Assessment of Operator Reliability in Ultrasound of the Median and Ulnar Nerve Using Bland-Altman Analysis
Abstract
:1. Introduction
- To develop a short standardized protocol to assess the level of agreement between operators based on sample size and precision calculations of Bland–Altman analysis;
- To use this protocol in a team of operators with different expertise levels in nerve ultrasound and compare the results of Bland–Altman agreement analysis to the calculation of intraclass correlation coefficients (ICCs) and coefficients of variation.
2. Materials and Methods
2.1. Participants
2.2. Ultrasound Examination
2.3. Blinding
2.4. Statistical Calculations
3. Results
3.1. Demographics
3.1.1. Sample Size and Normal Distribution Analysis
3.1.2. Preiss–Fisher Procedure
3.1.3. Bland–Altman Analysis
4. Discussion
- That operator reliability in nerve ultrasound of the median and ulnar nerve can be evaluated with a short prospective controlled protocol using Bland–Altman statistics;
- That a clear distinction between an untrained rater, trained novices after two months of training, and an experienced rater can be made using Bland–Altman agreement analysis.
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
BMI | body mass index |
CSA | cross-sectional area |
ICC | intraclass correlation coefficients |
LoA | limits of agreement |
CI | Confidence interval |
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Nerve Site | Rater Mean (SD) | Rater 2 Mean (SD) | Rater 3 Mean (SD) | Rater 4 Mean (SD) | Rater 5 Mean (SD) |
---|---|---|---|---|---|
Median nerve at the carpal tunnel CSA | 8.01 (1.30) | 7.49 (1.71) | 8.20 (2.23) | 8.94 (1.05) | 7.90 (1.32) |
Median nerve in the forearm CSA | 7.40 (1.68) | 6.29 (1.22) | 6.80 (1.34) | 6.33 (1.16) | 6.80 (1.27) |
Median nerve in the upper arm CSA | 7.93 (1.76) | 8.77 (1.13) | 8.63 (1.78) | 8.49 (1.12) | 8.86 (1.37) |
Ulnar nerve at Guyon’s canal CSA | 5.71 (1.46) | 4.83 (0.86) | 5.06 (1.12) | 5.54 (0.79) | 5.21 (0.67) |
Ulnar nerve in the forearm CSA | 5.33 (1.21) | 5.34 (1.51) | 5.24 (1.49) | 5.70 (0.73) | 5.41 (0.89) |
Ulnar nerve in the upper arm CSA | 7.40 (1.29) | 7.13 (1.49) | 6.74 (1.55) | 6.77 (1.38) | 7.74 (1.77) |
Rater | Training Time | Bland–Altman Agreement Analysis Mean Differences | Bland–Altman Agreement Analysis Limits of Agreement (Approximate 95% CI) [Exact 95% CI] | Interrater Reliability Intraclass Correlation Coefficients (95% CI) | Coefficient of Variation | Intrarater Reliability Intraclass Correlation Coefficients (95% CI) |
---|---|---|---|---|---|---|
control | none | 0.2 | −4.6/5.0 (−5.9/6.3) [−6.0/6.4] | 0.23 (0–0.49) | 26.3% | 0.05 (0–0.35) |
1 | 2 months | 0.0 | −2.8/2.8 (−3.6/3.6) [−3.7/3.7] | 0.68 (0.47–0.81) | 14.3% | 0.73 (0.55–0.85) |
2 | 2 months | −0.3 | −2.7/2.0 (−3.4/2.7) [−3.5/2.8] | 0.77 (0.60–0.87) | 12.9% | 0.72 (0.54–0.84) |
3 | 2 months | −0.2 | −2.9/2.5 (−3.7/3.2) [−3.7/3.3] | 0.75 (0.58–0.86) | 13.9% | 0.62 (0.40–0.78) |
4 | 2 years | −0.0 | −2.3/2.2 (−2.9/2.8) [−2.9/2.9] | 0.78 (0.62 to 0.88) | 11.6% | 0.89 (0.81–0.94) |
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Philipps, J.; Mork, H.; Katz, M.; Knaup, M.; Beyer, K.; Spies, K.; Corbach, J.; Schellinger, P.D. Assessment of Operator Reliability in Ultrasound of the Median and Ulnar Nerve Using Bland-Altman Analysis. Diagnostics 2021, 11, 2134. https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11112134
Philipps J, Mork H, Katz M, Knaup M, Beyer K, Spies K, Corbach J, Schellinger PD. Assessment of Operator Reliability in Ultrasound of the Median and Ulnar Nerve Using Bland-Altman Analysis. Diagnostics. 2021; 11(11):2134. https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11112134
Chicago/Turabian StylePhilipps, Jörg, Hannah Mork, Maria Katz, Mark Knaup, Kira Beyer, Kristina Spies, Johannes Corbach, and Peter D. Schellinger. 2021. "Assessment of Operator Reliability in Ultrasound of the Median and Ulnar Nerve Using Bland-Altman Analysis" Diagnostics 11, no. 11: 2134. https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11112134