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Reliability and Concurrent Validity of Shoulder Tissue Irritability Classification
Stephen M Kareha1, Philip W McClure2, Alicia Fernandez-Fernandez3
1Physical Therapy at St. Luke's, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA.
Physical Therapy
|January 22, 2021
Summary
The STAR-Shoulder tissue irritability rating system shows acceptable reliability and a strong link with patient outcomes, supporting its use in clinical decision-making for shoulder pain.
Area of Science:
- Orthopedics
- Physical Therapy
- Clinical Measurement
Background:
- Clinical practice guidelines recommend rating tissue irritability for decision-making.
- The Staged Algorithm for Rehabilitation Classification: Shoulder Disorders (STAR-Shoulder) proposed a method for rating tissue irritability.
- The reliability and validity of the STAR-Shoulder irritability rating system were previously unknown.
Purpose of the Study:
- To examine the reliability of shoulder tissue irritability ratings.
- To assess the concurrent validity of shoulder tissue irritability ratings.
- To determine the utility of the STAR-Shoulder system in guiding treatment strategy and intensity.
Main Methods:
- A prospective, repeated-measures, cross-sectional design was employed.
- 101 participants with shoulder pain were assessed by blinded raters for tissue irritability.
- Patient-reported outcome (PRO) measures of pain and disability were collected and compared with irritability ratings.
Main Results:
- Interrater reliability for tissue irritability was 0.69 (67% agreement).
- All PRO measures showed significant differences across the three levels of tissue irritability.
- Receiver operating characteristic curve analysis was used to derive cut-off scores for PRO instruments.
Conclusions:
- The STAR-Shoulder tissue irritability rating system demonstrates acceptable reliability.
- A strong relationship exists between PRO measures and therapist-rated tissue irritability.
- These findings support the clinical use of the STAR-Shoulder irritability rating system for guiding treatment.
