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Validity and reproducibility of the Cooperative Cataract Research Group (CCRG) cataract classification system.

The validity and reproducibility with which six classifiers [one experienced (L.T.C.), and five novices (W.G., F.G., W.W., J.W. and O.W.)] used the CCRG cataract classification system was assessed. The validity of index classifications was assessed by computing sensitivities and pairwise interclass correlations between experienced and novice classifiers using the former's classification as the standard. The number of unordered combinations of terms in the CCRG's classification was reduced by combining cortical terms according to the CCRG's accepted system of staged simplification. The number of combinations of terms at each stage is as follows: Stage I (greater than 1000); II (127); III (63); IV (15); V (7); VI and VII (3) and VIII (2). Excellent agreement was obtained between the experienced and novice classifiers for Stages VII and VIII of the classification, good agreement for Stages V and VI and poor agreement for Stages IV, III and II (sensitivities of 97, 96, 72, 59, 40, 24 and 20% respectively). Good agreement was also achieved for the classifications of single lenticular regions, except for subcapsular regions. The intra- and interobserver reproducibility was assessed by computing the Kappa statistic to (1) compare classifications between novice observers and (2) compare repeat classifications made by the same observer by viewing the same cataract once on each of three different days. The novice classifiers had excellent intraobserver reproducibility for Stages VII and VIII (Kappas of 0.87 and 0.97 respectively), good reproducibility for Stages IV, V and VI (Kappas of 0.53, 0.62 and 0.62, respectively) and marginal reproducibility for stages II and III (Kappas of 0.39 and 0.40, respectively). The intraobserver reproducibility of the experienced classifier was superior to the others for virtually all characteristics with excellent reproducibility for Stages IV, V, VI, VII and VIII with Kappas of 0.79, 0.90, 1.0, 1.0 and 1.0, respectively and good reproducibility for Stages II and III (Kappas of 0.55 and 0.64, respectively). These results indicate that the simplified CCRG cataract classification system (Stages IV-VIII) passes the minimum standards for reproducibility. The performance of the experienced classifier far exceeds the minimum standards and indicates the feasibility of improving classifier performance with training and practice.

Cataract↗

Reproducibility of ambulatory blood pressure monitoring.

OBJECTIVE: To investigate whether blood pressure monitoring is reproducible. DESIGN: Reproducibility of ambulatory blood pressure monitoring data was assessed by means of traditional and relatively new statistical methods, namely correlation coefficients, regression analysis and agreement analysis. METHODS: Ninety-one normotensive and hypertensive, uncomplicated outpatients underwent monitoring twice (mean interval 241 days). Data were analysed for reproducibility, correlation, difference and adaptation. Analyses were performed to verify the reproducibilities of the diagnosis of hypertension and of the treatment assessment. RESULTS: Ambulatory blood pressure monitoring is highly reproducible in terms of traditional statistics, but not in terms of the agreement analysis (error as high as 18 mmHg), although it performs better than does office sphygmomanometry (error as high as 38 mmHg). Reproducibility is acceptable in normotensive subjects and in patients who respond to treatment, but untreated hypertensives and those who do not respond to treatment show a worse ratio. CONCLUSION: The reproducibility of ambulatory blood pressure monitoring requires improvement. We do not know how many repeated measurements we need before diagnosing hypertension. Spontaneous variability of blood pressure interferes with blood pressure reproducibility. Diagnosis and treatment assessment in hypertension must take into account poor reproducibility.

Journal Article↗

Evaluation of the reproducibility of the World Health Organization classification of common ovarian cancers. With emphasis on methodology.

