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Singh R.V.1,2, Trewartha G.1, Stokes K.1, McKay C.1
1University of Bath, Health, Bath, United Kingdom, 2University of the West of England, Allied Health Professions, Bristol, United Kingdom
Background: The scapula plays an integral role in shoulder function and there is evidence of an association between scapula dysfunction and shoulder pain in overhead athletes. In rugby, players' shoulders are subject to numerous impact forces that are shown to result in alterations of the static position and dynamic function of the scapula. Clinicians managing athletes with shoulder pain and those at risk of developing shoulder pain need to be able to reliably assess the scapula position statically and dynamically. Consequently, it is important to be aware of the reliability of the available assessment measures of scapula positioning in sports physical therapy settings. Additionally, the agreement between novice and expert clinician's evaluation of an athlete's scapula position will further define the scope of these clinical tests in the prevention and management of rugby players with shoulder pain.
Purpose: To assess the inter - rater reliability between expert and novice raters of the static scapula posture and scapula dyskinesis tests in rugby union players.
Methods: Four novice raters and one expert rater evaluated the static scapula posture in five scapula planes of movement (scapula plane, sagittal plane, transverse plane, horizontal plane and vertical plane) at rest in all participants using palpation and visual observation while the scapular dyskinesis test was video recorded and evaluated by all raters the following day. All novice raters underwent a day of training to familiarise them with the scapula posture and scapula dyskinesis tests. The novice raters had 2 years of experience in the assessment and management of musculoskeletal conditions as university undergraduate students while the experienced rater was a post graduate qualified chartered physiotherapist with more than 15 years of clinical experience. The participants were male university rugby union players who attended 3 testing sessions (session 1: n=17, session 2: n=11 and session 3: n= 16), each 1 week apart. Each participant that met the inclusion criteria was randomly allocated to be assessed by all raters. Cohens Kappa was used to analyse the data in a software package for statistical analysis (IBM Statistics 22). All participants provided written consent to participate in the study and ethics was approved by the university´s research ethics committee.
Results: For inter-rater reliability of shoulder posture mean the mean kappa values ranged from poor to moderate (0-0.447) agreement between the novice raters and the expert rater. For scapular dyskinesis the mean kappa values ranged from slight to fair (0.07-0.17) agreement between the novice raters and the expert rater
Conclusion(s): Ratings of the scapula posture and scapula dyskinesis by novice and expert raters has poor to moderate reliability and warrants caution when used to make clinical decisions based on observation alone.
Implications: The scapula posture and scapula dyskinesis tests must be used with an awareness of the limitations to the reliability and in particular when used by novice sports physical therapists. These tests should be used in conjunction with other clinical tests when assessing rugby players shoulders.
Funding acknowledgements: The author would like to thank the Private Physiotherapy Educational Foundation for the research grant funding.
Topic: Musculoskeletal: upper limb
Ethics approval: University of the West of England, Bristol, Research Ethics Committee.
All authors, affiliations and abstracts have been published as submitted.
