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: 1.91). 09/2010; 96(3):179-90. DOI: 10.1016/
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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Available from: Chris Littlewood, Dec 18, 2014
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    • "The inter-rater reliability of the most common tests varies greatly. Inter-rater reliability of active abduction and abduction trajectory pain is moderate (May et al. 2010). "
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    Acta Orthopaedica 05/2014; 85(3):1-9. DOI:10.3109/17453674.2014.920991 · 2.77 Impact Factor
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    • "Subjects with and without shoulder pain were accepted for participation. Clinical tests were not used to identify the source of shoulder pain due to the low level of validity and reliability of diagnostic shoulder tests [32, 33]. Thus this study examined individuals with nonspecific shoulder pain. "
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    12/2013; 2013(5):475870. DOI:10.1155/2013/475870
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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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