Abstract
Objective
To describe and determine the intertester reliability of a newly developed classification system of shoulder syndrome recognition.
Design
Intertester reliability study.
Setting
Fourteen primary care physiotherapy clinics.
Participants
Two hundred and fifty-five patients with shoulder pain. Inclusion criterion: presence of shoulder pain aring within the glenohumeral or associated joints and structures. Exclusion criteria: previous shoulder surgery, surgical candidates, recognised malignancy, systemic illness, or concurrent cervical pain and/or radiculopathy.
Intervention
Examiners were 55 physiotherapists who were arranged in pairs; each patient received two independent and blinded assessments, one by each of the paired physiotherapists. This shoulder classification approach contains three main clinical syndromes: Pattern 1 (impingement pain), Pattern 2 (acromioclavicular joint pain) and Pattern 3 (shoulder pain: frozen shoulder, glenohumeral arthritis, massive cuff tear, subscapularis tear, painful laxity, post-traumatic instability, internal derangement).
Main outcome measures
Percentage agreement and Cohen's kappa coefficient.
Results
The mean age of patients was 46.6 years (standard deviation 16.3, range 16 to 86), and 57% were male. Physiotherapists agreed on the pattern of shoulder pain for 205 of the 255 shoulders assessed (agreement rate 80%); the kappa coefficient was 0.664 (95% confidence interval 0.622 to 0.706; P
<0.001). Of the 205 agreements, Pattern 1 was the most common condition; physiotherapists agreed on this pattern for 139 patients (68%). Both physiotherapists diagnosed Pattern 2 for 20 patients and Pattern 3 for 46 patients.
Conclusion
This clearly defined system uses key elements of the history and examination to classify patients with shoulder pain. The kappa coefficient denotes good reproducibility.
Citation
Intertester reliability of a classification system for shoulder pain Tom Carter, Hamilton Hall, Greg McIntosh, John Murphy, Janice MacDougall, Christina Boyle
Physiotherapy - March 2012 (Vol. 98, Issue 1, Pages 40-46, DOI: 10.1016/j.physio.2010.12.003)