Abstract
OBJECTIVE: To examine the inter- and intra-rater reliability of the pull test in patients with Parkinson's disease (PD) using the extracted pull force. METHODS: In this inter- and intra-rater reliability study, two raters performed a pull test on 30 patients with PD. The pull force was quantified using inertial sensors attached to the rater's right hand and the patient's lower trunk. In this study, the pull force was calculated as an extracted three-dimensional vector quantity, the resultant acceleration, and was expressed in m/s2. Inter- and intra-rater reliabilities were analyzed using the interclass correlation coefficient (ICC) for the pull force and Cohen's weighted kappa (κw) for the pull test score. Furthermore, Bland-Altman analysis was used to investigate systematic errors. RESULTS: The inter- and intra-rater reliability of the pull force was very poor (ICC = 0.033-0.214). Bland-Altman analysis revealed no systematic errors in the pull forces between the two test points. Conversely, κw for the pull test scores ranged from 0.763 to 0.920, indicating substantial to almost perfect agreement. CONCLUSION: The pull test score was reliable despite variations in the quantified pull force for inter- and intra-rater reliability. Our findings suggest that the pull test is a robust tool for evaluating postural instability in patients with PD and that the pull force probably does not affect scoring performance.