levels in different disease models.

Objective Few studies have examined children's enrollment in high-deductible health plans (HDHPs) and associations with health service use. We examine trends, health service use, and financial barriers to care for US children with high-deductible private insurance. Methods Trend data on HDHP enrollment were available for 58,910 children ages 0 to 17 with private insurance from the 2007 to 2018 National Health Interview Survey. Health service indicators were examined in a cross-sectional sample of 23,959 children in the 2014-2018 datasets. High deductible was defined as a minimum of $2,700 for a family in 2018. Chi-square tests examined associations of HDHPs with health service indicators. Logistic regression models adjusted for sociodemographics and child health. Results The percent of privately insured children with HDHPs increased from 18.4% to 48.6% from 2007 to 2018. In adjusted regression, those with HDHPs fared worse than those with traditional plans on 7 of 10 measures and those with HDHPs and no health savings account (HSA) fared worse on eight. While small differences were found for various child-focused measures, the most consistent differences were found for family-focused measures. Parents with HDHPs were more likely than parents with traditional private insurance to report they had delayed or forgone their medical care (10.2% vs 5.7%), had problems paying medical bills (15.7% vs 10.3%), and had family medical debt (34.1% vs 25.8%). Conclusions Privately insured families have seen substantial growth in high-deductible plans in the last decade. Families with HDHPs, especially those without HSAs, have more financial barriers to care.

Using cross-asset return data in global financial markets, we propose a novel empirical framework to identify the causal structure of the asset risk spillover network. The joint return distribution of the global financial system can be characterized using a directed acyclic graph approach. However, since assets tend to be highly correlated during market turbulence, when adopting a nodewise penalized regression approach for neighborhood estimation, parameter estimates will receive large standard errors, and edges cannot be reliably estimated. In this work, we propose a two-stage approach for directed acyclic graph skeleton estimation for highly correlated variables. In the first stage, a variable screening ensemble is incorporated into the sparse partial least squares regression method to both reduce the size of the active variables set and impose an adaptive penalization on the weight vectors. In the second stage, a modified PC algorithm based on Gram-Schmidt orthogonalization is applied to remove the false positive edges. Simulation studies are conducted to demonstrate the effectiveness of the proposed method. Finally, we apply our method to analyze the asset risk spillover channels for international financial assets during the COVID-19 pandemic.

Background: Duchenne muscular dystrophy (DMD) is a rare x-linked recessive genetic disorder affecting 1 in every 5000–10000 [1, 2]. This disease leads to a variable but progressive sequential pattern of muscle weakness that eventually causes loss of important functional milestones such as the ability to walk. With promising drugs in development to ameliorate the effects of muscle weakness, these treatments must be associated with a clinically meaningful functional change. Objective: The objective of this analysis is to determine both distribution, minimal detectable change (MDC), and anchor-based, minimal clinically important difference, (MCID) of 12 month change values in standardized time function tests (TFT) used to monitor disease progression in DMD. Method: This is a retrospective analysis of prospectively collected data from a multi-center prospective natural history study with the Cooperative International Neuromuscular Research Group (CINRG). This study calculated MDC and MCID values for 3 commonly used timed function tests typically used to monitor disease progression; supine to stand (STS), 10 meter walk/run (10MWT), and 4 stair climb (4SC). MDC used standard error of measurement (SEM) while MCID measurements used the Vignos scale as an anchor to determine clinical change in functional status. Results: All 3 TFT were significantly important clinical endpoints to detect MDC and MCID changes. MDC and MCID 12 month changes were significant in 10MWT (–0.138, –0.212), Supine to Stand (–0.026, –0.023) and 4 stair climb (–0.034, –0.035) with an effect size greater or close to 0.2. Conclusion: The 3 TFT are clinically meaningful endpoints used to establish change in DMD. MCID values were higher than MDC values indicating that an anchor-based approach using Vignos as a clinically meaningful loss of lower extremity abilities is appropriate to assess change in boys with DMD.

