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肩部不稳定测试的检查者间可靠性评估。

An assessment of the interexaminer reliability of tests for shoulder instability.

作者信息

Tzannes Anthony, Paxinos Anastasios, Callanan Mary, Murrell George A C

机构信息

Sports Medicine and Shoulder Service, Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, Australia.

出版信息

J Shoulder Elbow Surg. 2004 Jan-Feb;13(1):18-23. doi: 10.1016/j.jse.2003.09.002.

Abstract

Accurate noninvasive clinical tests of shoulder instability are important in assessing and planning treatment for glenohumeral joint instability. An interexaminer agreement trial was undertaken to estimate the reliability of commonly used clinical tests for shoulder instability. Thirteen patients with a history suggestive of instability, who had been referred to a shoulder specialist for treatment of their symptomatic shoulders, were examined by four examiners of differing experience. Good to excellent interexaminer agreement was found for most variations of the load-and-shift test, with the best agreement in the 90 degrees abducted position for the anterior direction (intraclass correlation coefficient [ICC] = 0.72) and in the 0 degrees abducted position for the posterior (ICC = 0.68) and inferior (ICC = 0.79) directions. Fair to good interexaminer reliability was found for the sulcus sign (ICC = 0.60). With regard to the provocative tests, agreement was best when apprehension was used as the criterion for a positive test and was better for the relocation (ICC = 0.71) and release tests (ICC = 0.63) than for the apprehension (ICC = 0.47) and augmentations tests (ICC = 0.48). Reliability was poor (ICC < 0.31) when pain was used as the criterion for a positive test. These results indicate that the load-and-shift, sulcus, and provocative tests (apprehension, augmentation, relocation, and release) are reliable clinical tests for instability in symptomatic patients when care is taken with respect to arm positioning and if apprehension is used as the criterion for a positive provocative test.

摘要

准确的肩部不稳定无创临床测试对于评估和规划盂肱关节不稳定的治疗至关重要。进行了一项检查者间一致性试验,以评估常用肩部不稳定临床测试的可靠性。13例有不稳定病史且因有症状的肩部被转诊至肩部专科医生处治疗的患者,由4名经验不同的检查者进行检查。对于负荷-移位试验的大多数变体,检查者间一致性良好至优秀,其中前向90度外展位(组内相关系数[ICC]=0.72)以及后向(ICC=0.68)和下向(ICC=0.79)0度外展位的一致性最佳。沟征的检查者间可靠性为中等至良好(ICC=0.60)。关于激发试验,以恐惧作为阳性试验标准时一致性最佳,复位试验(ICC=0.71)和释放试验(ICC=0.63)的一致性优于恐惧试验(ICC=0.47)和增强试验(ICC=0.48)。以疼痛作为阳性试验标准时可靠性较差(ICC<0.31)。这些结果表明,当注意手臂位置并且以恐惧作为阳性激发试验的标准时,负荷-移位、沟征和激发试验(恐惧、增强、复位和释放)对于有症状患者的不稳定是可靠的临床测试。

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