Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players

Background—Palpation is an important clinical test for jumper's knee.

Objectives—To (a) test the reproducibility of palpation tenderness, (b) evaluate the sensitivity and specificity of palpation in subjects with clinical symptoms of jumper's knee, and (c) determine whether tenderness to palpation may serve as a useful screening test for patellar tendinopathy. The yardstick for diagnosis of patellar tendinopathy was ultrasonographic abnormality.

Methods—In 326 junior symptomatic and asymptomatic athletes' tendons, palpation was performed by a single examiner before ultrasonographic examination by a certified ultrasound radiologist. In 58 tendons, palpation was performed twice to test reliability. Tenderness to palpation was scored on a scale from 0 to 3 where 0 represented no pain, and 1, 2, and 3 represented mild, moderate, and severe tenderness respectively.

Results—Patellar tendon palpation was a reliable examination for a single examiner (Pearson r = 0.82). In symptomatic tendons, the positive predictive value of palpation was 68%. As a screening examination in asymptomatic subjects, the positive predictive value of tendon palpation was 36–38%. Moderate and severe palpation tenderness were better predictors of ultrasonographic tendon pathology than absent or mild tenderness (p<0.001). Tender and symptomatic tendons were more likely to have ultrasound abnormality than tenderness alone (p<0.01).

Conclusions—In this age group, palpation is a reliable test but it is not cost effective in detecting patellar tendinopathy in a preparticipation examination. In symptomatic tendons, palpation is a moderately sensitive but not specific test. Mild tenderness in the patellar tendons in asymptomatic jumping athletes should be considered normal.

Multiple mini-interview : how long is long enough?

Objectives The multiple mini-interview (MMI) overcomes the limitations of the traditional panel interview by multiple sampling to provide improved objectivity and reliability. Reliability of the MMI is affected by number of stations; however, there are few data reporting the influence of interview duration on MMI outcome and reliability. We aimed to determine whether MMI stations can be shortened without affecting applicant rankings or compromising test reliability.
Methods A total of 175 applicants were interviewed and assessed at 10 8-minute stations. Applicants were scored once after 8 minutes at five control stations and twice after 5 minutes and 8 minutes at five experimental stations. Scores at 5 and 8 minutes were compared using t-tests and correlation coefficients. Rankings of applicants based on 5- and 8-minute scores were compared using Spearman's rank order coefficient. The reliability of the MMI was examined for 5- and 8-minute scores using generalisability theory.
Results Mean scores at 5 minutes were lower than mean scores at 8 minutes. Cumulative scores at 5 minutes were also lower. There were highly significant correlations between 5- and 8-minute scores at all experimental stations (0.82–0.91; P < 0.01) and between the cumulative scores at 5 and 8 minutes (0.92; P < 0.01). There was a strong correlation between applicant rankings based on cumulative 5- and 8-minute scores (Spearman's rank order coefficient 0.92). Reliability was not affected.
Conclusions Reducing the duration of MMI stations from 8 to 5 minutes conserves resources with minimal effect on applicant ranking and test reliability.

Medication administration via enteral tubes : a survey of nurses' practices

Aim: This article is a report of a study examining the practices of acute care nurses when administering medication via enteral tubes. Background. Administering medication via enteral tubes is predominantly a nursing responsibility across countries. It is important to establish what nurses actually do when giving enteral medication to inform policy and continuing education development.

Method: In 2007, a survey was conducted using a random sample of acute care nurses at two large metropolitan hospitals in Melbourne, Australia. There were 181 Registered Nurses who participated in the study; 92 (50Æ8%) practised in intensive care units, 52 (28Æ7%) in surgical areas, 30 (16Æ6%) in medical areas and 7 (3Æ9%) were from combined medical–surgical areas. The questionnaire was developed by the researchers and a pilot study was conducted in August 2006 to test reliability, face validity and user-friendliness of the tool.

Results: Nurses reported using a range of methods to verify enteral tube position prior to administering enteral medication; some were unreliable methods. A majority reported administering enteric-coated and slow or extended release forms of medication, and giving solid forms of medication when liquid form was available. Nearly all (96%) reported flushing a tube after giving medication, 28% before, and 12% always flushed between each medication.

Conclusion: Enteral medication administration practices are inconsistent. Some nurses are using unsafe practices and may therefore compromise patient care.

Tests examining skill outcomes in sport: A systematic review of measurement properties and feasibility

Background
A high level of participant skill is influential in determining the outcome of many sports. Thus, tests assessing skill outcomes in sport are commonly used by coaches and researchers to estimate an athlete’s ability level, to evaluate the effectiveness of interventions or for the purpose of talent identification.

Objective
The objective of this systematic review was to examine the methodological quality, measurement properties and feasibility characteristics of sporting skill outcome tests reported in the peer-reviewed literature.

Data Sources
A search of both SPORTDiscus and MEDLINE databases was undertaken.

Study Selection
Studies that examined tests of sporting skill outcomes were reviewed. Only studies that investigated measurement properties of the test (reliability or validity) were included. A total of 22 studies met the inclusion/exclusion criteria.

