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

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