Reliability of a measure of post-stroke shoulder pain in patients with and without aphasia and/or unilateral spatial neglect.
OBJECTIVE
To determine the inter/intra-rater reliability of expert physiotherapists (PTs) measuring post-stroke shoulder pain with 100 mm vertical visual analogue scales (VAS; intensity, frequency and affective response) and a categorical site-of-pain scale.


METHODS
Three PTs independently rated subjects (normal clinical procedure but with a standardized starting position) on three days, at the same time of day, during one week in a randomized order determined by a nested latin square. Reliability for VAS scores was determined with the intraclass correlation coefficient (ICC) and for site-of-pain with the kappa statistic (kappa). Acceptable reliability was set at 0.75. The limits of agreement were also calculated.


METHODS
Community.


METHODS
Thirty-three patients, mean time post stroke 42 months (range 7-360).


RESULTS
Mean inter-rater reliability was 0.79 for intensity, 0.75 for frequency and 0.62 for affective response (ICC). The limits of agreement were wide and rater bias was significant for 6/27 ratings. Mean intra-rater reliability was 0.70 for intensity, 0.77 for frequency and 0.69 for affective response (ICC). For site-of-pain inter-rater reliability ranged from 0.156 (kappa) to 0.385 (kappa) and intrarater reliability ranged from 0.300 (kappa) to 0.559 (kappa).


CONCLUSIONS
Although inter-rater reliability was acceptable for intensity and frequency there was a consistently large systematic bias between pairs of raters. Agreement might be improved if a standardized assessment procedure was used and/or if training in pain behaviour interpretation was provided.
Pomeroy
V M
VM
The Stroke Association's Therapy Research Unit, The University of Manchester, Salford Royal Hospitals NHS Trust, UK. vpomeroy@fs1.ho.man.ac.uk
Frames
C
C
Faragher
E B
EB
Hesketh
A
A
Hill
E
E
Watson
P
P
Main
C J
CJ
D000368:Aged; D000369:Aged, 80 and over; D001037:Aphasia / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010147:Pain Measurement / Q000379:methods*; D010468:Perceptual Disorders / Q000209:etiology*; D011446:Prospective Studies; D020069:Shoulder Pain / Q000175:diagnosis* / Q000209:etiology; D020521:Stroke / Q000150:complications*