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      Test-retest repeatability of strength capacity, aerobic power and pericranial tenderness of neck and shoulder muscles in children - relevant for tension-type headache

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          Frequent or chronic tension-type headache in children is a prevalent and debilitating condition for the child, often leading to medication overuse. To explore the relationship between physical factors and tension-type headache in children, the quality of repeated measures was examined. The aim of the present study was to determine the test-retest repeatability of parameters determining isometric neck and shoulder strength and stability, aerobic power, and pericranial tenderness in children.


          Twenty-five healthy children, 9 to 18 years of age, participated in test-retest procedures within a 1-week interval. A computerized padded force transducer was used for testing. The tests included the isometric maximal voluntary contraction and force steadiness of neck flexion and extension, and the isometric maximal voluntary contraction and rate of force of the dominant shoulder. Pericranial tenderness was recorded by means of standardized manual palpation, and a submaximal cycle ergometer test predicted maximal oxygen uptake (VO 2 max). The measurements were evaluated in steps, using the intraclass correlation coefficient (ICC); changes in the mean between the two test occasions; the levels of agreement, visualized in Bland-Altman Plots; and by quantifying the variability.


          The results showed an acceptable test-retest repeatability of isometric maximal voluntary contraction (ICC 0.90–0.97). The force steadiness measurements revealed a trend of systematic changes in the direction of neck flexion and need further examination in both healthy and ill children. The rate of force development, Total Tenderness Score, and prediction of VO 2 max showed repeatability, with ICC 0.80–0.87.


          The measurements of strength capacity, aerobic power, and tenderness provide acceptable repeatability, suitable for research in children.

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          Most cited references 32

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          Statistical methods for assessing agreement between two methods of clinical measurement.

          In clinical measurement comparison of a new measurement technique with an established one is often needed to see whether they agree sufficiently for the new to replace the old. Such investigations are often analysed inappropriately, notably by using correlation coefficients. The use of correlation is misleading. An alternative approach, based on graphical techniques and simple calculations, is described, together with the relation between this analysis and the assessment of repeatability.
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            Comparing methods of measurement: why plotting difference against standard method is misleading.

            When comparing a new method of measurement with a standard method, one of the things we want to know is whether the difference between the measurements by the two methods is related to the magnitude of the measurement. A plot of the difference against the standard measurement is sometimes suggested, but this will always appear to show a relation between difference and magnitude when there is none. A plot of the difference against the average of the standard and new measurements is unlikely to mislead in this way. We show this theoretically and by a practical example.
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              How to assess the reliability of measurements in rehabilitation.

               M Downham,  J Lexell (2005)
              To evaluate the effects of rehabilitation interventions, we need reliable measurements. The measurements should also be sufficiently sensitive to enable the detection of clinically important changes. In recent years, the assessment of reliability in clinical practice and medical research has developed from the use of correlation coefficients to a comprehensive set of statistical methods. In this review, we present methods that can be used to assess reliability and describe how data from reliability analyses can aid the interpretation of results from rehabilitation interventions.

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                Dove Medical Press
                28 August 2013
                : 6
                : 643-651
                [1 ]Department of Health Sciences, Lund University, Scania, Sweden
                [2 ]Children’s Headache Clinic, Department of Pediatrics, University of Copenhagen, Herlev Hospital, Herlev, Denmark
                [3 ]National Research Centre for the Working Environment, Copenhagen, Denmark
                [4 ]Danish Headache Center, Department of Neurology, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark
                [5 ]Department of Physiotherapy and Occupational Therapy, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark
                [6 ]Department of Physiotherapy, Medical Department, University of Copenhagen, Herlev Hospital, Herlev, Denmark
                Author notes
                Correspondence: Birte Tornøe, Department of Pediatrics E, Herlev Hospital, Arkaden, Herlev Ringvej 75, 2730 Herlev, Denmark, Tel +45 3868 1067, Email birte.tornoee@ 123456regionh.dk
                © 2013 Tornøe et al, publisher and licensee Dove Medical Press Ltd

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Original Research


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