Pedro scale what is it

Although kappa and ICC values are continuous data, we believe that physical therapists collapse these continuous data into discrete categories when they recall the results of reliability studies.

Data to support this contention, however, are lacking. The categories provide a description of the level of reliability that some readers may find useful. They should not be used to make a judgment as to whether the level of reliability is acceptable or not. Such a decision would require a consideration of how the data will be used.

The reliability of ratings of individual scale items is shown in Tables 1 and 2. From the study with the largest sample ie, study 2 , kappa values for individual scale items ranged from. The reliability of consensus ratings ie, ratings made by a panel of 2 or 3 raters ranged from.

For the remaining 6 items, the reliability was within the same benchmark for individual and consensus ratings. The ICC for consensus ratings was slightly higher at. The standard error of the measurement for the consensus ratings was 0. Rating this item requires a decision as to whether groups of subjects in a RCT were similar on key prognostic indicators prior to the intervention.

Our impression is that intention-to-treat analysis is better reported in more recent articles. Our reliability for individual items is difficult to benchmark because only Clark et al 17 provided reliability estimates for each item using the Jadad scale, and the items in that scale are not sufficiently similar to items in the PEDro scale to allow meaningful comparison. For a number of the scale items, the base rate was either very high or very low. When interpreting the kappa values for these items, readers need to be aware of the behavior of kappa values.

Our opinion on this issue is closer to Shrout and colleagues' position, 32 and so we would defend the use of the kappa statistic in our study. We believe that the important issue is not a low base rate but the scenario where a data set has an artificially low base rate that is not representative of the population. In such a situation, both sides of the base rate problem debate would agree that the estimates of reliability provided by the kappa statistic are misleading.

In both studies, we randomly selected a sample of trials from the population of trials on the PEDro database. Not surprisingly, the base rates in the 2 samples were very similar to the base rate for the population see Moseley et al Accordingly, we believe that the use of the kappa statistic was justified in our studies and did not produce misleading inferences about reliability of ratings for items on the PEDro scale.

An understanding of the error associated with the PEDro scale can be used to guide the conduct of a systematic review that uses a minimum PEDro score as an inclusion criterion. We believe it is sensible to conduct a sensitivity analysis to see how the conclusions of a systematic review are affected by varying the PEDro cutoff. For example, in Maher's review of workplace interventions to prevent low back pain, 22 reducing the PEDro cutoff from the original strict PEDro cutoff of 6 to a less strict cutoff of 5 or even 4 did not change the conclusion that there was strong evidence that braces are ineffective in preventing low back pain.

Readers should have more confidence in the conclusion of a review that is unaffected by changing the quality cutoff. None of the scale items had perfect reliability for the consensus ratings consensus ratings are displayed on the PEDro database ; thus, users need to understand that the PEDro scores contain some error. Readers who use the total score to distinguish between low- and high-quality RCTs need to recall that the standard error of the measurement for total scores is 0.

The results of our studies indicate that the reliability of the total PEDro score, based on consensus judgments, is acceptable. The scale appears to have sufficient reliability for use in systematic reviews of physical therapy RCTs. National Health and Medical Research Council. Google Scholar. The art of quality assessment of RCTs included in systematic reviews.

J Clin Epidemiol. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study. Health Technol Assess. Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?

Herbert R , Gabriel M. Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review. The effectiveness of acupuncture in the management of acute and chronic low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Lumbar supports and education for the prevention of low back pain in industry: a randomized controlled trial. Conservative treatment of stress urinary incontinence in women: a systematic review of randomized clinical trials.

Br J Urol. The hazards of scoring the quality of clinical trials for meta-analysis. Impact of quality scales on levels of evidence inferred from a systematic review of exercise therapy and low back pain. Arch Phys Med Rehabil. Exercise therapy for low back pain. The Cochrane Library. Phys Ther. Quality in the reporting of randomized trials in surgery: is the Jadad scale reliable? Control Clin Trials. Assessing the quality of randomized trials: reliability of the Jadad scale.

Interrater reliability of the modified Jadad quality scale for systematic reviews of Alzheimer's disease drug trials. Dement Geriatr Cogn Disord. Assessing the quality of reports of randomized clinical trials: is blinding necessary?

