Kendall Richard, Werner Robert A
Division of Physical Medicine and Rehabilitation, University of Utah Orthopaedics Center, 590 Wakara Way, Salt Lake City, Utah 84108, USA.
Muscle Nerve. 2006 Aug;34(2):238-41. doi: 10.1002/mus.20554.
Low back pain and lumbar radiculopathy are among the most common painful disorders affecting the adult population. This study hypothesizes that there is good correlation between the diagnostic impression of an unblinded electromyographer, using clinical and electromyographic information, and an independent electromyographer, who uses the needle examination only to assess for lumbar radiculopathy. This is a prospective, single-blinded, observational pilot study. The needle examination was electronically recorded, reproduced, and shown to a second examiner, blinded to all clinical data. Diagnostic impressions from both examiners were recorded and evaluated for agreement. Six recorded cases were reviewed by 66 blinded examiners. Overall diagnostic agreement was 46.9% (60.5% faculty level, 28.5% resident level). Logistic regression shows a strong association between training level and agreement on diagnostic impression (odds ratio, 1.9; 95% confidence interval, 1.12-3.22; P = 0.019). This study shows that there is fair interrater reliability between faculty-level examiners and poor reliability among resident-level examiners when the needle examination is used to evaluate patients with lumbar radiculopathy.
下背痛和腰椎神经根病是影响成年人群的最常见疼痛性疾病。本研究假设，使用临床和肌电图信息的非盲法肌电图检查医师的诊断印象与仅使用针极检查来评估腰椎神经根病的独立肌电图检查医师之间存在良好的相关性。这是一项前瞻性、单盲观察性试点研究。针极检查通过电子方式记录、复制并展示给对所有临床数据均不知情的第二位检查者。记录两位检查者的诊断印象并评估其一致性。66位不知情的检查者对6例记录病例进行了审查。总体诊断一致性为46.9%（教员水平为60.5%，住院医师水平为28.5%）。逻辑回归显示培训水平与诊断印象的一致性之间存在强关联（优势比为1.9；95%置信区间为1.12 - 3.22；P = 0.019）。本研究表明，当使用针极检查评估腰椎神经根病患者时，教员水平的检查者之间具有中等程度的评分者间可靠性，而住院医师水平的检查者之间可靠性较差。
