Interrater reliability of the Adapted Fresno Test across multiple raters

Abstract

Purpose: The Adapted Fresno Test (AFT) is a seven-item instrument for assessing knowledge and skills in the major domains of evidence-based practice (EBP), including formulating clinical questions and searching for and critically appraising research evidence. This study examined the interrater reliability of the AFT using several raters with different levels of professional experience. Method: The AFT was completed by physiotherapists and occupational therapists, and a random sample of 12 tests was scored by four raters with different levels of professional experience. Interrater reliability was calculated using intra-class correlation coefficients (ICC [2, 1]) for the individual AFT items and the total AFT score. Results: Interrater reliability was moderate to excellent for items 1 and 7 (ICC=0.63–0.95). Questionable levels of reliability among raters were found for other items and for the total score. For these items, the raters were clustered into two groups—“experienced” and “inexperienced”—and then examined for reliability. The reliability estimates for rater 1 and rater 2 (“inexperienced”) increased slightly for items 2 and 5 and for the total score, but not for other items. For raters 3 and 4 (“experienced”), ICCs increased considerably, indicating excellent reliability for all items and for the total score (0.80–0.99), except for item 4, which showed a further decrease in ICC. Conclusion: Use of the AFT to assess knowledge and skills in EBP may be problematic unless raters are carefully selected and trained.