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Application of Mixed Effects Limits of Agreement in the Presence of Multiple Sources of Variability: Exemplar from the Comparison of Several Devices to Measure Respiratory Rate in COPD Patients

Parker, Richard A.; Weir, Christopher J.; Rubio, Noah; Rabinovich, Roberto; Pinnock, Hilary; Hanley, Janet; McCloughan, Lucy; Drost, Ellen M.; Mantoani, Leandro C.; MacNee, William; McKinstry, Brian

Authors

Richard A. Parker

Christopher J. Weir

Noah Rubio

Roberto Rabinovich

Hilary Pinnock

Lucy McCloughan

Ellen M. Drost

Leandro C. Mantoani

William MacNee

Brian McKinstry



Abstract

Introduction
The Bland-Altman limits of agreement method is widely used to assess how well the measurements produced by two raters, devices or systems agree with each other. However, mixed effects versions of the method which take into account multiple sources of variability are less well described in the literature. We address the practical challenges of applying mixed effects limits of agreement to the comparison of several devices to measure respiratory rate in patients with chronic obstructive pulmonary disease (COPD).
Methods
Respiratory rate was measured in 21 people with a range of severity of COPD. Participants were asked to perform eleven different activities representative of daily life during a laboratory-based standardised protocol of 57 minutes. A mixed effects limits of agreement method was used to assess the agreement of five commercially available monitors (Camera, Photoplethysmography (PPG), Impedance, Accelerometer, and Chest-band) with the current gold standard device for measuring respiratory rate.
Results
Results produced using mixed effects limits of agreement were compared to results from a fixed effects method based on analysis of variance (ANOVA) and were found to be similar. The Accelerometer and Chest-band devices produced the narrowest limits of agreement (-8.63 to 4.27 and -9.99 to 6.80 respectively) with mean bias -2.18 and -1.60 breaths per minute. These devices also had the lowest within-participant and overall standard deviations (3.23 and 3.29 for Accelerometer and 4.17 and 4.28 for Chest-band respectively).
Conclusions
The mixed effects limits of agreement analysis enabled us to answer the question of which devices showed the strongest agreement with the gold standard device with respect to measuring respiratory rates. In particular, the estimated within-participant and overall standard deviations of the differences, which are easily obtainable from the mixed effects model results, gave a clear indication that the Accelerometer and Chest-band devices performed best.

Citation

Parker, R. A., Weir, C. J., Rubio, N., Rabinovich, R., Pinnock, H., Hanley, J., …McKinstry, B. (2016). Application of Mixed Effects Limits of Agreement in the Presence of Multiple Sources of Variability: Exemplar from the Comparison of Several Devices to Measure Respiratory Rate in COPD Patients. PLOS ONE, 11(12), https://doi.org/10.1371/journal.pone.0168321

Journal Article Type Article
Acceptance Date Nov 15, 2016
Online Publication Date Dec 14, 2016
Publication Date Dec 14, 2016
Deposit Date Jan 24, 2017
Publicly Available Date Jan 24, 2017
Journal PLOS ONE
Print ISSN 1932-6203
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 11
Issue 12
Article Number e0168321
DOI https://doi.org/10.1371/journal.pone.0168321
Keywords Chronic obstructive pulmonary disease, accelerometers, measurement equipment, confidence intervals, normal distribution, analysis of variants, hopsitals, statistics,
Public URL http://researchrepository.napier.ac.uk/Output/670209

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