AIM The pharmacokinetic (PK) properties of cyclosporine (CsA) in renal transplant recipients are patient- and time-dependent. Knowledge of this time-related variability is necessary to maintain or achieve CsA target exposure. Here, we aimed to identify factors explaining variabilities in CsA PK properties and characterize time-varying clearance (CL/F) by performing a comprehensive analysis of CsA PK factors using population PK (popPK) modeling of long-term follow-up data from our institution. METHODS In total, 3674 whole-blood CsA concentrations from 183 patients who underwent initial renal transplantation were analyzed using nonlinear mixed-effects modeling. The effects of potential covariates were selected according to a previous study and well-accepted theoretical mechanisms. Model-informed individualized therapeutic regimens were also evaluated. RESULTS A two-compartment model adequately described the data and the estimated mean CsA CL/F was 32.6 L h-1 (relative standard error: 5%). Allometrically scaled body size, hematocrit (HCT) level, CGC haplotype carrier status, and postoperative time may contribute to CsA PK variability. The CsA bioavailability in patients receiving a prednisolone dose (PD) of 80 mg was 20.6% lower than that in patients receiving 20 mg. A significant decrease (52.6%) in CL/F was observed as the HCT increased from 10.5% to 60.5%. The CL/F of the non-CGC haplotype carrier was 14.4% lower than that of the CGC haplotype carrier at 3 months post operation. CONCLUSIONS By monitoring body size, HCT, PD, and CGC haplotype, changes in CsA CL/F over time could be predicted. Such information could be used to optimize CsA therapy. CsA dose adjustments should be considered in different postoperative periods.

Summary Background & aims A limited number of studies have developed simple anthropometric equations that can be implemented for predicting muscle mass in the local community. Several studies have suggested calf circumference as a simple and accurate surrogate maker for muscle mass. We aimed to develop and cross-validate a simple anthropometric equation, which incorporates calf circumference, to predict appendicular skeletal muscle mass (ASM) using dual-energy X-ray absorptiometry (DXA). Furthermore, we conducted a comparative validity assessment of our equation with bioelectrical impedance analysis (BIA) and two previously reported equations using similar variables. Methods ASM measurements were recorded for 1262 participants (837 men, 425 women) aged 40 years or older. Participants were randomly divided into the development or validation group. Stepwise multiple linear regression was applied to develop the DXA-measured ASM prediction equation. Parameters including age, sex, height, weight, waist circumference, and calf circumference were incorporated as predictor variables. Total error was calculated as the square root of the sum of the square of the difference between DXA-measured and predicted ASMs divided by the total number of individuals. Results The most optimal ASM prediction equation developed was: ASM (kg) = 2.955 × sex (men = 1, women = 0) + 0.255 × weight (kg) − 0.130 × waist circumference (cm) + 0.308 × calf circumference (cm) + 0.081 × height (cm) − 11.897 (adjusted R2 = 0.94, standard error of the estimate = 1.2 kg). Our equation had smaller total error and higher intraclass correlation coefficient (ICC) values than those for BIA and two previously reported equations, for both men and women (men, total error = 1.2 kg, ICC = 0.91; women, total error = 1.1 kg, ICC = 0.80). The correlation between DXA-measured ASM and predicted ASM by the present equation was not significantly different from the correlation between DXA-measured ASM and BIA-measured ASM. Conclusions The equation developed in this study can predict ASM more accurately as compared to equations where calf circumference is used as the sole variable and previously reported equations; it holds potential as a reliable and an effective substitute for estimating ASM.

BACKGROUND: SATIS-Stroke questionnaire has been translated and adapted for use in the Brazilian population, however, it is necessary to test the measurement properties in Brazilian population. OBJECTIVE: To test the reliability, agreement, concurrent validity, and diagnostic accuracy of the SATIS-Stroke. METHODS: Chronic stroke survivors were included. The calculations were made using scores in logits (Rasch Model). Reliability was tested using the intraclass correlation coefficient (ICC(2,1)), standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman plots. Concurrent validity was analyzed using Spearman's correlation coefficient. For such, the correlation between SATIS-Stroke and Stroke Specific Quality of Life (SS-QOL) questionnaires was determined. Diagnostic accuracy was estimated based on the area under the receiver operating characteristic (ROC) curve with a 95% confidence interval and considering the sensitivity and specificity of SATIS-Stroke in differentiating different types of activity and participation. RESULTS: Eighty stroke survivors were analyzed. Mean age was 57.98±13.85 years and 45.2% had severe impairment. Excellent reliability was found (intra-observer ICC(2,1) = 0.90; 95% CI: 0.84, 0.93; inter-observer ICC(2,1) = 0.89; 95% CI: 0.83, 0.93). The Bland-Altman plot demonstrated satisfactory agreement. In the analysis of concurrent validity, a strong, positive, significant correlation was found between SATIS-Stroke and SS-QOL (r(s) = 0.74; p

