Interobserver Agreement Vertaling
Descriptions of sara, ASMK, PBS, GMFCS-E&R and MF values can be found in Table 22. Enrolled patients showed a binary distribution of ASMK scores (ASMK scores 1 and 3) corresponding to outpatient and non-outpatient function, respectively. There was no association between cross-sectional SARA DE scores and age or duration of illness (Spearmans Rho, rs = 0.110; p = 0.58; and rs = -0.108; p = 0.59). For missing data, see Appendix A. The Inter-Observer Agreement (ICC) of SARAGAIT/POSTURE, SARATOTAL and SARAKINETIC was high (0.97; 0.97; and 0.88, respectively). RT3DE scans of 18 random patients were reanalyzed to assess reproducibility within and between observers for IDS measurement. SDI measurements were performed twice on different days by the same observer to assess intra-observer variability. In addition, a second blind observer made measurements of interobserver variability. Intra-observer reproducibility was good, with an average difference of 0.02 (2.5%) between repeated measurements by the same observer (Figure 4). Similarly, the agreement of the measurements of two different observers with an average difference of 0.38 (3.2%) was good (Figure 4). The intraclass correlation coefficient for intra- and interobserver comparisons was 0.97 and 0.96 respectively (P In children and young adults with AEO, we wanted to investigate the conceptual validity of SARAGAIT/POSTURE subscores. SARAGAIT/POSTURE subscores showed high inter-observer agreement (ICC) and were strongly associated with other quantitative scales for coordinative motor function, such as: active and static equilibrium (ASMK, PBS), limb kinetic performance (SARAKINETIC, AS) and total axy scores (SARATOTAL). In addition, we also observed a strong correlation between SARAGAIT/POSTURE subscores and GMFCS (E&R) classification levels, originally developed for the assessment of functional motility in children with cerebral palsy (Palisano et al., 1997, 2008).
The discriminatory validity of the SARAGAIT/POSTURE subscale between the measurement of ataxia and comorbidity factors (muscle weakness and myoclonus) was incomplete. For children and young adults with OAE, we conclude that SARAGAIT/POSTURE scores are reliable. However, the SARAGAIT/POSTURE parameters do not sufficiently distinguish between the influence of ataxia and muscle weakness. This implies that gait and posture values should be interpreted in homogeneous subgroups of OAE that take into account comorbid muscle weakness. In the group of patients with dilated cardiomyopathy, mechanical LV dysysynchrony was also studied by Doppler imaging of color tissues. Using this method, mechanical LV dysysynchrony was defined as a septum-lateral wall delay ≥60 ms, as described above.13 In patients with dilated cardiomyopathy, the mean septum-lateral delay assessed by Doppler imaging of the color tissue was 57 (37) ms. Since mechanical LV dysysynchrony was assessed by RT3DE, the cut-off value used to define mechanical LV dysysynchrony was arbitrarily defined as the mean + 3SD of the IDS found in the healthy population of the present study (IDS = 4%). The concordance between Doppler imaging of color tissues and rt3DE was analyzed, and in 10 patients (45%) both methods demonstrated significant LV mechanical dysysynchrony, while in 6 patients (27%) both methods indicated the absence of mechanical LV dysysynchrony. Therefore, the agreement between the 2 techniques used to define LV mechanical dysysynchrony was 72% (k = 0.5, P = 0.02). Results: The Inter-Observer Agreement (ICC) for the EOA SARAGAIT/POSTURE subscores was high (0.97).
SARAGAIT/POSTURE strongly correlated with other ataxia and functional scales [ASMK (rs = -0.819; p < 0.001); PBS (rs = -0.943; p < 0.001); GMFCS-E&R (rs = -0.862; p < 0.001); SARAKINETIC (rs = 0.726; p < 0.001); AS (rs = 0.609; p = 0.002); and SARATOTAL (rs = 0.935; p < 0.001)]. Comorbid myopathy affected SARAGAIT/POSTURE scores by concomitant muscle weakness, while comorbid myoclonus mainly affected SARAKINETIC scores. Finally, the reproducibility of the IDS measurements was studied by repeated measurements by 2 observers; Intra- and inter-observer variability was analysed using the Bland-Altman method. In addition, the intra-class correlation coefficient was calculated for inter- and intra-observer comparisons. A P-value of less than 0.05 was considered significant. All data was analyzed with the SPSS version 12.0 statistics package (SPDD, Inc., Chicago, Illinois). In addition, the agreement between the presence/absence of mechanical LV dysysynchrony in tissue Doppler imaging and RT3DE was expressed as a percentage with the corresponding k-value. In tissue Doppler imaging, mechanical LV dysysynchrony was defined as a septum-wall side delay ≥60 ms.13 The definition of mechanical LV dysysynchrony with RT3DE was established with an arbitrary cut-off calculated as an average + 3SD of sDI in the healthy population of the present study, similar to what other authors have previously described.15 In previous studies on AEO, we have shown that ataxic ganges assessment tools can contribute to the early detection of undeniable osteoarthritis in young patients (Lawerman et al., 2016).
In addition, well-validated clinical biomarkers for assessing osteoarthritis gait and posture are useful for evaluating pediatric treatment strategies to train trunk muscle function (van Diest et al., 2016; Schatton et al., 2017). In the present study, we observed excellent inter-observer agreement (ICC) on saragait/posture subscores, which was within the same range as SARATOTAL and SARAKINETIC subscores. These SARATOTAL endpoints are consistent with previously published CCI data in adult patients with predominantly AOA phenotypes (Schmitz-Hubsch et al., 2006). 2Nederlandse vertaling 2009 NetChild Network for Childhood Disability Research, Utrecht, The Netherlands, 15-10-2017 canchild.ca/system/tenon/assets/attachments/000/000/067/original/GMFCS-ER_Translation-Dutch.pdf. Conclusion: In young patients with osteoarthritis, separate SARAGAIT/POSTURE parameters show good inter-observer agreement and convergent validity, which implies the reliability of the scale. For incomplete discriminatory validity, it is advisable to interpret SARAGAIT/POSTURE scores for comorbid muscle weakness. Influence of myopathy and myoclonus on SARA % subscores. The x-axis represents the EOA phenotypes (myopathic versus non-myopathic and myoclonic versus non-myoclonic). The y-axis represents the median SARAGAIT/POSTURE % subscore subscore (i.e., [SARAGAIT/Subscore POSTURE/overall median score] × 100%, A,C); and the median subscore in % SARAKINETIC (i.e., [SARAKINETIC MEDIAN score/overall median score] × 100%, B,D). The boxes represent the bottom quartile, the median quartile and the top quartile; The whiskers represent the minimum and maximum relative % sub-points.
SARAGAIT/POSTURE, SARA Gait and Posture Subscore; SARAKINETIC, SARA KINETIC SECONDARY SCORE. Comparison of the % contribution of SARAGAIT/POSTURE to SARATOTAL between the myopathic and non-myopathic subgroups showed a significantly higher % contribution of SARAGAIT/POSTURE in the myopathic subgroup (A), while the % contribution of SARAKINETIC was not significantly different between the two groups (B). Comparison of SARAKINETIC`s % contribution to SARATOTAL between the myoclonic and non-myoclonic subgroups showed a significantly higher % contribution in the myoclonic subgroup (C), while the % contribution of SARAGAIT/POSTURE showed a significantly lower % contribution in the myoclonic subgroup (D). . . .