Reliability of assessment tools in rehabilitation: an illustration of appropriate statistical analyses
Reliability of assessment tools in rehabilitation: an illustration of appropriate statistical analyses
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DOI：
10.1191/026921598672178340
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发表时间：
1998-06-01
影响因子：
3
通讯作者：
Stokes, M
中科院分区：
文献类型：
--
作者：
Rankin, G;Stokes, M
目的：以实时超声测量肌肉尺寸为例，为可靠性研究的适当统计分析提供实用指南。设计：评估者间和评估者内（扫描间和日间）可靠性。受试者：10 名年龄 22-58 岁的正常受试者（5 名男性）。方法：使用实时超声检查测量胫骨前肌群的横截面积（CSA）。主要结果指标：组内相关系数（ICC） ICC 的 95% 置信区间 (CI)，以及用于评估一致性的 Bland 和 Altman 方法，其中包括计算测量之间的平均差异 ((d) over bar)、(d) over bar 的 95% CI、差异的标准差 (SDdiff)、95% 一致性限度和可靠性系数。结果：评估者间可靠性较高，ICC (3,1) 为 0.92，95% CI 为0.72 --> 0.98。 Bland 和 Altman 检验的测量值之间存在合理的一致性，因为 (d) 超过条形为 -0.63 cm(2)，(d) 超过条形的 95% CI 为 -1.4 --> 0.14 cm(2)，SDdiff 为 1.08 cm(2)，95% 一致限为 -2.73 --> 1.53 cm(2)，可靠性系数为 2.4。扫描间重复性很高，第 1 天和第 2 天的 ICC (1,1) 分别为 0.94 和 0.93，95% Cf 分别为 0.8 --> 0.99 和 0.75 --> 0.98。测量结果与 Bland 和 Altman 检验显示出良好的一致性：(d) 第 1 天的超标为 0.15 cm(2)，第 2 天的超标为 -0.32 cm(2)，(d) 第 1 天超标的 95% CI 为 -0.51 --> 0.81 cm(2)，第 2 天为 -0.98 --> 0.34 cm(2)；两天的 SDdiff 均为 0.93 cm(2)，第 1 天的 95% 一致性限值为 -1.71 --> 2.01 cm(2)，第 2 天的 95% 一致性限值为 -2.18 --> 1.54 cm(2)；第 1 天的可靠性系数为 1.80，第 2 天的可靠性系数为 1.88。日间 ICC (1,2) 为 0.92，95% CI 0.69 --> 0.98。 (d) 上方条为 -0.98 cm(2)，SDdiff 为 1.25 cm(2)，95% 一致限为 -3.48 --> 1.52 cm(2)，可靠性系数为 2.8。 (d) 超过条形 (-1.88 --> -0.08 cm(2)) 的 95% CI 和分布图显示出对第 2 天较大测量值的偏差。结论：ICC 和 Bland 和 Altman 检验适合于分析与所述设计类似的可靠性研究，但单独的检验都无法提供足够的信息，建议同时使用这两种检验。
Objective: To provide a practical guide to appropriate statistical analysis of a reliability study using real-time ultrasound for measuring muscle size as an example.Design: inter-rater and intra-rater (between-scans and between-days) reliability.Subjects: Ten normal subjects (five male) aged 22-58 years.Method: The cross-sectional area (CSA) of the anterior tibial muscle group was measured using real-time ultrasonography.Main outcome measures: Intraclass correlation coefficients (ICCs) and the 95% confidence interval (CI) for the ICCs, and Bland and Altman method for assessing agreement, which includes calculation of the mean difference between measures ((d) over bar), the 95% CI for (d) over bar, the standard deviation of the differences (SDdiff), the 95% limits of agreement and a reliability coefficient.Results: inter-rater reliability was high, ICC (3,1) was 0.92 with a 95% CI of 0.72 --> 0.98. There was reasonable agreement between measures on the Bland and Altman test, as (d) over bar was -0.63 cm(2), the 95% CI for (d) over bar was -1.4 --> 0.14 cm(2), the SDdiff was 1.08 cm(2), the 95% limits of agreement -2.73 --> 1.53 cm(2) and the reliability coefficient was 2.4. Between-scans repeatability was high, ICCs (1,1) were 0.94 and 0.93 with 95% Cfs of 0.8 --> 0.99 and 0.75 --> 0.98, for days 1 and 2 respectively. Measures showed good agreement on the Bland and Altman test: (d) over bar for day 1 was 0.15 cm(2) and for day 2 it was -0.32 cm(2), the 95% CIs for (d) over bar were -0.51 --> 0.81 cm(2) for day 1 and -0.98 --> 0.34 cm(2) for day 2; SDdiff was 0.93 cm(2) for both days, the 95% limits of agreement were -1.71 --> 2.01 cm(2) for day 1 and -2.18 --> 1.54 cm(2) for day 2; the reliability coefficient was 1.80 for day 1 and 1.88 for day 2. The between-days ICC (1,2) was 0.92 and the 95% CI 0.69 --> 0.98. The (d) over bar was -0.98 cm(2), the SDdiff was 1.25 cm(2) with 95% limits of agreement of -3.48 --> 1.52 cm(2) and the reliability coefficient 2.8. The 95% CI for (d) over bar (-1.88 --> -0.08 cm(2)) and the distribution graph showed a bias towards a larger measurement on day 2.Conclusions: The ICC and Bland and Altman tests are appropriate for analysis of reliability studies of similar design to that described, but neither test alone provides sufficient information and it is recommended that both are used.