The reliability and concurrent validity of scapular plane shoulder elevation measurements using a digital inclinometer and goniometer

This study investigated the reliability and concurrent validity of active shoulder elevation in the scapular plane (scaption) using a digital inclinometer and goniometer. Two investigators used a goniometer and digital inclinometer to measure scaption on 30 asymptomatic participants in a blinded repeated measures design. Good reliability was present with intraclass correlation coefficients (ICCs) for intrarater reliability of goniometry?=?0.87, intrarater digital inclinometry?=?0.88, interrater goniometry?=?0.92, and interrater digital inclinometry?=?0.89. The minimal detectable change (MDC95) for the interrater analysis indicated that a change equal to or greater than 8 degrees for goniometry and 9 degrees for inclinometry is required to be 95% certain that the change is not due to intertrial variability or measurement error. The concurrent validity between goniometry and digital inclinometry was excellent with an ICC value of 0.94 for both raters. The 95% limits of agreement suggest that the difference between these two measurement instruments can be expected to vary by up to ±11 degrees. The results support the interchangeable use of goniometry and digital inclinometer for measuring scaption. Clinicians and researchers should consider the MDC values presented when interpreting change during subsequent measurement sessions.     

The reliability and concurrent validity of scapular plane shoulder elevation measurements using a digital inclinometer and goniometer

This study investigated the reliability and concurrent validity of active shoulder elevation in the scapular plane (scaption) using a digital inclinometer and goniometer. Two investigators used a goniometer and digital inclinometer to measure scaption on 30 asymptomatic participants in a blinded repeated measures design. Good reliability was present with intraclass correlation coefficients (ICCs) for intrarater reliability of goniometry?=?0.87, intrarater digital inclinometry?=?0.88, interrater goniometry?=?0.92, and interrater digital inclinometry?=?0.89. The minimal detectable change (MDC₉₅) for the interrater analysis indicated that a change equal to or greater than 8 degrees for goniometry and 9 degrees for inclinometry is required to be 95% certain that the change is not due to intertrial variability or measurement error. The concurrent validity between goniometry and digital inclinometry was excellent with an ICC value of 0.94 for both raters. The 95% limits of agreement suggest that the difference between these two measurement instruments can be expected to vary by up to ±11 degrees. The results support the interchangeable use of goniometry and digital inclinometer for measuring scaption. Clinicians and researchers should consider the MDC values presented when interpreting change during subsequent measurement sessions.     

Scapular muscle tests in subjects with shoulder pain and functional loss: reliability and construct validity

BACKGROUND AND PURPOSE: Scapular muscle performance evaluated with a handheld dynamometer (HHD) has been investigated only in people without shoulder dysfunction for test-retest reliability of data obtained with a single scapular muscle test. The purpose of this study was to assess the reliability, error, and validity of data obtained with an HHD for 4 scapular muscle tests in subjects with shoulder pain and functional loss. SUBJECTS AND METHODS: Subjects (N=40) with shoulder pain and functional loss were tested by measuring the kilograms applied with an HHD during 3 trials for muscle tests for the lower trapezius, upper trapezius, middle trapezius, and serratus anterior muscles. Concurrently, surface electromyography (sEMG) data were collected for the 4 muscles. The same procedures were performed 24 to 72 hours after the initial testing by the same tester. Muscle tests were performed 3 times, and the results were averaged for data analysis. RESULTS: Intraclass correlation coefficients for intratester reliability of measurements of isometric force obtained using an HHD ranged from .89 to .96. The standard error of the measure (90% confidence interval [CI]) ranged from 1.3 to 2.7 kg; the minimal detectable change (90% CI) ranged from 1.8 to 3.6 kg. Construct validity assessment, done by comparing the amounts of isometric muscle activity (sEMG) for each muscle across the 4 muscle tests, revealed that the muscle activity of the upper trapezius and lower trapezius muscles was highest during their respective tests. Conversely, the isometric muscle activity of the middle trapezius and serratus anterior muscles was not highest during their respective tests. DISCUSSION AND CONCLUSION: In people with shoulder pain and functional loss, the intrarater reliability and error over 1 to 3 days were established using an HHD for measurement of isometric force for the assessment of scapular muscle performance. Error values can be used to make decisions regarding individual patients. Construct validity was established for the lower and upper trapezius muscle tests; therefore, these tests are advocated for use. However, construct validity was not demonstrated for the serratus anterior and middle trapezius muscle tests as performed in this study. Further investigation of these muscle tests is warranted.     

