Original article
Diagnostic ultrasound in patients with shoulder pain: An inter-examiner agreement and reliability study among Dutch physical therapists

https://doi.org/10.1016/j.msksp.2020.102283Get rights and content

Highlights

  • The overall agreement among PTs using MSU is high for detecting cuff tendinopathy.

  • The overall agreement among PTs using MSU is high for detecting FTR in the cuff.

  • Reliability value for detecting a FTR in the cuff is fair.

  • Reliability values for detecting a PTR in the cuff is slight.

Abstract

Study design

A cross-sectional inter-examiner agreement and reliability study among physical therapists in primary care.

Background

musculoskeletal ultrasound (MSU) is frequently used by physical therapists to improve specific diagnosis in patients with shoulder pain, especially for the diagnosis rotator cuff tendinopathy (RCT) including tears.

Objectives

To estimate the inter-examiner agreement and reliability in physical therapists using MSU for patients with shoulder pain.

Methods

Physical therapists performed diagnostic MSU in 62 patients with shoulder pain. Both physical therapists were blinded to each other's results and patients were not informed about the test results. We calculated the overall inter-examiner agreement, specific positive and negative inter-examiner agreement, and inter-examiner reliability (Cohen's Kappa's).

Results

Overall agreement for detecting RC ruptures ranged from 61.7% to 85.5% and from 43.9% to 91.4% for specific positive agreement. The specific negative agreement was lower with values ranging from 44.4% to 79.1% for RC ruptures. Overall agreement for other pathology than ruptures related to SAPS, ranged from 72.6% to 93.6% and from 77.3% to 96% for specific positive agreement. The specific negative agreement was lower with values ranging from 44.4% to 79.1% for RC ruptures and 52.5%–83.3% for other pathology than ruptures related to SAPS. Reliability values varied from substantial for any thickness ruptures to moderate for partial thickness ruptures and fair for full thickness tears. Moreover, reliability was fair for cuff tendinopathy. The reliability for AC arthritis and no pathology found was fair and moderate. There was substantial agreement for the calcifying tendinopathy.

Conclusions

Physical therapists using MSU agree on the diagnosis of cuff tendinopathy and on the presence of RCT in primary care, but agree less on the absence of pathology.

Section snippets

Background

Shoulder pain is the second most reported musculoskeletal symptom (Greving et al., 2012). A common clinical diagnosis for shoulder pain is subacromial pain syndrome (SAPS) (Diercks et al., 2014; Karel et al., 2017). This clinical diagnosis is mainly based on history taking and physical tests (Hegedus et al., 2008; Michener et al., 2009). The term SAPS include pathologies such as: bursitis, tendinosis calcarea, supraspinatus tendinopathy, tear(s) of the rotator cuff, biceps tendinitis and tendon

Study design

A cross-sectional inter-examiner agreement and reliability study. Agreement explores how outcomes of different examiners agree and is expressed in terms of observed agreement and proportion of specific agreement. Specific agreement distinguishes agreement on positive or negative outcomes. Reliability is described as how patients can be distinguished from each other, despite measurement errors (H. C. de Vet et al., 2013). The Medical Ethical Committee of the Erasmus University approved this

Results

We finally included a total of 62 patients, with a mean age of 54.4 years (SD 15.4) of which 36 was female and 26 was male. All patients had unilateral shoulder pain for more than 6 weeks. In 40 of the 62 cases the right shoulder was affected.

Discussion

We found high overall agreement as well as high specific positive agreement for detecting rotator cuff ruptures and other pathology causing SAPS. For both, the overall agreement and the positive agreement was higher than the specific negative agreement. Physical therapists specialized in MSU agree more on the presence of rotator cuff tears and other pathology causing SAPS by using ultrasound than on the absence of pathology.

To the best of our knowledge this is the first inter-examiner agreement

Acknowledgement

This study was funded by SIA-RAAK. The Ministry of Education has made this funding available for the innovation and promotion of research. This study was also partly funded by a program grant of the Dutch Arthritis Foundation.

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