Search Results (1,338)

Objective: Evaluate the test–retest reliability of quadriceps corticospinal excitability and intracortical excitability using transcranial magnetic stimulation (TMS). Design: A test–retest observational cohort study. Methods: Twelve healthy adults attended two laboratory sessions, seated with their knee at 90 degrees and fitted with electrodes on the rectus femoris (RF), vastus lateralis (VL) and vastus medialis (VM). TMS was used to assess the active motor threshold (AMT), motor evoked potential (MEP) amplitude, short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF). Individual results were calculated as the mean and median of the 10 trials of each measure for MEP, SICI and ICF. Intraclass correlation coefficients were calculated. Results: All muscles showed good or excellent reliability for the mean and median measures of the MEP amplitude (ICC ≥ 0.820) as well as the AMT of the RF (ICC = 0.991). SICI showed good reliability in the mean and median measures of the RF and the mean measure of the VL (ICC ≥ 0.809), moderate reliability in both measures of the VM (ICC ≥ 0.655) and was not significant for the median measure of the VL (ICC = 0.513). ICF showed excellent reliability in the mean measure of each muscle and median measure of the RF (ICC ≥ 0.906), with good reliability in the median measure of the VL (ICC = 0.888) and moderate reliability in the median measure of the VM (ICC = 0.719). Conclusion: The mean of an individual’s quadriceps corticospinal excitability and intracortical excitability have good or excellent reliability for every TMS measure, in every muscle (except SICI of the VM). With the previous reliability of TMS measures mostly investigating the upper limbs, these results offer important context for neurophysiological research in the quadriceps. Full article

Background: This study aimed to compare the measurement agreement and intramethod reliability of four cephalometric analysis workflows: manual tracing, semi-automated digital analysis (Dolphin), fully automated AI-based analysis (WebCeph), and expert-adjusted AI analysis (WebCeph+). Methods: In this retrospective method-comparison study, 67 lateral cephalometric radiographs were initially included. After the exclusion of radiographs containing extreme values, 54 radiographs (35 females, 19 males; mean age: 15.0 ± 2.13 years) were analyzed. Twenty-one skeletal, dental, and soft-tissue parameters (13 angular, 8 linear) were evaluated across the four methods. Intramethod repeatability was assessed via the intraclass correlation coefficient (ICC). Intermethod comparisons were analyzed using ANOVA and post hoc pairwise tests. Pragmatic clinical relevance thresholds were predefined as ±2 degrees for angular measurements and ±2 mm for linear measurements. Results: All methods demonstrated high intramethod reliability, with ICC values exceeding 0.90 in 20 out of 21 parameters. Manual and Dolphin methods yielded statistically comparable results (p > 0.05). In contrast, WebCeph differed significantly from manual and/or Dolphin in seven parameters, including SNA, IMPA, Go-Gn length, Pog to N-perpendicular, Wits appraisal, nasolabial angle, and mentolabial angle (p < 0.05). Several discrepancies exceeded the predefined pragmatic thresholds (±2 degrees and ±2 mm), highlighting their potential clinical relevance. After expert adjustment (WebCeph+), statistically significant inter-workflow differences were no longer observed; however, residual individual-level variability remained for selected parameters. Conclusions: Fully automated WebCeph analysis showed limited agreement with manual and semi-automated methods for several clinically relevant measurements. Expert adjustment reduced systematic mean discrepancies and improved agreement with clinician-dependent workflows; however, residual individual-level variability remained for selected parameters. AI-driven cephalometric analysis should therefore be considered a supportive tool requiring specialist verification rather than an unsupervised replacement for conventional methods. Full article

