ArticlesInterobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis☆,☆☆,★,★★,♢,♢♢
Section snippets
Patients
The participants of the reproducibility study were recruited from the study population of an RCT, comparing the effectiveness of corticosteroid injections, physiotherapy, and a wait-and-see policy for lateral epicondylitis.19 Patients were eligible for participation in the RCT if they had pain at the lateral side of the elbow, which increased with pressure on the lateral epicondyl and during resisted dorsiflexion of the wrist. Other inclusion criteria were elbow complaints ≥6 weeks, age between
Patients
The 50 participants of the reproducibility study were enrolled between July 1998 and January 1999. The mean age ± SD of the 50 patients was 47±11 years, and 40% of the patients were women (table 1).Empty Cell Participants (N=50) Female (%) 20 (40) Mean age (SD) in years 47 (11) Dominant side affected (%) 35 (70) Elbow disability (median, IQR)* 5.5 (1.5–13.3) Pain during the day (median, IQR)† 1 (0–4) * Modified Pain Free Function Questionnaire: scores range from 0 to 40, with
Discussion
This study investigated the interobserver reproducibility of severity of complaints, grip strength, and pressure pain threshold in 50 patients with lateral epicondylitis. The results showed excellent reliability for the severity of complaints, pain-free grip strength, and maximum grip strength (ICC≥.90). The pressure pain threshold was clearly less reliable (ICC range,.72–.77). Systematic differences (bias) between the physiotherapists were found for the assessment of maximum grip strength and
Conclusion
Interobserver reproducibility for all outcome measures, except for pressure pain threshold, showed excellent results. An overall assessment of severity of symptoms by a trained physiotherapist showed good agreement and reliability and is a relevant measure in day-to-day clinical care. Some interobserver variation should be taken into account, particularly when examiners have different backgrounds and training. Pain-free grip strength showed high reliability and agreement, is relatively easy to
Acknowledgements
We thank Samyra Keus for performing the assessments.
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Supported by the Netherlands Organization for Scientific Research and the Health Insurance Council's Fund for Investigative Medicine.
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Reprint requests to Nynke Smidt, PhD, Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststr 7, 1081 BT Amsterdam, The Netherlands, e-mail: [email protected].
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