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Reliability and repeatability of the Hoffmann sign.

Thiru M Annaswamy1, Tomoya Sakai, Lance L Goetz

  • 1Physical Medicine & Rehabilitation Service, Dallas VA Medical Center and University of Texas Southwestern Medical Center, Dallas, TX 75216, USA. thiru.annaswamy@va.gov

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Summary

The Hoffmann sign demonstrates substantial inter-rater and intrasubject reliability, and outstanding intrarater reliability. This neurological test shows consistent results when performed by different examiners and by the same examiner over time.

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Area of Science:

  • Neurology
  • Clinical assessment
  • Diagnostic reliability

Background:

  • The Hoffmann sign is a clinical neurological reflex used to assess upper motor neuron lesions.
  • Reliability of clinical signs is crucial for accurate diagnosis and patient management.
  • Standardization of examination techniques is essential for reproducible clinical findings.

Purpose of the Study:

  • To evaluate the inter-rater, intrarater, and intrasubject reliability of the Hoffmann sign.
  • To assess the consistency of the Hoffmann sign when performed by different examiners and by the same examiner over time.
  • To determine the diagnostic accuracy of the Hoffmann sign under standardized conditions.

Main Methods:

  • Observational, cross-sectional study conducted at a Veterans Affairs medical center.
  • Fifty-two consenting subjects without specific neurological conditions or contraindications were recruited.
  • The Hoffmann sign was elicited using a standardized technique by multiple investigators across two sessions, with Cohen's κ coefficient calculated for reliability measures.

Main Results:

  • Inter-rater reliability (Cohen's κ) was 0.65, indicating substantial agreement between different examiners.
  • Intrarater reliability (Cohen's κ) was 0.89, demonstrating outstanding agreement for the same examiner across trials.
  • Intrasubject reliability (Cohen's κ) was 0.73, showing substantial agreement for the same subject across sessions.

Conclusions:

  • The Hoffmann sign exhibits substantial inter-rater and intrasubject reliability when performed with a standardized technique.
  • The sign demonstrates outstanding intrarater reliability, suggesting high consistency by individual examiners.
  • These findings support the use of the Hoffmann sign as a reliable clinical assessment tool in neurological examinations.