Seven pathologists independently classified 50 slides of ovarian tumors using category I of the World Health Organization classification (WHO I), each case being seen twice under different random code numbers. Intraobserver reproducibility and interobserver reproducibility, based on consistent interpretations, were both suboptimal. However, scrutiny suggested that no pathologist was a source of excessive variability, nor was suboptimal interobserver reproducibility simply due to intraobserver variability. Neither could excessive variability be attributed to skewing of results by a subgroup of unclassifiable cases. However, clearcut sources of variability were identified among the categories of WHO I, namely, mixed epithelial, unclassified epithelial, and undifferentiated carcinoma. There was also considerable variability in distinguishing serous and endometrioid neoplasms, and in identifying tumors of low malignant potential. These findings should not be misconstrued as implying that pathologists in routine practice cannot diagnose common ovarian cancers reproducibly for patient care purposes. Availability of clinical and macroscopic data, extensive sampling, histochemistry, and consultation combine, in an uncontrolled and highly individualistic fashion, to render routine service work very different from this highly controlled formal exercise. Furthermore, at the current state of the therapeutic art, many of the taxonomic problems identified in this study may have little clinical significance. Nonetheless, this study has strengthened the evidence that there may be important problems in classifying common ovarian cancers reproducibly using WHO I, and that WHO I may require greater clarity to enhance reproducibility. Current emphasis on quality assurance dictates reconsideration of the literature on reproducibility of histopathologic taxonomy, which has tended to inculpate pathologists as sources of variability. Virtually all of this literature is subject to some degree of skepticism due to deficiencies in methodology. Consideration of the question of how to measure reproducibility in anatomic pathology leads us to suggest that the community of pathologists should address the need to decrease ambiguity in classification systems as an important step toward optimizing reproducibility.

Female↗

Intra- and interinstrument reproducibility of migration parameters in capillary electrophoresis for substance identification in systematic toxicological analysis.

The intra- and interinstrument reproducibilities of four capillary electrophoresis instruments were studied for identification purposes in systematic toxicological analysis (STA). A test set of 20 acidic test compounds and 5 reference compounds were analyzed for five days on each instrument using capillary zone electrophoresis (CZE) and micellar electrokinetic chromatography (MEKC). The buffers consisted of 90 mM borate set at pH 8.4 (CZE) and 20 mM phosphate and 50 mM sodium dodecyl sulfate set at pH 7.5 (MEKC). All analyses were carried out using fused silica capillaries at an electric field strength of 52.6 kV/m. The use of a reproducible identification parameter is very important in STA. To deal with the poor reproducibility of the migration time, we recently introduced the corrected effective mobility. In this study, we investigated the intra- and interinstrument reproducibility of the migration time, the effective mobility, and the corrected effective mobility. Large differences in intra-instrument reproducibility were found when the migration time was used. The calculation of the effective mobility and the corrected effective mobility diminished these differences and enhanced the interinstrument reproducibility roughly by a factor 3. For (corrected) effective mobilities, intrainstrument reproducibilities were between 0.8-2.6% and interinstrument reproducibilities were between 3.2-3.9%.

Chromatography, Micellar Electrokinetic Capillary↗

Characterisation, asymmetry and reproducibility of on- and off-transient pulmonary oxygen uptake kinetics in endurance-trained runners.

