Department of Physical Medicine & Rehabilitation, The University of Texas Southwestern Medical Center at Dallas, USA.
Am J Phys Med Rehabil. 2010 Jul;89(7):561-9. doi: 10.1097/PHM.0b013e3181e29a3b.
This study was performed to investigate the interrater reliability of needle electromyographic findings and electrodiagnostic impressions among expert electrodiagnosticians.
Twenty-nine electromyographic recordings were chosen for this study from a larger prospective, observational cohort of 89 consecutive subjects, who were referred for electrodiagnostic evaluation of the lower limbs in a hospital-based spine clinic. The parent study was designed to evaluate the utility of electrodiagnostic findings in predicting outcomes after epidural steroid injections in lumbar radiculopathy. An unmasked, American Board of Electrodiagnostic Medicine board-certified examiner with knowledge of the patient's history and physical examination performed all initial electrodiagnostic evaluations, including needle electromyographic examination of a standardized set of six limb muscles and lumbar paraspinals representing L3 through S1 myotomes. The insertional and spontaneous activities of all muscles were recorded as de-identified digital video files with only muscle names visible. Motor units were not analyzed. Two independent, American Board of Electrodiagnostic Medicine board-certified examiners, who were masked to the patient's name, history, physical examination, and the electrodiagnostic report, reviewed 29 study subjects' digital video files. They rated each muscle's insertional and spontaneous activity on a standardized scoring sheet. After the examination was scored, they also generated a diagnostic impression of no evidence, possible evidence, or clear evidence of lumbar radiculopathy. Interrater reliability between the unmasked examiner and the two independent, masked examiners was assessed by Cohen's kappa statistic for electromyographic scoring of the muscles examined and for diagnostic impression.
The interrater reliability was substantial (kappa >0.60) showing >60% agreement for the scoring of most of the muscles examined. The overall diagnostic impression showed outstanding interrater reliability (kappa >0.90) showing >90% agreement between the unmasked and masked examiners. There were no significant differences in the scoring between the two masked examiners.
Needle electromyographic assessment of lower-limb and lumbar paraspinal muscles in the electrodiagnostic evaluation of lumbar radiculopathy is objective and highly reliable when performed by well trained and qualified electromyographers. Masked validation can be performed in electromyographic-based research.
本研究旨在调查在下肢根性神经病的硬膜外类固醇注射后，电诊断结果对预测结果的效用评估中，专家电诊断医师对肌电图检查结果和电诊断印象的评分的组内可靠性。
本研究共纳入 29 例肌电图记录，这些记录来自于一个更大的前瞻性、观察性队列的 89 例连续患者，这些患者因下肢电诊断评估而被收入医院脊柱科。该研究旨在评估在下肢根性神经病的硬膜外类固醇注射后，电诊断结果对预测结果的效用。一位未被蒙蔽、具有美国电诊断医学委员会认证资格、了解患者病史和体检情况的检查者对所有初始电诊断评估进行了检查，包括对 6 块肢体肌肉和代表 L3 到 S1 运动神经节的腰椎旁肌进行标准化的肌电图检查。所有肌肉的插入和自发性活动均记录为仅显示肌肉名称的去识别数字视频文件。未分析运动单位。两位独立的、具有美国电诊断医学委员会认证资格的检查者对 29 名研究对象的数字视频文件进行了评估，他们对每个肌肉的插入和自发性活动进行评分，并且对这些评分使用标准化的评分表。检查评分后，他们还生成了下肢根性神经病的无证据、可能证据或明确证据的诊断印象。对未被蒙蔽的检查者和两位独立的、被蒙蔽的检查者进行了肌电图检查肌肉评分和诊断印象的组内可靠性评估，采用 Cohen's kappa 统计量。
肌电图检查肌肉评分的组内可靠性为高度可靠（kappa>0.60），显示大多数检查肌肉的>60%一致性。总体诊断印象的组内可靠性为极好（kappa>0.90），显示未被蒙蔽的检查者和被蒙蔽的检查者之间的>90%一致性。两位被蒙蔽的检查者之间的评分无显著差异。
由训练有素且合格的肌电图检查者对下肢和腰椎旁肌进行肌电图检查，在下肢根性神经病的电诊断评估中是客观且高度可靠的。可以在肌电图为基础的研究中进行被蒙蔽的验证。
