Development Of A Novel Grading Scale Based On The ULNT1 And BPTT

Abstract

PURPOSE: Upper Limb Neurodynamic Tests assess for mechanosensitivity, with moderate degrees of reliability and validity. The purpose of this study was to assess inter and intra-rater accuracy of a novel standardized grading scale based on neurodynamic tests demonstrated to bias the median nerve and brachial plexus. METHODS: Participants attending lectures on neural mobilization were instructed in a novel grading scale based on the Upper Limb Neurodynamic Test 1 and Brachial Plexus Tension Test. At least one hour after instruction, participants were shown 7 different videos of a possible 14 test positions in random order and asked to score the tests on a data collection sheet. To determine accuracy in Phase II, at least one month after participating in Phase I, nine of the 307 clinicians were re-tested by again viewing the 7 videos and scoring the tests. RESULTS: In Phase I, SPSS 22.1 was used for descriptive statistics and ANOVA data analysis. Fifty eight percent achieved the correct response for all 7 positions, 23.5% for six positions, and 12.1% for five positions 4.6 % for 4 positions and less than 2% accurate for 3 or less test positions. Of note, clinicians with 1 – 5 years of experience scored significantly better than clinicians with 15+ years of experience (p<.002). There were no significant differences in accuracy between groups of clinicians based on area of specialty or location. In Phase II a similar analysis included 9 participants, 89% achieved the correct response for all 7 positions, with 100% achieving a correct response to 6 or more positions. CONCLUSION: Previous authors have identified the value of neural mobility testing but have not utilized a specific grading scale. This study is the first step to identifying and testing a clinical scale that may have utility in the clinic. Our results demonstrate good accuracy of responses among all clinicians in their ability to correctly identify test positions in this grading scale. However, there was a significant difference in accuracy between clinicians with 1 – 5 years of experience vs. clinicians with 15+ years of experience. This grading system may provide quantified outcome in neural mobility scoring for clinical utility. Further testing is needed to ascertain why differences exist in two levels of years of experience.