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How reliably do rheumatologists measure shoulder movement?

J L Hoving^1,2, R Buchbinder^1,2, S Green³, A Forbes², N Bellamy⁴, C Brand⁵, R Buchanan⁶, S Hall⁷, M Patrick⁸, P Ryan⁹, A Stockman⁵

¹ Department of Clinical Epidemiology, Cabrini Hospital, Australia
² Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
³ Monash Institute of Health Services Research, Monash Medical Centre, Clayton, Australia
⁴ Centre of National Research on Disability and Rehabilitation Medicine, Royal Brisbane Hospital, Herston, Australia
⁵ Centre for Rheumatic Disease, Royal Melbourne Hospital, Parkville, Australia
⁶ Department of Rheumatology, Austin and Repatriation Medical Centre, Heidelberg, Australia
⁷ Cabrini Hospital, Melbourne, Australia
⁸ Box Hill Hospital, Box Hill, Australia
⁹ Alfred Hospital, Prahran, Australia

Correspondence to:
Correspondence to:
Dr J L Hoving, Department of Clinical Epidemiology, Cabrini Hospital and Monash, University Department of Epidemiology and Preventive Medicine, Suite 41 Cabrini Medical Centre, 183 Wattletree Rd, Malvern, Victoria 3144, Australia;
Jan.Hoving{at}med.monash.edu.au

Objective: To assess the intrarater and interrater reliability among rheumatologists of a standardised protocol for measurement of shoulder movements using a gravity inclinometer.

Methods: After instruction, six rheumatologists independently assessed eight movements of the shoulder, including total and glenohumeral flexion, total and glenohumeral abduction, external rotation in neutral and in abduction, internal rotation in abduction and hand behind back, in random order in six patients with shoulder pain and stiffness according to a 6x6 Latin square design using a standardised protocol. These assessments were then repeated. Analysis of variance was used to partition total variability into components of variance in order to calculate intraclass correlation coefficients (ICCs).

Results: The intrarater and interrater reliability of different shoulder movements varied widely. The movement of hand behind back and total shoulder flexion yielded the highest ICC scores for both intrarater reliability (0.91 and 0.83, respectively) and interrater reliability (0.80 and 0.72, respectively). Low ICC scores were found for the movements of glenohumeral abduction, external rotation in abduction, and internal rotation in abduction (intrarater ICCs 0.35, 0.43, and 0.32, respectively), and external rotation in neutral, external rotation in abduction, and internal rotation in abduction (interrater ICCs 0.29, 0.11, and 0.06, respectively).

Conclusions: The measurement of shoulder movements using a standardised protocol by rheumatologists produced variable intrarater and interrater reliability. Reasonable reliability was obtained only for the movement of hand behind back and total shoulder flexion.

Keywords: reliability; shoulder; range of motion; outcome measurement

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