title: A study of the noninstrumented physical examination of the knee found high observer variability.
abstract: OBJECTIVE
  This study estimated the inter- and intraobserver reliability of a set of noninstrumented physical examination measures for knee pain in older adults.
  
  
  METHODS
  Forty-five patients from primary care, and 13 patients from secondary care, were each examined by two out of a team of three physical therapists, and were reexamined by one of these observers 1 month later. The examination items were standardized and included dichotomous, ordinal and continuous variables considered relevant to a primary care context.
  
  
  RESULTS
  For individual dichotomous items, median interobserver and intraobserver agreement (kappa) was 0.22 (interquartile range IQR=0.12-0.35) and 0.41 (IQR=0.28-0.56) respectively. For ordinally rated variables, weighted kappa ranged from -0.08 to 0.43 for interobserver agreement, and from 0.00 to 0.79 for intraobserver agreement. The median intraclass correlation coefficient for continuous examination variables was 0.80 (range 0.68-0.89) for interobserver agreement, and 0.84 (range 0.67-0.95) for intraobserver agreement.
  
  
  CONCLUSIONS
  For trained but nonexpert examiners, agreement was generally poor for dichotomous and ordinal examination items; however, kappa-values are liable to be depressed by the low prevalence of clinical signs in this sample. Agreement on continuous variables was notably better.
authors.affiliation: Primary Care Sciences Research Centre, Keele University, Staffordshire ST5 5BG, UK.
authors.forename: Laurence
authors.initials: L
authors.lastname: Wood
authors.forename: George
authors.initials: G
authors.lastname: Peat
authors.forename: Ross
authors.initials: R
authors.lastname: Wilkie
authors.forename: Elaine
authors.initials: E
authors.lastname: Hay
authors.forename: Elaine
authors.initials: E
authors.lastname: Thomas
authors.forename: Julius
authors.initials: J
authors.lastname: Sim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005530:Foot Deformities / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007717:Knee / Q000473:pathology / Q000503:physiopathology*; D007719:Knee Joint / Q000002:abnormalities / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D020370:Osteoarthritis, Knee / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D010146:Pain; D010147:Pain Measurement / Q000379:methods*; D010173:Palpation; D010808:Physical Examination / Q000379:methods*; D026741:Physical Therapy Modalities; D015203:Reproducibility of Results; D012189:Retrospective Studies