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Measuring subluxation of the hemiplegic shoulder: reliability of a method
I A Snels1, H Beckerman, J J ten Kate
1Department of Rehabilitation Medicine, University Hospital, and Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
Objective:
Subluxation of the shoulder after stroke can be measured according to the method described by Van Langenberghe and Hogan.
Methods:
To evaluate the reliability of this method, the shoulder radiographs of 25 patients were available for this study. Two independent raters each assessed these radiographs twice.
Results:
The intrarater reliability was good: percentage of agreement was 88 and 84%, weighted kappa, 0.69 [95% confidence interval (CI), 0.38-1.0] and 0.78 (95% CI, 0.60-0.95) for raters 1 and 2, respectively. The interrater reliability was poor: percentage of agreement was 36 and 28%, kappa, 0.11 (95% CI, 0.0-0.31) and 0.09 (95% CI, 0.0-0.23) in sessions 1 and 2, respectively. Subsequently the original method was adjusted by combining two categories (no subluxation and beginning subluxation) into one ("no clinically important subluxation").
Conclusions:
After this adjustment of the categories, the interrater reliability improved [percentage of agreement, 72%, and kappa, 0.49 (95% CI, 0.18-0.80)], but did not reach acceptable values.