Repeatability of the Universiti Teknologi MARA reading Charts

Objective: This study was done to investigate the repeatability measurements in reading rate using the Universiti Teknologi MARA Malay related words (UiTM-Mrw) reading chart and Universiti Teknologi MARA Malay unrelated words (UiTM-Muw) reading chart. Methodology: Thirty normally sighted participants were randomly recruited through randomised sampling (mean age =21.5±1.1 years). Participants were instructed to read aloud, clearly and as quickly as possible at 2 different sessions using two different charts. The two charts were selected at random sequence. A minimum of 7 days interval was used to minimizethe learning affect. The time taken to read each chart was recorded and any errors while reading was noted. Reading performance was quantified as reading rate in words per minute (wpm). Results: Comparison of reading rate between session 1 and session 2 was not significantly different(p=0.894, df=1, F=0.018) for UiTM-Mrw reading chart. The reading rate between session 1 and 2 also showed no significant difference (p=0.99, df=1, F=2.811) in UiTM-Muw reading chart. Intraclass correlation coefficient (ICC) showed a good consistency in repeatability for both UiTM-Mrw reading chart and UiTM-Muw reading chart with ICC values of 0.849 and 0.814 respectively. The Bland and Altman plot between measurement of reading rate in session 1 and session 2 showed a good agreement in UiTM-Mrw reading chart and UiTM-Muw reading chart. Conclusion: Both UiTM-Mrw reading chart and UiTM-Mur reading chart showed a good consistency and good agreement in repeated measurement of reading rate.


Introduction
Reading is one of the important evaluations in quality of life.It was foundto affect the quality of life especially among those with vision impairment [1][2][3][4] .The reading performance was one of the important aspects of the evaluation in eye examination 5 .It should be done in a standardized technique and repeatable to monitor the visual performancewith time.
Reading performance should be evaluated using the reading chart to represent real reading condition.Routine near visual acuity measurement using Snellen notation had shown low correlation and can only predicted 10 percent of individual reading speed because it only involved recognition of single letter rather than giving real reading information 6 .Reading is a complex processes that involves decoding and linguistic comprehension components in acquiring meaning from printed or written words 7 .Among all available reading chart, there were MNRead acuity chart 8 , the practical near acuity chart 9 , Radner reading chart 10 , Bailey-Lovie reading chart 11 12,13 .The repeatability of clinical measurement is importance to be assessed in order to produce a good reliability and consistent outcomes.Any new reading chart will be tested its test-retest reliability as in previous studies [14][15][16][17][18] .In this study, the UiTM-  using the print sizes ranging from 1.3 LogMAR (N40) to 0.0 LogMAR (N1).A maximum of 60 characters per sentence was used (5 to 10 standardlength words).They were fourteen sentences in the sets of related words and unrelated words.
The sentences for UiTM-Mrw reading chart were constructed based on from Grade 3 to 6 Malay school textbooks, whereby for UiTM-Muw reading chart the words were randomly selected from Daftar Kata Bahasa Melayu Sekolah Kebangsaan.The Daftar Kata Bahasa Melayu Sekolah Kebangsaan is the registry for Malay language words for primary schools.The related words set was constructed to mimics real reading activity.The unrelated words were constructed in meaningless sentence to remove any cues in reading process 19 .The font typeface used was "Times new roman" 20 .The sentences were aligned to the left and printed in 100% contrast.

Study protocols
The participants were instructed to read loudly the UiTM-Mrw chart and UiTM-Muw chart at random sequence.The UiTM reading chart was placed at 40 cm on an inclined reading stand at 45 degree.
The reading chart was covered prior to the start of reading performance evaluation.The participants were instructed to read the charts from the largest print to the smallest print.The time taken to read was recorded to the nearest 0.1s and any errors in reading such as omission, missing the words were recorded.
Reading rate was calculated in words per minutes (wpm) 21 .The participants were asked to come again for second reading performance evaluation with a 7-day interval from the first session of evaluation.The agreement of reading rate for UiTM-Mrw reading chart and UiTM-Muw reading chart were determine using Bland-Altman plot [22][23][24] as in figure 3. Three lines are displayed on the Bland-Altman plot.The thick blue line represents the mean difference of reading rate between two sessions, the upper and lower red dash lines represent the 95% limit of agreement (±1.96SD).The agreement of reading rate for UiTM-Mrw reading chart between session 1 and session 2 showed a good agreement (figure 3a).The mean difference, lower limit and upper limit of reading rate for UiTM-Mrw reading chart were 1.1±8.95wpm, -45.9 wpm and 48.1 wpm respectively.The reading rate evaluation in session 1 and session for UiTM-Muw reading chart showed a good agreement as shown in figure 3b.The mean difference, lower limit and upper limit of reading rate for UiTM-Mrw reading chart were-7.8±14.Possible reason in the disparity of the outcome was younger participant than in this study since they used the children from Grade 3 to Grade 8 15 .