The purpose of this study was three-fold: (1) to characterise both the on- and off-transient oxygen uptake (V(.)O(2)) kinetics in endurance runners during moderate-intensity treadmill running; (2) to determine the degree of symmetry between on- and off-transients; and (3) to determine the reproducibility of V(.)O(2) kinetic parameters in endurance runners. Twelve endurance-trained runners [mean (SD) age 25.2 (4.7) years, body mass 70.1 (9.7) kg, height 179.5 (7.5) cm, ventilatory threshold (V(T)), 3,429 (389) ml.min(-1), maximal V(.)O(2) (V(.)O(2max)) 4,138 (625) ml.min(-1)] performed two multiple square-wave transition protocols on separate days. The protocol consisted of six (three transitions, 15 min rest, three transitions) square-wave transitions from walking at 4 km.h(-1) to running at a speed equivalent to 80% of the V(.)O(2) at the V(T) (80%V(T)). To determine the reproducibility, the protocol was repeated on a separate day (i.e. a test-retest design). Pulmonary gas-exchange was measured breath-by-breath. The V(.)O(2) data were modelled [from 20 s post-onset (or offset) of exercise] using non-linear least squares regression by a mono-exponential model, incorporating a time delay. The on- and off-transient time constants (tau(on) and tau(off)), mean response times (MRT(on) and MRT(off)) and amplitudes (A(on) and A(off)) were obtained from the model fit. On- and off transient kinetics were compared using paired t-tests. The reproducibility of each kinetic parameter was explored using statistical (paired t-tests) and non-statistical techniques [95% limits of agreement (LOA, including measurement error and systematic bias) and coefficient of variation (CV)]. It was found that the tau(on) [12.4 (1.9)] was significantly (P<0.001) shorter than tau(off) [24.5 (2.3) s]. Similarly, MRT(on) [27.1 (1.9) s] was shorter than MRT(off) [33.4 (2.2) s]. With respect to the reproducibility of the parameters, paired t-tests did not reveal significant differences between test 1 and test 2 for any on- or off-transient V(.)O(2) kinetic parameter (P>0.05). The LOA for tau(on) (1.9 s), tau(off) (2.3 s), MRT(on) (1.2 s), MRT(off) (3.2 s), A(on) (204 ml.min(-1)) and A(off) (198 ml.min(-1)) were narrow and acceptable. Furthermore, the measurement error (range, 4.3 to 15.1%) and CV (1.3 to 4.8%) all indicated good reproducibility. There was a tendency for tau(off) to be more reproducible than tau(on). However, MRT(on) was the most reproducible kinetic parameter. Overall, the results suggest that: (1) a multiple square-wave transition protocol can be used to characterise, reproducibly, both on- and off-transient V(.)O(2) kinetic parameters during treadmill running in runners; (2) the phase II time constant is independent of V(.)O(2) (max), and (3) asymmetry exists between on- and off transient V(.)O(2) kinetic parameters.

Adult↗

Reproducibility of methods for assessing baroreflex sensitivity and temporal QT variability in end-stage renal disease and healthy subjects.

Spontaneous baroreflex sensitivity (BRS), the reflex heart rate modulation in response to blood pressure changes (predominantly an index of cardiac vagal activity) and temporal QT variability (an index of myocardial repolarization) have been demonstrated to convey important prognostic information. The information about reproducibility of BRS and temporal QT variability is limited and there is lack of information regarding patients with cardiovascular diseases. We investigated reproducibility of spontaneous BRS using the sequence technique and temporal QT variability index (QTVI) in terms of intra-, interexaminer and within-subject variability in end-stage renal disease patients (ESRD, n=17, age 55+/-14 years) and healthy subjects (HS, n=29, age 32+/-12 years, P<0.01). ECG and blood pressure (Portapres) were recorded on two separate days and BRS and QTVI were evaluated by two independent examiners. The mean heart rate was similar in ESRD patients in comparison to healthy controls, whereas the mean arterial pressure was 13 % higher in ESRD patients (P<0.01). Spontaneous BRS was 62% lower (P<0.01) and QTVI was 41% higher in ESRD patients (P<0.01) compared to healthy subjects, respectively. Coefficient of variation (CV) of within-subject reproducibility of BRS and QTVI measurements was moderate (BRS: 33 % for ESRD, 27% for HS; QTVI: 40% for ESRD, 18% for HS). The 95% limit of within-subject reproducibility of BRS measurements was 3.8 ms/mm Hg for ESRD patients and 8.1 ms/mm Hg for healthy subjects; whereas the 95% limit of reproducibility of within-subject reproducibility of QTVI measurements was 0.73 for ESRD patients and 0.55 for healthy subjects. Concordance correlation coefficients of within-subject variability of BRS and QTVI were between 0.74 and 0.83 in both groups. CV of intra- and inter-examiner reproducibility of BRS and QTVI measurements in both groups ranged between 1 and 11%. In conclusion, the intra- and inter-examiner reproducibility/agreement of BRS and QTVI were high, whereas the within-subject reproducibility of these two methods was moderate, in both ESRD patients and healthy subjects. Thus, small differences in BRS and QTVI in longitudinal/interventional studies should be interpreted with caution.

Adult↗

Reproducibility of heart rate variability and blood pressure variability in individuals with spinal cord injury.

