Garcia Grant H, Liu Joseph N, Wong Alexandra C, Gowd Anirudh K, Romeo Anthony A, Dines Joshua S, Gulotta Lawrence V
Orthopedics. 2018 Nov 1;41(6):e820-e826. doi: 10.3928/01477447-20180912-08. Epub 2018 Sep 18.
Long-term clinical evaluation is becoming more important, yet difficulties exist because there are substantial patient costs for extended follow-up. The goal of this study was to validate whether a new shoulder motion evaluation is reproducible and reliable with physician examination. Consecutive patients were administered a shoulder motion assessment during their clinic visit. Patients completed the same evaluation 2 weeks after their visit to determine test-retest reliability. Exact and approximate (within 20° or 4 spinal levels) agreements between patient and physician measurements were calculated. A total of 112 patients (224 shoulders) with an average age of 56.7 years were evaluated. The most common diagnoses were osteoarthritis (33.0%) and rotator cuff tear (32.1%). All motion questions had greater than 50% exact patient-physician agreement and greater than 70% approximate agreement. When agreement was off, patients more often underestimated their motion. There was substantial clinician-patient agreement for all questions and almost perfect agreement for forward elevation (intraclass correlation coefficient, 0.78) and internal rotation (intraclass correlation coefficient, 0.77). On test-retest reliability testing, patient-patient agreement was substantial for external rotation at the side (intraclass correlation coefficient, 0.71). There was near perfect agreement for internal rotation (intraclass correlation coefficient, 0.83) and abduction (intraclass correlation coefficient, 0.81) testing. This shoulder assessment tool had both good agreement to physician examination and substantial agreement on correlation testing. There was substantial agreement between follow-up visits, suggesting excellent reproducibility. This motion assessment shows effectiveness with most shoulder pathologies. It is recommended as a good screening tool for both clinical and research purposes requiring long-term follow-up in which in-person clinical examinations may be costly and time consuming. [Orthopedics. 2018; 41(6):e820-e826.].
长期临床评估正变得越来越重要，但由于延长随访会给患者带来高昂费用，所以仍存在困难。本研究的目的是验证一种新的肩部运动评估方法在医生检查时是否具有可重复性和可靠性。连续的患者在门诊就诊时接受肩部运动评估。患者在就诊2周后完成相同评估，以确定重测信度。计算患者与医生测量结果之间的精确和近似（在20°或4个脊柱节段范围内）一致性。共评估了112例患者（224个肩部），平均年龄56.7岁。最常见的诊断是骨关节炎（33.0%）和肩袖撕裂（32.1%）。所有运动问题的患者与医生精确一致性均超过50%，近似一致性超过70%。当一致性出现偏差时，患者往往低估自己的运动能力。所有问题的医患一致性都很高，前屈（组内相关系数，0.78）和内旋（组内相关系数，0.77）几乎完全一致。在重测信度测试中，患侧外旋的患者间一致性较高（组内相关系数，0.71）。内旋（组内相关系数，0.83）和外展（组内相关系数，0.81）测试几乎完全一致。这种肩部评估工具与医生检查的一致性良好，相关性测试的一致性也很高。随访之间的一致性很高，表明具有出色的可重复性。这种运动评估对大多数肩部疾病都有效。它被推荐为一种良好的筛查工具，适用于需要长期随访的临床和研究目的，因为亲自进行临床检查可能成本高昂且耗时。[《骨科》。2018年；41(6):e820 - e826。]