Background and Purpose. The aim of this study was to examine 5 commonly used questionnaires for assessing disability in people with low back pain. The modified Oswestry Disability Questionnaire, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire, the Waddell Disability Index, and the physical health scales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were compared in patients undergoing physical therapy for low back pain. Subjects and Methods. Patients with low back pain completed the questionnaires during initial consultation with a physical therapist and again 6 weeks later (n=106). Test-retest reliability was examined for a group of 47 subjects who were classified as “unchanged” and a subgroup of 16 subjects who were self-rated as “about the same.” Responsiveness was compared using standardized response means, receiver operating characteristic curves, and the proportions of subjects who changed by at least as much as the minimum detectable change (MDC) (90% confidence interval [CI] of the standard error for repeated measures). Scale width was judged as adequate if no more than 15% of the subjects had initial scores at the upper or lower end of the scale that were insufficient to allow change to be reliably detected. Results. Intraclass correlation coefficients (2,1) calculated to measure reliability for the subjects who were classified as “unchanged” and those who were self-rated as “about the same” were greater than .80 for the Oswestry and Quebec questionnaires and the SF-36 Physical Functioning scale and less than .80 for the Waddell and Roland-Morris questionnaires and the SF-36 Role Limitations–Physical and Bodily Pain scales. None of the scales were more responsive than any other. Discussion and Conclusion. Measurements obtained with the modified Oswestry Disability Questionnaire, the SF-36 Physical Functioning scale, and the Quebec Back Pain Disability Scale were the most reliable and had sufficient width scale to reliably detect improvement or worsening in most subjects. The reliability of measurements obtained with the Waddell Disability Index was moderate, but the scale appeared to be insufficient to recommend it for clinical application. The Roland-Morris Disability Questionnaire and the Role Limitations–Physical and Bodily Pain scales of the SF-36 appeared to lack sufficient reliability and scale width for clinical application.

Background The Keele STarT MSK Tool is a 10-item questionnaire developed to classify patients suffering from one of the five most common types of musculoskeletal pain into 3 sub-groups of risk of chronic pain (i.e. low risk, medium risk and high risk). Objective The objective of the present study was to translate the Keele STarT MSK Tool into French and to evaluate its main psychometric properties. Methods The translation and intercultural adaptation of the questionnaire were carried out using a 6-step process. The following psychometric properties were investigated: floor and ceiling effects, construct validity, internal consistency and test-retest reliability including Standard Error of Measurement and Smallest Detectable Change. Results 101 patients suffering from musculoskeletal pain participated in the study. No floor nor ceiling effects were observed. A Cronbach’s alpha of 0.65 was found, revealing a moderate internal consistency. Nevertheless, all items were demonstrated to be significantly correlated with the total score (range of correlations: r=0.2 for item 7 to r=0.78 for item 1). A good construct validity was also found with a significant correlation of r=0.78 between the French Keele STarT MSK Tool and the ÖMPSQ-short. Test-retest reliability was excellent (Intraclass Correlation Coefficient 0.97). A Standard Error of Measurement of 0.42 and a Smallest Detectable Change of ±1.17 were measured. Conclusion A validated French version of the Keele STarT MSK Tool is now available and can be used by health practitioners to stratify patients as being at low, medium or high risk of persistent musculoskeletal pain.

Objectives To assess test–retest reliability, internal consistency, construct validity, and the presence of ceiling and floor effects in the Brazilian version of the Short-Form Neck Disability Index (SF-NDI) in patients with chronic neck pain. Methods One hundred and fifty-six patients answered the Numerical Pain Rating Scale (NPRS), Short-Form Neck Disability Index (SF-NDI), Tampa Scale of Kinesiophobia (TKS), Pain Catastrophizing Scale (PCS), and the 36-Item Short-Form Health Survey questionnaire (SF-36). Another sample (n = 51) filled the SF-NDI at two different times, and test–retest reliability was measured using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (MDC). The internal consistency of the SF-NDI was analyzed by Cronbach's alpha. To determine construct validity, Spearman's correlation coefficient was used to determine the magnitude of the correlation between the score of the SF-NDI and other measurement instruments: NPRS, TKS, PCS, SF-36, and original NDI. Results SF-NDI presented substantial reliability (ICC = 0.844) and adequate internal consistency (Cronbach's alpha = 0.778). We observed significant values and with a correlation magnitude greater than 0.80 for the SF-NDI with the original NDI, between 0.30 and 0.50 for the correlations with TKS, and the functional capacity and pain domains of the SF-36, and less than 0.30 with the other study instruments. No participant reached the maximum score. Ceiling and floor effects were not observed. Conclusions SF-NDI with 5 items has adequate measurement properties in Brazilian chronic neck pain patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00586-021-07019-4.

