Reliability of clinical tests in the assessment of patients with neck/shoulder problems-impact of history.
METHODS
A clinical trial on patients receiving neck/shoulder physical examinations.


OBJECTIVE
To analyze reliability of clinical tests, prevalence of positive findings in the assessment of neck/shoulder problems in primary care patients, and the impact of history, including pain drawing, on these parameters.


BACKGROUND
Reliability of clinical tests varies, perhaps partly because of the impact of history. To our knowledge, this has not been studied before.


METHODS
Two examiners independently assessed 100 patients with a set of 66 clinical tests divided into 9 categories. Half of the patients were examined with and the other half without knowledge of history. Reliability as expressed by percentage agreement, kappa coefficients, and prevalence of positive findings was calculated.


RESULTS
Reliability of clinical tests was poor or fair in several categories and did not alter with history. Only a bimanual sensitivity test reached good kappa values. With known history, prevalence of positive findings increased. Bias was apparent in all test categories except sensitivity tests. Four out of five patients were diagnosed to have neurogenic dysfunction in the affected area.


CONCLUSIONS
Our sensitivity test was the most reliable and also exempt from bias and should be studied further. Some common tests may not be reliable. History had no impact on reliability of our tests but increased the prevalence of positive findings. Neurogenic dysfunction seems very common in patients with neck and/or shoulder problems and should be screened for.
Bertilson
Bo C
BC
Torvalla Sports Medical Clinic, Stockholm, Sweden. bo.bertilson@klinvet.ki.se
Grunnesjö
Marie
M
Strender
Lars-Erik
LE
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis*; D009460:Neurologic Examination / Q000379:methods; D015588:Observer Variation; D015203:Reproducibility of Results; D020069:Shoulder Pain / Q000175:diagnosis*