Green S, Buchbinder R, Forbes A, Bellamy N
Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Vic., Australia.
Arthritis Care Res. 1998 Feb;11(1):43-52. doi: 10.1002/art.1790110108.
To develop a standardized protocol for measurement of shoulder movements using a gravity inclinometer designed for use in clinical trials, and to assess its intra- and interrater reliability in a group of manipulative physiotherapists.
After instruction, 6 manipulative physiotherapists independently assessed 8 movements of the shoulder, including total and glenohumeral flexion (TF, GHF), total and glenohumeral abduction (TA, GHA), external rotation in neutral (ERN) and abduction (ERA), internal rotation in abduction (IRA), and hand behind back (HBB), in random order in 6 patients with shoulder pain and stiffness according to a 6 x 6 Latin square design using the standardized protocol. The assessments were then repeated. Analysis of variance was used to partition total variability into components of variance in order to calculate intraclass correlation coefficients (ICCs).
The intra- and interrater reliability of the different movements varied widely. Reliability was higher for TF and TA than for the corresponding glenohumeral movements (e.g., intrarater ICCs: TF = 0.80, GHF = 0.65, TA = 0.75, GHA = 0.62). Interrater reliability was higher in the second round suggesting a practice effect (e.g., round 1, 2 interrater ICCs TF = 0.62, 0.82; TA = 0.62, 0.88; ERN = 0.85, 0.95).
The measurement of the active range of TF, TA, ERN, and HBB, measured by manipulative physiotherapists following the standardized protocol, has intra- and interrater reliability acceptable for use as an outcome measure in clinical trials assessing interventions for shoulder pain.
制定使用一种专为临床试验设计的重力倾角仪测量肩部运动的标准化方案，并评估其在一组手法治疗物理治疗师中的组内和组间可靠性。
在接受指导后，6名手法治疗物理治疗师根据6×6拉丁方设计，按照标准化方案，对6例肩部疼痛和僵硬患者的8种肩部运动进行独立评估，这些运动包括总屈曲和盂肱关节屈曲（TF、GHF）、总外展和盂肱关节外展（TA、GHA）、中立位外旋（ERN）和外展时外旋（ERA）、外展时内旋（IRA）以及手背后（HBB），评估顺序随机。然后重复进行评估。采用方差分析将总变异性分解为方差成分，以计算组内相关系数（ICC）。
不同运动的组内和组间可靠性差异很大。TF和TA的可靠性高于相应的盂肱关节运动（例如，组内ICC：TF = 0.80，GHF = 0.65，TA = 0.75，GHA = 0.62）。第二轮的组间可靠性更高，提示存在练习效应（例如，第一轮、第二轮组间ICC：TF = 0.62，0.82；TA = 0.62，0.88；ERN = 0.85，0.95）。
手法治疗物理治疗师按照标准化方案测量的TF、TA、ERN和HBB的主动活动范围，其组内和组间可靠性可接受，可作为评估肩部疼痛干预措施的临床试验中的一项结局指标。
