The Interrater Reliability of Subjective Assessments of the Babinski Reflex

Dafkin, Chloe; Green, Andrew; Kerr, Samantha; Veliotes, Demetri; Olivier, Benita; McKinon, Warrick

doi:10.1080/00222895.2015.1047486

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…16 In a comparison of neurologic assessments of 12 medical students and 12 neurologists, a substantial interrater agreement within the neurologist and student groups (kappa 0.72 and 0.67, respectively) was also reported. 19 In our study, despite a different level of experience among observers, an upgoing thumb was detected with a substantial level of agreement, emphasizing our ability to easily teach the examination even to lay persons.…”

Section: Discussionmentioning

confidence: 51%

The upgoing thumb sign

et al. 2017

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Section: Discussionmentioning

confidence: 51%

The upgoing thumb sign

et al. 2017

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“…The reliability of the Babinski sign also ranges from poor to moderate in cohorts of individuals with and without a variety of neurological diseases. 18 , 92 , 93 This variability in assessment stems from differences in technique as well as in interpretation. Of note, the Babinski sign requires both extension of the great toe and fanning of the other toes; withdrawal of the foot or isolated toe extension are not consistent with a positive test.…”

Section: Discussionmentioning

confidence: 99%

The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy - A Systematic review and Meta-analysis

Jiang,

Davies,

Zipser

et al. 2023

Global Spine Journal

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Study Design Delayed diagnosis of degenerative cervical myelopathy (DCM) is likely due to a combination of its subtle symptoms, incomplete neurological assessments by clinicians and a lack of public and professional awareness. Diagnostic criteria for DCM will likely facilitate earlier referral for definitive management. Objectives This systematic review aims to determine (i) the diagnostic accuracy of various clinical signs and (ii) the association between clinical signs and disease severity in DCM? Methods A search was performed to identify studies on adult patients that evaluated the diagnostic accuracy of a clinical sign used for diagnosing DCM. Studies were also included if they assessed the association between the presence of a clinical sign and disease severity. The QUADAS-2 tool was used to evaluate the risk of bias of individual studies. Results This review identified eleven studies that used a control group to evaluate the diagnostic accuracy of various signs. An additional 61 articles reported on the frequency of clinical signs in a cohort of DCM patients. The most sensitive clinical tests for diagnosing DCM were the Tromner and hyperreflexia, whereas the most specific tests were the Babinski, Tromner, clonus and inverted supinator sign. Five studies evaluated the association between the presence of various clinical signs and disease severity. There was no definite association between Hoffmann sign, Babinski sign or hyperreflexia and disease severity. Conclusion The presence of clinical signs suggesting spinal cord compression should encourage health care professionals to pursue further investigation, such as neuroimaging to either confirm or refute a diagnosis of DCM.

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“…The dogs analysed in this study were examined under clinical conditions in an identical manner, in the same room and using an identical set of tools. Nevertheless, the impact of quality of both video and examination on the IA cannot be quantified and it must be kept in mind, that the evaluation of standardized examination procedures based on video-analysis might result in an artificially high IA [43]. Considering the setting was the same for every observer, the results are comparable between the groups.…”

Section: Discussionmentioning

confidence: 99%

Comparison of interobserver agreement between the evaluation of bicipital and the patellar tendon reflex in healthy dogs

et al. 2019

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The reliability of reflex-assessment is currently debatable, with current literature regarding the patellar tendon reflex (PTR) as highly reliable, while the biceps tendon reflex (BTR) is regarded to be of low reliability in the dog. Such statements are, however, based on subjective observations rather than on an empirical study. The goals of this study were three-fold: (1) the quantification of the interobserver agreement (IA) on the evaluation of the canine bicipital (BTR) and patellar tendon (PTR) reflex in healthy dogs, (2) to compare the IA of the BTR and PTR evaluation and (3) the identification of intrinsic ( sex , age , fur length , weight ) and extrinsic ( observer´s expertise , body side ) risk factors on the IA of both reflexes. The observers were subdivided into three groups based on their expected level of expertise (neurologists = highest -, practitioners = middle–and veterinary students = lowest level of expertise). For the BTR, 54 thoracic limbs were analyzed and compared to the evaluation of the PTR on 64 pelvic limbs. Each observer had to evaluate the reflex presence (RP) ( present or absent ) and the reflex activity (RA) using a 5-point ordinal scale. Multiple reliability coefficients were calculated. The influence of the risk factors has been calculated using a mixed regression-model. The Odds Ratio for each factor was presented. The higher the level of expertise the higher was the IA of the BTR. For RP(BTR), IA was highest for neurologists and for RA(BTR) the IA was lowest for students. The level of expertise had a significant impact on the degree of the IA in the evaluation of the bicipital tendon reflex: for the RA(BTR), practitioners had a 3.4-times (p = 0.003) and students a 7.0-times (p < 0.001) higher chance of discordance. In longhaired dogs the chance of disagreement was 2.6-times higher compared to shorthaired dogs in the evaluation of RA(BTR) (p = 0.003). Likewise, the IA of the RP(PTR) was the higher the higher the observers´ expertise was with neurologists having significantly highest values (p < 0.001). The RA(PTR) has been evaluated more consistent by practitioners and students than the RA(BTR). For practitioners this difference was significant (< 0.01). Our data suggests that neurologists assess the bicipital and patellar tendon reflex in dogs most reliably. None of the examined risk factors had a significant impact on the degree of IA in the evaluation of RP(PTR), while students had a 4.4-times higher chance of discordance when evaluating the RA(PTR) compared to the other groups. This effect was significant (p < 0.001). Neurologists can reliably assess the bicipital and patellar tendon reflex in healthy dogs. Observer´s level of expertise and the fur length of the dog affect the degree of IA of RA(BTR). The influence of the observer´s expertise is higher on the evaluation of the BTR than on...

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The Interrater Reliability of Subjective Assessments of the Babinski Reflex

Cited by 4 publications

References 14 publications

The upgoing thumb sign

The upgoing thumb sign

The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy - A Systematic review and Meta-analysis

Comparison of interobserver agreement between the evaluation of bicipital and the patellar tendon reflex in healthy dogs

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