BackgroundPeople with Parkinson’s disease are less physically active than controls. It is important to promote physical activity, which can be assessed using different methods. Subjective measures include physical activity questionnaires, which are easy and cheap to administer in clinical practice. Knowledge of the psychometric properties of physical activity questionnaires for people with Parkinson’s disease is limited. The aim of this study was to evaluate the test-retest reliability of physical activity questionnaires in individuals with Parkinson’s disease without cognitive impairment.MethodsForty-nine individuals with Parkinson’s disease without cognitive impairment participated in a test-retest reliability study. At two outpatient visits 8 days apart, the participants completed comprehensive questionnaires and single-item questions: International Physical Activity Questionnaire-Short Form (IPAQ-SF), Physical Activity Scale for the Elderly (PASE), Saltin-Grimby Physical Activity Level Scale (SGPALS) and Health on Equal Terms (HOET). Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), limits of agreement, weighted kappa or the Svensson method.ResultsSeveral of the physical activity questionnaires had relatively low test-retest reliability, including the comprehensive questionnaires (IPAQ-SF and PASE). Total physical activity according to IPAQ-SF had an ICC value of 0.46 (95% confidence interval [CI], 0.21–0.66) and SEM was 2891 MET-min/week. The PASE total score had an ICC value of 0.66 (95% CI, 0.46–0.79), whereas the SEM was 30 points. The single-item scales of SGPALS-past six months (SGPALS-6 m) and HOET question 1 (HOET-q1) with longer time frames (6 or 12 months, respectively) showed better results. Weighted kappa values were 0.64 (95% CI, 0.45–0.83) for SGPALS-6 m and 0.60 (95% CI, 0.39–0.80) for HOET-q1, whereas the single-item questions with a shorter recall period had kappa values ConclusionsSingle-item questions with a longer time frame (6 or 12 months) for physical activity were shown to be more reliable than multi-item questionnaires such as the IPAQ-SF and PASE in individuals with Parkinson’s disease without cognitive impairments. There is a need to develop a core outcome set to measure physical activity in people with Parkinson’s disease, and there might be a need to develop new physical activity questionnaires.

Introduction The Brief Illness Perception Questionnaire (BIPQ) is an instrument for assessing the illness perception. Illness perception varies between individuals based on their health status. There is no study that assess the psychometric properties of the Persian version of BIPQ in neck pain patients. The goal of this study was to evaluate the reliability, construct validity, and exploratory factor analysis of the Persian BIPQ in individuals with non-specific chronic neck pain. Methods This is a cross-sectional study in which 123 individuals with non-specific chronic neck pain participated. 60 participants examined after 7 days for testing reliability. Reliability was assessed by intra-class correlation coefficient, standard error of measurement, and minimal detectable change. For assessing construct validity and item-total correlation, correlation tests were used. Also, exploratory factor analysis was done to assess the factor structure of the BIPQ. Results Exploratory factor analysis' results showed that there were 2 factors with Eigenvalues >1. Factor 1 included “identity”, “consequence”, “timeline”, and “emotional response”. Factor 2 consisted of “coherence” and “treatment control”. The intra-class correlation coefficient and the cronbach's alpha for the total score was 0.8 and 0.86 respectively. Results of correlation tests showed an acceptable construct validity except with SF-12 mental component. Item-total correlation tests demonstrated that the correlations were above 0.3 for all subscales except for “treatment control” and “coherence”. Conclusion BIPQ has an acceptable properties to assess illness perception in individuals with non-specific chronic neck pain. The results of exploratory factor analysis and item-total correlation confirmed that 2-subscale version is more acceptable.

BACKGROUND Suboptimal adherence to antiretroviral therapy (ART) is responsible for most virologic failure among adolescents with HIV. Methods for objectively measuring adherence to ART are limited. This study assessed the association between ritonavir concentrations in hair and self-reported adherence and modified directly administered ART on virologic outcomes among HIV-infected adolescents who were virologically failing second-line ART in Harare, Zimbabwe. METHODS HIV-infected adolescents on atazanavir-based or ritonavir-based second-line treatment for >6 months with viral load ≥1000 copies/mL were randomized to either modified directly administered ART (mDAART) plus standard of care (intervention) or standard of care alone (control). Questionnaires were administered; viral load and hair samples were collected at baseline and after 90 days. Virological suppression was defned as

