Validity and reliability of instruments to assess potential mediators of children's physical activity : a systematic review

This paper aimed to (1) identify potential mediators reported in children's physical activity interventions; and (2) review the psychometric properties of measures of potential mediators included in such interventions. A systematic search of the literature was conducted and studies that reported potential mediators and/or the psychometric properties of measures of potential mediators were retrieved and reviewed. The studies were reviewed for the following psychometric properties: face/logical, construct, and criterion validity; and test–retest and internal consistency (factor analysis and Cronbach's α) reliability. Twenty-one potential mediators were identified from 24 published children's physical activity intervention studies; 17 individual, three social, and one physical environmental. Overall, there was considerable variation in the reporting of the psychometric properties of these measures. Reliability properties (specifically Cronbach's α) were more commonly reported than validity properties; however, for many potential mediators, the quality of these measures was low. Future studies should examine the psychometric properties of measures of potential mediators to ensure appropriate, valid and reliable instruments are used. This will assist in the ability to accurately determine the efficacy of physical activity interventions among children.

The reliability of two visual motor integration tests used with health adults

Occupational therapists often assess the visual motor integration (VMI) skills of children, adults, and the elderly, which are parts of the Body Functions and Structures of the International Classification of Functioning, Disability and Health. Objective. As it is imperative that therapists use tests and measures with strong psychometric properties, this study aims to examine the reliability of two VMI tests used with adults. Method. Sixty-one healthy adults, 18 males and 43 females, with an average age of 31.82 years, completed the Developmental Test of Visual Motor Integration (DTVMI) and the Full Range Test of Visual Motor Integration (FRTVMI). The Cronbach's alpha coefficient was used to examine the tests’ internal consistency, while the Spearman's rho correlation was used to evaluate the test–retest reliability, intrarater reliability, and interrater reliability of the two VMI tests. Results. The Cronbach's alpha coefficient for the DTVMI and FRTVMI was 0.66 and 0.80, respectively. The test–retest reliability coefficient was 0.77 (p < .001) for the DTVMI and 0.61 (p < .001) for the FRTVMI. The interrater reliability correlation was significant for both DTVMI at 0.79 (p < .001) and FRTVMI at 0.80 (p < .001). The DTVMI intrarater reliability correlation result was 0.95 (p < .001) and the FRTVMI at 0.87 (p < .001). Conclusion. Overall, the DTVMI and the FRTVMI exhibited moderate to high levels of reliability when used with a sample of healthy adults. Both VMI tests appear to exhibit reasonable levels of reliability and are recommended for use with adults and the elderly.

Reliability of isokinetic strength and aerobic power testing for patients with chronic heart failure

PURPOSE: The objective of this study was to assess the reliability of testing skeletal muscle strength and peak aerobic power in a clinical population of patients with chronic heart failure (CHF).

METHODS: Thirty-three patients with CHF (New York Heart Association (NYHA) Functional Class 2.3 ± 0.5; left ventricular ejection fraction 27% ± 7%; age 65 ± 9 years; 28:5 male-female ratio) underwent two identical series of tests (T1 and T2), 1 week apart, for strength and endurance of the muscle groups responsible for knee extension/flexion and elbow extension/flexion. The patients also underwent two graded exercise tests on a bicycle ergometer to measure peak oxygen consumption (VO_2peak). Three months later, 18 of the patients underwent a third test (T3) for each of the measures. Means were compared using MANOVA with repeated measures for strength and endurance, and ANOVA with repeated measures for VO_2peak.

RESULTS: Combining data for all four movement patterns, the expression of strength increased from T1 to T2 by 12% ± 25% (P < .001; intraclass correlation coefficient [ICC] = 0.89). Correspondingly, endurance increased by 13% ± 23% (P = .004; ICC = 0.87). Peak oxygen consumption was not significantly different (16.2 ± 0.8 and 16.1 ± 0.8 mL·kg^-1·min^-1 for T1 and T2, respectively;P = .686; ICC = 0.91). There were no significant differences between T2 and T3 for strength (2% ± 17%;P = .736; ICC = 0.92) or muscle endurance (-1% ± 15%;P = .812; ICC = 0.96), but VO_2peak decreased from 16.7 ± 1.2 to 14.9 ± 0.9 mL·kg^-1·min^-1 (-10% ± 18%;P = .021; ICC = 0.89).

