Intertester-Reliabilität des Skapula-Dyskinesis-Tests – Wie gut sind Physiotherapeuten in der Bewegungsbeobachtung?

Zusammenfassung

Bewegungsbeobachtung ist ein wesentlicher Bestandteil des physiotherapeutischen Untersuchungs- und Behandlungsprozesses. Eine ausreichende Intertester-Reliabilität stellt die Grundlage der Kommunikation zwischen Therapeuten sowie für einen nachvollziehbaren evidenzbasierten Untersuchungs- und Behandlungsprozess dar. Die vorliegende Studie untersucht die Intertester-Reliabilität der Observation der Skapulabewegungen während der Armhebung in der sagittalen und frontalen Ebene (Skapula-Dyskinesis-Test).

Das Maß der Intertester-Reliabilität der Beurteilung der Skapulabewegungen war „leicht” bis „mittelmäßig”. Wurde die Skapulabewegung nach 3 Kategorien beurteilt (keine Dyskinesis/leichte Dyskinesis/offensichtliche Dyskinesis), fiel die Übereinstimmung zwischen den Therapeuten deutlich geringer aus als bei Beurteilung nach einem Ja-/nein-System. Da die Beurteilung nach dem System mit 3 Kategorien eine unbefriedigende Zuverlässigkeit aufweist und keinen zusätzlichen klinischen Nutzen bringt, wird für den Skapula-Dyskinesis-Test bei der Beurteilung von Patienten mit Schulterproblemen die Verwendung von 2 Kategorien (Dyskinesis ja/Dyskinesis nein) empfohlen.

Abstract

Movement observation is a major component of physiotherapeutic assessment and treatment. An adequate inter-tester reliability is the basis for communication between physiotherapists as well as for evidence-based assessment and treatment procedures. This study assessed the inter-tester reliability of monitoring the scapula during arm lifting in the sagital and frontal plane (scapula dyskinesis test).

The inter-tester reliability of the scapula movement assessment was ”fair” to ”average”. When scapula movement was assessed according to a 3-level scale (no dyskinesis, subtle dyskinesis and obvious dyskinesis) the level of agreement between physiotherapists was considerably lower than in 2-level scale assessment (yes/no). As the assessment using the 3-level scale showed a dissatisfactory reliability and as this test does not yield additional clinical benefit for the scapula dyskinesis test for the assessment of patients with shoulder problems the use of the 2-level scale (yes/no) is recommended.

Schlüsselwörter

Intertester-Reliabilität - Kappa - PABAK - Skapula-Dyskinesis - Bewegungsbeobachtung

Key words

inter-tester reliability - kappa - PABAK - scapula dyskinesis - movement observation