Background Evaluations of prophylactic measures to prevent cerebral-desaturation-events (CDEs) during anesthesia in beach-chair-position (BCP) for shoulder surgeries haven't been done earlier. We analyzed the effectiveness of various types of prophylactic measures usable in this clinical setting. Methods We performed a meta-analysis (PROSPERO-CRD-42020167285) of trials that reported incidence of CDEs, different cerebral-regional-oxygen-saturation (rSO2) and jugular-venous-oxygen-saturation (SjvO2) values (baseline, minimum, serial rSO2, and SjvO2 measurements, and critical CDEs) of anesthetized subjects undergoing elective shoulder surgeries in BCP. Considering the type of prophylactic measures used, (pharmacological or non-pharmacological), the subgroup analysis was planned. Outcomes included (1) rSO2 and SjvO2 data with and without the use of prophylactic measures to prevent CDEs, recorded for different intervals of time, and (2) the number of subjects experiencing CDEs and hypotension episodes. Results A total of 12 studies (786 subjects) were included. We observe a lower absolute rSO2 values for early (vs controls; mean difference [MD], -13.58%; 95% confidence interval [CI] -16.03 to -11.4; I2 = 0%, P=0.97) and all-time periods (vs controls; MD, -12.23%; 95% CI -14.59 to -9.87; I2 = 0%, P = 0.82) for vaso-active agent prophylaxis. The lowest achieved rSO2 values too were lower for vaso-active agent prophylaxis (vs controls; MD, -12.72%; 95% CI -15.28 to -10.15; I2 = 0%, P = 0.99). The risk of developing CDEs was higher with vaso-active agent prophylaxis (vs controls; risk ratio, 4.01; 95% CI 1.82 to 8.81; I2 = 0%, P = 0.75). Subgroup analysis revealed targeted-mild-hypercarbia as an effective measure in preserving cerebral oxygenation ([vs controls; MD, 4.93%; 95% CI 2.45 to 7.41; I2 = 0%, P = 0.83] and [vs controls; MD, 6.00%; 95% CI 3.35 to 8.65; I2 = 0%, P = 0.32], for all-time overall and lowest achieved absolute rSO2, respectively). Similarly, targeted-mild-hypercarbia had successfully prevented the fall of rSO2 with change of positions (supine to BCP; MD, 1.56%, 95% CI -0.71 to 3.83; I2 = 6%, P = 0.30). Meta-regressions revealed statistically significant highest estimate (Estimate, 7.8; standard error [SE], 1.534; 95% CI 4.8 to 10.8, P Conclusions Targeted-mild-hypercarbia techniques can effectively reduce BCP-CDEs. Evidence doesn't favor prophylactic vaso-active-agents' use for the prevention of cerebral desaturations irrespective whether their use interfere with cerebral oximetry readings.

The purpose of this study was to verify the accuracy of the agreement between heart rate at the first ventilatory threshold (HRVT1) and heart rate at the end of the 6-min walk test (HR6MWT) in coronary artery disease (CAD) patients on β-blockers treatment. This was a cross-sectional study with stable CAD patients, which performed a cardiopulmonary exercise test (CPET) on a treadmill and a 6-min walk test (6MWT) on nonconsecutive days. The accuracy of agreement between HRVT1 and HR6MWT was evaluated by Bland–Altman analysis and Lin’s concordance correlation coefficient (rc), mean absolute percentage error (MAPE), and standard error of estimate (SEE). Seventeen stable CAD patients on β-blockers treatment (male, 64.7%; age, 61± 10 years) were included in data analysis. The Bland–Altman analysis revealed a negative bias of -0.41 ± 6.4 bpm (95% limits of agreements, -13 to 12.2 bpm) between HRVT1 and HR6MWT. There was acceptable agreement between HRVT1 and HR6MWT (rc = 0.84; 95% confidence interval, 0.63 to 0.93; study power analysis= 0.79). The MAPE of the HR6MWT was 5.1% and SEE was 6.6 bpm. The ratio HRVT1/HRpeak and HR6MWT/HRpeak from CPET were not significantly different (81%± 5% vs. 81%± 6%, P= 0.85); respectively. There was a high correlation between HRVT1 and HR6MWT (r= 0.85, P< 0.0001). Finally, the results of the present study demonstrate that there was an acceptable agreement between HRVT1 and HR6MWT in CAD patients on β-blockers treatment and suggest that HR6MWT may be useful to prescribe and control aerobic exercise intensity in cardiac rehabilitation programs.

