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Ensuring inter-tester reliability of voluntary muscle and monofilament sensory testing in the INFIR Cohort Study

Ensuring inter-tester reliability of voluntary muscle and monofilament sensory testing in the INFIR Cohort Study
Ensuring inter-tester reliability of voluntary muscle and monofilament sensory testing in the INFIR Cohort Study
Objective: To assess the reliability of monofilament (MF) and voluntary muscle strength (VMT) testing carried out by nine physiotherapy staff recruited for the ILEP Nerve Function Impairment & Reaction (INFIR) Cohort Study in India.

Design: A multiple pair inter-tester reliability study was carried out in Uttar Pradesh, India. Newly trained testers were paired up with an experienced physiotherapist, whose assessment served as the gold standard. Each pair completed a series of assessments. All testers had undertaken a week of specific VMT and MF training, followed by a month of practice in the hospital setting. Reliability was assessed by calculating weighted Kappa (Kw) statistics, which may be interpreted as the chance-corrected proportion of agreement between testers.

Results: Eight newly-trained physiotherapists and one physiotechnician took part in the study. In the early stages of the study some areas of weak agreement were identified and correct assessment technique was reviewed, particularly for the eye. Good to very good reliability (Kw 0•62 to 0•99) was found for all sensory tests and most muscle strength tests. The only lower Kw scores (0•48 to 0•59, suggesting only moderate reliability) were for the VMT of muscles supplied by the median nerve in one of the study’s two field centres. Even in this case, testers never varied by more than one grade, but calculation of Kw was negatively influenced by a lack of variation among the subjects. In addition, testers never varied by more than one grade from the gold standard.

Conclusion: Even though all testers were professionally trained and received additional specific training and practice in MF and VMT testing, discrepancies in technique required an early review and correction. This fact highlights the need for careful training and formal reliability testing. This should extend to referral centres where staff are involved in assessing the symptoms of reaction and monitoring response to treatment. Reliability testing provides the opportunity to address important discrepancies in technique that may persist even in the presence of protocols and qualified and trained staff. It is therefore a valuable tool as part of a training procedure for situations, where patients may be assessed by different testers. Overall, our results were deemed good enough to proceed with the INFIR study, using VMT and MF testing as a baseline against which to compare more sophisticated methods of nerve function testing.
sensory testing, infir cohort study
0305-7518
122-130
Roberts, Anne E.
2fa5ea88-759d-4856-aae0-c036787e02f3
Nicholls, Peter G.
524cf465-2f84-41f4-9580-94abed4c3f65
Maddali, Pranava
7e58b32b-e593-4f2b-9ab5-b88239502fea
van Brakel, Wim H.
0ab1a81c-c2f5-46c9-9119-e9a7ba05c25c
Roberts, Anne E.
2fa5ea88-759d-4856-aae0-c036787e02f3
Nicholls, Peter G.
524cf465-2f84-41f4-9580-94abed4c3f65
Maddali, Pranava
7e58b32b-e593-4f2b-9ab5-b88239502fea
van Brakel, Wim H.
0ab1a81c-c2f5-46c9-9119-e9a7ba05c25c

Roberts, Anne E., Nicholls, Peter G., Maddali, Pranava and van Brakel, Wim H. (2007) Ensuring inter-tester reliability of voluntary muscle and monofilament sensory testing in the INFIR Cohort Study. Leprosy Review, 78 (2), 122-130.

Record type: Article

Abstract

Objective: To assess the reliability of monofilament (MF) and voluntary muscle strength (VMT) testing carried out by nine physiotherapy staff recruited for the ILEP Nerve Function Impairment & Reaction (INFIR) Cohort Study in India.

Design: A multiple pair inter-tester reliability study was carried out in Uttar Pradesh, India. Newly trained testers were paired up with an experienced physiotherapist, whose assessment served as the gold standard. Each pair completed a series of assessments. All testers had undertaken a week of specific VMT and MF training, followed by a month of practice in the hospital setting. Reliability was assessed by calculating weighted Kappa (Kw) statistics, which may be interpreted as the chance-corrected proportion of agreement between testers.

Results: Eight newly-trained physiotherapists and one physiotechnician took part in the study. In the early stages of the study some areas of weak agreement were identified and correct assessment technique was reviewed, particularly for the eye. Good to very good reliability (Kw 0•62 to 0•99) was found for all sensory tests and most muscle strength tests. The only lower Kw scores (0•48 to 0•59, suggesting only moderate reliability) were for the VMT of muscles supplied by the median nerve in one of the study’s two field centres. Even in this case, testers never varied by more than one grade, but calculation of Kw was negatively influenced by a lack of variation among the subjects. In addition, testers never varied by more than one grade from the gold standard.

Conclusion: Even though all testers were professionally trained and received additional specific training and practice in MF and VMT testing, discrepancies in technique required an early review and correction. This fact highlights the need for careful training and formal reliability testing. This should extend to referral centres where staff are involved in assessing the symptoms of reaction and monitoring response to treatment. Reliability testing provides the opportunity to address important discrepancies in technique that may persist even in the presence of protocols and qualified and trained staff. It is therefore a valuable tool as part of a training procedure for situations, where patients may be assessed by different testers. Overall, our results were deemed good enough to proceed with the INFIR study, using VMT and MF testing as a baseline against which to compare more sophisticated methods of nerve function testing.

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More information

Published date: June 2007
Keywords: sensory testing, infir cohort study

Identifiers

Local EPrints ID: 59019
URI: http://eprints.soton.ac.uk/id/eprint/59019
ISSN: 0305-7518
PURE UUID: 5a25dc58-d133-40e4-a8eb-f55146961851

Catalogue record

Date deposited: 21 Aug 2008
Last modified: 07 Jan 2022 22:34

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Contributors

Author: Anne E. Roberts
Author: Peter G. Nicholls
Author: Pranava Maddali
Author: Wim H. van Brakel

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