Reliability and diagnostic characteristics of clinical tests of upper limb motor function

There is a paucity of information on the inter-rater reliability and predictive value of components of the neurological examination. Selected tests of upper limb motor function were studied in 34 patients with Parkinson's disease, upper motor neuron disease or cerebellar disease and in 25 control participants. Video recordings were independently evaluated and scored by two clinicians to determine inter-rater reliability (kappa) and predictive values. Kappa values ranged from 0.00 to 0.73. Highest positive predictive values (PPV) were obtained for the Barré test, arm raise, forearm rolling and finger nose tests. Negative predictive values (NPV) were mostly low, with highest values for unimanual sequential finger tap and rhythmic tap. The combined tests had PPV of 0.58 and NPV of 0.73. This study demonstrates that these clinical tests have poor inter-rater reliability and low negative predictive value when used in isolation.