Study Appraisal and Synthesis Methods
A customised checklist of assessment criteria, based on previous research, was utilised for the purpose of this review.

Results
A range of sports were the subject of the 22 studies included in this review, with considerations relating to methodological quality being generally well addressed by authors. A range of methods and statistical procedures were used by researchers to determine the measurement properties of their skill outcome tests. The majority (95 %) of the reviewed studies investigated test–retest reliability, and where relevant, inter and intra-rater reliability was also determined. Content validity was examined in 68 % of the studies, with most tests investigating multiple skill domains relevant to the sport. Only 18 % of studies assessed all three reviewed forms of validity (content, construct and criterion), with just 14 % investigating the predictive validity of the test. Test responsiveness was reported in only 9 % of studies, whilst feasibility received varying levels of attention.

Limitations
In organised sport, further tests may exist which have not been investigated in this review. This could be due to such tests firstly not being published in the peer-review literature and secondly, not having their measurement properties (i.e., reliability or validity) examined formally.

Conclusions
Of the 22 studies included in this review, items relating to test methodological quality were, on the whole, well addressed. Test–retest reliability was determined in all but one of the reviewed studies, whilst most studies investigated at least two aspects of validity (i.e., content, construct or criterion-related validity). Few studies examined predictive validity or responsiveness. While feasibility was addressed in over half of the studies, practicality and test limitations were rarely addressed. Consideration of study quality, measurement properties and feasibility components assessed in this review can assist future researchers when developing or modifying tests of sporting skill outcomes.

Fundamental movement skills are more than run, throw and catch: the role of stability skills

INTRODUCTION: In motor development literature fundamental movement skills are divided into three constructs: locomotive, object control and stability skills. Most fundamental movement skills research has focused on children's competency in locomotor and object control skills. The first aim of this study was to validate a test battery to assess the construct of stability skills, in children aged 6 to 10 (M age = 8.2, SD = 1.2). Secondly we assessed how the stability skills construct fitted into a model of fundamental movement skill. METHOD: The Delphi method was used to select the stability skill battery. Confirmatory factor analysis (CFA) was used to assess if the skills loaded onto the same construct and a new model of FMS was developed using structural equation modelling. RESULTS: Three postural control tasks were selected (the log roll, rock and back support) because they had good face and content validity. These skills also demonstrated good predictive validity with gymnasts scoring significantly better than children without gymnastic training and children from a high SES school performing better than those from a mid and low SES schools and the mid SES children scored better than the low SES children (all p < .05). Inter rater reliability tests were excellent for all three skills (ICC = 0.81, 0.87, 0.87) as was test re-test reliability (ICC 0.87-0.95). CFA provided good construct validity, and structural equation modelling revealed stability skills to be an independent factor in an overall FMS model which included locomotor (r = .88), object control (r = .76) and stability skills (r = .81). DISCUSSION: This study provides a rationale for the inclusion of stability skills in FMS assessment. The stability skills could be used alongside other FMS assessment tools to provide a holistic assessment of children's fundamental movement skills.

The test-retest reliability of the child-initiated pretend play assessment

OBJECTIVE: The purpose of this study is to establish the test–retest reliability of the Child-Initiated Pretend Play Assessment (ChIPPA) (Stagnitti, 2002a; Stagnitti, Unsworth, & Rodger, 2000).

METHOD: The first author rated 38 preschool children ages 4 and 5 years (4 with developmental delay and 34 typically developing) on the ChIPPA. The ChIPPA employs conventional play materials and unstructured play materials to assess three qualities of a child's play ability: elaborateness of play action, ability to substitute objects during play, and the child's need to imitate the modelled actions of the examiner. The ChIPPA was administered twice, at a 2-week interval, to each participant.

RESULTS: Test–retest intraclass correlation coefficients (ICCs) (Type 2,1) calculated for each of the three elaborate play measures ranged from .73 to .84. A test–retest ICC of .56 was obtained for object substitution with unstructured play materials. The test–retest ICC obtained for the combined score for unstructured and conventional play materials was .57. Percentage agreement figures ranging from 63.2% to 84.2% were obtained on test–retest of the object substitution with conventional toys and imitated actions measures. There was no significant difference between test and retest scores for these measures based on a Wilcoxon Matched Pairs Signed-Ranks Test (Wilcoxon Sign Test).

CONCLUSION: Elaborate play scores, object substitution with conventional toys score, and imitation scores on the ChIPPA showed stability over time. Object substitution scores using unstructured materials were the least stable play measures and appeared to be related to the child's play themes. Since play is the primary occupation of children, it is essential that therapists have a reliable measure of play behavior. The test–retest reliability results from the ChIPPA provide evidence that this assessment produces a stable measure of play behavior that can then guide therapists when planning intervention strategies for children.