Scapular positioning in patients with shoulder pain: a study examining the reliability and clinical importance of 3 clinical tests

Nijs J, Roussel N, Vermuelen K, Souvereyns G. Scapular positioning in patients with shoulder pain: a study examining the reliability and clinical importance of 3 clinical tests.

Objective

To examine the interobserver reliability, internal consistency, and clinical importance of 3 clinical tests for the assessment of scapular positioning in patients with shoulder pain.

Design

Prospective repeated-measures design.

Setting

Private practices for physical therapy and hospital outpatient physical therapy divisions.

Participants

Twenty-nine patients with shoulder pain who were diagnosed by a physician as having a shoulder disorder.

Interventions

Not applicable.

Main Outcome Measures

Study participants filled in a visual analog scale for pain and the Shoulder Disability Questionnaire. Next, 2 assessors performed the following tests: measurement of the distance between the posterior border of the acromion and the table, measurement of the distance from the medial scapular border to the fourth thoracic spinous processes, and the lateral scapular slide test.

Results

The interobserver reliability coefficients were greater than .88 (intraclass correlation coefficients) for the measurement of the distance between the posterior border of the acromion and the table, were greater than .50 for the measurement of the distance from the medial scapular border to the fourth thoracic spinous processes, and were greater than .70 for the lateral scapular slide test. The Cronbach α coefficient for internal consistency for all tests was .88. No associations between the outcome of the tests and self-reported pain severity or disability were found.

Conclusions

These data provide evidence favoring the interobserver reliability of 2 of 3 tests for the assessment of scapular positioning in patients with shoulder pain. The clinical importance of the tests’ outcomes, however, is questionable.     

Measurements of scapular position and rotation: a reliability study

Smooth motion of the scapula and humerus with respect to the thorax is essential for shoulder function and abnormalities may indicate clinical entities. Recent studies have made an attempt to devise simple, practical means of quantifying scapular position. The aim of this study was to examine the intra-tester and inter-tester reliability of two methods and to determine if significant differences existed between the dominant versus non-dominant extremity. Seventeen healthy volunteers (4 M; 13 F) were examined by two testers. The tape measurements consisted of the classic methods of Kibler and DiVeta in three sitting postures, expanded by the measurement of the linear distance from the medial border to the thoracic mid-line, and the scapular size measure. The SAS software package was used for data analysis. The Intraclass Correlation Coefficient (ICC) intra-tester reliability ranged between 0.96–0.8 for both methods without significant differences, whereas the ICC for inter-tester reliability ranged between 0.42–0.9 with higher values (moderate and good) for the Kibler technique. In the additional tests high values were also obtained for ICC intra-tester, except for the measurements of the linear distance of the medial border of the scapula to the thoracic mid-line and the distance of the inferior process of the acromion to the third vertebra, both in 90° abduction and internal rotation. The ICC for inter-tester was only acceptable for the DiVeta measurement on 45° abduction. Significant differences were noted between both testers on the following measures: Kibler in 45° abduction, DiVeta in 45° abduction and 90° abduction and the scapular size measure. The comparison of dominant versus non-dominant extremity revealed larger but not significantly different means for the dominant extremity in the classic methods. Significant differences occurred for Tester 1 in the measurement of the distance of the medial border to the thoracic mid-line and Tester 2 in DiVita in 45° abduction. The SEM values never exceeded 1 cm. We believe that the Kibler technique holds promise for further studies, has the advantage of measuring in three positions and with some familiarisation can be reliable. Further research is necessary in patients with pathological conditions. Copyright © 1996 Whurr Publishers Ltd.     

Measurement of sacroiliac joint dysfunction: a multicenter intertester reliability study

BACKGROUND AND PURPOSE: Previous research suggests that visual estimates of sacroiliac joint (SIJ) alignment are unreliable. The purpose of this study was to determine whether handheld calipers and an inclinometer could be used to obtain reliable measurements of SIJ alignment in subjects suspected of having SIJ dysfunction. SUBJECTS: Seventy-three subjects, evaluated at 1 of 5 outpatient clinics, participated in the study. METHODS: A total of 23 therapists, randomly paired for each subject, served as examiners. The angle of inclination of each innominate was measured while the subject was standing. The position of the innominates relative to each other was then derived. An intraclass correlation coefficient (ICC), the standard error of measurement (SEM), and a kappa coefficient were calculated to examine the reliability of the derived measurements. RESULTS: The ICC was .27, the SEM was 5.4 degrees, and the kappa value was .18. CONCLUSION AND DISCUSSION: Measurements of SIJ alignment were unreliable. Therapists should consider procedures other than those that assess SIJ alignment when evaluating the SIJ.     