Individuals with spinal cord injury (SCI) are prone to orthostatic intolerance and an increased risk of cardiovascular disease. The use of heart rate variability (HRV) and blood pressure variability (BPV) as indices of cardiovascular regulation would be valuable in this population; however, their reproducibility has yet to be tested in those with SCI. The purpose of this study was to examine the day-to-day reproducibility of resting HRV and BPV in individuals with SCI. Ten individuals (age 35.9 +/- 13.2 yrs) with chronic (5.4 +/- 7.7 years post injury) SCI (C4-T12; ASIA A-C) participated. On two occasions within a two-week period, 10-minute supine electrocardiogram and Finapres blood pressure recordings were obtained during spontaneous breathing. Computer software calculated frequency domain measures of HRV and BPV (Low frequency (LF) power, High frequency (HF) power, and LF:HF ratio). Intraclass correlations coefficients (R) were used as an index of day-to-day reproducibility, and analyses were conducted on all participants and only those with tetraplegia. For HRV, measures of heart rate, LF, and LF:HF were found to be highly reproducible (R = 0.82-0.88); however, the reproducibility of HF was found to be poor (all participants: R = 0.53, tetraplegia: R = 0.66). Measures of blood pressure as well as systolic BPV also showed high reproducibility (R = 0.72-0.93). Measures of diastolic BPV were less reproducible but still acceptable (R = 0.71-0.89) with the exception of LF:HF(DBP) (R = 0.51). In conclusion, despite the autonomic dysfunction associated with SCI, measures of HRV and BPV may still be used as reproducible indices of autonomic cardiovascular regulation in this population.

Adult↗

Interstudy reproducibility of right ventricular volumes, function, and mass with cardiovascular magnetic resonance.

BACKGROUND: Cardiovascular magnetic resonance (CMR) has shown excellent results for interstudy reproducibility in the assessment of left ventricular (LV) parameters. However, interstudy reproducibility data for the more complex-shaped right ventricle in a large study group have not yet been reported. We sought to determine the interstudy reproducibility of measurements of right ventricular (RV) volumes, function, and mass with CMR and compare it with correspondent LV values. METHODS: Sixty subjects (47 men; 20 healthy volunteers, 20 patients with heart failure, 20 patients with ventricular hypertrophy) underwent 2 CMR studies for assessment of RV measurements with a minimum time interval between each study. RESULTS: The overall interstudy reproducibility (range between groups) for the RV was 6.2% (4.2%-7.8%) for end-diastolic volume, 14.1% (8.1%-18.1%) for end-systolic volume, 8.3% (4.3%-10.4%) for ejection fraction (EF), and 8.7% (7.8%-9.4%) for RV mass. RV reproducibility was not as good as for the LV for all measures in all 3 groups, but this was only statistically significant for EF (P <.01). CONCLUSIONS: CMR showed good interstudy reproducibility for RV function parameters in healthy subjects, patients with heart failure, and patients with hypertrophy, which suggests that CMR is reliable for serial RV assessment. These data can be used to power sample sizes for longitudinal research studies of RV volume and function. The reproducibility values were similar to, but generally lower than, the reproducibility values for the LV in the same study population, which indicates that sample sizes for RV studies are in general larger than those for LV studies.

Adult↗

Reproducibility of nitrate-stimulated tilt testing in patients with suspected vasovagal syncope and a healthy control group.

OBJECTIVE: Nitrate-stimulated tilt testing may be used to diagnose vasovagal syncope or to guide therapy. To date, the reproducibility of the test in patients with clinically suspected vasovagal syncope and healthy controls is undetermined. A high reproducibility is a prerequisite for correct interpretation of the test result. This study investigates the reproducibility of a nitrate-stimulated tilt test in patients with clinically suspected vasovagal syncope and a healthy control group. METHODS AND RESULTS: We studied 43 patients (24 women, 19 men) with a typical history of vasovagal syncope and 18 healthy controls (3 women, 15 men). We used a combined tilt protocol with a 30-minute passive and 15-minute nitrate-stimulated phase. The second tilt test was performed 16 +/- 12 days after the first. In both patients and controls, overall positive tilt responses were reproduced in the second test in 100%. In contrast to this, the reproducibility of an overall negative test was 50% in patients but 93% in controls. Overall hemodynamic responses to tilt were reproducible in 80%. CONCLUSION: Nitrate-stimulated tilt testing in both patients with suspected vasovagal syncope and controls has an excellent reproducibility of positive results but a moderate reproducibility of negative results. Importantly, these results are still valid at a repeat interval of 2 weeks and longer. These data suggest that in patients with suspected vasovagal syncope, a nitrate-stimulated tilt test may provide a suitable tool to evaluate the efficacy of a therapeutic approach.