A simple objective test is required to identify people with impaired physical aspects of health-related quality of life (QOL) due to intermittent claudication. This study assessed the relationship of QOL, function and physical activity to the need to stop during a six-minute walking test (6MWT) amongst people with intermittent claudication.This was a prospective case-control study conducted at two centers in Australia. 173 participants with a history of intermittent claudication and peripheral artery disease diagnosed by ankle brachial pressure index0.9, completed two 6MWTs one week apart. QOL was assessed with the short form (SF)-36. Physical activity was assessed by an accelerometer to record step count, stepping time and energy expenditure over 7 days. Physical performance was assessed by the Short Physical Performance Battery (SPPB) test. The associations of the need to stop at least once during the 6MWT with QOL, function and activity were assessed using Mann Whitney U test and analysis of covariates.Participants that had to stop at least once during the two 6MWTs (46; 26.6%) had significantly lower scores for three of the domains (physical functioning, role-physical and bodily pain) and the physical component summary (PCS) measure of the SF-36 compared to those who did not need to stop (n = 127; 73.4%). After adjusting for the risk factor co-variates (diabetes, hypertension and ankle brachial pressure index) which were significantly unequally distributed, needing to stop during the 6MWTs was significantly associated with a lower PCS score (adjusted mean 36.5, standard error 0.8 vs. 30.5, standard error 1.3; F = 14.0; P0.001; partial eta squared 0.077). Participants that had to stop at least once during the two 6MWTs had significantly lower 7-day step count, time stepping and energy expenditure, but not total SPPB score, compared to those who did not need to stop.Needing to stop during a 6MWT identified participants with intermittent claudication with poorer QOL and less physical activity compared to those that do not need to stop.

Aim: to assess the effectiveness of structured teaching programme on knowledge and attitude regarding vitamin A deficiency and its prophylaxis among mothers of under five children. Objectives: (1). To assess the knowledge and attitude among mothers of under five children on vitamin A deficiency and its Prophylaxis. (2). To find the effectiveness of Structured Teaching Programme in terms of gaining knowledge and attitude of mothers regarding Vitamin A deficiency and its prophylaxis for under five children. (3). To find association between the pre test level of knowledge and attitude among mothers of under five children with their selected demographic variables. Methodology: A pre experimental research design was adopted for the study. 50 samples were selected by using non probability convenience sampling technique. The pre and post test level knowledge and attitude was assessed by using structured knowledge questionnaires and attitude scale respectively. Results: The pre test mean was 7.76 with the standard deviation of 2.17 and the post test mean was 16.68 with the standard deviation of 1.81. The mean difference of pre and post test is 8.92; standard error is 0.281. The ‘T’ value is 31.74 is Highly Significant at p

Objective:We sought to determine who is involved in the care of a trauma patient.Methods:We recorded hospital personnel involved in 24 adult Priority 1 trauma patient admissions for 12 h or until patient demise. Hospital personnel were delineated by professional background and role.Results:We cataloged 19 males and 5 females with a median age of 50-y-old (interquartile range [IQR], 35.5-67.5). The average number of hospital personnel involved was 79.71 (standard deviation, 17.62; standard error 3.6). A median of 51.2% (IQR, 43.4%-59.8%) of personnel were first involved within hour 1. More personnel were involved in direct versus indirect care (median 54.5 [IQR, 47.5-67.0] vs 25.0 [IQR, 22.0-30.5];P< 0.0001). Median number of health-care professionals and auxiliary staff were 74.5 (IQR, 63.5-90.5) and 6.0 (IQR, 5.0-7.0), respectively. More personnel were first involved in hospital locations external to the emergency department (median, 53.0 [IQR, 41.5-63.0] vs 27.5 [IQR, 24.0-30.0];P< 0.0001). No differences existed in total personnel by Injury Severity Score (P= 0.1266), day (P= 0.7270), or time of admission (P= 0.2098).Conclusions:A large number of hospital personnel with varying job responsibilities respond to severe trauma. These data may guide hospital staffing and disaster preparedness policies.

Investigate difference, agreement, and bias between maximal oxygen consumption (VO2max) measured by indirect calorimetry and the Heart Rate Ratio Method (HRRM) for estimating VO2max using measured and age-predicted maximum heart rate (HRmax) in a sample of middle-aged and older adults. Eleven men and nine women (age: 61.8 ± 8.5 years, VO2max: 36.6 ± 9.5 mL/kg/min, N = 20) had their VO2max measured via a maximal graded exercise test and confirmed using a verification bout on a treadmill ergometer. Participants’ VO2max was estimated via the HRRM using measured and age-predicted HRmax. Difference, agreement, and bias between methods were assessed using a one-way repeated measures Analysis of Variance (ANOVA), Lin’s concordance correlation coefficient, and Bland–Altman plots, respectively. There were no statistical differences between methods of assessing VO2max, F(1.13, 21.47) = 0.583, p = 0.473, generalized eta-squared = 0.012. The standard error of the estimate (SEE) for the HRRM using measured or predicted HRmax was 5.2% and 5.6% of the mean VO2max, respectively. Both HRRM predictions had poor agreement with VO2max (rc ≤ 0.40). There was a systematic bias to underestimate as VO2max increased for HRRM using measured HRmax, F(1, 18) = 17.40, p

