Interobserver and intraobserver reliability of therapist-assisted videotaped evaluations of upper-limb hemiplegia

Therapist-assisted videotaped sessions have been used to augment physical examinations in the evaluation of hand and arm function in patients with spastic hemiplegia. The purpose of this study was to assess the interobserver and intraobserver reliability of standardized videotaped examinations in the evaluation and functional classification of these patients.

Three examiners reviewed standardized videotaped examinations of 10 adolescents with spastic hemiplegia on 2 separate occasions. All 10 patients were under consideration for surgical intervention for their upper-extremity dysfunction. Videotapes were used to assess upper-extremity range of motion, finger and thumb deformity, and reach, pinch, and grip function. Upper-extremity function was graded according to the House and Mowery classification systems. Interobserver and intraobserver reliabilities were measured with the kappa coefficient.

Range of motion, deformity, and upper-extremity functional strategy assessment showed slight to excellent interobserver reliability and good to almost perfect intraobserver reliability. Interobserver and intraobserver reliability of the consolidated House classification system was more reliable than the Mowery or standard House classification systems.

Evaluations of standardized videotaped examinations in patients with hemiplegia were reliable between and among observers. Such therapist-assisted videotaped evaluations may provide useful data for clinical decision-making and multicenter outcomes studies in patients with upper-extremity involvement with spastic hemiplegia.