Background/Objectives: Shear wave elastography (SWE) may provide an objective method for quantifying piriformis muscle stiffness, but its clinical and research use requires evidence that the measurement procedure is reliable. This study aimed to determine the intra- and inter-examiner reliability of a standardized SWE protocol for assessing piriformis muscle stiffness and to provide measurement error thresholds for clinical interpretation. Methods: Twenty-one healthy volunteers were assessed bilaterally by two examiners with different levels of ultrasound experience. The piriformis muscle was identified in the long axis beneath the gluteus maximus, and SWE images were acquired using a standardized protocol. Each side was measured twice by each examiner, resulting in 168 ultrasound images. Reliability was analyzed using side-specific observations (n = 42). Intraclass correlation coefficients (ICCs), standard errors of measurement (SEMs) and minimal detectable changes (MDCs) were calculated for shear modulus and shear wave speed. Results: Inter-examiner reliability was good for single measurements, with ICCs of 0.872 for shear modulus and 0.813 for shear wave speed. When the average of two measurements was used, ICCs were similar, reaching 0.876 and 0.832, respectively. Inter-examiner MDC values ranged from 6.1 to 6.2 kPa for shear modulus and from 0.37 to 0.39 m/s for shear wave speed. Intra-examiner reliability was excellent for both examiners, with ICCs ranging from 0.938 to 0.979. Test–retest MDC values ranged from 2.7 to 3.3 kPa for shear modulus and from 0.19 to 0.22 m/s for shear wave speed. Conclusions: SWE provides good inter-examiner and excellent intra-examiner reliability for assessing piriformis muscle stiffness using a standardized acquisition protocol. Longitudinal assessments should preferably be performed by the same examiner, and changes should be interpreted in relation to SEM and MDC values, particularly in multi-examiner settings where absolute measurement error is larger. These thresholds reflect measurement error and should not be interpreted as evidence of diagnostic validity or responsiveness to treatment. Full article

Portable force platforms are increasingly used for neuromuscular performance assessment in field-based environments; however, their validity may vary depending on the analyzed variable and the experimental configuration. The present study investigated the concurrent validity and test–retest reliability of a novel portable force platform (Fitforce) during commonly used static and dynamic performance assessments under field-based conditions. Thirty recreationally active male university students (age: 24.5 ± 4.1 years; height: 177.1 ± 6.18 cm; body mass: 75.38 ± 4.62 kg) performed the isometric mid-thigh pull (IMTP) and countermovement jump (CMJ) on two force platforms positioned in a stacked configuration, with the Fitforce system placed on top of a laboratory-grade reference platform (ForceDecks). Concurrent validity was evaluated using paired comparisons, intraclass correlation coefficients (ICC), coefficients of determination (R²), and Bland–Altman analyses. Test–retest reliability of the Fitforce system was assessed across two testing sessions conducted 24 h apart. Very high agreement was observed between systems for IMTP-derived variables (ICC = 0.95–0.98) and for CMJ propulsion-related variables, including jump height, flight time, and peak take-off force (ICC = 0.92–0.96). In contrast, peak landing force showed poor agreement across systems (ICC = −0.88, R² = 0.19), with substantial systematic bias, whereas braking phase duration showed only moderate agreement (ICC = 0.50). Excellent test–retest reliability was observed across all IMTP (ICC > 0.96; CV% < 3.59) and CMJ (ICC > 0.97; CV% < 3.42) variables. Bland–Altman analyses demonstrated narrow limits of agreement for IMTP and propulsion-related CMJ variables but wide limits for landing-related force measurements. The Fitforce platform demonstrates strong concurrent agreement and excellent between-day reliability for selected IMTP and CMJ propulsion-related force–time variables under field-based conditions. However, landing-related variables should be interpreted cautiously under stacked measurement configurations due to their sensitivity to rapid impact transients and force transmission characteristics. Full article

Background: The conventional Hess–Lancaster test is widely used to assess ocular misalignment across diagnostic gaze positions, but it relies on subjective responses and manual recording. Virtual reality may provide a more standardized framework for ocular motility assessment. Objectives: To evaluate the agreement and within-method repeatability of point-by-point deviation measurements obtained with the conventional Hess–Lancaster test and a VR-based Hess–Lancaster assessment implemented in Dicopt Pro. Methods: This cross-sectional observational study included 52 adults with suspected or diagnosed ocular motility disorders. Participants underwent both assessments using the same predefined gaze positions. Agreement was assessed using Bland–Altman analysis, concordance correlation coefficients, mean absolute differences, and mixed-effects modeling. Repeatability was evaluated in a subset with repeated measurements using session-to-session differences and intraclass correlation coefficients. Results: The VR-based assessment showed moderate agreement with the conventional test, with a mean concordance correlation coefficient of 0.57 for both eyes. Mean bias was 1.22 prism diopters for the right eye and 0.10 prism diopters for the left eye. Repeatability estimates were moderate-to-good, with ICC values ranging from 0.62 to 0.83, although repeated measurements were available only in a subset of participants. Conclusions: The VR-based Hess–Lancaster assessment showed small mean differences and moderate agreement with the conventional test, although both methods should be interpreted within the context of the complete clinical examination. Full article