CONCLUSIONS: These data suggest that in a population of patients with CHF, a familiarization trial for skeletal muscle strength testing is necessary. Although familiarization is not required for assessing oxygen consumption as a single measurement, VO_2peak declined markedly in the 3-month period for which these patients were followed. Internal consistency within patients was high for the second and third strength trials and the first and second tests of VO_2peak.

A systematic review of the validity and reliability of sedentary behaviour measures used with children and adolescents

The aim of this review was to evaluate the reliability and validity of methods used to assess the multiple components of sedentary behaviour (i.e. screen time, sitting, not moving and existing at low energy expenditure) in children and adolescents. Twenty-six studies met our inclusion criteria and were reviewed. Thirteen studies reported the reliability of self- and proxy-report measures of sedentary behaviour and seven of these were found to have acceptable test–retest reliability. Evidence for the criterion validity of self- and proxy-report measures was examined in three studies with mixed results. Seven studies examined the reliability and/or validity of direct observation and the findings were generally positive. Five studies demonstrated the utility of accelerometers to accurately classify sedentary behaviour. Self-report measures provide reliable estimates of screen time, yet their validity remains largely untested. While accelerometers can accurately classify participants’ behaviour as sedentary, they do not provide information about type of sedentary behaviour or context. Studies utilizing measures of sedentary behaviour need to more adequately report on the validity and reliability of the measures used.We recommend the use of objective measures of sedentary behaviour such as accelerometers, in conjunction with subjective measures (e.g. self-report), to assess type and context of behaviour.

Reliability of the modified child and adolescent physical activity and nutrition survey, physical activity (CAPANS-PA) questionnaire among chinese-australian youth

Background : Evidence suggests that differences exist in physical activity (PA) participation among Culturally and Linguistically Diverse (CALD) children and adolescents. It is possible that these differences could be influenced by variations in measurement technique and instrument reliability. However, culturally sensitive instruments for examining PA behaviour among CALD populations are lacking. This study tested the reliability of the Child and Adolescent Physical Activity and Nutrition Survey (CAPANS-PA) recall questionnaire among a sample of Chinese-Australian youth.
Methods : The psychometric property of the CAPANS-PA questionnaire was examined among a sample of 77 Chinese-Australian youth (aged 11 - 14 y) who completed the questionnaire twice within 7 days. Test-retest reliability of individual items and scales within the CAPANS-PA questionnaire was determined using Kappa statistics for categorical variables and intraclass correlation coefficients (ICC) for continuous variables.
Results : The CAPANS-PA questionnaire demonstrated acceptable test-retest reliability for frequency and duration of time spent in weekly Moderate to Vigorous Physical Activity (MVPA) (ICC ≥ 0.70) for all participants. Test-retest reliability for time spent in weekly sedentary activities was acceptable for females (ICC = 0.82) and males (ICC = 0.72).
Conclusions : The results suggest the CAPANS-PA questionnaire provides reliable estimates for type, frequency and duration of MVPA participation among Chinese-Australian youth. Further investigation into the reliability of the sedentary items within the CAPANS-PA is required before these items can be used with confidence. This study is novel in that the reliability of instruments among CALD groups nationally and internationally remains sparse and this study contributes to the wider body of available psychometrically tested instruments. In addition, this study is the first to our knowledge to successfully engage and investigate the basic health enhancing behaviours of Chinese-Australian adolescents.

The reliability of two visual motor integration tests used with children

Occupational therapists often assess the visual motor integration (VMI) skills of children and young people. It is important that therapists use tools with strong psychometric properties. This study aims to examine the reliability of 2 VMI tests. Ninety-two children between the ages of 5 and 17 years (response rate of 31%) completed 2 VMI tests: the Developmental Test of Visual Motor Integration (DTVMI) and the Full Range Test of Visual Motor Integration (FRTVMI). Cronbach's alpha coefficient was used to examine the internal consistency of the 2 VMI tests whereas Spearman's rho correlation was used to evaluate the test–retest reliability, intrarater reliability, and interrater reliability of the 2 VMI tests. The Cronbach's alpha coefficient for the DTVMI was .82 and .72 for the FRTVMI. The test–retest reliability coefficient was .73 (p = .000) for the DTVMI and .49 (p = .05) for the FRTVMI. The interrater correlation was significant for both the DTVMI at .94 (p = .000) and FRTVMI at .68 (p = .001). The DTVMI intrarater reliability correlation result was .90 (p = .000) and the FRTVMI at .85 (p = .000). Overall, the DTVMI exhibited a higher level of reliability than the FRTVMI. Both VMI tests appear to exhibit reasonable levels of reliability and are recommended for use with children and young people.

