Roberts Anne E, Nicholls Peter G, Maddali Pranava, Van Brakel Wim H
The Leprosy Mission Trust India, CNI Bhavan, 11 Pandit Pant Marg, New Delhi, India.
Lepr Rev. 2007 Jun;78(2):122-30.
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.
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.
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.
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.
评估为印度ILEP神经功能损伤与反应（INFIR）队列研究招募的9名物理治疗人员进行单丝（MF）和随意肌力量（VMT）测试的可靠性。
在印度北方邦进行了一项多对测试者间可靠性研究。新培训的测试者与一名经验丰富的物理治疗师配对，后者的评估作为金标准。每对测试者完成一系列评估。所有测试者都接受了为期一周的特定VMT和MF培训，随后在医院环境中进行了一个月的实践。通过计算加权Kappa（Kw）统计量来评估可靠性，该统计量可解释为测试者之间经机会校正的一致比例。
8名新培训的物理治疗师和1名物理技术员参与了研究。在研究初期，发现了一些一致性较弱的领域，并对正确的评估技术进行了审查，特别是眼部的评估技术。所有感觉测试和大多数肌肉力量测试的可靠性良好至非常好（Kw为0.62至0.99）。唯一较低的Kw分数（0.48至0.59，表明可靠性仅为中等）出现在该研究两个现场中心之一的正中神经支配肌肉的VMT测试中。即使在这种情况下，测试者之间的差异也从未超过一个等级，但Kw的计算受到受试者之间缺乏变异性的负面影响。此外，测试者与金标准之间的差异也从未超过一个等级。
尽管所有测试者都接受了专业培训，并在MF和VMT测试中接受了额外的特定培训和实践，但技术上的差异仍需要早期审查和纠正。这一事实凸显了仔细培训和正式可靠性测试的必要性。这应扩展到转诊中心，那里的工作人员参与评估反应症状和监测治疗反应。可靠性测试提供了一个机会，以解决即使存在方案以及合格且经过培训的工作人员，技术上仍可能存在的重要差异。因此，在患者可能由不同测试者进行评估的情况下，它是培训程序的一个有价值的工具。总体而言，我们的结果被认为足以进行INFIR研究，使用VMT和MF测试作为基线，以便与更复杂的神经功能测试方法进行比较。
