Effect of clinician's experience and expertise on the inter- and intra-observer reliability of hip migration index in children with cerebral palsy: A STROBE-compliant retrospective study.

ABSTRACT: Few studies have investigated the reliability of Reimers' hip migration percentage (RMP) in children with cerebral palsy (CP). Most studies on the topic reflected rating results of physician with a similar level of experience from the same expertise. This study aimed to determine the effect of clinician's experience and expertise on the intra-and inter-observer reliability of RMP.In this retrospective observational study, hip radiographs of children with CP were identified. 5 observers with different degrees of working experience from 3 different clinical fields, including orthopedics, radiology, and physical medicine and rehabilitation, performed all RMP measurements. All measurements were repeated 6 weeks later by the same observers. Inter- and intra-observer reliability for RMP measurements were assessed using Intraclass Correlation Coeficient (ICC), calculated from 2 sets of repeated measurements on a subset of 50 hips, with a 6 week apart for each observer.Fifty hip radiographs of 25 children with CP (10 females and 15 males; mean age: 6 years; age range: 2-8 years) were examined in the current study. No significant differences existed in intra-and inter-observer measurements. Excellent intra-observer reliability was observed between the 2 separate measurements for each observer, with a mean ICC of 0.976 (range: 0.956-0.989; P < .001). Among 5 observers, inter-observer reliability was excellent for the 2 separate RMP measurements, with the mean ICC minimally increasing between the 2 measurement periods (mean ICC: 0.928, range: 0.838-0.979 and mean ICC: 0.936, range: 0.861-0.983, respectively) (P < .001).Clinician's experience and expertise may not affect inter-and intra-observer reliability of RMP measurements.

The reliability and validity of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke.

PURPOSE: Psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke have received some attention recently, mostly using classical approaches, but there is still an absence of investigation from a modern psychometric perspective. This study aimed to test the reliability and validity of the WHODAS-II in stroke, using modern psychometric analysis. METHODS: A total of 188 community-dwelling poststroke patients were recruited. Internal construct validity was assessed by Rasch analysis, reliability by internal consistency and person separation index (PSI), and external construct validity by associations with Functional Independence Measure (FIM(™)). RESULTS: Rasch analysis indicated that total score (based upon 32 items, omitting the work-related items) was satisfactory, after adjustment for local dependency. The proposed "activities" and "participation" components also satisfied Rasch model expectations. An existing short form was problematic due to inclusion of a work-related item, but an alternative 10-item version was acceptable. Cronbach's α for the WHODAS-II, its domains and components varied between 0.83 and 0.99 and PSI between 0.70 and 0.95. External construct validity was confirmed by expected correlations with FIM(™). CONCLUSIONS: WHODAS-II provides a reliable and valid instrument for measuring disability and components of "activities" and "participation" in stroke survivors. Various combinations of the item set may provide a range of scales to suit most research needs.

Mycosis fungoides in a patient with ankylosing spondylitis during infliximab therapy.

Immunosuppressive therapies, in particular cyclosporine, are known to induce the development of lymphoproliferative malignancies. In general, the lymphomas that occur in the setting of impaired immune function are B cell non-Hodgkin's lymphomas, often large cell lymphomas. Mycosis fungoides (MF) is the most common form of cutaneous T cell lymphomas, which can require persistent antigen and superantigen stimulation by way of chronic immunosuppression and HIV. Tumor necrosis factor antagonists, which are novel immunomodulatory agents, might produce significant adverse effects, including an increased risk of malignancy. Currently available data do not show whether these agents were the proximate cause of the reported lymphomas. We present a 32-year-old male with ankylosing spondylitis treated with infliximab who developed MF during the second year of therapy.