• Journal of East-West Nursing Research
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• v.26 no.1
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• pp.91-99
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• 2020

Purpose: The study aims to assess the inter-rater reliability of the Korean Triage and Acuity Scale between the research nurses and the triage nurses. Methods: Interrater reliability was measured on 400 adult (≧15) and 400 pediatric (<15) patients who visited the emergency medical center from January 4 to June 30, 2018. Results: The study result showed that the inter-rater reliability of the Korean Triage and Acuity Scale was substantial, with κ=.73 (95% Confidence interval= .68-.78) and 77.0 percent agreement. The inter-rater of Pediatric Korean Triage and Acuity Scale was also substantial, with κ=.76 (95% Confidence interval= .71-.82) and 83.8 percent agreement. Conclusion: Although the inter-rater reliability of the Korean Triage and Acuity Scale was acceptable, the percent agreement was lower than the desirable level (<80.0%). It was confirmed that Pediatric Korean Triage and Acuity Scale had an acceptable level of inter-rater reliability and percent agreement for clinical use. Efforts should be made to improve the reliability in the future.

• The Journal of Internal Korean Medicine
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• v.34 no.3
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• pp.231-239
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• 2013

Objectives : This study was performed to evaluate inter-rater and intra-rater reliability of interpretation and reproducibility of a pulse analyser (MAXMAC27-Plus). Methods : 38 of 40 volunteers completed the pulse analysis consecutively. Three Korean medical doctors who had at least 2 years of clinical experience interpreted the pulse waves for 3 aspects of size, depth and shape, then inter-rater reliability and crude agreement was obtained. Reinterpretation was done 2 weeks later and intra-rater reliability and crude agreement was obtained. Intra-rater reliability and crude agreement between 1st and 2nd measurement was calculated. Cohen's weighted kappa for size, Cohen's kappa for depth and shape were used as statistical analysis. Results : Inter-rater reliability of size, depth and shape among 3 raters was 0.598, 0.604, and 0.312, respectively, showing moderate to substantial agreement. Average intra-rater reliability between 1st and 2nd interpretation of size, depth and shape was 0.806, 0.705, and 0.638, respectively, showing substantial to almost perfect agreement. However, intra-rater reliability between consecutive measurements of size, depth and shape was 0.221, 0.121, and 0.194, respectively, which showed only poor to fair agreement. Conclusions : Intra-rater and inter-rater reliability of one pulse wave showed relatively high concordance. Training by a clinical expert may effect better concordance among raters. Test-retest reliability showed poor agreement. Improvement of measurement technique and device performance will be needed.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.30 no.4
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• pp.97-103
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• 2017

Objectives : To identify whether pattern identification using nasal endoscopy for rhinitis can be applied as a tool for evaluating rhinitis in routine care setting, we performed a inter-rater reliability study on this pattern identification. Methods : Two Korean medicine doctors assessed 290 left/right nasal endoscopy photograph cases of rhinitis patients with pattern identification using nasal endoscopy. This pattern identification consist of four assessment items, nasal membrane color(pale/hyperemia), nasal membrane humidity(dryness/dampness), rhinorrhea(watery/yellow), and turbinate membrane edema(atrophic/edematous). Cohen's kappa statistic and Percentage agreement were used to evaluate the inter-rater reliability. Results : Inter-rater percentage agreement and Kappa coefficient for left nasal endoscopy photograph cases was from 'slight' to 'moderate'(% agreement: 40.00-67.59%/Kappa: 0.06-0.407). Only the agreement of 'rhinorrhea (watery/yellow)' item was moderate(% agreement: 67.59%/Kappa: 0.407). Inter-rater percentage agreement and Kappa coefficient for right nasal endoscopy photograph cases was also from 'slight' to 'moderate'(% agreement: 42.41-68.97%/Kappa: 0.109-0.465). Only the agreement of 'rhinorrhea(watery/yellow)' item was moderate(% agreement: 68.97%/Kappa: 0.465). Conclusions : It is necessary to resolve problems such as cut-off value setting, bipolar evaluation values(pale/hyperemia, dryness/dampness, watery/yellow, atrophic/edematous) and weighting items. Further rigorous studies that overcome the limitations of the current research are warranted.