Reliability and validity of psychosocial and environmental correlates measures of physical activity and screen-based behaviors among Chinese children in Hong Kong

Background : Insufficient participation in physical activity and excessive screen time have been observed among Chinese children. The role of social and environmental factors in shaping physical activity and sedentary behaviors among Chinese children is under-investigated. The purpose of the present study was to assess the reliability and validity of a questionnaire to measure child- and parent-reported psychosocial and environmental correlates of physical activity and screen-based behaviors among Chinese children in Hong Kong.

Methods : A total of 303 schoolchildren aged 9-14 years and their parents volunteered to participate in this study and 160 of them completed the questionnaire twice within an interval of 10 days. Intraclass correlation coefficients (ICCs), kappa statistics, and percent agreement were performed to evaluate test-retest reliability of the continuous and categorical variables, respectively. Exploratory factor analyses (EFAs) were conducted to assess convergent validity of the emergent scales. Cronbach's alpha and ICCs were performed to assess internal and test-retest reliability of the emergent scales. Criterion validity was assessed by correlating psychosocial and environmental measures with self-reported physical activity and screen-based behaviors, measured by a validated questionnaire.

Results : Reliability statistics for both child- and parent-reported continuous variables showed acceptable consistency for all of the ICC values greater than 0.70. Kappa statistics showed fair to perfect test-retest reliability for the categorical items. Adequate internal consistency and test-retest reliability were observed in most of the emergent scales. Criterion validity assessed by correlating psychosocial and environmental measures with child-reported physical activity found associations with physical activity in the self-efficacy scale (r = 0.25, P < 0.05), the peer support for physical activity scale (r = 0.25, P < 0.05) and home physical activity environmental (r = 0.14, P < 0.05). Children's screen-based behaviors were associated with the family support for physical activity scale (r = -0.22, P < 0.05) and parental role modeling of TV (r = 0.12, P = 0.053).

Conclusions : The findings provide psychometric support for using this questionnaire for examining psychosocial and environmental correlates of physical activity and screen-based behaviors among Chinese children in Hong Kong. Further research is needed to develop more robust measures based on the current questionnaire, especially for peer influence on physical activity and parental rules on screen-based behaviors.

Reliability and validity of the modified Chinese version of the children's leisure activities study survey (CLASS) questionnaire in assessing physical activity among Hong Kong children

This study aimed to examine the reliability and validity of the modified Children’s Leisure Activities Study Survey (CLASS) Chinese-version questionnaire in assessing physical activity among Hong Kong Chinese Children. Test-retest reliability was examined in 84 boys and 136 girls aged 9–12 years by comparing data from two administrations of the survey conducted one week apart. Validity was determined by comparing data from the second administration with accelerometer estimates. The results suggested that the questionnaire provided reliable and valid estimates in overall physical activity patterns in Hong Kong Chinese children. However, substantial overestimation was observed in vigorous activity.

Training improves interobserver reliability for the diagnosis of scaphoid fracture displacement

Background The diagnosis of displacement in scaphoid fractures is notorious for poor interobserver reliability.

Questions/purposes We tested whether training can improve interobserver reliability and sensitivity, specificity, and accuracy for the diagnosis of scaphoid fracture displacement on radiographs and CT scans.

Methods Sixty-four orthopaedic surgeons rated a set of radiographs and CT scans of 10 displaced and 10 nondisplaced scaphoid fractures for the presence of displacement, using a web-based rating application. Before rating, observers were randomized to a training group (34 observers) and a nontraining group (30 observers). The training group received an online training module before the rating session, and the nontraining group did not. Interobserver reliability for training and nontraining was assessed by Siegel’s multirater kappa and the Z-test was used to test for significance.

