INTRA- AND INTER-RATER RELIABILITY OF THE AMPUTEE MOBILITY PREDICTOR IN THE LOCAL CLINICAL ENVIRONMENT

EUGENIA SOLEDAD MUÑOZ LARROSA; CESAR IGNACIO DUTTO; VERÓNICA BARRERA; CECILIA BERNAL; PAOLA CATALFAMO FORMENTO

Porto Alegre, RS

Congreso; VXII Congresso Brasilero de Biomecânica, I Encuentro Latinoamericano de Biomecánica e VII Simposio en Neurociencia Aplicada; 2017

Sociedade Brasileira de Biomecánica

INTRODUCTION The Amputee Mobility Predictor© (AMP) is an outcome measure designed to measure ambulatory potential of lower-limb amputees with (AMPPRO) and without (AMPnoPRO) the use of a prosthesis (1), and its use in clinical environments has been endorsed (2). Gailey et al.(1) tested the intra and inter-rater reliability of the test on trained and experienced examiners, with promising results. As part of a clinical investigation, the test was proposed as one of the clinical outcomes of a local protocol, where the degree of training and experience of the raters may be variable. Given that the psychometric properties of any outcome measure are specific to the population and setting in which the measures are used (3), it is important to test de reliability in the local clinical environment and to evaluate the impact of the experience and training on the reliability of the outcome.METHODS Videographic data of 5 unilateral trans-tibial amputees while performing the test with their prostheses was used. The participants were at different stages of the rehabilitation program. Two groups of raters participated: an experienced group (EG), formed by 4 specialists with at least 5 years of experience in either Analysis of Human Movement or clinical patient evaluations; an inexperienced group (IG), formed by 4 examiners. The evaluations were performed in random order. All the raters were trained in a 1-hour session, using a video of a healthy person performing the AMP test. Then, each rater scored the 5 patients and in a second session (14 ± 7 days after the first) the evaluation was repeated. Intra-class correlation coefficient (ICC) was used to determine intra and inter-rater reliabilities using the second model on a single measurement, as used in the literature (2, 4-6).RESULTS AND DISCUSSION ICC inter-rater were obtained for the complete group ICCinter= 0.869, and for each subgroup: ICCinter_EG= 0.9026 and ICCinter_IG,1= 0.8498. These results show a substantial reliability (7), with a greater reliability in the EG. In the second measurement, ICCinter_GI,2= 0.9348, indicating that the reliability increases with practice (or increased training). Regarding the intra-raters reliability: ICCintra=0.8929, ICCintra_EG= 0.9055 y ICCintra_IG= 0.8824. These results show that AMPRO has substantial intra-rater repeatability within the group of examiners (7). These results are slightly lower to those obtained by the authors of the AMP (ICCintra_O=0.96). The difference may be due to the degree of training given to the original raters.CONCLUSION The AMPPRO showed substantial reliability values, indicating that it is feasible to be applied in a local clinical environment. The reliability was greater in raters who had experience and training in patient assessment, but it was substantial for all groups. Results also showed that training may increase the reliability of the test in a group of inexperienced raters.REFERENCES1. Gailey RS, Roach KE, Applegate EB, Cho B, Cunniffe B, Licht S, Maguire M, Nash MS. The Amputee Mobility Predictor: an instrument to assess determinants of the lower-limb amputee ability to ambulate. Arch Phys Med Rehabil 2002;83:613-27..2. Cole M. J., Cumming J., Golland N., Hayes S., Ostler C., Scopes J., Tisdale L. BACPAR Toolbox of outcome measures. 2014; Version 2.3. Sauer B., VanderWeele T. J. Use of Directed Acyclic Graphs. Developing a Protocol for Observational Comparative Effectiveness Research: A User?s Guide. 2013; Vol. 1: 85?134.4. Prieto Luis, Lamarca Rosa, Casado Alfonso. La evaluación de la fiabilidad en las observaciones clínicas: el coeficiente de correlación intraclase. MedicinaClinica. 1998; Vol. 110. Núm. 4.5. Pita Fernández S, Pértegas Díaz S. La fiabilidad de las mediciones clínicas: El análisis de concordancia para variables numéricas. 1995; 1?11.6. Hernández I., Porta M., Miralles M., García Benavides F., Bolúmar F. La cuantificación de la variabilidad en las observaciones clínicas. Medicinal Clínica. 1990; 424?429.7. Michael S. Kramer y Alvan R. Feinstein. Clinical Biostatics LIV. The biostatics of concordance. Clin. Pharmacol. 1981;111-123