Adolescent↗

The short-term and long-term reproducibility of spectral turbulence and late potential variables of the signal-averaged ECG in a population sample of healthy subjects and the impact of gender, age, and noise.

Previous methods for frequency domain analysis of the signal-averaged ECG (SAECG) have had low reproducibility. The reproducibility of time domain late potential analysis and spectral turbulence analysis was evaluated with 2 immediately consecutive SAECG recordings in 121 randomly selected subjects without heart disease (short-term) and also in 47 subjects after 1 month (long-term). A test was late potential positive if 2 or more of 3 variables were outside the reference limits and spectral turbulence positive if the score was 3 or 4. The short-term reproducibility was high for the filtered QRS duration (FQRSD), root mean square amplitude of the last 40 ms (RMS40) and high frequency low amplitude signals less than 40 microV (HFLAS40) of the time domain and total QRS duration (TQRSD), power spectral density of the last 40 ms and the late potential duration of time domain analogous analyses. The Spearman rank order correlation coefficients were 0.89, 0.88, and 0.84 and 0.97, 0.91 and 0.97, respectively. The reproducibility of the spectral score variables varied, and the correlation for the low slice correlation ratio was 0.71, spectral entropy 0.61, interslice correlation mean 0.58, and interslice correlation SD 0.28. A diagnostic inconsistency between 2 tests occurred in 0 (0%) subjects in late potential analysis if FQRSD was required for positivity, and in 7 (6%) otherwise, and in 9 (7%) of spectral turbulence analysis. If the spectral variable mean peaks per slice, with a correlation of 0.89, replaced interslice correlation SD in the spectral score, diagnostic inconsistency occurred in 0 (0%) subjects. The reproducibility seemed higher in women and in younger people but significantly only for interslice correlation subjects mean and HFLAS40. The long-term reproducibility did not differ significantly from short-term for any variable. In conclusion, the reproducibility was high in all time domain and time domain analogous variables. It varied among the spectral turbulence score variables and was very low for interslice correlation SD. The reproducibility of the spectral score improved substantially if this variable was replaced by mean peaks per slice.

Adult↗

The reproducibility of organ position using active breathing control (ABC) during liver radiotherapy.

