Interrater and intrarater reliability in the measurement of kyphosis in postmenopausal women with osteoporosis
Interrater and intrarater reliability in the measurement of kyphosis in postmenopausal women with osteoporosis
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DOI：
10.1097/00007632-199809150-00013
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发表时间：
1998-09-15
期刊：
影响因子：
3
通讯作者：
Bibershtein, S
中科院分区：
文献类型：
--
作者：
Lundon, KMA;Li, AMWY;Bibershtein, S
研究设计。使用重复随机测量进行可靠性研究，涉及 3 名观察者、26 名受试者和 3 台仪器。 目标。确定最可靠、最具成本效益、无创且临床可行的测量脊柱后凸的方法。背景数据摘要。临床上最有用、无创且可靠的测量脊柱骨质疏松症（脊柱后凸）姿势畸形的方法仍然不合格。尽管传统上使用昂贵的侵入性X线造影来评估脊柱后凸，但这种方法的可靠性仍然值得怀疑。方法。加拿大多伦多女子学院医院骨质疏松症项目招募了 26 名骨矿物质密度已知且诊断为骨质疏松症的绝经后妇女。胸椎后凸的无创测量由三名训练有素的检查员使用 DeBrunner 后凸测量仪和柔性曲线尺进行。使用在矢状平面上获得的X射线胶片来比较每种方法的评估者内和评估者间可靠性。脊柱姿势根据Itoi (1990)的方法进行分类。使用SAS统计软件进行统计计算。结果，根据关键双向方差分析的结果（类内相关系数2,1），每个观察者使用DeBrunner's kyphometer和柔性曲线尺获得了一致的测量结果。对健康背部 (n = 11) 和圆背 (n = 13) 这两个亚组的测量显示，每种无创仪器的使用一致，并且检查者对特定工具有一定的偏好。与使用柔性曲线尺获得的结果相比，使用德布伦纳的测光仪获得的评分者内和评分者间可靠性稍好一些。塌陷数据的双向方差分析（组内相关系数2,1）显示后凸测量仪、屈曲尺或X射线照相仪测量胸椎后凸的可靠性没有显着差异。结论。屈曲尺和德布伦纳脊柱后凸测量仪在测量脊柱后凸方面的一致性最接近；与柔性曲线尺和伦琴X射线照相仪相比，Kyphometer在评估者内和评估者间的可靠性方面表现出最小的变化。然而，柔性曲线尺可以对姿势进行定性评估，并且是最具成本效益的仪器。这项研究的结果挑战了传统观念，即X线摄影分析是评估脊柱后凸的最佳方法。 DeBrunner 的脊柱后凸测量仪和柔性尺可能代表脊柱后凸 X 线摄影评估的可行、经济高效且无创的替代方案。
Study Design. A reliability study was performed using repeated random measurements involving three observers, 26 subjects and three instruments.Objectives. To determine the most reliable, cost-effective, noninvasive, and clinically feasible method of measuring spinal kyphosis.Summary of Background Data. The most clinically useful, noninvasive and reliable method of measuring postural deformity in spinal osteoporosis (kyphosis) remains unqualified. Despite traditional use of costly, invasive roentgenographs for the evaluation of spinal kyphosis, the reliability of this method remains questionable.Methods. Twenty-six postmenopausal women with known bone mineral density and a diagnosis of osteoporosis were recruited from the Osteoporosis Program at Women's College Hospital, Toronto, Canada. Noninvasive measurements of thoracic kyphosis were obtained by three trained examiners using the DeBrunner's kyphometer and the flexicurve ruler. The intrarater and interrater reliability of and between each method was compared, using roentgenographic films obtained in the sagittal plane. Spinal posture was classified according to the method of Itoi (1990). Statistical computations were performed using SAS statistical software.Results, Consistent measurements were obtained with the DeBrunner's kyphometer and the flexicurve ruler by each observer, according to the results of critical two-way analysis of variance (Intraclass Correlation Coefficient 2,1). Measurements in two subgroups, healthy backs (n = 11)and rounded backs (n = 13), showed consistent use of each noninvasive instrument with some examiner preference for specific tools. There was marginally better intrarater and interrater reliability using the DeBrunner's kyphometer compared with that obtained with the flexicurve ruler. Two-way analysis of variance (Intraclass Correlation Coefficient 2,1) of cololapsed data showed no significant difference in the reliability of the kyphometer, flexicurve ruler, or roentgenographs in the measurement of thoracic kyphosis.Conclusions. The flexicurve ruler and DeBrunner's kyphometer had the closest agreement in the measurement of spinal kyphosis; The kyphometer demonstrated the least variation in intrarater and interrater reliability when compared with the flexicurve ruler and roentgenographs. The flexicurve ruler permits qualitative assessment of posture, however, and is the most cost-effective instrument. The results of this study challenge the traditional belief that roentgenographic analysis is the best method for evaluating spinal kyphosis. The DeBrunner's kyphometer and flexible ruler may represent viable, cost-effective and noninvasive alternatives to roentgenographic evaluation of spinal kyphosis.