Croft P, Pope D, Boswell R, Rigby A, Silman A
ARC Epidemiology Research Unit, University of Manchester.
Br J Rheumatol. 1994 Oct;33(10):942-6. doi: 10.1093/rheumatology/33.10.942.
The aim of the study was to assess the observer variation between trained primary care physicians in their assessment of two key shoulder movements: elevation and external rotation. Six observers each examined and recorded their visual estimate of the range of movements in six patients assessed in random order. There was good agreement on the range of passive elevation assessed to the start of pain (if present): intraclass correlation coefficient (ICC) = 0.84, and to the point of maximum elevation: ICC = 0.95. There was no evidence of an important systematic bias between observers. By contrast, external rotation was poorly reproducible: ICC = 0.43, with important systematic differences between observers. In the second experiment, six observers simultaneously witnessed a range of movements in a single volunteer subject, and the agreement on their visual estimation of the angles achieved was assessed. There was a marked reduction in the systematic bias in external rotation, but agreement was still poor. Agreement for elevation remained high with a reduction in the small amount of bias observed in the first experiment when variability in both examination and visual assessment had been investigated. We conclude that shoulder elevation is a reliable measurement for use in multicentre studies by trained primary care physicians. By contrast, external rotation is poorly reproducible because of systematic variation in examination technique and random variation in visual assessment.
本研究的目的是评估经过培训的初级保健医生在评估两个关键肩部动作（抬高和外旋）时的观察者差异。六位观察者分别对六名患者进行检查，并按随机顺序记录他们对动作范围的视觉估计。在评估被动抬高至疼痛开始（若存在疼痛）时的动作范围方面，观察者之间有良好的一致性：组内相关系数（ICC）=0.84；在评估至最大抬高程度时，ICC = 0.95。没有证据表明观察者之间存在重要的系统偏差。相比之下，外旋的可重复性较差：ICC = 0.43，观察者之间存在重要的系统差异。在第二个实验中，六位观察者同时观察一名志愿者受试者的一系列动作，并评估他们对所达到角度的视觉估计的一致性。外旋的系统偏差明显减少，但一致性仍然较差。对于抬高的一致性仍然很高，并且在第一个实验中观察到的少量偏差有所减少，在第一个实验中对检查和视觉评估的变异性都进行了研究。我们得出结论，肩部抬高是经过培训的初级保健医生在多中心研究中可使用的可靠测量方法。相比之下，由于检查技术的系统变化和视觉评估的随机变化，外旋的可重复性较差。