Shoulder dysfunction assessment: self-report and impaired scapular movements

BACKGROUND AND PURPOSE: Shoulder dysfunction is common in various patient populations. This investigation was performed to assess shoulder dysfunction with self-report and performance-based functional measures. SUBJECTS: Fifty men (25 with shoulder dysfunction and 25 without shoulder dysfunction) participated in this study. METHODS: Self-report functional disabilities were assessed with the Flexilevel Scale of Shoulder Function (FLEX-SF), and electromagnetic tracking sensors were used to monitor 3-dimensional scapular movements during 4 functional tasks. RESULTS: Relative to the control group, the group with shoulder dysfunction showed significant alterations in scapular movements (averages of 6.9 degrees less posterior tipping, 5.7 degrees less upward rotation, and 2.3 cm more elevation). Scapular kinematics correlated significantly (r) with the Self-report FLEX-SF measure during functional tasks (posterior tipping = .454 to .712, upward rotation = .296 and .317, and elevation = -.310). DISCUSSION AND CONCLUSION: Functional disabilities were identified with self-report and performance-based functional measures. The inadequate scapular posterior tipping and scapular upward rotation as well as the excessive elevation may have implications in planning intervention strategies for people with shoulder dysfunction.     

Comparison of scapular kinematics and muscle strength between those with a positive and a negative Scapular Assistance Test

BackgroundThe Scapular Assistance Test was suggested to directly assess the influence of scapular motion on pain and indirectly measure the function of the scapular rotators. However, it is still not clear if individuals with a positive Scapular Assistance Test actually present changes in scapular motion and muscle strength. This study compared scapular kinematics and muscle strength between those with a positive Scapular Assistance Test and those with a negative Scapular Assistance Test.MethodsFifty individuals with shoulder pain were randomly allocated to: positive (n = 25) or negative Scapular Assistance Test (n = 25) group. Scapular kinematics was measured during elevation and lowering of the arm. Strength of the serratus anterior and lower trapezius was also measured. Two-way analysis of variance was used to compare kinematics between groups. Unpaired Student's t-test and Mann-Whitney test were used to compare strength of serratus anterior and lower trapezius, respectively.FindingsThere were no differences (P > 0.05) in scapular internal rotation and upward rotation between both groups. For scapular tilt, there was group main effect (P < 0.05) during elevation and lowering of the arm, whereas the positive Scapular Assistance Test group presented greater scapular anterior tilt. There was no difference (P > 0.05) in strength between groups.InterpretationIndividuals with a positive Scapular Assistance Test are more likely to present decreased scapular posterior tilt in those with shoulder pain. Strength of the scapular muscles seems to be same in those with a positive and a negative Scapular Assistance Test.     

Development of the Hand Active Sensation Test: reliability and validity

OBJECTIVE: To develop and establish the reliability and validity of a new quantitative functional measure of haptic perception in the hand, the Hand Active Sensation Test (HASTe). DESIGN: Reliability was assessed by test-retest sessions. Validity was assessed via discriminant analysis, concurrent validity with 2-point discrimination and wrist position test, and receiver operating characteristic (ROC) curve construction. SETTING: Subject preference. PARTICIPANTS: Heterogeneous sample of 28 stroke survivors and 28 individually matched controls. INTERVENTION: Subjects used 1 hand to manipulate HASTe objects that vary by weight or texture to complete 18 match-to-sample trials. MAIN OUTCOME MEASURES: Two-point discrimination threshold, Wrist Position Sense Test (WPST) average error, and HASTe accuracy score. RESULTS: Test-retest reliability was strong (intraclass correlation coefficient model 3,1 = .77). The HASTe score significantly discriminated the groups (t = 8.3, P < .001) and correlated with 2-point discrimination (r = -.67, P < .001) and WPST (r = -.60, P < .001). ROC curve area was .94 for test 1 and .92 for the average of 2 tests. CONCLUSIONS: The HASTe is a reliable and valid functional measure of haptic perception, appears to detect impairment of haptic perception even in stroke survivors with no reported sensory deficits, and may provide valuable quantitative clinical data about complex sensory loss and hand function after stroke.     