PURPOSE: To evaluate the intrafraction and interfraction reproducibility of liver immobilization using active breathing control (ABC). METHODS AND MATERIALS: Patients with unresectable intrahepatic tumors who could comfortably hold their breath for at least 20 s were treated with focal liver radiation using ABC for liver immobilization. Fluoroscopy was used to measure any potential motion during ABC breath holds. Preceding each radiotherapy fraction, with the patient setup in the nominal treatment position using ABC, orthogonal radiographs were taken using room-mounted diagnostic X-ray tubes and a digital imager. The radiographs were compared to reference images using a 2D alignment tool. The treatment table was moved to produce acceptable setup, and repeat orthogonal verification images were obtained. The positions of the diaphragm and the liver (assessed by localization of implanted radiopaque intra-arterial microcoils) relative to the skeleton were subsequently analyzed. The intrafraction reproducibility (from repeat radiographs obtained within the time period of one fraction before treatment) and interfraction reproducibility (from comparisons of the first radiograph for each treatment with a reference radiograph) of the diaphragm and the hepatic microcoil positions relative to the skeleton with repeat breath holds using ABC were then measured. Caudal-cranial (CC), anterior-posterior (AP), and medial-lateral (ML) reproducibility of the hepatic microcoils relative to the skeleton were also determined from three-dimensional alignment of repeat CT scans obtained in the treatment position. RESULTS: A total of 262 fractions of radiation were delivered using ABC breath holds in 8 patients. No motion of the diaphragm or hepatic microcoils was observed on fluoroscopy during ABC breath holds. From analyses of 158 sets of positioning radiographs, the average intrafraction CC reproducibility (sigma) of the diaphragm and hepatic microcoil position relative to the skeleton using ABC repeat breath holds was 2.5 mm (range 1.8-3.7 mm) and 2.3 mm (range 1.2-3.7 mm) respectively. However, based on 262 sets of positioning radiographs, the average interfraction CC reproducibility (sigma) of the diaphragm and hepatic microcoils was 4.4 mm (range 3.0-6.1 mm) and 4.3 mm (range 3.1-5.7 mm), indicating a change of diaphragm and microcoil position relative to the skeleton over the course of treatment with repeat breath holds at the same phase of the respiratory cycle. The average population absolute intrafraction CC offset in diaphragm and microcoil position relative to skeleton was 2.4 mm and 2.1 mm respectively; the average absolute interfraction CC offset was 5.2 mm. Analyses of repeat CT scans demonstrated that the average intrafraction excursion of the hepatic microcoils relative to the skeleton in the CC, AP, and ML directions was 1.9 mm, 0.6 mm, and 0.6 mm respectively and the average interfraction CC, AP, and ML excursion of the hepatic microcoils was 6.6 mm, 3.2 mm, and 3.3 mm respectively. CONCLUSION: Radiotherapy using ABC for patients with intrahepatic cancer is feasible, with good intrafraction reproducibility of liver position using ABC. However, the interfraction reproducibility of organ position with ABC suggests the need for daily on-line imaging and repositioning if treatment margins smaller than those required for free breathing are a goal.

Humans↗

Reproducibility of ultrasound blood flow measurement of the superior mesenteric artery before and after exercise.

This study examines the reproducibility of gastro-intestinal blood flow measurements in the superior mesenteric artery (SMA) both before and immediately after exercise with Doppler ultrasound measurements. Twelve well-trained males (mean +/- SD: age 25.9 +/- 3.8 yr; VO2max 4.8 +/- 0.91 x min(-1)) were measured twice (trial 1 and 2) with a 1 week interval before and immediately after 1 hr cycling at 70% VO2max. Duplex scanning was performed with the athletes in supine position immediately after transition from a chair (before exercise) or bicycle (after exercise). The variability of three measurements before exercise was studied within both trials (short-term reproducibility) and the mean pre-exercise values were compared between the trials (long-term reproducibility). In addition, post-exercise measurements were compared in the same way. Reproducibility was tested using the coefficient of variation and Cronbach's alpha. Mean pre-exercise blood flow was 424 +/- 66 ml/min (n = 12) in trial 1 and 375 +/- 38 ml/min (n = 11) in trial 2. Immediately after exercise blood flow had decreased by 49% to 214 +/- 36 ml/min (p <0.01) in trial 1 and by 38% to 234 +/- 36 ml/min (p < 0.01) in trial 2. Blood flow before and after exercise was not significantly different between trials (paired t-test) and therefore reproducible at the group level. Before exercise a good to fair reproducibility was observed both at the short-term (Cronbach's alpha: 0.88 in trial 1, 0.73 in trial 2, n = 11), and at the long-term (alpha = 0.80, n= 11). In contrast, long-term reproducibility immediately after exercise was poor (alpha = -0.99, n = 8 and alpha = 0.36, n = 7 after the first and second cycling period, respectively). In conclusion, duplex scanning of SMA after a sitting-supine transition in well-trained subjects is not a reproducible method at the individual level for intestinal blood flow measurements immediately after exercise.

Adult↗

Interstudy reproducibility of parameters of left ventricular diastolic function: a Doppler echocardiography study.

