Inter-rater-agreement in clinical tests of subacromial impingement

Abstract

Introduction: Shoulder pain is a common complain in the population. Subacromial impingement syndrome(SIS) is cause of many of these. SIS is a clinical diagnosis, mainly based on impingement signs. Clinical tests used for diagnosing specific disease, must be valid and reliable and have as high sensitivity and specificity as possible. They should be easy to learn and to reproduce.

Material and method: Tests included were Neers test, Hawkins test, painful arch and isometric test of the supraspinatus. 25 patients referred to the Orthopeadic Dep., Ullevål hospital, for chronic pain in the shoulder, were consecutively included in the study. 3 patients had bilateral shoulder pain. A total of 28 shoulders were examined first by a medical student, then by either of two experienced physicans. The student was taught by the most experienced doctor. There was agreement on how to score the tests in advance.

Aim: To check inter-rater-agreement between the examiners for each test.

Results: The inter-rater-agreement was poor and varied a lot with which examiners that was compared. Generally, there was better agreement between the most experienced physican and the student.

Conclusion: The poor results may be explained by little experience by the student, not enough training in advance, uncertainty in interpreting the tests results or that the test are too complicated. The study has a weakness in few patients included and that only two examiners have examined each patient. There is still much uncertainty concerning inter-rater-agreement of clinical tests used in diagnosing SIS. Further studies should be done.