Results There was a small, but significant difference in the interobserver reliability for displacement ratings in favor of the training group compared with the nontraining group. Ratings of radiographs and CT scans combined resulted in moderate agreement for both groups. The average sensitivity, specificity, and accuracy of diagnosing displacement of scaphoid fractures were, respectively, 83%, 85%, and 84% for the nontraining group and 87%, 86%, and 87% for the training group. Assuming a 5% prevalence of fracture displacement, the positive predictive value was 0.23 in the nontraining group and 0.25 in the training group. The negative predictive value was 0.99 in both groups.

Conclusions Our results suggest training can improve interobserver reliability and sensitivity, specificity and accuracy for the diagnosis of scaphoid fracture displacement, but the improvements are slight. These findings are encouraging for future research regarding interobserver variation and how to reduce it further.

The letter contrast sensitivity test : clinical evaluation of a new design

PURPOSE. To compare the reliability, validity, and responsiveness of the Mars Letter Contrast Sensitivity (CS) Test to the Pelli-Robson CS Chart.

METHODS. One eye of 47 normal control subjects, 27 patients with open-angle glaucoma, and 17 with age-related macular degeneration (AMD) was tested twice with the Mars test and twice with the Pelli-Robson test, in random order on separate days. In addition, 17 patients undergoing cataract surgery were tested, once before and once after surgery.

RESULTS. The mean Mars CS was 1.62 log CS (0.06 SD) for normal subjects aged 22 to 77 years, with significantly lower values in patients with glaucoma or AMD (P < 0.001). Mars test-retest 95% limits of agreement (LOA) were ±0.13, ±0.19, and ±0.24 log CS for normal, glaucoma, and AMD, respectively. In comparison, Pelli-Robson test-retest 95% LOA were ±0.18, ±0.19, and ±0.33 log CS. The Spearman correlation between the Mars and Pelli-Robson tests was 0.83 (P < 0.001). However, systematic differences were observed, particularly at the upper-normal end of the range, where Mars CS was lower than Pelli-Robson CS. After cataract surgery, Mars and Pelli-Robson effect size statistics were 0.92 and 0.88, respectively.

CONCLUSIONS. The results indicate the Mars test has test-retest reliability equal to or better than the Pelli-Robson test and comparable responsiveness. The strong correlation between the tests provides evidence the Mars test is valid. However, systematic differences indicate normative values are likely to be different for each test. The Mars Letter CS Test is a useful and practical alternative to the Pelli-Robson CS Chart.

Interobserver reliability of radial head fracture classification : two-dimensional compared with three-dimensional CT

Background: The Broberg and Morrey modification of the Mason classification of radial head fractures has substantial interobserver variation. This study used a large web-based collaborative of experienced orthopaedic surgeons to test the hypothesis that three-dimensional reconstructions of computed tomography (CT) scans improve the interobserver reliability of the classification of radial head fractures according to the Broberg and Morrey modification of the Mason classification.

Methods: Eighty-five orthopaedic surgeons evaluated twelve radial head fractures. They were randomly assigned to review either radiographs and two-dimensional CT scans or radiographs and three-dimensional CT images to determine the fracture classification, fracture characteristics, and treatment recommendations. The kappa multirater measure (κ) was calculated to estimate agreement between observers.

Results: Three-dimensional CT had moderate agreement and two-dimensional CT had fair agreement among observers for the Broberg and Morrey modification of the Mason classification, a difference that was significant. Observers assessed seven fracture characteristics, including fracture line, comminution, articular surface involvement, articular step or gap of ≥2 mm, central impaction, recognition of more than three fracture fragments, and fracture fragments too small to repair. There was a significant difference in kappa values between three-dimensional CT and two-dimensional CT for fracture fragments too small to repair, recognition of three fracture fragments, and central impaction. The difference between the other four fracture characteristics was not significant. Among treatment recommendations, there was fair agreement for both three-dimensional CT and two-dimensional CT.

Conclusions: Although three-dimensional CT led to some small but significant decreases in interobserver variation, there is still considerable disagreement regarding classification and characterization of radial head fractures. Three-dimensional CT may be insufficient to optimize interobserver agreement.