Background: Full-body motion capture using commercial virtual reality (VR) systems offers unique opportunities for augmenting common functional assessment such as the timed up-and-go (TUG) test. The purpose of this study was to determine whether task performance (chair, walk, turns) during a VR version (vTUG) is parametrically equivalent to the standard test (sTUG). Methods: Twenty healthy adult participants (age 19–71 years) were evaluated with the sTUG followed by the vTUG version of the same test. Body trackers were used to capture kinematics during both tests. TUG time was measured manually with a stopwatch. Tracker data were used to automatically quantify total TUG time and sub-task times for chair, walk and turn portions. Absolute agreement was evaluated using Intraclass Correlation Coefficient (ICC(2,k)) and Bland–Altman analysis. A custom survey was used to evaluate user satisfaction. Results: Very good agreement (ICC > 0.8) was found between sTUG and vTUG for manual and automated measures of total time. ICCs for sub-task times were acceptable (ICC > 0.7) for chair rise, walks and first turn but less so for second turn and sit (ICC < 0.7). User satisfaction was high, and there were no adverse events. Interpretation: The vTUG and sTUG are parametrically equivalent, though sub-task segmentation may require more research. Nevertheless, VR body trackers are a value-added feature whether used with the vTUG or the sTUG and warrant further investigation. Full article

This study evaluates Retuve, an open-source explainable pipeline for the automated analysis of infant hip ultrasound cine sweeps. Retuve combines segmentation, Graf-plane calibration, and frame filtering. In a retrospective multicenter study, we tested the full pipeline on an external set of 109 hips from a Canadian community clinic, with internal developmental validation of segmentation on 90 hips and Graf-plane calibration on 419 hips. On the external test set, Retuve achieved 100% specificity and 91% sensitivity for expert agreement regarding whether a sweep contained an analyzable frame, compared with 75% specificity and 96% sensitivity for a radiology fellow; specificity was based on 16 expert-negative examinations. For alpha angle and acetabular coverage, Retuve achieved consistency intraclass correlation coefficients (ICCs) of 0.77 and 0.74, comparable to the fellow’s 0.70 and 0.74. However, alpha-angle absolute agreement was lower (ICC 0.55, 95% confidence interval (CI) −0.07–0.81), consistent with systematic measurement bias. Internal developmental validation showed Component 1 mask mean average precision at 50% intersection-over-union (mAP50) of 0.753 and box mAP50 of 0.883 and a Component 2 ICC of 0.792. Retuve can select analyzable frames and recover measurements from variable-quality cine sweeps, but alpha-angle calibration requires refinement. Future prospective work should evaluate developmental dysplasia of the hip (DDH) diagnostic accuracy, clinical treatment decision support, and screening outcomes. Full article

This study was based on a 30 m inside-foot long-pass scenario and aimed to preliminarily evaluate the agreement between MediaPipe Pose, DWPose, YOLO-Pose, and Xsens, as well as their practical utility under real-field conditions. Twelve elite male football players performed 15 consecutive long-passes, with data collected simultaneously using Xsens and two smartphones positioned at 15° and 35° to the right front of the participants. The Intraclass Correlation Coefficient (ICC (2,1)) and Bland–Altman analysis were used to evaluate discrete kinematic measures. Continuous kinematic agreement was assessed using Root Mean Square Error (RMSE) and the Coefficient of Multiple Determination (CMD), while Statistical Parametric Mapping (SPM) and Statistical non-Parametric Mapping (SnPM) compared differences across the entire analysis interval. Across the three models, CMD ranged from 0.13 ± 0.17 to 0.67 ± 0.25, and RMSE ranged from 9.88 ± 8.20° to 39.92 ± 10.44°. The SPM and SnPM results showed that significant differences were mainly concentrated in the bilateral hip, knee, and ankle joints. The three models cannot yet be used for field-based high-precision kinematic data measurement; however, MediaPipe Pose and DWPose may be selectively used for rapid screening of movement patterns and analysis of movement trends in football-specific technical movements. Full article

