Reliability of Performance-Based Clinical Measurements to Assess Shoulder Girdle Kinematics and Positioning: A Systematic Review
Authors:
D'Hondt N, E., Kiers, H., Pool, J. J., Hacquebord, S. T., Terwee, C. B., and Veeger, D. E.
Abstract:
BACKGROUND: Deviant shoulder girdle movement is suggested as an eminent factor in the aetiology of shoulder pain. Reliable measurements of shoulder girdle kinematics are a prerequisite for optimizing clinical management strategies.
PURPOSE: To evaluate reliability, measurement error and internal consistency of measurements with performance-based clinical tests for shoulder girdle kinematics and positioning in patients with shoulder pain.
DATA SOURCES: Medline, Embase, CINAHL and SPORTDiscus were systematically searched from inception to August 2015.
STUDY SELECTION: Articles published in Dutch, English or German were included when these involved the evaluation of at least one of the measurement properties of interest.
DATA EXTRACTION: Two reviewers independently evaluated the methodological quality per studied measurement property with the 4-point-rating-scale of the COSMIN-checklist, extracted data and assessed adequacy of the measurement properties.
DATA SYNTHESIS: Forty studies comprising more than 30 clinical tests were included. Tests were disentangled to their actual reported measurements and then categorized into: 1) positional measurements; 2) measurements of dynamic characteristics; 3) tests to diagnose shoulder girdle impairment. Best evidence synthesis of the tests was performed per measurement for each measurement property.
LIMITATIONS: All studies had significant limitations including incongruence between test description and actual reported measurements and a lack of reporting on Minimal Important Change. In general methodological quality of the selected studies was fair to poor.
CONCLUSIONS: High quality evidence indicates that measurements with the Modified scapular Assistance Test are not reliable for clinical use. Sound recommendations for the use of other tests could not be made due to inadequate evidence. Across studies diversity in description, performance and interpretation of similar tests was present and different criteria were used to establish similar diagnoses, mostly without taking into account a clinically meaningful context. Consequently these tests lack face validity, which hampers their clinical use. Further research on validity and how to integrate a clinical meaningful context of movement in clinical tests is warranted.