In their seminal 2001 work, Acemoglu, Johnson, and Robinson (AJR) argued that institutions influence economic development, using the logarithm of settler mortality as an instrument to establish a causal effect. A number of economists and other social scientists have challenged this work in terms of both data and identification strategy. Some of those criticisms concerned the IV estimated coefficients and standard errors, which were nearly twice as large as the OLS coefficients and standard errors. The research uses machine learning to test the robustness of AJR’s findings. Using the AJR dataset, which I randomly divide into training data and testing data, I am able to predict the average protection against expropriation risk from settler mortality. These predicted values of property rights protection are then regressed on per capita GDP growth. The results indicate a strong and positive effect of property rights protection on growth, consistent with AJR’s earlier results. Moreover, the use of machine learning to obtain institutional values yields estimates close to the OLS estimates, unlike AJR. Removing African countries and Neo-European countries, such as Canada, Australia, USA, and New Zealand, does not alter the sign and significance of the coefficient of interest. These results suggest that machine learning can be helpful to economists facing data issues.

Background Determination of gestational age in goats was performed using ultrasound measurements of different fetal biometric parameters. There are no data showing quadratic and exponential dependence between fetal heart parameters and gestational age. Objectives The objective of the present study was to test the significance of the defined indicators (fetal heart rate, longitudinal and transverse fetal heart axes) for determining gestational age in local Bulgarian goats. Methods A total of 24 pregnant local Bulgarian goats, aged between 2 and 5 years, body weight 42–50 kg were included in the study. Ultrasonographic examinations were performed weekly on gestational days 21, 28, 35, 42 and 49. After gestational day 49 until parturition, scans were performed biweekly. The data from the measurements were subjected to linear (y = a + bx), quadratic (y = aх 2 + bх + c) and exponential (y = ax n) correlation. Results: Average fetal heart rate values decreased with pregnancy progression. The coefficient of determination (R2) and standard error of estimate (SEE) of the heart rate indicator were 0.72, 0.75, 0.58 and 15.1, 14.4, 19.2 days, respectively, for the three correlations. Longitudinal diameter (long axis) had the following values for R2 = 0.94, 0.96, 0.96 and for SEE = 7.0, 5.5, 5.5 days, for the linear, quadratic and exponential correlations, respectively, while the values of the fetal heart transverse diameter (short axis) were higher than those of the external one (R2 = 0.95, 0.97, 0.97). Simultaneously, SEE is lower (SEE = 6.1, 4.9, 5.0 days) compared to that found for the long heart fetal axis. Conclusions For precise estimation of gestational age, use of longitudinal (long) and transverse (short) axes is recommended. Fetal heart rate is not an exact indicator but can be used as a reference for gestational age along with changes in the heart size and echogenicity., The objective of this study is to determine gestational age in Bulgarian local goats through ultrasonographic measurements of some fetal heart indicators (heart rate, longitudinal and transverse heart axes). For precise estimation of gestational age, use of longitudinal (long) and transverse (short) axes is recommended. Fetal heart rate is not an exact indicator but can be used as a reference for gestational age along with changes in the heart size and echogenicity.

Background/purpose The aim of this study was to systematically review all COVID-19 publications to summarize the clinical features, assess comorbidities, prevalence, and disease outcomes. Methods Included were all COVID-19 published studies between January 1 to July 20, 2020. The random effect model was used to calculate the pooled prevalence and corresponding 95% confidence interval (CI). Publication bias was assessed using the funnel plot for the standard error by logit event. Results The mean age of the patients was 46.8 years (95% CI, 41.0–52.6) and males comprised 54.0% (95% CI, 51.3–56.7). Total co-morbidities prevalence was 29.5% (95% CI, 19.0–36.6), with diabetes mellitus being the most prevalent 13.8% (95% CI, 8.7–21.1), followed by hypertension 11.7% (95% CI, 5.7–22.6), and cardiovascular disease 9.7% (95% CI, 6.5–14.2). The most common clinical manifestations were fever, 82.0% (95% CI, 67.7–90.8), cough 54.3% (95% CI, 45.5–62.9), fatigue 30.2% (95% CI, 23.3–38.1), sputum 28.5% (95% CI, 21.2–37.2), sore throat 21.7% (95% CI, 14.6–31.0), and headache 11.0% (95% CI, 7.9–15.2). The most common COVID-19 serious complications were RNA Anemia 98.2% (95% CI, 96.2–99.2), hospitalization 83.7% (95% CI, 76.0–89.3), bilateral pneumonia 70.9% (95% CI, 58.2–81.0); of those hospitalized 43.5% (95% CI, 24.9–64.2) were discharged. Fatality accounted for 10.5% (95% CI 6.8–16.1). Conclusion Patients infected with COVID-19 coronavirus showed a wide range of clinical presentation with non-specific symptoms.

