Nomden Jettie G, Slagers Anton J, Bergman Gert J D, Winters Jan C, Kropmans Thomas J B, Dijkstra Pieter U
Department of Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Man Ther. 2009 Apr;14(2):152-9. doi: 10.1016/j.math.2008.01.005. Epub 2008 Mar 10.
The object of this study was to assess interobserver reliability in 23 tests concerning physical examination of the shoulder girdle. A physical therapist and a physical therapist/manual therapist independently performed a physical examination of the shoulder girdle in 91 patients with shoulder complaints of varying severity and duration. The observers assessed 23 items in total: active and passive abductions, passive external rotation, hand in neck (HIN) test, hand in back (HIB) test, impingement test according to Neer, springing test of the first rib and joint play test of the acromioclavicular joint. The interobserver reliability was evaluated by means of a Cohen's Kappa, the weighted Kappa and the intraclass correlation (ICC). Criteria for acceptable reliability were: Kappa value>or=0.60, ICC>or=0.75 or an absolute agreement>or=80%. The results showed that Kappa values varied from 0.09 (springing test first rib, stiffness) to 0.66 (springing test first rib, pain), weighted Kappa varied from 0.35 (pain during HIB) to 0.73 (range of motion HIB) and ICC varied from 0.54 (abduction passive starting point painful arc) to 0.96 (active and passive ranges of motion in abduction). In total 11 (48%) items fulfilled the criteria of acceptable reliability. In conclusion, there appears to be a great deal of variation in the reliability of the tests used in the physical examination of the shoulder girdle. Over 50% of the tests did not meet the statistical criteria for acceptable reliability.
本研究的目的是评估在23项关于肩胛带体格检查测试中的观察者间信度。一名物理治疗师和一名物理治疗师/手法治疗师对91例有不同严重程度和病程的肩部疾病患者独立进行肩胛带的体格检查。观察者总共评估了23项内容：主动和被动外展、被动外旋、颈后试验（HIN）、背后试验（HIB）、Neer撞击试验、第一肋弹跳试验和肩锁关节关节活动度试验。通过Cohen's Kappa系数、加权Kappa系数和组内相关系数（ICC）评估观察者间信度。可接受信度的标准为：Kappa值≥0.60，ICC≥0.75或绝对一致性≥80%。结果显示，Kappa值从0.09（第一肋弹跳试验，僵硬）到0.66（第一肋弹跳试验，疼痛）不等，加权Kappa值从0.35（HIB试验时疼痛）到0.73（HIB试验活动范围）不等，ICC从0.54（外展被动起始点疼痛弧）到0.96（外展主动和被动活动范围）不等。总共有11项（48%）符合可接受信度标准。总之，肩胛带体格检查中所使用测试的信度似乎存在很大差异。超过50%的测试未达到可接受信度的统计标准。
