Interrater Reliability of the History and Physical Examination in Patients With Mechanical Neck Pain

Abstract Background and Purpose. Neck flexor muscle endurance has been negatively correlated with cervical pain and dysfunction. The purposes of this study were to determine rater reliability in subjects both withand without neck pain and to determine whether there was a difference in neck flexor muscle endurance between the 2 groups. Subjects. Forty-one subjects with and without neck pain were enrolled in this repeated-measures reliability study. Methods. Two raters used an isometric neck retraction test to assess neck flexor muscle endurancefor all subjects during an initial session, and subjects without neck pain returned for testing 1 week later. Results. For the group without neck pain, intrarater reliability was good to excellent (intraclass correlation coefficient [ICC(3,1)]=.82–.91), and interrater reliability was moderate to good (ICC[2,1]=.67–.78). The associated standard error of measurement (SEM) ranged from 8.0 to 11.0 seconds and from 12.6 to 15.3 seconds, respectively. For the group with neck pain, interrater reliability was moderate(ICC[2,1]=.67, SEM=11.5). Neck flexor muscle endurance test results for the group without neck pain (X̄=38.95 seconds, SD=26.4) and the group with neck pain (X̄=24.1 seconds, SD=12.8) were significantly different. Discussion and Conclusion. Reliability coefficients differed between the 2 groups and ranged from moderate to excellent and improved after the first test session. The interrater reliability of data obtained with the neck flexor muscle endurance test in people with neck pain must be improved in order for clinicians to distinguish a clinically meaningful change from measurement error. Neck flexor muscle endurance was both statistically and clinically greater for subjects without neck pain than for those with neck pain.

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Human- Versus Machine Learning–Based Triage Using Digitalized Patient Histories in Primary Care: Comparative Study (Preprint)

10.2196/preprints.18930 ◽

2020 ◽

Author(s):

Artin Entezarjou ◽

Anna-Karin Edstedt Bonamy ◽

Simon Benjaminsson ◽

Pawel Herman ◽

Patrik Midlöv

Keyword(s):

Machine Learning ◽

Primary Care ◽

Physical Examination ◽

Medical History ◽

Primary Care Physicians ◽

Interrater Reliability ◽

Reference Group ◽

Majority Vote ◽

Medical Histories ◽

Using Data

BACKGROUND Smartphones have made it possible for patients to digitally report symptoms before physical primary care visits. Using machine learning (ML), these data offer an opportunity to support decisions about the appropriate level of care (triage). OBJECTIVE The purpose of this study was to explore the interrater reliability between human physicians and an automated ML-based triage method. METHODS After testing several models, a naïve Bayes triage model was created using data from digital medical histories, capable of classifying digital medical history reports as either in need of urgent physical examination or not in need of urgent physical examination. The model was tested on 300 digital medical history reports and classification was compared with the majority vote of an expert panel of 5 primary care physicians (PCPs). Reliability between raters was measured using both Cohen κ (adjusted for chance agreement) and percentage agreement (not adjusted for chance agreement). RESULTS Interrater reliability as measured by Cohen κ was 0.17 when comparing the majority vote of the reference group with the model. Agreement was 74% (138/186) for cases judged not in need of urgent physical examination and 42% (38/90) for cases judged to be in need of urgent physical examination. No specific features linked to the model’s triage decision could be identified. Between physicians within the panel, Cohen κ was 0.2. Intrarater reliability when 1 physician retriaged 50 reports resulted in Cohen κ of 0.55. CONCLUSIONS Low interrater and intrarater agreement in triage decisions among PCPs limits the possibility to use human decisions as a reference for ML to automate triage in primary care.

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Defining normal jugular venous pressure with ultrasonography

CJEM ◽

10.1017/s1481803500012409 ◽

2010 ◽

Vol 12 (04) ◽

pp. 320-324 ◽

Cited By ~ 3

Author(s):

Steven J. Socransky ◽

Ray Wiss ◽

Ron Robins ◽

Alexandre Anawati ◽

Marc-Andre Roy ◽

...

