A specific algorithm has been proposed for classifying impingement related shoulder pain in athletes with overhead activity. Data on the inter-examiner reproducibility of the suggested clinical tests and criteria and their mutual dependencies for identifying subacromial impingement symptoms (SIS) are not available.
To test the inter-examiner reproducibility of selected tests and criteria suggested for classifying SIS and the mutual dependencies of each of the individual tests and SIS.
A standardised three-phase protocol for clinical reproducibility studies was followed, consisting of a training, an overall agreement and a study phase. To proceed to the study phase, an overall agreement of 0.80 was required. In total 10, 20 and 44 subjects were included in the three phases, respectively. The case prevalence in the study phase was 50%. The inclusion criterion for cases was ≥3, and for controls ≤1 positive test out of four. Cohen's κ statistics were used for calculating agreement.
In the overall agreement phase, an agreement of 0.90 was obtained, while in the study phase it was 0.98 with a κ of 0.95 for SIS. κ Values for the individual tests varied between 0.60 and 0.95. Mutual dependencies between each test and SIS showed Neer's test with anterior pain to be most often used to determine SIS.
Inter-examiner reproducibility was moderate to almost perfect for the selected tests and criteria for SIS. The next challenge will be to establish reproducibility in clinical practice, as well as the validity of the tests and criteria for SIS.
This study examines the inter-tester reproducibility of Hawkins', Neer's, Jobe's and Apprehension tests, included in a recent clinical reasoning algorithm, both as individual tests and as performed as a battery of tests for screening for subacromial impingement symptoms (SIS) in overhead athletes.
Furthermore, the mutual dependency of each individual test and SIS was determined.
Overall, the reproducibility was almost perfect for tests and criteria for SIS when following a standardised test protocol for reliability and validity studies.
Mutual dependency was highest for Neer's test with anterior pain and SIS, implying that this was the test most often used to determine SIS.
Strengths and limitations of this study
The strength of the study is the strict adherence to a standardised study protocol for reproducibility and validity studies, with a training and an overall agreement phase, including the requirement of a 0.50 prevalence of SIS, before performing the study phase. Since the study population consisted of overhead athletes, for whom the algorithm is intended, data can be generalised to the target population.
The limitation of the study is that the current mutual dependencies may have been deceptively high because of a possible bias due to the inclusion criteria used in this algorithm, since subjects with two out of four positive test responses are not included. However, this limitation has not biased the high reproducibility of the tests and criteria for SIS.