Rate of Agreement between an Experienced and Novice Clinician in the Application of a Clinical Diagnostic Rule for Subacromial Impingement Syndrome: A Pilot Study




Laura, Sherrill
Jurado, Jan
Thomas, Andrew Charles

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Background and Purpose: To determine the rate of agreement between a novice clinician and an expert clinician based on their ability to apply special tests from a clinical decision rule (CDR) for subacromial impingement syndrome (SAIS) proposed by Michener et al (2009).

Design: One group, repeated-measures reliability study.

Methods: Examination of 12 subjects with shoulder pain by a novice and expert rater included five SAIS tests: painful arc, Neer, Hawkins-Kennedy, empty can, and the external rotation test. A kappa analysis was performed to assess rate of agreement between examiners.

Results: 100% agreement (K = 1.000) existed between novice and expert findings for the Hawkins-Kennedy test and the diagnosis of SAIS through the CDR. Moderate agreement was established for the painful arc test (K = 0.567), and fair agreement was indicated by the Neer (K = 0.316), Empty Can (K = 0.297), and External Rotation (K = 0.217) tests.

Conclusions: The results of this study suggest usage of CDRs may normalize clinical knowledge between novice and expert clinicians in the physical diagnosis of SAIS.



physical therapy, shoulder impingement, diagnosis, manual tests, inter-rater reliability