BACKGROUND AND METHODS: Interstudy reproducibility of echocardiography for the assessment of parameters of left ventricular (LV) diastolic function is disputed. Therefore, we evaluated the reproducibility of echocardiography for assessment of LV diastolic Doppler parameters in 40 consecutive patients (age range: 19-77 years), who underwent 2 echocardiographic examinations by trained sonographers following a standard protocol, in conditions in which intrapatient sources of variability were minimized. RESULTS: Interstudy reproducibility of measurements of the ratio of early (E) to late (A) peak velocities of transmitral flow (E/A) at tips of the mitral valve leaflets was found to be very good and substantially greater than analogous measurement obtained at mitral annulus level. Reproducibility of measurement of atrial filling fraction was good both at tips of mitral leaflets and at annular level. Interstudy reproducibility of isovolumic relaxation time and E-wave deceleration time was moderate. Measurements of E-wave propagation rate and the ratio of early (E') to late (A') peak velocities of diastolic excursion of lateral mitral annulus (E'/A') by Doppler tissue were found highly reproducible. Intrastudy between-reading reproducibility of Doppler parameters of LV diastolic function were overall very good, except for E-wave deceleration time. However, 80% confidence interval of absolute between-study differences of diastolic parameters were relatively large, and ranged from -0.11 to +0.19 for E/A at tips of mitral valve; -5 to +9 cm/s for E-wave propagation rate; and -0.69 to +0.19 for Doppler tissue-derived E'/A'. CONCLUSIONS: Under a standardized echocardiographic protocol and sonographers' training program, echocardiography can be a reproducible method for serial assessment of Doppler parameters of LV diastolic function, especially in cohort studies.

Adult↗

Natural head posture--considerations of reproducibility.

This three-part study investigated the reproducibility of natural head posture (NHP) using radiographs and photographs. In part 1, reproducibility of cephalograms 1 year after the introduction of NHP was investigated and found to be less favourable (Dahlberg coefficient of 2.99 degrees) than most other previous investigations. In order to minimize radiation exposure of patients, reproducibility of photographs and method agreement between photographs and cephalograms were investigated in part 2. Reproducibility of the two photographs was poor (2.71 degrees). However, method agreement between cephalograms and the photographs taken at the same time was good (1.39 degrees). Replacement of the radiographic method with the photographic method for assessing NHP reproducibility appeared justified. Changing the protocol for achieving NHP in part 3 of the study improved reproducibility substantially (1.41 degrees). Various statistical methods were used to assess reproducibility and method agreement. Bland and Altman's graphical representation was found to be the most appropriate for method agreement. The Dahlberg coefficient, commonly used to assess NHP repeatability/reproducibility, does not provide an extreme enough interval to allow a sufficient clinical assessment of a method to be undertaken, compared with the reproducibility coefficient. That is, the latter provides a 95 per cent range, compared with 52 per cent with Dahlberg.

Cephalometry↗

Reproducibility of performance-based and self-reported measures of functional status.

BACKGROUND: The reproducibility of a performance-based and a self-reported measure of functional status was investigated, as well as the impact of age and cognitive function on the reproducibility. METHODS: Of a random sample of 114 men of the 1995 survey of the Zutphen Elderly Study, 105 men (aged 79.9 +/- 4.5 years) participated in a test-retest study. They filled out a questionnaire on disabilities and carried out performance tests twice, in a 2-week interval. Four performance tests were administered (standing balance, walking speed, chair stand, and external shoulder rotation), and a summary performance score was constructed. The number of self-reported disabilities in basic activities of daily living, mobility, and instrumental activities of daily living were assessed. Kappa statistics and Pearson correlation coefficients between test and retest measurements were computed for the total group and stratified by age and cognitive function. RESULTS: Three performance tests and the summary performance score had fair to good reproducibility (walking speed: Pearsons r = .90, chair stand: r = .82, shoulder rotation: kappa = .49, summary score: kappa = .52). Only the test for standing balance was poorly reproducible (kappa = .29). The self-reported functional status was fairly to good reproducible (kappa = .63, r = .87). Self-reported functional status was significantly less reproducible in very old and cognitively impaired than in younger and nonimpaired individuals. CONCLUSIONS: In the elderly male subjects, performance tests and self-reported disabilities had moderate to good reproducibility, with the exception of the test for standing balance. In very old or cognitively impaired populations, self-reported functional status may have a lower reproducibility.

Activities of Daily Living↗

Reproducibility of the circadian systolic blood pressure variation in the elderly.

