Clinical examination of athletes with groin pain: an intraobserver and interobserver reliability study.
BACKGROUND
Groin pain is a diagnostic and therapeutic challenge to sports medicine. The literature provides no consensus on definitions of or diagnostic criteria for groin pain in athletes. To compare the results of research and treatments, the methods used to diagnose and evaluate the degree of groin pain must be clearly defined and reproducible.


OBJECTIVE
To describe clinical examination techniques for groin pain in athletes and evaluate the intraobserver and interobserver reliability of these.


METHODS
Eighteen athletes, nine with sports related groin pain and nine without groin pain, were examined by two doctors and two physiotherapists. The examiners were trained in the examination techniques before the study. The examiners were blinded to the symptoms and identity of the subjects. The subjects were examined twice by each examiner in random order. The examinations included evaluation of adductor muscle related pain and strength, iliopsoas muscle related pain, strength, and flexibility, abdominal muscle related pain, and strength and pain at the symphysis joint. Kappa statistics and percentage of agreement were used to evaluate the data.


RESULTS
Overall, the kappa values and percentage of agreement were in accordance and showed good reliability of the examinations. The kappa values for the intraobserver agreement were above 0.60 in 11 of 14 tests, and those for the interobserver agreement of the pain tests were above 0.60 in eight of 10 tests. The only test without acceptable interobserver reliability was the strength test for iliopsoas muscle.


CONCLUSIONS
All but one of the tests investigated were reproducible and subject only to limited intraobserver and interobserver variation.
Amager University Hospital, Orthopaedic Surgery Department, Italiensvej 1, Copenhagen DK-2300 S, Denmark. per.holmich@ah.hosp.dk
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Hölmich
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Hölmich
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Bjerg
D000328:Adult; D001265:Athletic Injuries / Q000175:diagnosis*; D006119:Groin / Q000293:injuries*; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000502:physiology; D015588:Observer Variation; D010146:Pain / Q000209:etiology*; D010808:Physical Examination / Q000592:standards; D015203:Reproducibility of Results; D012916:Soccer / Q000293:injuries