Fairfield Hospital, Polding St. & Prairievale Rd., Prairiewood, 2176, NSW, Australia; Western Sydney University, Narellan Rd., Campbelltown, 2560, NSW, Australia.
Flinders University, College of Nursing and Health Sciences, Sturt Rd., Bedford Park, 5042, SA, Australia.
Musculoskelet Sci Pract. 2022 Aug;60:102560. doi: 10.1016/j.msksp.2022.102560. Epub 2022 Mar 29.
Hand therapists often work in roles which require an advanced level of experience as Advanced Scope Practitioners (ASP). However, it is not known whether clinical decisions are similar between hand therapists and surgeons when managing simple hand fractures.
To determine the level of agreement between (i) a hand therapist and five hand surgeons and (ii) three hand therapists, for the management of adults with closed metacarpal fracture(s).
A prospective, blinded, crossover inter-rater reliability study.
Patient volunteers with closed metacarpal fracture(s) were assessed independently in the first study (n = 90) by a hand therapist and one of five hand surgeons and in the second study (n = 57) by three hand therapists in a randomised order, with each practitioner recording whether the patient participant should be managed conservatively, trialled with conservative or offered surgical treatment. The level of agreement between the hand therapist and hand surgeons was calculated using Cohen's kappa coefficient and between the three hand therapists by calculating Fleiss' Kappa. The observed agreement was also calculated as the proportion of cases for which the assessors had agreement for management.
There was good agreement between the hand therapist and surgeons (k = 0.68; 95% CI: 0.537-0.831) and amongst the three hand therapists (k = 0.663; 95% CI: 0.554-0.773) in determining the management of adults with closed metacarpal fracture(s).
Hand therapists and surgeons make similar management decision for patients with metacarpal fractures supporting the role of hand therapists as ASP.
手部治疗师通常在需要高级经验的角色中工作，例如高级实践范围治疗师（ASP）。然而，当管理简单的手部骨折时，手部治疗师和外科医生的临床决策是否相似尚不清楚。
确定手部治疗师（i）与五名手部外科医生和（ii）三名手部治疗师之间在管理成人闭合掌骨骨折方面的管理决策的一致性水平。
前瞻性、盲法、交叉评分者间可靠性研究。
通过手部治疗师和五名手部外科医生中的一名在第一项研究（n=90）中独立评估闭合掌骨骨折患者志愿者，并通过三名手部治疗师在第二项研究（n=57）中随机顺序评估，每位从业者记录患者参与者是否应保守治疗、保守治疗试验或接受手术治疗。使用 Cohen 的kappa 系数计算手部治疗师和手部外科医生之间的一致性水平，并使用 Fleiss' Kappa 计算三名手部治疗师之间的一致性水平。观察一致性也计算为评估者对管理达成一致的病例比例。
手部治疗师和外科医生之间（k=0.68；95%CI：0.537-0.831）以及三名手部治疗师之间（k=0.663；95%CI：0.554-0.773）在确定成人闭合掌骨骨折的管理方面具有良好的一致性。
手部治疗师和外科医生对掌骨骨折患者做出类似的管理决策，支持手部治疗师作为 ASP 的角色。
