Exploring expert variability in defining pseudoparalysis: an international survey.

Area of Science:

• Orthopedic Surgery
• Shoulder Surgery
• Musculoskeletal Disorders

Background:

• Disagreement exists among shoulder surgery experts regarding the definition of pseudoparalysis.
• Previous studies have used heterogeneous patient populations and varying definitions, hindering outcome comparisons.
• No prior study has surveyed international experts on pseudoparalysis definition using questionnaires and video assessments.

Purpose of the Study:

• To evaluate the level of agreement among shoulder surgeons in defining and applying the term pseudoparalysis.
• To test the hypothesis that inter-rater agreement for classifying patients with pseudoparalysis would be poor.

Main Methods:

• International shoulder surgeons were surveyed electronically on their preferred definition of pseudoparalysis.
• Surgeons reviewed video examinations of 10 patients and classified them as having pseudoparalysis or not.
• Inter-rater and intrarater reliability were calculated using kappa (κ) coefficients.

Main Results:

• Overall inter-rater agreement for pseudoparalysis classification was κ = 0.59.
• Intrarater reliability for definition selection was κ = 0.64, while for video classification it was κ = 0.78.
• Agreement varied based on surgeon age and shoulder caseload percentage.

Conclusions:

• Shoulder surgeons exhibit poor agreement on the definition and classification of pseudoparalysis.
• Intrarater reliability was higher for video-based classification than for definition selection.
• The term pseudoparalysis should be used cautiously in clinical studies due to the lack of expert consensus.