Literatur

• 1 Bak K, Wiesler E R, Poehling G G. Consensus statement on shoulder instability.  Arthroscopy. 2010;  26 249-255
• 2 Borstad J D, Ludewig P M. The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals.  Journal of Orthopaedics & Sports Physical Therapy. 2005;  35 227-238
• 3 Burkhart S, Morgan C, Kibler B. The Disabled Throwing Shoulder: Spectrum of Pathology Part III: The SICK Scapula, Scapular Dyskinesis, the Kinetic Chain, and Rehabilitation.  The Journal of Arthroskopic and Related Surgery. 2003;  19 641-661
• 4 Byrt T, Bischop J, Carlin J. Bias, Prevalence and Kappa.  Journal of Clinical Epidemiology. 1993;  46 423-429
• 5 Fedorak C, Ashworth N, Marshall J et al. Reliability of the Visual Assessment of Cervical and Lumbar Lordosis: How Good Are We?.  Spine. 2003;  28 1857-1859
• 6 Feinstein A, Cicchetti D. High agreement but low Kappa: I. The problem of two paradoxes.  Journal of Clinical Epidemiology. 1990;  43 543-549
• 7 Feinstein A, Cicchetti D. High agreement but low Kappa: II. Resolving the paradoxes.  Journal of Clinical Epidemiology. 1990;  43 551-558
• 8 Fleiss J L, Nee J C, Landis J R. Large sample variance of kappa in the case of different sets of raters.  Psychological Bulletin. 1979;  86 974-977
• 9 Fritz J M. Evidence-Based Examination of Diagnostic Information. In: Boissonnault W G Primary Care for the Physical Therapist – Examination and Triage.. St. Louis: Elsevier Saunders; 2005
• 10 Gross S. The Kappa Coefficient of Agreement for Multiple Observers when the Number of Subjects Is Small.  Biometrics. 1986;  42 883-893
• 11 Grouven U, Bender R, Ziegler A et al. Der Kappa-Koeffizient.  DMW – Deutsche Medizinische Wochenschrift. 2007;  132 e65-e68
• 12 Herbert L, Moffet H, McFadyen B et al. Scapular behaviour in shoulder impingement syndrome.  Arch Phys Med Rehabil. 2002;  83 60-69
• 13 Hoehler F. Bias and prevalence effects on kappa viewed in terms of sensitivity and specificity.  Journal of Clinical Epidemiology. 2000;  53 499-503
• 14 Inman V T, Saunders M, Abbott L C. Observations of the function of the shoulder joint.  Journal of Bone and Joint Surgery. 1944;  26A 1-31
• 15 Jaggi A, Lambert S. Rehabilitation for shoulder instability.  British Journal of Sports Medicine. 2010;  44 333-340
• 16 Karduna A R, McClure P W, Michener L A et al. Dynamic Measurements of Three-Dimensional Scapular Kinematics: A Validation Study.  Journal of Biomechanical Engineering. 2001;  123 184-190
• 17 Karduna A R, Kerner P, Lazarus M. Effects of scapular orientation on subacrominal contact forces. In: Kirsch B, Walker C, Memberg B Proceedings of the fourth conference of the International Shoulder Group.. Cleveland/Ohio; 2002
• 18 Kibler B W. Management of the scapula in glenohumeral instability.  Techniques in Shoulder & Elbow Surgery. 2003;  4 89-98
• 19 Kibler B W, McMullen J. Scapular dyskinesis and its relation to shoulder pain.  Journal of the American Academy of Orthopaedic Surgeons. 2003;  11 142-151
• 20 Kibler W B, Sciascia A. Current concepts: scapular dyskinesis.  British Journal of Sports Medicine. 2009;  44 300-305
• 21 Kibler B, Ludewig P, McClure P W et al. Scapular Summit 2009: Introduction.  Journal of Orthopaedic and Sports Physical Therapy. 2009;  39 A1-A8
• 22 King J. Software Solutions for Obtaining a Kappa-Type Statistic for Use with Multiple Raters. Paper presented at the annual meeting of the Southwest Educational Research Association. Dallas/Texas; 2004
• 23 Landis J, Koch G. The Measurement of Observer Agreement for Categorical Data.  Biometrics. 1977;  33 159-174
• 24 Ludewig P M, Cook T M. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement.  Physical Therapy. 2000;  80 276-291
• 25 Magosch P, Habermeyer P, Lichtenberg S. Konservative Therapie bei Schulterinstabilität.  Arthroskopie. 2004;  17 146-154
• 26 May S, Littlewood C, Bishop A. Reliability of procedures used in the physical examination of non-specific low back pain: A systematic review.  Australian Journal of Physiotherapy. 2006;  52 91-102
• 27 McClure P W, Bialker J, Neff N et al. Kinematics in people with shoulder impingement syndrome before and after a 6-week exercise program.  Physical Therapy. 2004;  84 832-848
• 28 McClure P, Tate A, Kareha S et al. A clinical method for identifiying scapular dyskinesis, Part 1: Reliability.  Journal of Athletic Training. 2009;  44 160-164
• 29 McCully S P, Suprak D N, Kosek P et al. Suprascapular nerve block disrupts the normal pattern of scapular kinematics.  Clinical Biomechanics. 2006;  21 545-553
• 30 Mell A, Lascalza S, Guffey P et al. Effect of rotator cuff pathology on shoulder rhythm.  Journal of Shoulder and Elbow Surgery. 2005;  14 S58-S64
• 31 Michener L A, McClure P W, Karduna A R. Anatomical and biomechanical mechanisms of subacrominal impingement syndrome.  Clinical Biomechanics. 2003;  18 369-379
• 32 Paletta G A, Warner J JP, Warren R F et al. Shoulder kinematics with two-plane x-ray evaluation in patients with anterior instability or rotator cuff tearing.  Journal of Shoulder and Elbow Surgery. 1997;  6 516-527
• 33 Schöttker-Königer T, Schwaller A, Baeyens J P et al. Skapulakinematik bei atraumatischer Schulterinstabilität – 3D-Untersuchung mittels elektromagnetischer Sensoren.  manuelletherapie. 2007;  11 168-176
• 34 Seffinger M A, Najim W I, Mishra S I et al. Reliability of Spinal Palpation for Diagnosis of Back and Neck Pain.  Spine. 2004;  29 E413-E425
• 35 Seitz A L, McClure P W, Finucane S et al. Mechanisms of rotator cuff tendinopathy: Intrinsic, extrinsic, or both?.  Clinical Biomechanics. 2011;  26 1-12
• 36 Sim J, Wright C. The Kappa Statistic in Reliability Studies: Use, Interpretation, and Sample Size Requirements.  Physical Therapy. 2005;  85 257-268
• 37 Tate A, McClure P, Kareha S et al. A clinical method for identifying scapular dyskinesis, Part 2: Validity.  Journal of Athletic Training. 2009;  44 165-173
• 38 Thomas S J, Swanik K A, Swanik C B et al. Internal rotation deficits affect scapular positioning in baseball players.  Clin Orthop Relat Res. 2010;  468 1551-1557
• 39 Thomas S J, Swanik K A, Swanik C et al. Change in Glenohumeral Rotation and Scapular Position after Competitive High School Baseball.  Journal of Sport Rehabilitation. 2010;  19 125-135
• 40 Tucker W S, Armstrong C W, Gribble P A et al. Scapular Muscle Activity in Overhead Athletes with Symptoms of Secondary Shoulder Impingement During Closed Chain Exercises.  Archives of Physical Medicine and Rehabilitation. 2010;  91 550-556
• 41 Uhl T L, Kibler W B, Gecewich B et al. Evaluation of Clinical Assessment Methods for Scapular Dyskinesis. Arthroscop.  The Journal of Arthroscopic & Related Surgery. 2009;  25 1240-1248
• 42 Warner J JP, Micheli L J, Arslanian L E et al. Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability and impingement syndrome.  Clinical Orthopaedics and Related Research. 1992;  285 191-199
• 43 Yang J l, Jan M H, Hung C J et al. Reduced scapular muscle control and impaired shoulder joint position sense in subjects with chronic shoulder stiffness.  J Electromyogr Kinesiol. 2010;  20 206-211
• 44 Yano Y, Hamada J, Tamai K et al. Different scapular kinematics in healthy subjects during arm elevation and lowering: Glenohumeral and scapulothoracic patterns.  Journal of Shoulder and Elbow Surgery. 2010;  19 209-215