Background Understanding the phenotypic and genetic parameter estimates of growth traits is important for an effective livestock genetic improvement programme. Objectives In this study, we evaluated the phenotypic performances and estimated genetic parameters for birthweight (BWT), weaning weight (WWT), pre‐weaning average daily gain (PADG), pre‐weaning Kleiber ratio (PKR), pre‐weaning growth efficiency (PGE) and pre‐weaning relative growth rate (PRGR) of Fogera cattle in Ethiopia. Methods Growth data collected from 2000 to 2018 in Andassa Livestock Research Center were used for the study. General linear model of SAS 9.1 was used to estimate the least squares mean (LSM) ± standard error (SE) for phenotypic performances, and AI‐REML of Wombat software combined with a series of five single‐trait animal models to estimate phenotypic variance and its direct, maternal and residual components. Calf sex, calf birth season and calf birth year were the fixed effects considered. Results The overall LSM ± SE BWT, WWT, PADG, PKR, PGE and PRGR were 21.28 ± 0.05 kg, 97.99 ± 0.67 kg, 320.29 ± 2.79 g, 10.10 ± 0.04, 3.51 ± 0.35 and 1.95 ± 0.00, respectively. All the fixed effects considered significantly (p, The phenotypic and genetic parameter of birthweight (BWT), weaning weight (WWT), pre‐weaning average daily gain (PADG), pre‐weaning Kleiber ratio (PKR), pre‐weaning growth efficiency (PGE) and pre‐weaning relative growth rate (PRGR) were estimated for Fogera cattle in Ethiopia using data collected from 2000 to 2018 in Andassa Livestock Research Center. Positive and negative correlations were obtained between the traits for both genetic and phenotypic parameters. The positive and larger phenotypic and genetic correlations between most of the traits implied that selection based on one trait could improve the other traits.

The aim of this study was to determine whether the first sensation of stretching (ROMFSS) may predict the maximum range of motion (ROMMAX) in male (N = 37) and female (N = 32) volunteer subjects, and to assess the reliability of the ROM perceived by subjects in relation to a pre-determined ROM (ROM50%). Subjects attempted three experimental sessions with 48 hours between sessions 1 and 2 and 28 days between sessions 1 and 3. Within each session, five trials were performed with isokinetic equipment to assess posterior thigh muscle flexibility. The results revealed a strong and significant correlation between ROMMAX and ROMFSS for both sexes, females (r = 0.96, p < 0.001, R2 = 0.92) and males (r = 0.91, p < 0.001; R2 = 0.82). The accuracy of the model verified by the standard error of estimate (SEE) was high in the equations proposed for both female (SEE = 4.53%) and male (SEE = 5.45%). Our results revealed that ROMFSS may predict the ROMMAX for both male and female subjects. The ROMFSS may contribute to the development of evaluation methods that do not subject the individuals to conditions that may include unnecessary risk of injury and is well suited to monitor the training process of stretching exercises with submaximal loads. Key points An individual’s tolerance to stretching can be considered a continuum marked by the first sensation of stretching and the maximum range of motion as the continuum’s end-points. The first sensation of stretching and the point representing halfway between the first sensation and maximal range of motion are reliable measures in young men and women. The first sensation of stretching may be a safe and useful predictor of maximal range of motion.

SUMMARY OBJECTIVE: The aim of this study was to evaluate the intra- and inter-rater reliability of pressure pain threshold measurement on myofascial trigger points in the trapezius muscle in women with chronic neck pain. METHODS: This reliability study involved 30 volunteers with neck pain for more than 90 days. The assessment procedures were performed by blinded researchers. Two examiners, who were previously trained in the use of algometry, independently performed two assessments of the pressure pain threshold at two time intervals, one week apart. RESULTS: The study sample consisted of 30 young adult women. Excellent intra- and inter-rater reliability were found for the pressure pain threshold on myofascial trigger points, with intraclass correlation coefficient values ranging between 0.752 and 0.874, standard error of measurement ranging between 0.18 and 0.22 kg/cm2, and minimum detectable change ranging between 0.45 and 0.62 kg/cm2. CONCLUSION: The present study showed that the assessment of pressure pain threshold through algometry presents satisfactory intraclass correlation coefficient values, considering different time and examiners, contributing to the spread of the use of this tool as a quantitative method of pain evaluation in myofascial trigger points.