Role assessment of GIS analysis and its reliability while ranking urban sustainability using scenarios specific to regional climate, community and culture

Urban Sustainability expresses the level of conservation of a city while living a town or consuming its urban resources, but the measurement of urban sustainability depends on what are considered important indicators of conservation besides the permitted levels of consumption in accordance with adopted criteria. This criterion should have common factors that are shared for all the members tested or cities to be evaluated as in this particular case for Abu Dhabi, but also have specific factors that are related to the geographic place, community and culture, that is the measures of urban sustainability specific to a middle east climate, community and culture where GIS Vector and Raster analysis have a role or add a value in urban sustainability measurements or grading are considered herein. Scenarios were tested using various GIS data types to replicate urban history (ten years period), current status and expected future of Abu Dhabi City setting factors to climate, community needs and culture. The useful Vector or Raster GIS data sets that are related to every scenario where selected and analysed in the sense of how and how much it can benefit the urban sustainability ranking in quantity and quality tests, this besides assessing the suitable data nature, type and format, the important topology rules to be considered, the useful attributes to be added, the relationships which should be maintained between data types of a geo- database, and specify its usage in a specific scenario test, then setting weights to each and every data type representing some elements of a phenomenon related to urban suitability factor. The results of assessing the role of GIS analysis provided data collection specifications such as the measures of accuracy reliable to a certain type of GIS functional analysis used in an urban sustainability ranking scenario tests. This paper reflects the prior results of the research that is conducted to test the multidiscipline evaluation of urban sustainability using different indicator metrics, that implement vector GIS Analysis and Raster GIS analysis as basic tools to assist the evaluation and increase of its reliability besides assessing and decomposing it, after which a hypothetical implementation of the chosen evaluation model represented by various scenarios was implemented on the planned urban sustainability factors for a certain period of time to appraise the expected future grade of urban sustainability and come out with advises associated with scenarios for assuring gap filling and relative high urban future sustainability. The results this paper is reflecting are concentrating on the elements of vector and raster GIS analysis that assists the proper urban sustainability grading within the chosen model, the reliability of spatial data collected; analysis selected and resulted spatial information. Starting from selecting some important indicators to comprise the model which include regional culture, climate and community needs an example of what was used is Energy Demand & Consumption (Cooling systems). Thus, this factor is related to the climate and it‟s regional specific as the temperature varies around 30-45 degrees centigrade in city areas, GIS 3D Polygons of building data used to analyse the volume of buildings, attributes „building heights‟, estimate the number of floors from the equation, following energy demand was calculated and consumption for the unit volume, and compared it in scenario with possible sustainable energy supply or using different environmental friendly cooling systems this is followed by calculating the cooling system effects on an area unit selected to be 1 sq. km, combined with the level of greenery area, and open space, as represented by parks polygons, trees polygons, empty areas, pedestrian polygons and road surface area polygons. (initial measures showed that cooling system consumption can be reduced by around 15 -20 % with a well-planned building distributions, proper spaces and with using environmental friendly products and building material, temperature levels were also combined in the scenario extracted from satellite images as interpreted from thermal bands 3 times during the period of assessment. Other examples of the assessment of GIS analysis to urban sustainability took place included Waste Productivity, some effects of greenhouse gases measured by the intensity of road polygons and closeness to dwelling areas, industry areas as defined from land use land cover thematic maps produced from classified satellite images then vectors were created to take part in defining their role within the scenarios. City Noise and light intensity assessment was also investigated, as the region experiences rapid development and noise is magnified due to construction activities, closeness of the airports, and highways. The assessment investigated the measures taken by urban planners to reduce degradation or properly manage it. Finally as a conclusion tables were presented to reflect the scenario results in combination with GIS data types, analysis types, and the level of GIS data reliability to measure the sustainability level of a city related to cultural and regional demands.