Background: Autonomy in decision making is a critical component of respectful, person-centered maternity care. The Mother’s Autonomy in Decision Making (MADM) scale has been widely used internationally to evaluate women’s perceptions of autonomy during perinatal period. Objectives: To assess the reliability and validity of the Greek translation of the MADM questionnaire among postpartum women who have given birth in hospitals and clinics in Greece. Methods: A cross-sectional study was conducted with 450 postpartum women who gave birth in public and private maternity facilities in Greece. Participants completed the Greek MADM scale, and statistical analyses included exploratory and confirmatory factor analysis (EFA/CFA), internal consistency (Cronbach’s alpha), test–retest reliability (intraclass correlation coefficient, ICC), criterion validity (correlation with the Birth Satisfaction Scale (G-BSS), and Rasch analysis. Results: EFA revealed a one-factor structure explaining 77.6% of the variance (KMO = 0.913; Bartlett’s p < 0.001). CFA supported good model fit (CFI = 0.924, RMSEA = 0.085). The Greek MADM showed excellent internal consistency (Cronbach’s α = 0.951) and test–retest reliability (ICC = 0.995). Criterion validity was supported by moderate correlations with G-BSS subscales (r = 0.338–0.389, p < 0.005). Rasch analysis confirmed unidimensionality, high item reliability, and acceptable item fit. A cut-off score of 27.5 on the MADM scale was identified to distinguish between high and low–moderate birth satisfaction. Conclusions: The Greek version of the MADM scale demonstrates excellent psychometric properties and is a valid, reliable tool for assessing autonomy in maternity decision making. Its use can enhance quality assessment and promote respectful, autonomy-supportive perinatal care in Greek healthcare settings. Full article

Wearable inertial sensors offer a portable alternative to laboratory-grade force plates for postural stability assessment; however, their validity across progressively challenging balance tasks remains under-explored. This study evaluated the reliability and concurrent validity of inertially sensed metrics compared with force-plate-derived postural sway metrics across a five-level spectrum of unstable surfaces (Floor, Foam Pad, Rotating Disc, Air Disc, Bosu). Twenty-five healthy young women (22.1 ± 3.6 years, 1.64 ± 0.04 m, 58.44 ± 8.21 kg) performed five trials of single-leg standing (40 s each) on each surface. Postural sway was computed from antero-posterior (AP) and medio-lateral (ML) center of pressure (CoP) recordings using a force plate (Kistler, 9286 AA, Winterthur, Switzerland, sampling at 500 Hz) in synchronization with a lateral shank-mounted inertial sensor (Bionomadix BN-ACCL3, Biopac Systems, Inc., Santa Barbara, CA, USA, sampling at 100 Hz). In addition to reliability, a two-tiered analysis evaluated global concordance (unstandardized slopes) and method agreement (standardized z-scores). Intraclass correlation coefficients (ICCs) for the inertial sensor were excellent (range: 0.95–0.96), surpassing the force plate (range: 0.85–0.92) as trials accumulated. Analysis revealed moderate-to-good global concordance in the AP direction (r = 0.60, p = 0.001) and good-to-excellent in the ML one (r = 0.85, p < 0.001), validating the progressive intensifying effect of the surface graduation. Individual ranking agreement—evaluated via standardized z-scores—was also significant in both the AP (r = 0.61, p < 0.001) and the ML (r = 0.85, p < 0.001) directions, indicating a convergence into how the two modalities rank individual performance. Bland–Altman plots confirmed high absolute agreement between standardized scores, though a predictable proportional bias was observed in raw units, where the inertial sensor’s underestimation of sway magnitude increased linearly with task difficulty. The five-level postural challenge graduation is a highly reliable framework for balance assessment. While the shank-mounted sensor exhibits proportional underestimation of sway magnitude compared to the CoP at extreme intensities, its high internal stability and sensitivity to task difficulty make it a valid and robust tool for longitudinal clinical monitoring. Full article

