title: Diagnosis of shoulder pain by history and selective tissue tension: agreement between assessors.
abstract: METHODS
  Evaluation of agreement between assessors.
  
  
  OBJECTIVE
  To evaluate agreement between an expert in selective tissue tension (STT) and 3 other trained assessors, all using STT in conjunction with a preliminary clinical history, on their diagnostic labelling of painful shoulders.
  
  
  BACKGROUND
  Consensus on diagnostic labelling for shoulder pain is poor, hampering interpretation of the evidence for interventions. STT, a systematic approach to physical examination and diagnosis, offers potential for standardization, but its reliability is contentious.
  
  
  METHODS
  Four trained assessors, 1 of whom was considered an expert, separately assessed 56 painful shoulders in 53 subjects (32 male [mean+/-SD age, 51+/-13 years], 21 female [mean+/-SD age, 57+/-12 years]), using STT in conjunction with a preliminary clinical history. Assessors labelled each painful shoulder as "rotator cuff lesion," "bursitis," "capsulitis," "other diagnosis," or "no diagnosis." Combinations of diagnoses were allowed.
  
  
  RESULTS
  A diagnosis was made in every case, with less than 7% of the diagnoses being combined. With the diagnostic categories pooled, agreement (kappa and 95% confidence interval [CI]) between the expert assessor and each of the other assessors was good, ranging from 0.61 (0.44-0.78) to 0.75 (0.60-0.90). For single diagnostic categories, agreement between the expert and each of the others (dichotomized data) ranged from 0.35 (-0.03-0.73) to 0.58 (0.29-0.87) for bursitis; 0.63 (0.40-0.86) to 0.82 (0.65-0.99) for capsulitis; 0.71 (0.49-0.93) to 0.79 (0.61-0.96) for rotator cuff lesions; and from 0.69 (0.35-1.00) to 0.78 (0.48-1.00) for other diagnoses.
  
  
  CONCLUSIONS
  Overall, STT in conjunction with a preliminary clinical history enables good agreement between trained assessors. Future work is required to evaluate its criterion validity.
authors.affiliation: Teesside Centre for Rehabilitation Sciences, School of Health and Social Care, University of Teesside, Middlesbrough, UK. n.hanchard@tees.ac.uk
authors.forename: Nigel C A
authors.initials: NC
authors.lastname: Hanchard
authors.forename: Tracey E
authors.initials: TE
authors.lastname: Howe
authors.forename: Meg M
authors.initials: MM
authors.lastname: Gilbert
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D015588:Observer Variation; D009985:Orthopedics / Q000379:methods*; D010146:Pain / Q000175:diagnosis* / Q000209:etiology*; D010147:Pain Measurement / Q000379:methods*; D010808:Physical Examination; D026741:Physical Therapy Modalities; D012680:Sensitivity and Specificity; D000070599:Shoulder Injuries; D013718:Tensile Strength