Statistical analysis
Even though the UiTM-Muw reading chart showed a good repeatability, the reading rate was lower than MNRead acuity chart 14 .This was because reading the meaningful sentences will give an advantages of guessing cues for next word therefore the reading speed was higher than reading the unrelated words 19 .The reading rate among Malay speaker was reported to be 103.9±32.0wpm 25n = 193 , and similar with the reading rate of the UiTM-Muw reading chart i.e 116 wpm for session 1 and 124 wpm for session 2.
The similarity in both reading rate was because the Malay reading text used in this previous study was also constructed using unrelated words.Test-retest reliability of German Radner Reading chart showed high reliability and good reproducibility between two sessions 16 .The same goes with Dutch Radner reading chart 17 , which they found a good reliable test-retest and good agreement in reading speed among participants with low vision.In this study the ICC showed high reliability in the repeated measurements of the reading rate in the UiTM-Mrw reading chart as well as the UiTM-Muw reading chart i.e 0.85 and 0.81 respectively.Most of the testretest measurement in reading analyzed using the intraclass correlation coefficient to test the reliability of the repeated measurements 14,15,17 .The intra-class correlation coefficient was used to determine the consistency in the repeated measurements in reading performance evaluation 26 .Reliability and agreement analysis are necessary to estimate the amount of error in the assessment or scoring of tests and classification procedures 26 .Therefore, the higher the ICC values the better reproducibility of the measurement.The ICC value in Cronbach's alpha normally ranges between '0' to '1'.The closer Cronbach's alpha values to '1', the greater the consistency. 27The reliability was categorizedinto six orders which were >0.9 as excellent, >0.8 as good, >0.7 as acceptable, >0.6 as questionable, >0.5 as poor and <0.5 as unacceptable 27 .

Conclusions
In conclusion, the study had demonstrated that both the UiTM-Mrw reading chart and the UiTM-Muw reading chart provide good consistency and good agreement in repeated measurements of the reading rate among young adults.
) rule was used to measure the remote near point of convergence and near point of accommodation.The inclusion criteria for this study were distance visual acuity of 6/9 with habitual correction, no convergence and accommodation problem, fluently read the Malay and English reading material and the absence of eye pathology that can affect reading performance.This study adhered to the tenets of the Declaration of Helsinki and was approved by the Research Ethics Committee and approved by the UiTM ethic committee.The Universiti Teknologi MARA reading chart The Universiti Teknologi MARA Malay related word reading chart (UiTM-Mrw) (Figure 1(a)) and Universiti Teknologi MARA Malay unrelated word reading chart (UiTM-Muw) (Figure 1(b) were both

Figure 1 :
The UiTM reading charts (a) The UiTM Malay related words reading chart (b) The UiTM Malay unrelated word reading chart

Figure 1 :
Figure 1: The UiTM reading charts (a) The UiTM Malay related words reading chart (b) The UiTM Malay unrelated word reading chart (a) (b)

Figure 3 :
Figure 3: (a) Bland and Altman plot of reading rate between session 1 and 2 for UiTM-Mrw reading chart (b) Bland and Altman plot of reading rate between session 1 and 2 for UiTM-Muw chart.(a)(b) and many more.Most of the reading charts available were the English reading charts.It would be beneficial if there were a reading chart in Malay language to be used among Malay native speakers.The Universiti Teknologi MARA reading charts were set in two types which were the Universiti NNTeknologi MARA Malay related words (UiTM-Mrw) reading chart and Bangladesh Journal of Medical Science Vol.14(3)2015 p.236-240 DOI: http://dx.doi.org/10.3329/bjms.v14i3.18964 the Universiti Teknologi MARA Malay unrelated words (UiTM-Muw) reading chart.Reading speed of both UiTM-Mrw and UiTM-Muw reading chart was comparable with MNRead acuity chart and Colenbrander reading chart Mrw reading chart and UiTM-Muw reading chart were investigated for reliable repeatable outcomes in clinical use by analyzing the test-retest of reading rate in Malay language.