Model 001129角度测量仪信度与效度检验

本研究采用美国制造的电子角度测量仪对8名健康志愿者腕关节的屈、伸、尺外展和桡外展等功能位置多次重复检测 ,以评定该仪器的信度与效度。结果显示组内和组间信度检验指标AverageMeasurIntraclassCorrelation及95 %C.I.Lower与upper均处于0.900与1.000之间 ,提示该电子角度测量仪有很好的信度与效度 ,能准确测量ROM ,对查找关节活动的障碍因素,明确障碍程度 ,制订康复方案和判定治疗训练效果均有可靠的帮助     

Scapular position: the validity of skin surface palpation

The assessment of the resting position of the scapula forms part of the examination of upper quadrant posture. The purpose of this study was to determine if surface palpation is a valid indicator of actual scapular position. Twelve embalmed shoulders were examined and the actual location of three bony scapular landmarks and three bony thoracic landmarks were compared with surface palpation of these locations. The results, based on the upper value for a distance (with 95% confidence), suggested that the difference between the surface location of the root of the spine of the scapula, the acromial angle and the inferior angle would be less than 0.67 cm, 0.98 cm and 0.46 cm respectively from the centre of the bony locations. The difference between the twelfth thoracic spinous process (SP), the SP corresponding with the root of the spine of the scapula, and the SP corresponding with the inferior angle and the surface points would be 1.46 cm, 1.09 cm and 1.01 cm respectively. The results of this study suggest that surface palpation of scapular location is a valid method for determining the actual location of the scapula. The findings also suggest that surface palpation can determine the location of thoracic landmarks, which may serve as reference points for scapular position.     

Investigating the reliability and validity of the waterlow risk assessment scale: a literature review

The aim of this review was to examine health literature on the reliability and validity of the Waterlow pressure sore assessment scale. A systematic review of published studies relating to the topic was conducted and literature was examined for its relevancy to the topic under investigation. Findings suggest that despite the availability of over 40 assessment tools, the Waterlow assessment scale is the most frequently used by health care staff. Research suggests that the Waterlow Scale is an unreliable method of assessing individuals at risk of pressure sore development with all studies indicating a poor interrater reliability status. Its validity has also been criticized because of its high-sensitivity but low-specificity levels.     

The comprehensive Breast Cancer Knowledge Test: validity and reliability

Two subscales for a breast cancer knowledge test were developed and tested to be used (a) in determining a woman's general knowledge of breast cancer (i e risk factors and epidemiology) and her knowledge of breast cancer curability, and (b) in exploring the relationship between knowledge of breast cancer and utilization of screening practices These subscales were designed to be used in conjunction with the Breast Cancer Knowledge Test (BCKT), which assesses screening and detection knowledge The instrument was submitted to four experts in the field of oncology to establish content validity Reliability testing was conducted on a random sample of 182 women Internal consistency reliability for the post-tested general knowledge subscale was 0 60, and for the curability subscale was 0 62 The overall alpha coefficient was 0 71 In combination with the BCKT, these subscales can be used to describe a woman's knowledge of breast cancer     

Active movement measurements of the shoulder girdle in healthy subjects with goniometer and tape measure techniques: a study on reliability and validity

In response to the current need to develop objective measurement techniques for active movements of the shoulder girdle, this study had two goals: 1) to evaluate the reliability of the active range of motion (AROM) of shoulder girdle in elevation, protraction, and retraction with use of a goniometer and a tape measure and 2) to present the criterion-related validity of the reliable movements. Thirty healthy subjects performed two trials of each shoulder girdle AROM. They were assessed by two physical therapists, who used both evaluation techniques on two occasions. The generalizability theory was used to compute intratester (test-retest) and intertester reliability using dependability coefficients (phi) and standard errors of measurement (SEMs). The shoulder girdle movements were then evaluated with a movement analysis system (Optotrak 3020). The Pearson product-moment correlation coefficient (r) and paired t-tests were used to compare the results of clinical measurements with those of the movement analysis system. Overall, the reliability with the tape measure was good (phi = 0.78-0.91; SEM's = 0.7-1.1 cm) for the elevation motion. The goniometer was only reliable for intratester measures (phi = 0.78-0.79; SEM = 2.7 degrees) for the elevation motion. Retraction was reliable with the tape measure alone (phi = 0.76-0.84; SEM's = 0.5-0.7 cm). The criterion-related validity analysis revealed that measuring shoulder girdle elevation with the tape measure and goniometer, and retraction with the tape measure were not valid when evaluated against a gold standard, thus, both techniques have limitations in assessing true elevation and retraction measurements.     

