Inter-professional agreement of ultrasound-based diagnoses in patients with shoulder pain between physical therapists and radiologists in the Netherlands

M Thoomes-de Graaf; G G M Scholten-Peeters; E Duijn; Y H J M Karel; M P J van den Borne; A Beumer; R P G Ottenheijm; G J Dinant; E Tetteroo; C Lucas; B W Koes; A P Verhagen

doi:10.1016/j.math.2014.04.018

Inter-professional agreement of ultrasound-based diagnoses in patients with shoulder pain between physical therapists and radiologists in the Netherlands

Man Ther. 2014 Oct;19(5):478-83. doi: 10.1016/j.math.2014.04.018. Epub 2014 May 14.

Authors

Affiliations

¹ Research Group Diagnostics, Avans University of Applied Science, Breda, The Netherlands; Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands. Electronic address: [email protected].
² Research Group Diagnostics, Avans University of Applied Science, Breda, The Netherlands; Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
³ Department of Orthopaedic Surgery, AMPHIA Hospital, Breda, The Netherlands.
⁴ Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
⁵ Department of Radiology, AMPHIA Hospital, Breda, The Netherlands.
⁶ Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
⁷ Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.

PMID: 24898215
DOI: 10.1016/j.math.2014.04.018

Abstract

Study design: Reliability study.

Objectives: The aim of this study was to evaluate the interrater-reliability of the interpretation of diagnostic ultrasound in patients with shoulder pain between physical therapists and radiologists.

Background: Although physical therapists in The Netherlands increasingly use diagnostic ultrasound in clinical practice, there is no evidence available on its reliability.

Methods: A cohort study included patients with shoulder pain from primary care physiotherapy. Patients followed the usual diagnostic pathway of which diagnostic ultrasound could be a part. Patients that received diagnostic ultrasound also visited a radiologist within one week for a second one. Patients and radiologists were blinded for the diagnostic ultrasound diagnosis of the physical therapists. Agreement was assessed using Cohen's kappa statistics. Subgroup analysis was performed on education and experience.

Results: A total of 65 patients were enrolled and 13 physical therapists and 9 radiologists performed diagnostic ultrasound. We found substantial agreement (0.63 K) between physical therapists and radiologists on the assessment of full thickness tears. The overall kappa of all four diagnostic categories was 0.36, indicating fair agreement. The more experienced and highly trained physical therapists showed moderate agreement (0.43 K) compared to only slight agreement (0.17 and 0.09 K) from the less experienced and trained physical therapists with radiologists.

Conclusion: The reliability between physical therapists and radiologist on diagnostic ultrasound of shoulder patients in primary care is borderline substantial (Kappa = 0.63) for full thickness tears only. This level of reliability is relatively low when compared with the high reliability between radiologists. More experience and training of physical therapists may increase the reliability of diagnostic ultrasound.

Keywords: Agreement; Kappa; Physical therapy; Radiology; Ultrasonography.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Female
Humans
Male
Middle Aged
Netherlands
Observer Variation
Physical Therapists*
Physicians*
Reproducibility of Results
Shoulder Pain / diagnostic imaging*
Shoulder Pain / physiopathology*
Ultrasonography