Gladitz Luisa Marilena, Schöttker-Königer Thomas, Sturm Christian, Gutenbrunner Christoph, Ranker Alexander
From the Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany (LMG, CS, CG, AR); and University of Applied Sciences and Art, Hildesheim, Germany (TS-K).
Am J Phys Med Rehabil. 2021 Jun 1;100(6):539-545. doi: 10.1097/PHM.0000000000001731.
The aim of this study was to investigate the interrater reliability and intrarater reliability of the flexor pollicis longus muscle stretch reflex (FPLR) and compare it with clinically established reflexes.
A total of 71 healthy volunteers participated. The FPLR, biceps reflex, brachioradialis reflex, and patellar tendon reflex of each participant were tested bilaterally and rated by eight examiners (four experienced, four inexperienced). For intrarater reliability evaluation, five examiners rated the reflexes of four volunteers at four different points in time.
Analysis of the interrater reliability with Gwet's AC1 demonstrated almost perfect agreement for FPLR (Gwet's AC1 = 0.90), biceps reflex (Gwet's AC1 = 0.90), and patellar tendon reflex (Gwet's AC1 = 0.95) when using binary data (reflex present vs. absent). Only fair agreement was found for the brachioradialis reflex (Gwet's AC1 = 0.56). Experienced raters had a higher agreement than inexperienced raters did when rating the biceps reflex and the patellar tendon reflex. The intrarater reliability was almost perfect for the patellar tendon reflex (Gwet's AC1 = 0.94), followed by the FPLR (Gwet's AC1 = 0.83) with substantial agreement and the biceps reflex (Gwet's AC1 = 0.57) with moderate agreement.
The FPLR is a reliable diagnostic neuromuscular test and may therefore be useful in the clinical examination for C8/T1 nerve root lesions or pathologies of the interosseous anterior nerve.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.
Upon completion of this article, the reader should be able to: (1) Elicit the flexor pollicis longus muscle stretch reflex; (2) Discuss the disadvantage of kappa statistics in assessing the interrater reliability when the prevalence of the studied trait is very high or very low; and (3) Name the spinal nerves involved in the innervation of the flexor pollicis longus muscle.
Advanced.
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
本研究旨在调查拇长屈肌牵张反射（FPLR）的评分者间信度和评分者内信度，并将其与临床已确立的反射进行比较。
共有71名健康志愿者参与。对每位参与者的FPLR、肱二头肌反射、肱桡肌反射和髌腱反射进行双侧测试，并由8名检查者（4名经验丰富的，4名经验不足的）进行评分。为了评估评分者内信度，5名检查者在四个不同时间点对4名志愿者的反射进行评分。
使用二元数据（反射存在与否）时，采用Gwet's AC1分析评分者间信度，结果显示FPLR（Gwet's AC1 = 0.90）、肱二头肌反射（Gwet's AC1 = 0.90）和髌腱反射（Gwet's AC1 = 0.95）几乎完全一致。肱桡肌反射仅显示中等一致性（Gwet's AC1 = 0.56）。在对肱二头肌反射和髌腱反射进行评分时，经验丰富的检查者比经验不足的检查者一致性更高。髌腱反射的评分者内信度几乎完全一致（Gwet's AC1 = 0.94），其次是FPLR（Gwet's AC1 = 0.83），显示高度一致性，肱二头肌反射（Gwet's AC1 = 0.57）显示中等一致性。
FPLR是一种可靠的诊断性神经肌肉检查方法，因此可能有助于C8/T1神经根病变或骨间前神经病变的临床检查。
在http://www.physiatry.org/JournalCME在线完成自我评估活动和评价。
阅读本文后，读者应能够：（1）引出拇长屈肌牵张反射；（2）讨论kappa统计量在评估研究特征患病率非常高或非常低时评分者间信度的缺点；（3）说出支配拇长屈肌的脊神经。
高级。
学术物理医学与康复医师协会经继续医学教育认证委员会认可，可为医生提供继续医学教育。学术物理医学与康复医师协会指定此基于期刊的继续医学教育活动最多可获得1.0个美国医学协会医师认可奖第1类学分™。医生应仅根据其参与活动的程度申请相应学分。