Keyword(s):

Physical Examination ◽

Interrater Reliability ◽

Venous Pressure ◽

Jugular Venous Pressure ◽

Normal Range ◽

Convenience Sample ◽

A Value ◽

The Mean ◽

Research Assistants

ABSTRACT Objective: Determination of jugular venous pressure (JVP) by physical examination (E-JVP) is unreliable. Measurement of JVP with ultrasonography (U-JVP) is easy to perform, but the normal range is unknown. The objective of this study was to determine the normal range for U-JVP. Methods: We conducted a prospective anatomic study on a convenience sample of emergency department (ED) patients over 35 years of age. We excluded patients who had findings on history or physical examination suggesting an alteration of JVP. With the head of the bed at 45°, we determined the point at which the diameter of the internal jugular vein (IJV) began to decrease on ultrasonography (“the taper”). Research assistants used 2 techniques to measure U-JVP in all participants: by measuring the vertical height (in centimetres) of the taper above the sternal angle, and adding 5 cm; and by recording the quadrant in the IJV's path from the clavicle to the angle of the jaw in which the taper was located. To determine interrater reliability, separate examiners measured the U-JVP of 15 participants. Results: We successfully determined the U-JVP of all 77 participants (38 male and 39 female). The mean U-JVP was 6.35 (95% confidence interval 6.11–6.59) cm. In 76 participants (98.7%), the taper was located in the first quadrant. Determination of interrater reliability found κ values of 1.00 and 0.87 for techniques 1 and 2, respectively. Conclusion: The normal U-JVP is 6.35 cm, a value that is slightly lower than the published normal E-JVP. Interrater reliability for U-JVP is excellent. The top of the IJV column is located less than 25% of the distance from the clavicle to the angle of the jaw in the majority of healthy adults. Our findings suggest that U-JVP provides the potential to reincorporate reliable JVP measurement into clinical assessment in the ED. However, further research in this area is warranted.

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Concurrent validity and interrater reliability of a new smartphone application to assess 3D active cervical range of motion in patients with neck pain

Musculoskeletal Science and Practice ◽

10.1016/j.msksp.2017.12.006 ◽

2018 ◽

Vol 34 ◽

pp. 59-65 ◽

Cited By ~ 13

Author(s):

Martijn S. Stenneberg ◽

Harm Busstra ◽

Michel Eskes ◽

Emiel van Trijffel ◽

Erik Cattrysse ◽

...

Keyword(s):

Neck Pain ◽

Range Of Motion ◽

Concurrent Validity ◽

Interrater Reliability ◽

Smartphone Application ◽

Cervical Range Of Motion

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Extradural Spinal, Bone Marrow, and Renal Nephroblastoma

Journal of the American Animal Hospital Association ◽

10.5326/0390080 ◽

2003 ◽

Vol 39 (1) ◽

pp. 80-85 ◽

Cited By ~ 14

Author(s):

Angela M. Gasser ◽

William W. Bush ◽

Sionagh Smith ◽

Raquel Walton

Keyword(s):

Bone Marrow ◽

Neck Pain ◽

Physical Examination ◽

Neurological Examination ◽

Hind Limb ◽

Imaging Techniques ◽

Abdominal Mass ◽

Acute Onset ◽

Neurological Signs ◽

Multifocal Disease

A 1-year-old, female intact Shetland sheepdog presented with acute onset of neurological signs. Physical examination revealed a large abdominal mass. Neurological examination revealed multifocal disease with neck pain, short-strided forelimbs, and hind-limb paresis with loss of tail and anal tone. Blood work, imaging techniques, cytopathology, and histopathology led to a diagnosis of renal, bone-marrow, and extradural spinal nephroblastoma. This report documents potential clinical and pathological manifestations of canine nephroblastoma that have not been previously reported.

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