Diagnosis of shoulder pain by history and selective tissue tension: agreement between assessors

Hdl Handle:
http://hdl.handle.net/10149/58213
Title:
Diagnosis of shoulder pain by history and selective tissue tension: agreement between assessors
Authors:
Hanchard, N. C. A. (Nigel); Howe, T. E. (Tracey); Gilbert, M. M. (Meg)
Affiliation:
University of Teesside. School of Health and Social Care. Teesside Centre for Rehabilitation Sciences; Middlesbrough Primary Care Trust.
Citation:
Hanchard, N. C. A., Howe, T. E. and Gilbert, M. M. (2005) 'Diagnosis of shoulder pain by history and selective tissue tension: agreement between assessors', Journal of Orthopaedic and Sports Physical Therapy, 35 (3), pp.147-153.
Publisher:
Lippincott, Williams & Wilkins
Journal:
Journal of Orthopaedic and Sports Physical Therapy
Issue Date:
Mar-2005
URI:
http://hdl.handle.net/10149/58213
DOI:
10.2519/jospt.2005.1502
Abstract:
Study Design: Evaluation of agreement between assessors. Objective: To evaluate agreement between an expert in selective tissue tension (STT) and 3 other trained assessors, all using STT in conjunction with a preliminary clinical history, on their diagnostic labelling of painful shoulders. Background: Consensus on diagnostic labelling for shoulder pain is poor, hampering interpretation of the evidence for interventions. STT, a systematic approach to physical examination and diagnosis, offers potential for standardization, but its reliability is contentious. Methods and Measures: Four trained assessors, 1 of whom was considered an expert, separately assessed 56 painful shoulders in 53 subjects (32 male [mean ± SD age, 51 ± 13 years], 21 female [mean ± SD age, 57 ± 12 years]), using STT in conjunction with a preliminary clinical history. Assessors labelled each painful shoulder as ‘‘rotator cuff lesion,’’ ‘‘bursitis,’’ ‘‘capsulitis,’’ ‘‘other diagnosis,’’ or ‘‘no diagnosis.’’ Combinations of diagnoses were allowed. Results: A diagnosis was made in every case, with less than 7% of the diagnoses being combined. With the diagnostic categories pooled, agreement (kappa and 95% confidence interval [CI]) between the expert assessor and each of the other assessors was good, ranging from 0.61 (0.44-0.78) to 0.75 (0.60-0.90). For single diagnostic categories, agreement between the expert and each of the others (dichotomized data) ranged from 0.35 (–0.03-0.73) to 0.58 (0.29 0.87) for bursitis; 0.63 (0.40-0.86) to 0.82 (0.65-0.99) for capsulitis; 0.71 (0.49-0.93) to 0.79 (0.61-0.96) for rotator cuff lesions; and from 0.69 (0.35-1.00) to 0.78 (0.48-1.00) for other diagnoses. Conclusions: Overall, STT in conjunction with a preliminary clinical history enables good agreement between trained assessors. Future work is required to evaluate its criterion validity.
Type:
Article
Keywords:
shoulders; pain; orthopaedics; physical therapy; tissue tension; diagnostic labelling
ISSN:
0190-6011
Rights:
Subject to restrictions, author can archive post-print (ie final draft post-refereeing). For full details see http://www.sherpa.ac.uk/romeo/ [Accessed 15/12/09]
Citation Count:
3 [Scopus, 15/12/09]

Full metadata record

DC FieldValue Language
dc.contributor.authorHanchard, N. C. A. (Nigel)-
dc.contributor.authorHowe, T. E. (Tracey)-
dc.contributor.authorGilbert, M. M. (Meg)-
dc.date.accessioned2009-04-01T10:46:07Z-
dc.date.available2009-04-01T10:46:07Z-
dc.date.issued2005-03-
dc.identifier.citationJournal of Orthopaedic & Sports Physical Therapy; 35 (3): 147-153-
dc.identifier.issn0190-6011-
dc.identifier.doi10.2519/jospt.2005.1502-
dc.identifier.urihttp://hdl.handle.net/10149/58213-
dc.description.abstractStudy Design: Evaluation of agreement between assessors. Objective: To evaluate agreement between an expert in selective tissue tension (STT) and 3 other trained assessors, all using STT in conjunction with a preliminary clinical history, on their diagnostic labelling of painful shoulders. Background: Consensus on diagnostic labelling for shoulder pain is poor, hampering interpretation of the evidence for interventions. STT, a systematic approach to physical examination and diagnosis, offers potential for standardization, but its reliability is contentious. Methods and Measures: Four trained assessors, 1 of whom was considered an expert, separately assessed 56 painful shoulders in 53 subjects (32 male [mean ± SD age, 51 ± 13 years], 21 female [mean ± SD age, 57 ± 12 years]), using STT in conjunction with a preliminary clinical history. Assessors labelled each painful shoulder as ‘‘rotator cuff lesion,’’ ‘‘bursitis,’’ ‘‘capsulitis,’’ ‘‘other diagnosis,’’ or ‘‘no diagnosis.’’ Combinations of diagnoses were allowed. Results: A diagnosis was made in every case, with less than 7% of the diagnoses being combined. With the diagnostic categories pooled, agreement (kappa and 95% confidence interval [CI]) between the expert assessor and each of the other assessors was good, ranging from 0.61 (0.44-0.78) to 0.75 (0.60-0.90). For single diagnostic categories, agreement between the expert and each of the others (dichotomized data) ranged from 0.35 (–0.03-0.73) to 0.58 (0.29 0.87) for bursitis; 0.63 (0.40-0.86) to 0.82 (0.65-0.99) for capsulitis; 0.71 (0.49-0.93) to 0.79 (0.61-0.96) for rotator cuff lesions; and from 0.69 (0.35-1.00) to 0.78 (0.48-1.00) for other diagnoses. Conclusions: Overall, STT in conjunction with a preliminary clinical history enables good agreement between trained assessors. Future work is required to evaluate its criterion validity.-
dc.publisherLippincott, Williams & Wilkins-
dc.rightsSubject to restrictions, author can archive post-print (ie final draft post-refereeing). For full details see http://www.sherpa.ac.uk/romeo/ [Accessed 15/12/09]-
dc.subjectshoulders-
dc.subjectpain-
dc.subjectorthopaedics-
dc.subjectphysical therapy-
dc.subjecttissue tension-
dc.subjectdiagnostic labelling-
dc.titleDiagnosis of shoulder pain by history and selective tissue tension: agreement between assessors-
dc.typeArticle-
dc.contributor.departmentUniversity of Teesside. School of Health and Social Care. Teesside Centre for Rehabilitation Sciences; Middlesbrough Primary Care Trust.-
dc.identifier.journalJournal of Orthopaedic and Sports Physical Therapy-
ref.assessmentRAE 2008-
ref.citationcount3 [Scopus, 15/12/09]-
or.citation.harvardHanchard, N. C. A., Howe, T. E. and Gilbert, M. M. (2005) 'Diagnosis of shoulder pain by history and selective tissue tension: agreement between assessors', Journal of Orthopaedic and Sports Physical Therapy, 35 (3), pp.147-153.-
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