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Title: THE INTRA-RATER AND INTER-RATER RELIABILITY OF SCAPULAR ASSYMETRY ASSESSMENT IN VOLLEYBALL ATHLETES WITH CLINICAL EVALUATION METHODS

Authors:

Abstract

Background: It has been suggested that Scapular Asymmetries (SA) can have a significant effect on shoulder function and in the development of shoulder pain. SA present with increased protraction and depression in the dominant side and can be seen in either symptomatic or asymptomatic athletes. These are much more prominent in unilateral overhead athletes. Several clinical evaluation methods of SA have been used in the past in order to detect SA. However, less is known about the intra-rater and inter-rater reliability of these methods in professional volleyball players. Purpose: The aim of this retrospective study was to establish the intra-rater reliability of five different methods for quantifying SA in asymptomatic professional volleyball players. Methods: Ten male asymptomatic professional volleyball players were recruited (Age 30.5±2.67 years, BMI 23.1±0.32). In regards to sample size, for an expected reliability of 92%, based on the findings of previous studies, and acceptable reliability of at least 60%, in order to represent substantial reliability, 9 athletes were required for 5% significance level and a power of 80% for two examiners or at two different time points. These five methods measured a series of anthropometric characteristics of the scapula including 1) Height asymmetries of the Scapulae (SH), 2) the difference in the distance between the scapulae from the spine (DS), 3) the difference in the Posterior Displacement of each Scapula from the thoracic cage with a modified caliper (SPD), as well as, 4, 5) the posterior displacement of both scapulae from the thoracic cage in a static (SPDR) and a dynamic position (SPD-PUE). A written informed consent, which was approved by the University, was obtained from all the athletes who participated in this study. All experimental procedures conformed to the Declaration of Helsinki. The research protocol was approved by the University of West Attica. Results: Reliability values for the first and the second method were excellent for the inter-rater (ICC 0.90-0.97; SEM 0.17-0.16) and the intra-rater (ICC 0.90-0.98; SEM 0.16-0.13) evaluation. For the third method, the inter-rater and the intra-rater values were good to excellent (ICC 0.84-0.92; SEM 0.23-0.13). The last two methods showed good to acceptable inter-rater (ICC 0.70-0.68; SEM 0.23-0.27) and intra-rater values (ICC 0.66-0.77; SEM 0.20 for both). The Bland and Altman analysis did not reveal any systematic bias in any method. Conclusions: The findings of the present study propose several reliable methods for evaluating SA of asymptomatic male professional volleyball players in clinical practice. The Bland and Altman plots constructed in the study, along with the SEM and the SDD calculations, allowed to conclude that the methods proposed should reliably measure male asymptomatic overhead athletes. Implications: It would be regarding the reliability of several evaluation methods in scapula asymmetry assessment as an important diagnostic tool in overhead athletes. Funding: No funded this work Key words: Scapula asymmetry, Volley ball players, Clinical evaluation, Reliability
Title: THE INTRA-RATER AND INTER-RATER RELIABILITY OF SCAPULAR
ASSYMETRY ASSESSMENT IN VOLLEYBALL ATHLETES
WITH CLINICAL EVALUATION METHODS
Authors: Paraskevopoulos E., Plakoutsis, G., Gioftsos, G., Georgoudis, G., Papandreou, M.
Affiliations: Department of Physiotherapy, University of West Attica
contact: mpapand@uniwa.gr
Introduction
It has been suggested that Scapular
Asymmetries (SA) can have a significant
effect on shoulder function and in the
development of shoulder pain. Several
clinical evaluation methods of SA have
been used in the past in order to detect SA.
However, less is known about the intra-
rater reliability of these methods in
professional volleyball players. This study
aimed to establish the intra-rater and inter-
rater reliability of five different methods
for quantifying SA in asymptomatic
professional volleyball players.
Methods
Reliability values for the first and the second
method were excellent for the inter-rater
(ICC 0.90-0.97;SEM 0.17-0.16) and the
intra-rater (ICC 0.90-0.98; SEM 0.16-0.13)
evaluation. For the third method, the inter-
rater and the intra-rater values were good to
excellent (ICC 0.84-0.92;SEM 0.23-0.13).
Results
Conclusion
Ten male asymptomatic professional
volleyball players were recruited
(Age 30.5±2.67 years, BMI 23.1±0.32).
The findings of the present study propose
several reliable methods for evaluating SA
of asymptomatic male professional
volleyball players in clinical practice.
The Bland and Altman plots constructed in
the study, along with the SEM and the SDD
calculations, allowed us to speculate that
these five measurements methods should
reliably measure male asymptomatic
overhead athletes.
Five methods measured a series of
anthropometric characteristics of the
scapula including 1) height asymmetries of
the scapulae, 2) the difference in the
distance between the scapulae from the
spine, 3) the difference in the posterior
displacement of each scapula from the
thoracic cage with a modified caliper, as
well as, 4, 5) the posterior displacement of
both scapulae from the thoracic cage in a
static and a dynamic position (Fig 1).
Table 1. SH: Scapular Height, DS: Distance from Scapula, SPD: difference in Scapular inferior angle Posterior
Displacement between the right and the left scapula, SPDR: Scapular medial border Posterior Displacement at
Rest, SPD-PUE: Scapular medial border Posterior Displacement during the sitting hand Press-Up Exercise,
SD: Standard Deviations, ICC: Intraclass correlation coefficient CI: Confidence interval, SEM: Standard error
of measurement, SDD: Smallest Detectable Difference.
Figure 2. Bland and Altman plot shows the average of measurement values of the method of Scapular medial
border Posterior Displacement at Rest (SPDR) obtained by the first examiner in test/retest plotted against the
difference between the first and second measurement
Figure 1. Clinical evaluation methods for the assessment of 1) height asymmetries of the scapulae,
2) the difference in the distance between the scapulae from the spine, 3) the difference in the posterior
displacement of each scapula from the thoracic cage with a modified caliper, 4, 5) the posterior displacement
of both scapulae from the thoracic cage in a static and a dynamic position
12
3
4 5
The last two methods showed good to
acceptable inter-rater (ICC 0.70-0.68; SEM
0.23-0.27) and intra-rater values (ICC
0.66-0.77; SEM 0.20 for both) (Table 1).
The BlandAltman analysis showed that all
the data were inside the 95% confidence
limits and regression analysis did not reveal
any statistically significant proportional
bias (Fig 2).
References
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Intra
-Rater
Inter
-rater
Methods
Mean
±SD
ICC
95
%CI
Lower
Upper
Bound
SEM
SDD
1
.SH
1
.18 ±0.51
1
.21 ±0.55
0
.90
0
.90
0
.66-0.97
0
.65-0.97
0
.16
0
.17
0
.44
0
.48
2
.DS
1
.23 ±0.94
1
.26 ± 0.96
0
.98
0
.97
0
.94-0.99
0
.90-0.99
0
.13
0
.16
0
.36
0
.45
3
.SPD
0
.64 ±0.49
0
.62 ± 0.58
0
.92
0
.84
0
.71-0.98
0
.49-0.95
0
.13
0
.23
0
.38
0
.64
4
. SPDR
1
.3 ±0.35
1
.32 ± 0.42
0
.66
0
.70
0
.14-0.90
0
.16-0.91
0
.20
0
.23
0
.56
0
.63
5
.SPD-PUE
1
.67 ±0.43
1
.68 ±0.48
0
.77
0
.68
0
.34-0.93
0
.16-0.91
0
.20
0
.27
1
.56
0
.75
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