Rossi Denise Martineli, Pedroni Cristiane Rodrigues, Martins Jaqueline, de Oliveira Anamaria Siriani
Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Department of Physiotherapy and Occupational Therapy, São Paulo State University, Marília, São Paulo, Brazil.
PLoS One. 2017 Jul 27;12(7):e0181518. doi: 10.1371/journal.pone.0181518. eCollection 2017.
Clinical evaluation of scapular dyskinesis (SD) aims to identify abnormal scapulothoracic movement, underlying causal factors, and the potential relationship with shoulder symptoms. The literature proposes different methods of dynamic clinical evaluation of SD, but improved reliability and agreement values are needed. The present study aimed to evaluate the intrarater and interrater agreement and reliability of three SD classifications: 1) 4-type classification, 2) Yes/No classification, and 3) scapular dyskinesis test (SDT). Seventy-five young athletes, including 45 men and 30 women, were evaluated. Raters evaluated the SD based on the three methods during one series of 8-10 cycles (at least eight and maximum of ten) of forward flexion and abduction with an external load under the observation of two raters trained to diagnose SD. The evaluation protocol was repeated after 3 h for intrarater analysis. The agreement percentage was calculated by dividing the observed agreement by the total number of observations. Reliability was calculated using Cohen Kappa coefficient, with a 95% confidence interval (CI), defined by Kappa coefficient ±1.96 multiplied by the measurement standard error. The interrater analyses showed an agreement percentage between 80% and 95.9% and an almost perfect reliability (k>0.81) for the three classification methods in all the test conditions, except the 4-type and SDT classification methods, which had substantial reliability (k<0.80) in shoulder abduction. Intrarater analyses showed agreement percentages between 80.7% and 89.3% and substantial reliability (0.67 to 0.81) for both raters in the three classifications. CIs ranged from moderate to almost perfect categories. This indicates that the three SD classification methods investigated in this study showed high reliability values for both intrarater and interrater evaluation throughout a protocol that provided SD evaluation training of raters and included several repetitions of arm movements with external load during a live assessment.
肩胛运动障碍（SD）的临床评估旨在识别肩胛胸壁运动异常、潜在病因以及与肩部症状的潜在关系。文献中提出了不同的SD动态临床评估方法，但仍需要提高可靠性和一致性值。本研究旨在评估三种SD分类方法的评分者内和评分者间一致性及可靠性：1）4型分类法，2）是/否分类法，3）肩胛运动障碍测试（SDT）。对75名年轻运动员进行了评估，其中包括45名男性和30名女性。评分者在两名经过SD诊断培训的评分者的观察下，基于三种方法在一系列8 - 10个周期（至少8个且最多10个）的前屈和外展动作且有外部负荷的情况下对SD进行评估。3小时后重复评估方案以进行评分者内分析。一致性百分比通过将观察到的一致性除以观察总数来计算。可靠性使用Cohen Kappa系数计算，其95%置信区间（CI）由Kappa系数±1.96乘以测量标准误差定义。评分者间分析显示，在所有测试条件下，三种分类方法的一致性百分比在80%至95.9%之间，除了4型和SDT分类法在肩部外展时具有较高可靠性（k >
0.81）外，其他分类方法在肩部外展时具有实质性可靠性（k < 0.80）。评分者内分析显示，两名评分者在三种分类中的一致性百分比在80.7%至89.3%之间，可靠性较高（0.67至0.81）。置信区间范围从中度到几乎完美类别。这表明本研究中调查的三种SD分类方法在整个方案中对评分者内和评分者间评估均显示出高可靠性值，该方案为评分者提供了SD评估培训，并在现场评估期间包括了多次有外部负荷的手臂运动重复。
