Reliability and measurement precision of manual muscle testing (MMT) and hand-held dynamometry (HHD) were compared for children with spina bifida. Strength measures were obtained of the hip flexors, hip abductors, and knee extensors of 20 children (10 males, 10 females; mean age 9 years 10 months; range: 5 to 15 years) by two experienced physical therapists and a student physical therapist. Inter-tester reliability [ICC(2,1)] for HHD varied from 0.76 to 0.83, indicating excellent reliability for the three muscle groups. Inter-tester reliability for MMT was 0.75 for the hip abductor muscle group, indicating good reliability, and 0.37 to 0.40 for the remaining muscle groups. The minimum detectable change was 15N for HHD and 1 scale unit of a 0 to 5 MMT scale. The results suggest a situation-specific solution to the question of which method to use. To detect small strength changes over time in children with spina bifida, MMT should be used when the child has insufficient strength to move the limb against gravity; otherwise, HHD should be used.

Aim: The purpose of this study was to examine the intra-rater and inter-rater reliability of physiotherapists using the Pirani scoring system for clubfoot to score digital photographs of infants’ feet. Methods: Twelve infant feet were photographed to reflect variations in the six clinical signs of clubfoot. Physiotherapists viewed the photographs and scored the feet using the Pirani scoring system on two separate occasions. Results: Intra-rater reliability was excellent when scoring photographs, while inter-rater reliability was found to be fair to good for most subscales. Experienced therapists demonstrated higher reliability than novice therapists but not significantly so. Reliability was equivalent between the Pirani scoring system and a modified five-point scoring system created for this study. Scoring the rigidity of equinus subscale was found to be more reliable than the other subscales (P<0.01), which did not differ significantly from each other.

This study examines inter-rater reliability between physiotherapists using the Pirani scoring system for clubfoot, and whether the addition of two scale points to give a modified five-point severity scale improves reliability. A total of 65 infant feet were assessed by two raters, with 21 different rater combinations used. The Pirani scoring system was found to be a reliable assessment tool when used by physiotherapists to score clubfoot, with a minimum of fair to good inter-rater reliability demonstrated across all clinical signs. The modified five-point scale proved significantly more reliable than the three-point scale; however, the benefit is not sufficient to warrant varying the original three-point scale.

The meaning of childhood behavioural disorders (CBD) shifts in different settings. This article is the 3 first in a series of two that explores this concept and how culture shapes its meaning. This first article 4 is a conversation. A yarn with Aboriginal community leaders about what behavioural problems mean 5 to them. The second article discusses how the concept of CBD originated.