Objectives: The Arch Index (AI) is commonly used to assess medial longitudinal arch morphology; however, values obtained using different measurement technologies may not be interchangeable. This study aimed to compare AI values derived from optical pedography and a barometric platform during bilateral static stance assessment in children and to evaluate their agreement. Methods: Thirty-eight healthy children aged 5–10 years underwent standardized bilateral static foot assessment. AI was calculated using identical segmentation and formula for both systems. Paired t-tests, Pearson correlation, intraclass correlation coefficient, and Bland–Altman analysis were used to assess agreement between methods. Results: Optical pedography produced significantly higher AI values than barometric assessment for both the left (0.284 ± 0.055 vs. 0.188 ± 0.092) and right foot (0.286 ± 0.048 vs. 0.169 ± 0.072; p < 0.001). Agreement between methods was moderate (ICC = 0.494–0.581), with wide limits of agreement. Inter-method differences increased with age. Conclusions: AI values obtained from optical pedography and barometric platforms are not interchangeable in children. Consistent use of a single measurement technology is recommended in pediatric assessment to avoid misinterpretation of developmental changes. Full article

Background/Objectives: Frailty is well-recognized as a predictor of adverse postoperative outcomes. The Clinical Frailty Scale (CFS) is a widely recommended frailty assessment tool due to its simplicity and rapid bedside applicability; however, it has never been validated in Serbia. The aim of this study was to translate, culturally adapt, and validate the CFS in Serbia, in patients undergoing elective major surgical procedures. Methods: This cross-sectional study included 149 patients aged ≥50 years undergoing elective major urological oncology surgery. Frailty was assessed preoperatively using three scales: the CFS, the Edmonton Frail Scale (EFS), and the FRAIL scale. The CFS evaluations were independently performed by two raters and repeated after 7 days. Concurrent validity was evaluated via Spearman’s correlation between the CFS, the EFS, and the FRAIL scale. The “known-group” construct validity of the CFS was assessed using the test for trends across clinically relevant groups. Both inter-rater and test–retest reliability were assessed using the intraclass correlation coefficient (ICC). Results: The CFS was translated and culturally adapted into the Serbian language in accordance with ISPOR guidelines. The Serbian version of the CFS demonstrated both excellent inter-rater reliability (ICC = 0.957; 95% CI 0.941–0.968), and test–retest reliability (ICC = 0.958; 95% CI 0.943–0.970). A strong positive correlation was observed between the CFS and both the EFS (ρ = 0.698) and the FRAIL scale (ρ = 0.614). A known-group comparison confirmed the construct validity of the CFS. Conclusions: The Serbian version of the CFS is a reliable, valid, and clinically feasible tool for preoperative identification of frailty in patients aged 50 years and older undergoing major elective uro-oncological procedures. Full article

Background: Age-related hearing loss (HL) is a significant independent risk factor for Alzheimer’s disease (AD), yet the molecular mechanisms underlying this comorbidity and the comparative efficacy of hearing interventions for cognitive outcomes remain unclear. This study aims to integrate clinical evidence and molecular data to address these gaps. Objective: The objective of this study was to conduct a systematic review and network meta-analysis (NMA) in order to: (1) compare the effects of hearing interventions on cognitive function in AD patients; (2) identify and rank key microRNAs (miRNAs) associated with AD-HL comorbidity; (3) explore heterogeneity sources; and (4) cross-validate findings with internal clinical sequencing data. Methods: We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library, with a cut-off date of May 2024. Included studies involved AD patients with/without HL, reporting cognitive scores (MoCA, MMSE, and AVLT) or miRNA expression data. An NMA was performed to rank interventions (cochlear implants—CIs, hearing aids—HAs, and no intervention—NI) and miRNAs using surface under the cumulative ranking (SUCRA) curves. Heterogeneity was assessed via subgroup analysis and meta-regression. Pooled miRNA expression results were cross-validated against an internal clinical sequencing dataset (LC-P20240110033, n = 16) using the intraclass correlation coefficient (ICC) and Bland–Altman plots. Results: Twelve studies (2137 patients) were included. HL was significantly associated with worse cognitive function (MoCA: SMD = −0.82, 95% CI: −1.15 to −0.49; AVLT delayed recall: SMD = −1.12, 95% CI: −1.56 to −0.68). NMA revealed that the CI group (SUCRA = 0.89) was superior to the HA group (SUCRA = 0.62) and NI (SUCRA = 0.09) for preserving MoCA scores. Among the nine differentially expressed miRNAs identified in exploratory synthesis, three met strict quantitative criteria for NMA (reported in ≥2 independent studies with comparable quantification and variance data); hsa-miR-6875-5p was the most consistent biomarker (pooled FC = 1.52, 95% CI: 1.04–2.23), showing excellent agreement with sequencing data (FC = 3.29; ICC = 0.82, 95% CI: 0.67–0.91). Heterogeneity was significantly influenced by the miRNA detection platform (p = 0.04) and HL severity (p = 0.03). Conclusions: This study demonstrates that HL exacerbates cognitive decline in AD in a dose-dependent manner. Cochlear implants may offer superior cognitive protection compared to hearing aids. The consistently dysregulated hsa-miR-6875-5p emerges as a hypothesis-generating cross-modal biomarker, bridging clinical observation and molecular pathology in AD-HL comorbidity. Full article