OBJECTIVES: To establish the reproducibility of the nocturnal systolic blood pressure (SBP) change in elderly subjects and to examine the use of cumulative sums (cusums) analysis in the assessment of circadian SBP variation. SUBJECTS: Forty-two untreated elderly subjects (35 hypertensive, 7 normotensive) of mean age 75.5 years from the hypertension clinic at a large teaching hospital participated in a reproducibility study. METHODS: Twenty-four-hour ambulatory blood pressure monitoring was performed and repeated at a median interval of 2 months (range 2 weeks to 9 months). OUTCOME MEASURES: Reproducibility of circadian SBP variation from fixed time analysis of day-night SBP difference and from cusums-based parameters. RESULTS: Twenty-four-hour SBP values were highly reproducible with a coefficient of variation of 5.8%. However, the day-night SBP difference for fixed time periods was poorly reproducible, with a coefficient of variation > 130%. A substantial proportion of subjects (36-43%) altered their 'dipping status' between visits. The use of cusums analysis improved the reproducibility of measures of circadian SBP change (cusums plot height and maximum circadian variation) with coefficients of variation falling to 40 and 38%, respectively. CONCLUSIONS: The use of fixed time definitions results in poor reproducibility of the circadian SBP change in the elderly, which will lead to regression dilution bias when studying the relationship of circadian SBP variation to outcome measures in hypertension. The notion of dipping and non-dipping circadian blood pressure patterns should be abandoned in favour of more reproducible cusums-based measures of circadian blood pressure variation.

Aged↗

Reproducibility of heart rate variability, blood pressure variability and baroreceptor sensitivity during rest and head-up tilt.

OBJECTIVE: Previous studies have indicated moderate-to-poor reproducibility of heart rate variability (HRV) but the reproducibility of blood pressure variability (BPV) and spectral measures of baroreceptor sensitivity (BRS) are not well established. METHODS: We measured normal-to-normal heart beat (RR) interval and finger blood pressure (Finapres) in 14 healthy individuals on three different days. The protocol was 1 h of supine rest and 1 h of 60-degree head-up tilt. Time-series of consecutive 300-s segments as well as 1024-s segments of RR intervals and systolic, diastolic and mean blood pressures were extracted for the assessment of day-to-day and short-term reproducibility. Power spectrum analysis (Fourier) and transfer function analysis was performed. Reproducibility was assessed using the coefficient of variation (CV). The reproducibility of the mean RR interval, mean systolic, diastolic and mean blood pressure was good (CV<10 %). However, there was only moderate-to-poor reproducibility of the spectral parameters of HRV (CV range 18-36%) and BPV (16-44%) and moderate reproducibility of BRS (14-20%). CONCLUSION: Spectral estimates of BRS had only moderate reproducibility although it was better than the spectral estimates of HRV and BPV.

Adult↗

Reproducibility of symptom-limited exercise-stress testing performed 2 and 6 weeks after myocardial infarction.

To assess the reproducibility of variables with prognostic value from exercise testing, two symptom-limited treadmill exercise tests were performed in 76 consecutive patients at 2 weeks (predischarge) and 6 weeks after myocardial infarction. In addition, cardiac catheterization was performed at 6 weeks. Exercise duration showed a moderate increase from 7.9 +/- 4.4 min to 8.8 +/- 3.0 min (NS). The rate-pressure product increased from 22,377 +/- 5491 to 24,832 +/- 7261 (P less than 0.001). Reproducibility of ST-segment depression was dependent on the initial response: among the group of 25 patients with ST-segment depression at 2 weeks, only 13 (52%) patients had a reproducible result, whereas among the group of 51 patients without initial ST-segment depression, 40 (78%) patients showed reproducibility. There was no difference in coronary anatomy or ejection fraction between the groups with and without reproducibility results. Among the 30 patients with initial ST-segment elevation, 15 (50%) patients showed reproducibility, while among the 46 patients without initial ST-segment elevation, 42 (91%) patients showed reproducibility: the ejection fraction was significantly higher in the latter group than in the group of patients with lower reproducibility. Thus predischarge exercise testing in postinfarction patients identifies a different group of patients at risk compared to exercise testing after 6 weeks, due to considerable variation between the two tests.

Adult↗