肩组织激惹分类的可靠性和同时效度。

Reliability and Concurrent Validity of Shoulder Tissue Irritability Classification.

机构信息

Physical Therapy at St. Luke's, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA.

Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA.

出版信息

Phys Ther. 2021 Mar 3;101(3). doi: 10.1093/ptj/pzab022.

DOI:10.1093/ptj/pzab022

PMID:33481995

Abstract

OBJECTIVE

Rating tissue irritability has been recommended to aid decision making in several recent clinical practice guidelines. An explicit method for rating tissue irritability was proposed as part of the Staged Algorithm for Rehabilitation Classification: Shoulder Disorders (STAR-Shoulder), but the reliability and validity of this classification are unknown. The purpose of this study was to examine the reliability and concurrent validity of shoulder tissue irritability ratings as part of a system designed to guide appropriate treatment strategy and intensity.

METHODS

A clinical measurement, prospective repeated-measures cross-sectional design was used. The 101 consecutive participants with primary complaints of shoulder pain were assessed by pairs of blinded raters (24 raters in total) and rated for tissue irritability. Patients completed 3 patient-reported outcome (PRO) measures reflecting both pain and disability, and these scores were compared with ratings of tissue irritability. Paired ratings of irritability were analyzed for reliability with prevalence-adjusted, bias-adjusted Kappa for ordinal scales. Analysis of variance was used to compare PRO measures across different levels of irritability. Receiver operating characteristic curve analysis was utilized to derive cut-off scores for 3 PRO instruments.

RESULTS

Interrater reliability was 0.69 (95% CI = 0.59-0.78), with 67% agreement. All PRO measures were significantly different among 3 levels of tissue irritability.

CONCLUSION

There appears to be acceptable reliability and a strong relationship between PRO measures and therapist-rated tissue irritability, supporting the use of the STAR-Shoulder irritability rating system.

IMPACT

Several clinical practice guidelines have recommended that clinicians rate tissue irritability as part of their examination. This study provides important new information supporting the reliability and validity of the STAR-Shoulder tissue irritability rating system.

摘要

目的

在最近的几项临床实践指南中，建议对组织激惹性进行评分，以辅助决策。作为康复分类分级算法的一部分（STAR-Shoulder），提出了一种明确的组织激惹性评分方法，但该分类的可靠性和有效性尚不清楚。本研究的目的是检验 STAR-Shoulder 组织激惹性评分系统的可靠性和同时效度，该系统旨在指导适当的治疗策略和强度。

方法

采用临床测量、前瞻性重复测量的横截面设计。101 名原发性肩部疼痛患者由两组盲法评估者（共 24 名评估者）进行评估，并对组织激惹性进行评分。患者完成了 3 种反映疼痛和残疾的患者报告结局（PRO）测量，这些评分与组织激惹性评分进行了比较。采用调整了患病率和偏倚的有序量表 kapp 值对激惹性的配对评分进行可靠性分析。采用方差分析比较不同激惹性水平的 PRO 测量值。采用受试者工作特征曲线分析得出 3 种 PRO 工具的截断值。