Background: This study evaluated the reliability and reproducibility of biomechanical variables from a foot-mounted inertial measurement unit (IMU; Stryd^®) and a trunk-mounted triaxial accelerometer (TTA; RunEASI^®) during treadmill running. Methods: Thirteen trained male runners (age: 27.6 ± 8.2 years; body mass: 64.4 ± 6.1 kg; height: 174.2 ± 6.4 cm) completed four treadmill sessions separated by seven days, each with four 5-min trials at 13 km·h⁻¹. Reliability and reproducibility were assessed using intraclass correlation coefficients (ICCs), standard error of measurement (SEM), smallest worthwhile change (SWC) and coefficient of variation (CV). Results: Both devices showed excellent intra-session reliability (ICC ≥ 0.90). Inter-session reproducibility was high for the IMU in running power, step frequency, and ground contact time (ICC = 0.906–0.992; CV = 0.31–1.50%); the TTA showed excellent reproducibility for the spatiotemporal variables—step frequency, ground contact time, and flight ratio (ICC = 0.931–0.956), whereas impact-related variables showed only good reproducibility (ICC = 0.823–0.871; CV up to 7.76%). Mean step frequency values were similar between devices, but trial-to-trial agreement was limited (r = 0.447; R² = 0.20; Bland–Altman bias = 0.70 steps·min⁻¹, LoA: −15.08 to 16.47), and ground contact time showed systematic discrepancies, with the TTA underestimating values (bias = 16.86 ms, LoA: −45.64 to 11.92). Conclusions: Both sensors provide consistent measurements within their own systems; however, differences in sensing location produce different absolute values, so they should not be used interchangeably and interpretation must remain device-specific. Full article

Background/Objectives: Breathing is increasingly recognized as an integral component of the motor system, interacting with postural control and movement. Despite this, clinical assessment of respiratory function in children remains largely limited to physiological parameters, with relatively few tools available to evaluate breathing as an organized motor pattern. The aim of this study was to develop and preliminarily validate the Breath Motor Pattern Index (BMPI), an observational tool designed to assess the organization of respiratory motor patterns in children. Methods: A scoping review was conducted to identify key components of respiratory motor pattern organization. Based on these findings, the BMPI was developed and evaluated in a cohort of 210 children aged 0–72 months, divided into three groups: healthy controls, children with neurological conditions, and children with respiratory disorders. Inter-rater and test–retest reliability was assessed using intraclass correlation coefficients (ICC). Measurement error was quantified using the standard error of measurement (SEM) and minimal detectable change (MDC95). Construct-related validity was examined through correlations with the Gross Motor Function Measure (GMFM-88) and comparisons between clinical groups. Results: The BMPI showed high inter-rater reliability (ICC = 0.998) and test–retest reliability (ICC = 0.999), with low measurement error (SEM = 0.55; MDC95 = 1.53). A weak but statistically significant correlation with GMFM-88 was observed (rho = 0.23, p < 0.001). BMPI scores differed significantly between groups (p < 0.001), with lower values observed in the neurological group and higher values in the pulmonary group. Conclusions: The BMPI appears to be a promising observational tool with potential clinical applicability for assessing respiratory motor pattern organization in children. The findings support the conceptualization of breathing as an integrated component of the motor system while highlighting the need for further psychometric and longitudinal validation studies. Future research should further investigate the responsiveness of the BMPI as well as its potential utility in clinical decision-making and therapeutic monitoring. Full article