The reliability of the 1RM strength test for untrained middle-aged individuals

The one-repetition maximum (1RM) test is considered the gold standard for assessing muscle strength in non-laboratory situations. Since most previous 1RM reliability studies have been conducted with experienced young participants, it is unclear if acceptable test–retest reliability exists for untrained middle-aged individuals. This study examined the reliability of the 1RM strength test of untrained middle-aged individuals. Fifty-three untrained males (n = 25) and females (n = 28) aged 51.2 ± 0.9 years participated in the study. Participants undertook the first 1RM test (T1) 4–8 days after a familiarisation session with the same exercises. 1RM was assessed for seven different exercises. Four to eight days after T1, participants underwent another identical 1RM test (T2). Ten weeks later, 27 participants underwent a third test (T3). Intraclass correlation coefficients (ICC), typical error as a coefficient of variation (TEcv), retest correlation, repeated measures ANOVA, Bland–Altman plots, and estimation of 95% confidence limits were used to assess reliability. A high ICC (ICC > 0.99) and high correlation (r > 0.9) were found for all exercises. TEcv ranged from 2.2 to 10.1%. No significant change was found for six of the seven exercises between T1 and T2. Leg press was slightly higher at T2 compared to T1 (1.6 ± 0.6%, p = 0.02). No significant change was found between T2 and T3 for any exercise. 1RM is a reliable method of evaluating the maximal strength in untrained middle-aged individuals. It appears that 1RM-testing protocols that include one familiarisation session and one testing session are sufficient for assessing maximal strength in this population.

Reliability and validity of a reactive agility test for Australian football

Purpose: The aim of this study was to test the reliability and construct validity of a reactive agility test (RAT), designed for Australian Football (AF).

Methods: Study I tested the reliability of the RAT, with 20 elite junior AF players (17.44 ± 0.55 y) completing the test on two occasions separated by 1 wk. Study II tested its construct validity by comparing the performance of 60 participants (16.60 ± 0.50 y) spread over three aged-matched population groups: 20 athletes participating in a State Under-18 AF league who had represented their state at national competitions (elite), 20 athletes participating in the same league who had not represented their state (subelite), and 20 healthy males who did not play AF (controls).

Results: Test-retest reliability reported a strong correlation (0.91), with no significant difference (P = .22) between the mean results (1.74 ± 0.07 s and 1.76 ± 0.07 s) obtained (split 2+3). Nonparametric tests (Kruskal-Wallis and Mann-Whitney) revealed both AF groups performed significantly faster on all measures than the control group (ranging from P = .001 to .005), with significant differences also reported between the two AF groups (ranging from P = .001 to .046). Stepwise discriminant analyses found total time discriminated between the groups, correctly classifying 75% of the participants.

Conclusions: The RAT used within this study demonstrates evidence of reliability and construct validity. It further suggests the ability of a reactive component within agility test designs to discriminate among athletes of different competition levels, highlighting its importance within training activities.

Reliability and validity of the Melbourne edge test and high/low contrast visual acuity chart

Purpose. The purposes of the study were to investigate the test-retest reliability and the validity of new versions of the Melbourne Edge Test (MET) and the High/Low Contrast Visual Acuity (H/LCVA) chart and to investigate the agreement between the original and new versions.

Methods. The MET original photographic version, MET new light box version, H/LCVA Chart original photographic version, H/LCVA Chart new printed version, and the Pelli-Robson chart were administered twice to one eye of 22 subjects with low vision and 20 soft contact lenses wearers.

Results. For the low vision group, the test-retest 95% limits of agreement were ±5.2 dB for the MET new light box version and ±0.39 logarithm of the minimum angle of resolution (logMAR) for the LCVA component of the H/LCVA new printed version. For the soft contact lens group, the test-retest 95% limits of agreement were ±2.1 dB for the MET new light box version and ± 0.26 logMAR for the LCVA component of the H/LCVA new printed version. Moderate to high correlations were obtained between contrast sensitivity tests, thus providing evidence of validity. Scores obtained for the new test versions were significantly higher than the original versions (p < 0.01).

Conclusions. Of all the tests administered, the MET original photographic version and the Pelli-Robson Chart had the highest test-retest reliability for the low vision group. For the soft contact lens group, the H/LCVA original version (low contrast letters, 18% Weber) and the Pelli-Robson Chart had the highest reliability.

Interrater reliability assessment using the Test of Gross Motor Development-2

Objectives: The aim was to examine interrater reliability of the object control subtest from the Test of Gross Motor Development-2 by live observation in a school field setting. Design:: Reliability Study - cross sectional. Methods: Raters were rated on their ability to agree on (1) the raw total for the six object control skills; (2) each skill performance and (3) the skill components. Agreement for the object control subtest and the individual skills was assessed by an intraclass correlation (ICC) and a kappa statistic assessed for skill component agreement. Results: A total of 37 children (65% girls) aged 4-8 years (M= 6.2, SD=0.8) were assessed in six skills by two raters; equating to 222 skill tests. Interrater reliability was excellent for the object control subset (ICC= 0.93), and for individual skills, highest for the dribble (ICC= 0.94) followed by strike (ICC= 0.85), overhand throw (ICC= 0.84), underhand roll (ICC= 0.82), kick (ICC= 0.80) and the catch (ICC= 0.71). The strike and the throw had more components with less agreement. Conclusions: Even though the overall subtest score and individual skill agreement was good, some skill components had lower agreement, suggesting these may be more problematic to assess. This may mean some skill components need to be specified differently in order to improve component reliability.