Measuring walking within and outside the neighborhood in Chinese elders : reliability and validity

Background : Walking is a preferred, prevalent and recommended activity for aging populations and is influenced by the neighborhood built environment. To study this influence it is necessary to differentiate whether walking occurs within or outside of the neighborhood. The Neighborhood Physical Activity Questionnaire (NPAQ) collects information on setting-specific physical activity, including walking, inside and outside one's neighborhood. While the NPAQ has shown to be a reliable measure in adults, its reliability in older adults is unknown. Additionally its validity and the influence of type of neighborhood on reliability and validity have yet to be explored. Methods : The NPAQ walking component was adapted for Chinese speaking elders (NWQ-CS). Ninety-six Chinese elders, stratified by social economic status and neighborhood walkability, wore an accelerometer and completed a log of walks for 7 days. Following the collection of valid data the NWQ-CS was interviewer-administered. Fourteen to 20 days (average of 17 days) later the NWQ-CS was re-administered. Test-retest reliability and validity of the NWQ-CS were assessed. Results : Reliability and validity estimates did not differ with type of neighborhood. NWQ-CS measures of walking showed moderate to excellent reliability. Reliability was generally higher for estimates of weekly frequency than minutes of walking. Total weekly minutes of walking were moderately related to all accelerometry measures. Moderate-to-strong associations were found between the NWQ-CS and log-of-walks variables. The NWQ-CS yielded statistically significantly lower mean values of total walking, weekly minutes of walking for transportation and weekly frequency of walking for transportation outside the neighborhood than the log-of-walks. Conclusions : The NWQ-CS showed measurement invariance across types of neighborhoods. It is a valid measure of walking for recreation and frequency of walking for transport. However, it may systematically underestimate the duration of walking for transport in samples that engage in high levels of this type of walking.

Examining the validity and reliability of the Chinese version of the International Physical Activity Questionnaire, long form (IPAQ-LC)

Objective : To investigate the reliability and the validity of the long format, Chinese version of the International Physical Activity Questionnaire (IPAQ-LC).

Design : Cross-sectional study, examining the reliability and validity of the IPAQ-LC compared with a physical activity log (PA-log) and objective accelerometry.

Setting : Self-reported physical activity (PA) in Hong Kong adults. Subjects : A total of eighty-three Chinese adults (forty-seven males, thirty-six females) were asked to wear an ActiTrainer accelerometer (MTI-ActiGraph, Fort Walton Beach, FL, USA) for >10 h over 7 d, to complete a PA-log at the end of each day and to complete the IPAQ-LC on day 8. On a sub-sample of twenty-eight adults the IPAQ-LC was also administered on day 11 to assess its reliability.

Results : The IPAQ-LC had good test–retest reliability for grouped activities, with intra-class correlation coefficients ranging from 0·74 to 0·97 for vigorous, moderate, walking and total PA, with between-test effect sizes that were small (<0·49). The Spearman correlation coefficients were statistically significant for vigorous PA (r = 0·28), moderate + walking PA (r = 0·27), as well as overall PA (r = 0·35), when compared with the accelerometry-based criterion measures, but none of the IPAQ activity categories correlated significantly with the PA-log. In absolute units, only the IPAQ light and overall PA did not differ significantly from the accelerometry measures, yet overall PA was able to faithfully discriminate between quartiles of PA (P = 0·019) when compared to accelerometry.

Conclusions : The IPAQ-LC demonstrated adequate reliability and showed sufficient evidence of validity in assessing overall levels of habitual PA to be used on Hong Kong adults.

Reliability and validity of a new Building Environmental Quality Questionnaire

This study aimed to develop and then test the reliability and validity of a new self-report questionnaire method called the building environmental quality questionnaire (BEQQ) designed to assess the perceived environmental quality in residential apartments in Hong Kong. A total of 108 (46 men and 62 women) Chinese-speaking residents, between 16 and 81 years of age, took part and completed the questionnaire study. The subjects were recruited from 12 different buildings of three distinct quality ratings (low, medium and high) assigned by the building assessment tool called the building health and hygiene index (BHHI). The study was evaluated to determine reliability and this was assessed involving 20 of the participants (18% of the total sample size). The BEQQ was found to have good test-retest reliability, with intra-class correlation coefficient (ICC) values typically around 0.70. The validity testing, also using ICCs, generated moderate to high values for all BEQQ sub-categories (the mean value was around 0.80), indicating a good consistency among residents living within the same building. Finally, the summary BEQQ scores were significantly correlated (—0.68) with the BHHI ratings as the criterion standard. It is concluded that this eight-dimension instrument would provide a short and efficient questionnaire method to obtain self-reported information to determine the perceived residential building quality. The method was shown to yield adequate reliability and has been validated for use in empirical research.