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

N. C. A. (Nigel) Hanchard, T. E. (Tracey) Howe, M. M. (Meg) Gilbert

    Research output: Contribution to journalArticleResearchpeer-review

    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.
    Original languageEnglish
    Pages (from-to)147-153
    JournalJournal of Orthopaedic and Sports Physical Therapy
    Volume35
    Issue number3
    DOIs
    Publication statusPublished - 2005

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    Shoulder Pain
    Bursitis
    History
    Rotator Cuff
    Physical Examination
    Consensus
    Confidence Intervals

    Cite this

    Hanchard, N. C. A. (Nigel) ; Howe, T. E. (Tracey) ; Gilbert, M. M. (Meg). / Diagnosis of shoulder pain by history and selective tissue tension: agreement between assessors. In: Journal of Orthopaedic and Sports Physical Therapy. 2005 ; Vol. 35, No. 3. pp. 147-153.
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    title = "Diagnosis of shoulder pain by history and selective tissue tension: agreement between assessors",
    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.",
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    Diagnosis of shoulder pain by history and selective tissue tension: agreement between assessors. / Hanchard, N. C. A. (Nigel); Howe, T. E. (Tracey); Gilbert, M. M. (Meg).

    In: Journal of Orthopaedic and Sports Physical Therapy, Vol. 35, No. 3, 2005, p. 147-153.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Diagnosis of shoulder pain by history and selective tissue tension: agreement between assessors

    AU - Hanchard, N. C. A. (Nigel)

    AU - Howe, T. E. (Tracey)

    AU - Gilbert, M. M. (Meg)

    PY - 2005

    Y1 - 2005

    N2 - 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.

    AB - 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.

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