Diagnostic accuracy of the neurological upper limb examination I: Inter-rater re

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BMC Neurol. 2006 Feb 16;6(1):8

Diagnostic accuracy of the neurological upper limb examination I:

Inter-rater reproducibility of selected findings and patterns.

Jepsen JR, Laursen LH, Hagert CG, Kreiner S, Larsen AI.

ABSTRACT: BACKGROUND: We have previously assessed the reproducibility

of manual testing of the strength in 14 individual upper limb muscles

in patients with or without upper limb complaints. This investigation

aimed at additionally studying sensory disturbances, the

mechanosensitivity of nerve trunks, and the occurrence of physical

findings in patterns which may potentially reflect a peripheral

neuropathy. The reproducibility of this part of the neurological

examination has never been reported.

METHODS: Two blinded examiners performed a semi-quantitative

assessment of 82 upper limbs (strength in 14 individual muscles,

sensibility in 7 homonymous territories, and mechanosensitivity of

nerves at 10 locations). Based on the topography of nerves and their

muscular and cutaneous innervation we defined 10 neurological

patterns each suggesting a focal neuropathy. The individual findings

and patterns identified by the two examiners were compared.

RESULTS: Strength, sensibility to touch, pain and vibration, and

mechanosensitivity were predominantly assessed with moderate to very

good reproducibility (median kappa-values 0.54, 0.69, 0.48, 0.58, and

0.53, respectively). The reproducibility of the defined patterns was

fair to excellent (median correlation coefficient = 0.75) and the

overall identification of limbs with/without pattern(s) was good

(kappa = 0.75).

CONCLUSIONS: This first part of a study on diagnostic accuracy of a

selective neurological examination has demonstrated a promising inter-

rater reproducibility of individual neurological items and patterns.

Generalization and clinical feasibility require further

documentation: 1) Reproducibility in cohorts of other composition, 2)

validity with comparison to currently applied standards, and 3)

potential benefits that can be attained by the examination.