Salerno D F, Franzblau A, Werner R A, Chung K C, Schultz J S, Becker M P, Armstrong T J
Department of Environmental Health Science, School of Public Health, The University of Michigan, Ann Arbor, MI 48109-2029, USA.
Am J Ind Med. 2000 Apr;37(4):423-30. doi: 10.1002/(sici)1097-0274(200004)37:4<423::aid-ajim12>3.0.co;2-w.
Physical examination is a traditional outcome measure in epidemiological research. Its value as a reliable measure depends, in part, on the prevalence of positive findings. The purpose of this paper is to determine the empirical reliability of physical examination and anthropometry in a field study of upper extremity disorders among keyboard operators.
Two experienced examiners independently performed common provocative tests and procedures in physical examinations of the neck and upper extremity among 160 keyboard operators. Two additional examiners conducted anthropometric surveys among 137 workers. Inter-examiner reliability was assessed with observed agreement, kappa statistics, and intra-class correlations (ICC).
Observed agreement was between 96% and 100% for neck and upper extremity signs, muscle stretch reflexes, and muscle strength, however, with the exception of provocative tests, reliability statistics were unstable. Among the provocative tests, Phalen and Tinel tests had modest agreement after adjusting for chance (kappa range: 0.20-0.43). The carpal compression test had the best reliability (kappa=0.60 and kappa=0.67, left and right side, respectively). The ICCs for anthropometry ranged from 0.36-0.91.
Results from the study showed that statistically, except for the carpal compression test, physical examination contributed minimal reliable information. This was attributed mainly to the low prevalence of positive findings, and generally mild nature of upper extremity disorders in this population. The results are the best estimate of what would be found in a field study with experienced examiners. While it may reduce bias, separating physical examination from medical history may contribute to the poor reliability of findings. With a shift toward reliable measures, resources can be allocated to more effective tools, like questionnaires, in epidemiological research of upper extremity disorders among keyboard operators.
体格检查是流行病学研究中的一项传统结局指标。其作为可靠指标的价值部分取决于阳性结果的患病率。本文旨在确定在一项针对键盘操作员上肢疾病的现场研究中体格检查和人体测量学的实证可靠性。
两名经验丰富的检查人员在对160名键盘操作员进行颈部和上肢体格检查时独立进行了常见的激发试验和操作。另外两名检查人员对137名工人进行了人体测量调查。通过观察一致性、kappa统计量和组内相关系数（ICC）评估检查者间的可靠性。
颈部和上肢体征、肌肉牵张反射及肌肉力量的观察一致性在96%至100%之间，然而，除激发试验外，可靠性统计数据不稳定。在激发试验中，Phalen试验和Tinel试验在校正机遇后一致性一般（kappa范围：0.20 - 0.43）。腕部压迫试验的可靠性最佳（kappa分别为0.60和0.67，左侧和右侧）。人体测量学的ICC范围为0.36 - 0.91。
研究结果表明，从统计学角度看，除腕部压迫试验外，体格检查提供的可靠信息极少。这主要归因于阳性结果的低患病率以及该人群上肢疾病总体上的轻度性质。这些结果是在有经验的检查人员进行的现场研究中所能发现情况的最佳估计。虽然将体格检查与病史分开可能会减少偏倚，但这可能导致检查结果的可靠性较差。随着向可靠指标的转变，在键盘操作员上肢疾病的流行病学研究中，资源可分配给更有效的工具，如问卷。