PEDro: a database of randomised trials and systematic reviews in physiotherapy. Man Ther. Does spinal manipulative therapy help people with chronic low back pain? Australian Journal of Physiotherapy. Maher CG. A systematic review of workplace interventions to prevent low back pain.

The Delphi List: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. Kunz R , Oxman A. The unpredictability paradox: review of empirical comparisons of randomised and non-randomised clinical trials.

The effect of irradiation with ultra-violet light on the frequency of attacks of upper respiratory disease common colds. Am J Hyg. Landis J , Koch G. The measurement of observer agreement for categorical data. Fleiss JL. The Design and Analysis of Clinical Experiments. Google Preview. Reliability of Chalmers' scale to assess quality in meta-analyses on pharmacological treatments for osteoporosis. Ann Epidemiol. Balneotherapy and quality assessment: interobserver reliability of the Maastricht criteria list for blinded quality assessment.

Spitznagel E , Helzer J. A proposed solution to the base rate problem in the Kappa statistic. Arch Gen Psychiatry. Quantification of agreement in psychiatric diagnosis revisited. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation.

On 13 January PEDro contained 49, reports of randomised controlled trials, systematic reviews and evidence-based clinical practice guidelines. There were 38, trials, 10, reviews, and guidelines. The graph below illustrates the cumulative number of trials, reviews and guidelines available each year. PEDro indexes reports of trials, reviews and guidelines for all areas of physiotherapy.

The graph below illustrates the number of trials, reviews and guidelines available for each area of physiotherapy. Musculoskeletal and cardiothoracics had the largest quantity of trials, reviews and guidelines. Note that this graph is based on coding for 48, records with complete data records are in-process, so have not been coded for area of physiotherapy yet.

Each trial, review and guideline can be coded for more than one area of physiotherapy, so the total number of reports in this graph adds to more than 48, The PEDro scale was developed to help PEDro users to rapidly identify trials that are likely to be internally valid and have sufficient statistical information to guide clinical decision-making.

Each trial report is given a total PEDro score, which ranges from 0 to The graph below illustrates the number of trial reports scoring each total PEDro score. When subjects have been blinded, the reader can be satisfied that the apparent effect or lack of effect of treatment was not due to placebo effects or Hawthorne effects an experimental artifact in which subjects responses are distorted by how they expect the experimenters want them to respond.

Explanation: Blinding of therapists involves ensuring that therapists were unable to discriminate whether individual subjects had or had not received the treatment. Explanation: Blinding of assessors involves ensuring that assessors were unable to discriminate whether individual subjects had or had not received the treatment.

Note on administration: This criterion is only satisfied if the report explicitly states both the number of subjects initially allocated to groups and the number of subjects from whom key outcome measures were obtained.

Explanation: It is important that measurement of outcome are made on all subjects who are randomised to groups. Subjects who are not followed up may differ systematically from those who are, and this potentially introduces bias. The magnitude of the potential bias increases with the proportion of subjects not followed up. Note on administration: An intention to treat analysis means that, where subjects did not receive treatment or the control condition as allocated, and where measures of outcomes were available, the analysis was performed as if subjects received the treatment or control condition they were allocated to.

This criterion is satisfied, even if there is no mention of analysis by intention to treat, if the report explicitly states that all subjects received treatment or control conditions as allocated. Explanation: Almost inevitably there are protocol violations in clinical trials. Protocol violations may involve subjects not receiving treatment as planned, or receiving treatment when they should not have. Analysis of data according to how subjects were treated instead of according to how subjects should have been treated may produce biases.

It is probably important that, when the data are analysed, analysis is done as if each subject received the treatment or control condition as planned.

For a discussion of analysis by intention to treat see Elkins and Moseley, J Physiother ;61 3 Note on administration: A between-group statistical comparison involves statistical comparison of one group with another. Depending on the design of the study, this may involve comparison of two or more treatments, or comparison of treatment with a control condition.

The analysis may be a simple comparison of outcomes measured after the treatment was administered, or a comparison of the change in one group with the change in another when a factorial analysis of variance has been used to analyse the data, the latter is often reported as a group x time interaction. Explanation: In clinical trials, statistical tests are performed to determine if the difference between groups is greater than can plausibly be attributed to chance.

Note on administration: A point measure is a measure of the size of the treatment effect. The treatment effect may be described as a difference in group outcomes, or as the outcome in each of all groups.