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

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.