简易智力测试量表的效度及信度研究

目的　探讨简易智力测试量表 (AMT)的效度和信度 ,为临床应用提供客观依据。方法　 2组受试对象参加了测试 ,一组为病例组 (38例 ) ,另一组为对照组 (30例 )。 1周内对 2组对象用AMT和简易精神状态量表 (MMSE)进行 2次评估。将AMT结果与MMSE作相关性检验来验证AMT的效度 ;对 2次AMT结果作组间相关性分析来测试AMT的重复测试信度。结果　AMT和MMSE的总分和各分项分的Pearson相关系数r =0 .70 6～ 0 .833;AMT各项内容 2次重复测试结果的组间相关系数ICC =0 .810～ 0 .996;病例组和对照组的AMT总分分别为 (7.60± 2 .5 5 )分、(9.64± 0 .81)分 ,2者间差异有显著性 (P <0 .0 5 )。结论　AMT具有良好的效度和信度 ,可对受试者的认知功能进行快速筛选和初步评价     

Inter-rater reliability and validity of the screenassist lumbar questionnaire: a pilot study

Objective

The purpose of this study was to examine the validity and test–retest reliability of the ScreenAssist Lumbar Questionnaire (SALQ). If a high degree of reliability and validity could be determined, the questionnaire could provide physical therapists with a formal instrument to assist with the identification of patients with nonmusculoskeletal back pain or emergent musculoskeletal causes of back pain requiring referral to an alternate medical provider.

Methods

Participants were patients presenting to an internal medicine physician''s office with the main complaint of low back pain over a 6 months period. ScreenAssist Lumbar Questionnaire was performed twice on each patient within 48 hours of the appointment. A 4-month post-visit chart review was performed to compare scores and recommendations made by the questionnaire with the assessment and diagnosis made by the physician.

Results

The SALQ demonstrated a sensitivity of 0·100 (95% CI: 0·689–0·100) and specificity of 0·786 (95%CI: 0·492–0·951) compared to the assessment and diagnosis performed by the primary care physician. Overall, regarding the recommendation for referral, there was agreement on 20 of the 21 patients with a Kappa of 0·798.

Discussion

The overall test–retest reliability and validity for referral recommendation were high, which indicates that the SALQ may serve as an alternative to the use of red flags in isolation to assist the physical therapist in determining the need for medical referral as the practice continues to progress toward direct access. The positive outcome of this study supports the possible future benefit of the SALQ.     

Scapular manipulation for reduction of anterior shoulder dislocation without analgesia: Results of a prospective study

Objectives: To the best of knowledge, this was the first study of scapular manipulation technique (SMT) in Asia. We conducted this prospective study to report our experiences of reducing anterior shoulder dislocation by SMT without analgesia in a large study group in Iran. Methods: Scapular manipulation technique was applied to 111 patients presenting with anterior shoulder dislocation to the ED of the largest teaching hospital in north‐east of Iran between January 2009 and January 2010. Reduction was performed without medication and if unsuccessful, the second attempt was carried out with i.v. injection of midazolam. We also evaluated the pain experienced by the patients immediately after reduction attempt. Results: The study consisted of 112 dislocations (one patient had bilateral dislocation). We achieved a success rate of 87.5% without medication at the first attempt and 97.3% overall. In total, 98.2% of dislocations were reduced in less than 1 min. The success rate was significantly lower in the presence of greater tuberosity fractures and also in late presentations (>6 h after trauma). We showed a success rate of 100% in recurrent dislocations. Some 81.1% of the patients reported no pain or mild pain. No complications were observed. Conclusion: The results of our study showed that SMT even without medication is a safe, rapid and relatively painless technique in reducing anterior shoulder dislocation in the ED that might reduce medical resource utilization and can be cost‐effective.