Diagnostic classification of shoulder disorders: interobserver agreement and determinants of disagreement

doi:10.1136/ard.58.5.272

Annals of the Rheumatic Diseases 1999;58:272-277; doi:10.1136/ard.58.5.272

Ann Rheum Dis 1999;58:272-277 ( May )

Extended reports

Diagnostic classification of shoulder disorders: interobserver agreement and determinants of disagreement Andrea F de Winter,^a Marielle P Jans,^a Rob J P M Scholten,^a Walter Devillé,^a^b Dirkjan van Schaardenburg,^c Lex M Bouter^a^b

^a Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, the Netherlands, ^b Department of Epidemiology and Biostatistics, Faculty of Medicine, Vrije Universiteit, Amsterdam, the Netherlands, ^c Jan van Breemen Institute, Centre for Rheumatology and Rehabilitation, Amsterdam, the Netherlands

Correspondence to: Mrs A F de Winter, Institute for Research in Extramural Medicine, Faculty of Medicine, Vrije Universiteit, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.

Accepted for publication 18 February 1999

OBJECTIVES $---$ To assess the interobserver agreement on the diagnostic classification of shoulder disorders, based on history taking andphysical examination, and to identify the determinants of diagnosticdisagreement.
METHODS $---$ Consecutive eligible patients with shoulder pain were recruited in various health care settings in the Netherlands. Afterhistory taking, two physiotherapists independently performed aphysical examination and subsequently the shoulder complaintswere classified into one of six diagnostic categories: capsularsyndrome (for example, capsulitis, arthritis), acute bursitis,acromioclavicular syndrome, subacromial syndrome (for example,tendinitis, chronic bursitis), rest group (for example, unclearclinical picture, extrinsic causes) and mixed clinical picture.To quantify the interobserver agreement Cohen's $kappa$ was calculated.Multivariate logistic regression analysis was applied to determinewhich clinical characteristics were determinants of diagnosticdisagreement.
RESULTS $---$ The study population consisted of 201 patients with varying severity and duration of complaints. The $kappa$ for the classificationof shoulder disorders was 0.45 (95% confidence intervals (CI)0.37, 0.54). Diagnostic disagreement was associated with bilateralinvolvement (odds ratio (OR) 1.9; 95% CI 1.0, 3.7), chronic complaints(OR 2.0; 95% CI 1.1, 3.7), and severe pain (OR 2.7; 95% CI 1.3,5.3).
CONCLUSIONS $---$ Only moderate agreement was found on the classification of shoulder disorders, which implies that differentiation betweenthe various categories of shoulder disorders is complicated. Especiallypatients with high pain severity, chronic complaints and bilateralinvolvement represent a diagnostic challenge for clinicians. Asdiagnostic classification is a guide for treatment decisions,unsatisfactory reproducibility might affect treatment outcome.To improve the reproducibility, more insight into the reproducibilityof clinical findings and the value of additional diagnostic proceduresisneeded.

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

Technorati What's this?

This article has been cited by other articles:

Walmsley, S., Rivett, D. A., Osmotherly, P. G. (2009). Adhesive Capsulitis: Establishing Consensus on Clinical Identifiers for Stage 1 Using the Delphi Technique. ptjournal 89: 906-917 [Abstract] [Full Text]
Hegedus, E J, Goode, A, Campbell, S, Morin, A, Tamaddoni, M, Moorman, C T III, Cook, C (2008). Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br. J. Sports. Med. 42: 80-92 [Abstract] [Full Text]
Walsworth, M. K., Doukas, W. C., Murphy, K. P., Mielcarek, B. J., Michener, L. A. (2008). Reliability and Diagnostic Accuracy of History and Physical Examination for Diagnosing Glenoid Labral Tears. Am J Sports Med 36: 162-168 [Abstract] [Full Text]
Linsell, L., Dawson, J., Zondervan, K., Rose, P., Randall, T., Fitzpatrick, R., Carr, A. (2006). Prevalence and incidence of adults consulting for shoulder conditions in UK primary care; patterns of diagnosis and referral. Rheumatology (Oxford) 45: 215-221 [Abstract] [Full Text]
Ostor, A J K, Richards, C A, Prevost, A T, Hazleman, B L, Speed, C A (2004). Interrater reproducibility of clinical tests for rotator cuff lesions. Ann Rheum Dis 63: 1288-1292 [Abstract] [Full Text]
Hay, E M, Thomas, E, Paterson, S M, Dziedzic, K, Croft, P R (2003). A pragmatic randomised controlled trial of local corticosteroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care. Ann Rheum Dis 62: 394-399 [Abstract] [Full Text]
Shanahan, E M, Ahern, M, Smith, M, Wetherall, M, Bresnihan, B, FitzGerald, O (2003). Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain. Ann Rheum Dis 62: 400-406 [Abstract] [Full Text]
Norregaard, J, Krogsgaard, M R, Lorenzen, T, Jensen, E M (2002). Diagnosing patients with longstanding shoulder joint pain. Ann Rheum Dis 61: 646-649 [Abstract] [Full Text]

Services

Citing Articles

Google Scholar

PubMed

Topic Collections

Bookmark with

What's this?

Register for free content

The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.