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Intertester reliability of shoulder complaints diagnoses in primary health care

View Article: PubMed Central - PubMed

ABSTRACT

Objective: Shoulder complaints are frequently encountered in general practice, but precise diagnosing is challenging. This study investigated agreement of shoulder complaints diagnoses between clinicians in a primary health care setting.

Design: Cross-sectional study.

Setting: Four primary health care clinicians used patients’ history and functional examination of the shoulder by selective tissue tension techniques (STTs), to diagnose shoulder complaints.

Subjects: 62 patients, aged 18–75 years.

Main outcome measure: Reliability of diagnoses was assessed by observed intertester agreement and Cohen’s kappa. A total of 372 diagnostic pairs were available for intertester comparisons.

Results: Six diagnoses were assigned by all clinicians; supraspinatus-, infraspinatus-, subscapularis-tendinopathies; chronic subacromial bursitis; glenohumeral capsulitis, and acromioclavicular joint lesion. The observed agreement on these diagnoses ranged from 0.84 for glenohumeral capsulitis to 0.97 for acromioclavicular joint lesion. Kappa scores were 0.46 (95% CI 0.33, 0.58) for chronic subacromial bursitis; 0.53 (95% CI 0.34, 0.68), 0.59 (95% CI 0.47, 0.70), and 0.68 (95% CI 0.53, 0.82) for infraspinatus -, supraspinatus -, and subscapularis-tendinopathy, respectively. For glenohumeral capsulitis and acromioclavicular lesion kappa scores were 0.66 (95% CI 0.57, 0.73) and 0.78 (95% CI 0.61, 0.90). Kappa scores were higher for individual diagnoses than for individual tests, except for limitation in passive abduction (0.70, 95% CI 0.62, 0.78) and passive lateral rotation (0.66, 95% CI 0.57, 0.73).

Conclusions: Although experienced clinicians showed substantial intertester agreement, precise diagnoses of shoulder complaints in primary health care remain a challenge. The present results call for further research on refined diagnoses of shoulder complaints.

Key points: Based on medical history and a systematic functional examination by selective tissue tension techniques (STTs), we investigated the agreement of shoulder complaints diagnoses across four primary health care clinicians and 62 patients.

Key points: • Agreements on diagnoses were generally better than the agreement on individual tests.

Key points: • Good kappa scores were obtained for the diagnoses glenohumeral capsulitis, rotator cuff tendinopathy, and acromioclavicular lesion.

Key points: • Further research is necessary to investigate the diagnostic validity of functional shoulder examination by the STTs method.

Key points: • Further research is necessary to investigate the diagnostic validity of functional shoulder examination by the STTs method.

No MeSH data available.


Age distribution of the patients included in the study by sex (34 women and 28 men).
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Figure 0001: Age distribution of the patients included in the study by sex (34 women and 28 men).

Mentions: The study cohort included 34 women and 28 men between 18 and 75 years of age, of whom 63% were between 40 and 60 years of age (Figure 1). Women dominated in the age groups of 50 years and under, and men dominated in the age groups of 60 years or over. More than 90% of patients reported localization of symptoms to the shoulder, 89% to upper arm, 45% to the forearm and 27% to the fingers. In addition to pain (100%), 23 and 24% of patients reported paresthesia and numbness, respectively. In the medical history, 95% of participants reported symptoms to the C5 dermatome. Patient-reported causes of symptoms were equally distributed between overuse, trauma, and spontaneously occurring. In 75% of patients, the symptoms had lasted more than 26 weeks, and in 23%, 8–26 weeks. Sixty-eight percent of patients reported pain at rest, 90% activity-related pain, 71% nocturnal pain, and more than 70% reported problems lying on the affected shoulder.


Intertester reliability of shoulder complaints diagnoses in primary health care
Age distribution of the patients included in the study by sex (34 women and 28 men).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036011&req=5

Figure 0001: Age distribution of the patients included in the study by sex (34 women and 28 men).
Mentions: The study cohort included 34 women and 28 men between 18 and 75 years of age, of whom 63% were between 40 and 60 years of age (Figure 1). Women dominated in the age groups of 50 years and under, and men dominated in the age groups of 60 years or over. More than 90% of patients reported localization of symptoms to the shoulder, 89% to upper arm, 45% to the forearm and 27% to the fingers. In addition to pain (100%), 23 and 24% of patients reported paresthesia and numbness, respectively. In the medical history, 95% of participants reported symptoms to the C5 dermatome. Patient-reported causes of symptoms were equally distributed between overuse, trauma, and spontaneously occurring. In 75% of patients, the symptoms had lasted more than 26 weeks, and in 23%, 8–26 weeks. Sixty-eight percent of patients reported pain at rest, 90% activity-related pain, 71% nocturnal pain, and more than 70% reported problems lying on the affected shoulder.

View Article: PubMed Central - PubMed

ABSTRACT

Objective: Shoulder complaints are frequently encountered in general practice, but precise diagnosing is challenging. This study investigated agreement of shoulder complaints diagnoses between clinicians in a primary health care setting.

Design: Cross-sectional study.

Setting: Four primary health care clinicians used patients’ history and functional examination of the shoulder by selective tissue tension techniques (STTs), to diagnose shoulder complaints.

Subjects: 62 patients, aged 18–75 years.

Main outcome measure: Reliability of diagnoses was assessed by observed intertester agreement and Cohen’s kappa. A total of 372 diagnostic pairs were available for intertester comparisons.

Results: Six diagnoses were assigned by all clinicians; supraspinatus-, infraspinatus-, subscapularis-tendinopathies; chronic subacromial bursitis; glenohumeral capsulitis, and acromioclavicular joint lesion. The observed agreement on these diagnoses ranged from 0.84 for glenohumeral capsulitis to 0.97 for acromioclavicular joint lesion. Kappa scores were 0.46 (95% CI 0.33, 0.58) for chronic subacromial bursitis; 0.53 (95% CI 0.34, 0.68), 0.59 (95% CI 0.47, 0.70), and 0.68 (95% CI 0.53, 0.82) for infraspinatus -, supraspinatus -, and subscapularis-tendinopathy, respectively. For glenohumeral capsulitis and acromioclavicular lesion kappa scores were 0.66 (95% CI 0.57, 0.73) and 0.78 (95% CI 0.61, 0.90). Kappa scores were higher for individual diagnoses than for individual tests, except for limitation in passive abduction (0.70, 95% CI 0.62, 0.78) and passive lateral rotation (0.66, 95% CI 0.57, 0.73).

Conclusions: Although experienced clinicians showed substantial intertester agreement, precise diagnoses of shoulder complaints in primary health care remain a challenge. The present results call for further research on refined diagnoses of shoulder complaints.

Key points: Based on medical history and a systematic functional examination by selective tissue tension techniques (STTs), we investigated the agreement of shoulder complaints diagnoses across four primary health care clinicians and 62 patients.

Key points: • Agreements on diagnoses were generally better than the agreement on individual tests.

Key points: • Good kappa scores were obtained for the diagnoses glenohumeral capsulitis, rotator cuff tendinopathy, and acromioclavicular lesion.

Key points: • Further research is necessary to investigate the diagnostic validity of functional shoulder examination by the STTs method.

Key points: • Further research is necessary to investigate the diagnostic validity of functional shoulder examination by the STTs method.

No MeSH data available.