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Isokinetic Robotic Device to Improve Test-Retest and Inter-Rater Reliability for Stretch Reflex Measurements in Stroke Patients with Spasticity

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Pitfalls and important issues in testing reliability using intraclass correlation coefficients in orthopaedic

Kyoung Min Lee¹, Jaebong Lee, Chin Youb Chung

¹Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.

Clinics in Orthopedic Surgery

|June 5, 2012

Summary

Intra-class correlation coefficients (ICCs) in orthopedics are often misinterpreted. A higher ICC does not always mean less variability, as factors like data range and interobserver agreement influence values.

Keywords:

Intraclass correlation coefficient Orthopaedic research Reliability

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Area of Science:

Orthopedics
Biostatistics
Medical Research Methodology

Background:

Intra-class correlation coefficients (ICCs) are used to assess reliability in research.
Interpretation of ICCs is not consistently documented in orthopedic literature.
This study addresses the need for clarity in ICC application and interpretation within orthopedics.

Purpose of the Study:

To investigate the utilization of ICCs in orthopedic research.
To identify and demonstrate potential pitfalls in the application and interpretation of ICCs.
To provide recommendations for accurate reporting and understanding of ICC values.

Main Methods:

Systematic review of orthopedic articles using ICCs from PubMed.
Evaluation of journal demographics, ICC models, and statistical methods employed.
Reliability testing of common orthopedic physical examinations (Thomas test, Staheli test, popliteal angle) with simulated data sets.

Main Results:

A significant majority of orthopedic articles (63%) failed to specify the ICC model used.
Inconsistencies observed where measurements with larger differences had higher ICCs.
Simulated data showed ICC values are influenced by data range, slope parallelism, and interobserver variability.

Conclusions:

Absolute ICC values require careful interpretation; higher values do not inherently indicate less variability.
Factors such as the chosen ICC model, type, and measures significantly impact reported ICC values.
Researchers should clearly state ICC models and interpret values within the specific measurement context.