Article

Reliability of physical examination tests used in the assessment of patients with shoulder problems: A systematic review

Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK.
Physiotherapy (Impact Factor: 2.11). 09/2010; 96(3):179-90. DOI: 10.1016/j.physio.2009.12.002
Source: PubMed

ABSTRACT Shoulder pain is a common clinical problem, and numerous tests are used to diagnose structural pathology.
To systematically review the reliability of physical examination procedures used in the clinical examination of patients with shoulder pain.
MEDLINE, PEDro, AMED, PsychInfo, Cochrane Library (2009) and CINAHL were searched from the earliest record on the database to June 2009.
Reliability studies that included any patients with shoulder pain were analysed for their quality and reliability results.
Pre-established criteria were used to judge the quality of the studies (high quality >60% methods score) and satisfactory levels of reliability (kappa or intraclass correlation coefficient > or =0.85, sensitivity analysis 0.70). A qualitative synthesis was performed based on levels of evidence.
Thirty-six studies were included with a mean methods score of 57%. Seventeen studies were deemed to be of high quality; high-quality studies were less likely to meet the pre-agreed level of reliability. The majority of studies indicated poor reliability for all procedures investigated.
Overall, the evidence regarding reliability was contradictory.
There is no consistent evidence that any examination procedure used in shoulder assessments has acceptable levels of reliability. Alternate methods of classification which are reliable should be used to classify patients with shoulder problems.

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    • "Firstly, the criteria we use to define rotator cuff tendinopathy is broad and might include a range of biomedical diagnoses, including subacromial impingement, subacromial bursitis, rotator cuff tear, acromioclavicular joint osteoarthritis etc. However, in the absence of evidence to support the validity or reliability of such diagnoses (May et al., 2010), particularly in relation to the lack of association between pathology and pain, it is difficult to substantiate such an objection. Secondly, in the context of attempts to highlight the role of the CNS, such specific pathology or impairment terminology might be regarded as a backwards step because of their reference to specific peripheral tissue or mechanical mechanisms . "
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    ABSTRACT: Tendinopathy is a term used to describe a painful tendon disorder but despite being a well-recognised clinical presentation, a definitive understanding of the pathoaetiology of rotator cuff tendinopathy remains elusive. Current explanatory models, which relate to peripherally driven nocioceptive mechanisms secondary to structural abnormality, or failed healing, appear inadequate on their own in the context of current literature. In light of these limitations this paper presents an extension to current models that incorporates the integral role of the central nervous system in the pain experience. The role of the central nervous system (CNS) is described and justified along with a potential rationale to explain the favourable response to loaded therapeutic exercises demonstrated by previous studies. This additional consideration has the potential to offer a useful way to explain pain to patients, for clinicians to prescribe appropriate therapeutic management strategies and for researchers to advance knowledge in relation to this clinically challenging problem.
    Manual therapy 08/2013; 18(6). DOI:10.1016/j.math.2013.07.005 · 1.76 Impact Factor
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    • "Firstly, the criteria we use to define rotator cuff tendinopathy is broad and might include a range of biomedical diagnoses, including subacromial impingement, subacromial bursitis, rotator cuff tear, acromioclavicular joint osteoarthritis etc. However, in the absence of evidence to support the validity or reliability of such diagnoses (May et al., 2010), particularly in relation to the lack of association between pathology and pain, it is difficult to substantiate such an objection. Secondly, in the context of attempts to highlight the role of the CNS, such specific pathology or impairment terminology might be regarded as a backwards step because of their reference to specific peripheral tissue or mechanical mechanisms . "
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    ABSTRACT: a b s t r a c t Tendinopathy is a term used to describe a painful tendon disorder but despite being a well-recognised clinical presentation, a definitive understanding of the pathoaetiology of rotator cuff tendinopathy re-mains elusive. Current explanatory models, which relate to peripherally driven nocioceptive mechanisms secondary to structural abnormality, or failed healing, appear inadequate on their own in the context of current literature. In light of these limitations this paper presents an extension to current models that incorporates the integral role of the central nervous system in the pain experience. The role of the central nervous system (CNS) is described and justified along with a potential rationale to explain the favourable response to loaded therapeutic exercises demonstrated by previous studies. This additional consider-ation has the potential to offer a useful way to explain pain to patients, for clinicians to prescribe appropriate therapeutic management strategies and for researchers to advance knowledge in relation to this clinically challenging problem.
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    • "These diagnostic limitations highlight the need for a model that is not based on pathology but rather on clinical presentation. In fact, May et al. [5] recommend that clinicians should abandon the diagnostic pathological model. This classification of syndromes rather than specific aetiologies subscribes to that recommendation. "
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