Reliability of clinical tests in the assessment of patients with neck/shoulder problems -: Impact of history

Study Design. A clinical trial on patients receiving neck/shoulder physical examinations. Objectives. To analyze reliability of clinical tests, prevalence of positive findings in the assessment of neck/ shoulder problems in primary care patients, and the impact of history, including pain drawing, on these parameters. Summary of Background Data. Reliability of clinical tests varies, perhaps partly because of the impact of history. To our knowledge, this has not been studied before. Methods. Two examiners independently assessed 100 patients with a set of 66 clinical tests divided into 9 categories. Half of the patients were examined with and the other half without knowledge of history. Reliability as expressed by percentage agreement, kappa coefficients, and prevalence of positive findings was calculated. Results. Reliability of clinical tests was poor or fair in several categories and did not alter with history. Only a bimanual sensitivity test reached good kappa values. With known history, prevalence of positive findings increased. Bias was apparent in all test categories except sensitivity tests. Four out of five patients were diagnosed to have neurogenic dysfunction in the affected area. Conclusions. Our sensitivity test was the most reliable and also exempt from bias and should be studied further. Some common tests may not be reliable. History had no impact on reliability of our tests but increased the prevalence of positive findings. Neurogenic dysfunction seems very common in patients with neck and/or shoulder problems and should be screened for.