Intrarater and interrater reliability of three classifications for scapular dyskinesis in athletes

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.

Scapular Dyskinesis: From Basic Science to Ultimate Treatment

“…A good screening tool for the presence of SD is the yes/no method that categorizes abnormal shoulder types I, II, and III of SD into the "yes" category and type IV into the "no" category [22]. Therefore, four-type classification, yes/no classification and an SD test can be considered valuable methods that provide SD evaluation [112]. However, they do not seem to be useful in differentiating between shoulder pathologies, because of the sensitivities of 71% and 41% for the SD and SICK scapula tests, respectively [113].…”

The role of scapular dyskinesis on rotator cuff tears: a narrative review of the current knowledge

“…The yes/no method is used as a simple screening tool with a sensitivity of 74–78% and categorizes the three abnormal patterns into the ‘yes’ category, and type IV into the ‘no’ category. 12 , 13 …”

A Surface Curvature Technique for Analysing Scapular Dyskinesis

“…The main goal of the evaluation was to test the surface curvature technique in a clinical environment. Current diagnostic methods involve either a 4-type classification, a Yes/No classification or the scapular dyskinesis test (SDT) [13], which are primarily based on visual observations of the scapula. Observations are typically done at rest and during arm movements to detect any prominences or asymmetries and rely heavily on visual observations.…”