Abstract
Clinical evaluation of scapular dyskinesis (SD) aims to identify abnormal scapulothoracic movement, underlying causal factors, and the potential relationship with shoulder symptoms. The literature proposes different methods of dynamic clinical evaluation of SD, but improved reliability and agreement values are needed. The present study aimed to evaluate the intrarater and interrater agreement and reliability of three SD classifications: 1) 4-type classification, 2) Yes/No classification, and 3) scapular dyskinesis test (SDT). Seventy-five young athletes, including 45 men and 30 women, were evaluated. Raters evaluated the SD based on the three methods during one series of 8–10 cycles (at least eight and maximum of ten) of forward flexion and abduction with an external load under the observation of two raters trained to diagnose SD. The evaluation protocol was repeated after 3 h for intrarater analysis. The agreement percentage was calculated by dividing the observed agreement by the total number of observations. Reliability was calculated using Cohen Kappa coefficient, with a 95% confidence interval (CI), defined by Kappa coefficient ±1.96 multiplied by the measurement standard error. The interrater analyses showed an agreement percentage between 80% and 95.9% and an almost perfect reliability (k>0.81) for the three classification methods in all the test conditions, except the 4-type and SDT classification methods, which had substantial reliability (k<0.80) in shoulder abduction. Intrarater analyses showed agreement percentages between 80.7% and 89.3% and substantial reliability (0.67 to 0.81) for both raters in the three classifications. CIs ranged from moderate to almost perfect categories. This indicates that the three SD classification methods investigated in this study showed high reliability values for both intrarater and interrater evaluation throughout a protocol that provided SD evaluation training of raters and included several repetitions of arm movements with external load during a live assessment.
Highlights
Scapular dyskinesis (SD) can be clinically characterized by the prominence of the medial or inferomedial border, early scapular elevation or shrugging on arm elevation, or rapid downward rotation during arm lowering [1,2]
The 4-type classification proposed by Kibler et al (2002) is based on the specific kinematics of the scapula’s three-dimensional movement (Table 1), and the Yes/No classification proposed by Uhl et al (2009) [11] considers all patterns of scapular asymmetry suggested by Kibler et al (2002) into the “Yes” category, and the symmetric scapular motion into the “No” category (Table 1)
Provided that improved reliability values can be achieved by methodological improvements suggested by the three main studies [10,11,12] evaluated in the present study and considering the potential lack of consensus regarding appropriate measure and reduced reliability values [8,9], this study aimed to evaluate intra- and interrater reliability of the main three SD classification methods, 4-type, Yes/No, and scapular dyskinesis test (SDT), by using methodological improvements suggested by the original authors [10,11,12]
Summary
Scapular dyskinesis (SD) can be clinically characterized by the prominence of the medial or inferomedial border, early scapular elevation or shrugging on arm elevation, or rapid downward rotation during arm lowering [1,2]. A large number of clinical evaluation methods of scapular position and motion with different operational and methodological definitions have been reported in the literature [7,8,9]. Three main studies [10,11,12] of SD visual dynamic evaluation are suggested in the literature: 1) 4-type classification, 2) Yes/No classification, and 3) scapular dyskinesis test (SDT). The 4-type classification proposed by Kibler et al (2002) is based on the specific kinematics of the scapula’s three-dimensional movement (Table 1), and the Yes/No classification proposed by Uhl et al (2009) [11] considers all patterns of scapular asymmetry suggested by Kibler et al (2002) into the “Yes” category, and the symmetric scapular motion into the “No” category (Table 1). McClure et al (2009) [12] suggested that the SDT classifies SD based on the scapular movement disorder severity, i.e., obvious, subtle, and normal (Table 1)
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