• Journal of Korean Clinical Nursing Research
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• v.21 no.2
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• pp.207-214
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• 2015

Purpose: This study was aimed to investigate the effect of an education program on inter-rater agreement of Neonatal/Infant Braden Q Scale for clinical nurses working at a neonatal intensive care unit (NICU). Methods: This was single-arm pre and post experimental study. The participants were 12 nurses and 128 hospitalized neonates at a NICU from December, 2012 to March, 2013. Twelve nurses were divided into four different groups; for two groups were assigned nurses with 3 to 5 years of clinical experiences, and for the others with less than 1 year of clinical experience. The interventions were given by one wound ostomy specialist and two NICU nurses with over 5 years of clinical experiences for 1 hour twice. The inter-rater agreement was measured by intraclass-correlation coefficient. Results: Overall inter-rater agreement was improved from .87(95% CI: .80~.92) at the pre-test to .94(.91~.96) at post-test. Each inter-rater agreement except moisture and nutrition was also improved. Conclusion: The developed education program on scoring for Neonatal/Infant Braden Q scale was effective to improve the inter-rater agreement among clinical nurses. We suggest to privide an education for NICU nurse before using the Neonatal/Infant Braden Q scale in clinical settings.

• Physical Therapy Korea
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• v.21 no.3
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• pp.73-79
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• 2014

The purposes of the current study were to (1) estimate the inter-rater agreement for visual assessment of scapular downward rotation (SDR), (2) develop the scapular downward rotation index (SDRI) as a method to measure SDR objectively and quantitatively, and (3) analyze the intra- and inter-rater reliability of the SDRI. Twenty subjects with scapular downward rotation syndrome (SDRS) were recruited for this study. The visual assessment and the measurement for the SDRI were conducted by two examiners in two sessions each. The SDRI [$(a-b){\div}a{\times}100$] is calculated with the measurement of two linear distances: One is a perpendicular distance from the root of the scapular spine to the thoracic mid-line (a), and the other is a perpendicular distance from the inferior angle of the scapula to the thoracic mid-line (b). Cohen's kappa coefficient was calculated to estimate the inter-rater agreement for visual assessment. Intra-class correlation coefficients (ICCs) with a 95% confidence interval (CI), the standard error of measurement, and minimal detectable differences were calculated to assess intra- and inter-rater reliability of SDR measurement using the SDRI. The results indicated that the kappa coefficient of inter-rater agreement for visual assessment was fair (${\kappa}=.21$). The intra-rater reliability of SDR measurement using the SDRI was excellent for examiner 1 (ICC=.92, 95% CI=.78~.97) and good for examiner 2 (ICC=.82, 95% CI=.55~.93). The inter-rater reliability was moderate (ICC=.73, 95% CI=.32~.89). These findings showed that SDR measurement using the SDRI for subjects with SDRS may be considered reliable and better than the visual assessment.

• KIEAE Journal
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• v.12 no.3
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• pp.69-75
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• 2012

Developing reliable measures of the environment is important to increase our understanding of the environmental effects on walking among seniors. As a preliminary study for developing an instrument for measuring walkability of seniors' environment, the purpose of this study are to identify important assessment indicators associated with seniors' walking and to test their reliability using inter-rater and intra-rater reliability methods. A set of assessment indicators was identified through literature review, and field studies by trained raters were conducted in three senior centers located in Seongnam area in order to test reliability of the audit tool. The results indicated high percent agreement for most indicators and overall 91.6% and 86.1% of items assessed had good or medium inter-rater and intra-rater reliability, respectively. The reliable assessment indicators would provide reliable data for use in community-based audits of built environment in relation to walking among older adults. The findings showed that the indicators of aesthetics had lower reliability compare to safety, convenience, and access. Rater training with various images would improve rater agreement while reduce rater bias.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.26 no.2
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• pp.10-18
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• 2013

Objectives : We performed a pilot study to investigate inter- and intra-rater reliability of pattern identification using nasal endoscopy for allergic rhinitis(AR). Methods : Eight experts of ophthalmology, otolaryngology and dermatology of Korean medicine evaluated 20 nasal endoscopy photograph cases of AR patients with pattern identification index using nasal endoscopy for AR including the nasal membrane color(pale / hyperemia), nasal membrane humidity(dryness / dampness), rhinorrhea(watery / yellow), and membrane edema (atrophic / edematous) on nasal endoscopy. Results : Intra-rater agreement(%) and Kappa coefficient was generally from 'moderate' to 'good'(% agreement: 73.13-90% / Kappa coefficient: 0.547-0.748). Inter-rater agreement(%) and Kappa coefficient was also from 'moderate' to 'good' (% agreement: 65-85% / Kappa: 0.475-0.778) except 'humidity(dryness / dampness)' item (% agreement: 55.98% / Kappa: 0.340). In findings of subgroup analysis according to affiliation of raters, Inter-rater agreement(%) and Kappa coefficient of raters in same affiliation was higher than inter-rater agreement(%) and Kappa coefficient of raters in different affiliation except 'dryness / dampness' item. Conclusions : It is necessary to improve objectivity and reproducibility of pattern identification using nasal endoscopy for allergic rhinitis(AR) through the development of detail-oriented criteria and enhanced training of clinicians with development of standard operating procedures(SOPs).

