用于髌股关节不稳定的常见体格检查测试显示评分者间信度较低。
Common Physical Examination Tests for Patellofemoral Instability Demonstrate Weak Inter-Rater Reliability.
作者信息
Hiemstra Laurie A, O'Brien Catherine L, Lafave Mark R, Kerslake Sarah
机构信息
Banff Sport Medicine, Banff, Canada.
Department of Surgery, University of Calgary, Calgary, Canada.
出版信息
Arthrosc Sports Med Rehabil. 2021 May 8;3(3):e673-e677. doi: 10.1016/j.asmr.2021.01.004. eCollection 2021 Jun.
PURPOSE
The purpose of this study was to assess the inter-rater reliability of 3 common physical examination assessments, the Q-angle, J-sign, and apprehension test, used to evaluate patients presenting with recurrent lateral patellofemoral instability.
METHODS
A consecutive sample of 38 subjects with recurrent lateral patellofemoral instability in 2013 were included in this reliability study. Two orthopaedic surgeons performed the physical examination maneuvers blinded to each other. The physical examination tests were performed bilaterally and included the Q angle, the J-sign, and the apprehension test. To measure the inter-rater reliability, an intraclass correlation coefficient (ICC 2,κ) was used for both legs independently for Q-angle measurements. A Cohen's kappa was used to measure the inter-rater reliability for the J-sign and the apprehension test.
RESULTS
The measurement of the Q-angle demonstrated poor reliability (ICC 2,κ 0.18-0.44). The assessment of the J-sign demonstrated fair to moderate reliability (κ = 0.31 - 0.41), and the evaluation of apprehension demonstrated fair to substantial reliability (κ = 0.30 - 0.65). All 3 clinical tests demonstrated substantial variability comparing the reliability on the right and left limbs. Assessment of the quality of apprehension demonstrated good agreement between the examiners.
CONCLUSIONS
In this study of patients with recurrent lateral patellofemoral instability the common physical examination tests, Q-angle, J-sign, and apprehension demonstrated weak inter-rater reliability. These results indicate that these tests are not reliable for communication between health care practitioners or as evaluations for clinical research.
LEVEL OF EVIDENCE
Level IV, therapeutic case series.
目的
本研究旨在评估用于评估复发性外侧髌股关节不稳定患者的三种常见体格检查评估方法（Q角、J征和恐惧试验）的评分者间信度。
方法
本信度研究纳入了2013年38例复发性外侧髌股关节不稳定的连续样本。两名骨科医生在彼此不知情的情况下进行体格检查操作。体格检查测试双侧进行，包括Q角、J征和恐惧试验。为测量评分者间信度，Q角测量独立对双腿使用组内相关系数（ICC 2,κ）。使用Cohen's kappa系数测量J征和恐惧试验的评分者间信度。
结果
Q角测量显示信度较差（ICC 2,κ 0.18 - 0.44）。J征评估显示信度为中等（κ = 0.31 - 0.41），恐惧试验评估显示信度为中等至较高（κ = 0.30 - 0.65）。所有三项临床测试在比较左右肢体信度时均显示出较大变异性。恐惧试验质量评估显示检查者之间一致性良好。
结论
在这项针对复发性外侧髌股关节不稳定患者的研究中，常见的体格检查测试，即Q角、J征和恐惧试验，显示出较弱的评分者间信度。这些结果表明，这些测试对于医护人员之间的沟通或作为临床研究评估并不可靠。
证据水平
IV级，治疗性病例系列。
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