• Clinics in Shoulder and Elbow
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• v.25 no.1
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• pp.49-56
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• 2022

Background: The treatment approach for proximal humeral fractures is determined by various factors, including patient age, sex, dominant arm, fracture pattern, presence of osteoporosis, preexisting arthritis, rotator cuff status, and medical comorbidities. However, there is a lack of consensus in the literature regarding the optimal treatment for displaced proximal humeral fractures. This study aimed to assess and quantify the decision-making process for either conservative or surgical treatment and the choice of surgical method among shoulder surgeons when treating proximal humeral fractures. Methods: Forty sets of true anteroposterior view, scapular Y projection view, and three-dimensional computed tomography of proximal humeral fractures were provided to 12 shoulder surgeons along with clinical information. Surveys regarding Neer classification, decisions between conservative and surgical treatments, and chosen methods were conducted twice with an interval of 2 months. The factors affecting the treatment plans were also assessed. Results: The inter-rater agreement was fair for Neer classification (kappa=0.395), moderate for the decision between conservative and surgical treatments (kappa=0.528), and substantial for the chosen method of surgical treatment (kappa=0.740). The percentage of agreement was 71.1% for Neer classification, 84.6% for the decision between conservative and surgical treatment, and 96.4% for the chosen method of surgical treatment. The fracture pattern was the most crucial factor in deciding between conservative and surgical treatments, followed by age and physical activity. Conclusions: The decision between conservative and surgical treatment for proximal humeral fractures showed good agreement, while the chosen method between osteosynthesis and arthroplasty showed substantial agreement among shoulder surgeons.

• The Journal of Korean Physical Therapy
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• v.27 no.5
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• pp.311-314
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• 2015

Purpose: This study attempted to determine intra-rater reliability and inter-rater reliability for measurement of foot form using the FPI-6 (Foot Posture Index) in patients with hemiplegia caused by stroke. Methods: Twenty two stroke patients were recruited into the research and their foot posture was evaluated using the FPI. Two raters assessed 6 items sequentially in accordance with the FPI-6 manual. This procedure involved asking the subject to take several steps in-place, prior to settling into a comfortable stance position with double limb support. Subjects were instructed to stand still with their arms by their sides and look straight ahead. FPI-6 values ranged from -2 to +2 for each of the six criteria and from -12 to +12 for the total score, indicating a position for each foot either along the supinated (negative score) to pronated (more than +6) continuum of foot posture. Results: The results showed that intra-rater reliability and inter-rater reliability for a total FPI-6 score was high: 0.807-0.888. An almost perfect agreement between the two raters was identified in the foot's morphological classification (Somer's D=0.712; p<0.05). Intra-percentage agreement was high (88.6%). Conclusion: The FPI-6 is a quick, simple, and reliable clinical tool with demonstrated good to excellent intra-rater reliability and good inter-rater reliability when used in assessment of the stroke patient's foot.

• Journal of the Korean Society of Physical Medicine
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• v.9 no.2
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• pp.201-211
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• 2014

PURPOSE: The purpose of this study was to investigate the inter-rater absolute reliability and the concurrent validity of the Tinetti-gait scale that was translated into Korean for chronic stroke patients. METHODS: Fifty-two patients with post-stroke participated in this study. Inter-rater reliability was analyzed by Intraclass Correlation Coefficient ($ICC_{3,1}$) and Kappa coefficient, and absolute reliability was analyzed by the Standard Error of Measurement (SEM), and the Minimal Detectable Change (MDC). Concurrent validity was analyzed by correlating between the Tinetti-gait scale and physical functions. The physical functions were measured by using the Dynamic Gait Index(DGI), 10m walking test(10WT), One Leg Standing Test of affected/non-affected side(OLST), Sit to Stand test(STS), (Fugl Meyer assessment of Lower Extremity(FM-LE). RESULTS: The inter-rater reliability of the Tinetti-gait scale was high; $ICC_{(3,1)}=.91$ (95% CI=.85~.95) (very reliable), the range of Kappa coefficient were .73~.92 (substantial~good). The inter-rater agreement of the each item in Tinetti-gait scale ranged from .74 to .92 (95 % CI=.59~.95) (reliable~very reliable). The SEM and MDC were .56 and 1.55, respectively. In the results of concurrent validity, there were moderate positive correlation between Tinetti-gait scale and DGI (r=.78), 10WT (r=.74), OLST (r=.65~.73), FM-LE (r=67). And there was moderate negative correlation between Tinetti-gait scale and STS (r=-79) (p<.01). CONCLUSION: The Tinetti-gait scale(Korean version) was a reliable and valid tool to measure gait ability in patients with chronic stroke. Thus, it could be a useful tool for examining a gait ability of post-stroke patients. Further study should be conducted to investigate the usability to predict fall risk of post-stroke patients of the Tinetti-gait scale.