The interrater reliability of the classification of schouldercomplaints according to the Dutch College of General Practitioners guidelines and of clinical shouldertests

There is a lack of consensus on the appropriate diagnostic criteria for
shoulder complaints as well as the fact that several diagnostic classifications
have been proposed complicates diagnosis. The Dutch College of General
Practitioners has developed their guidelines
for the diagnosis and management of shoulder complaints in 1990 (revised
version in 2008). Concerning this guideline, patients are devided in three
subgroups. The inter-rater reliability of this classification has never been
examined.
Recently, an interesting clinical reasoning algorithm based on clinical tests
has been published by prof Ann Cools. However several shouldertests that are
used in this algorithm has not been assessed on inter-rater reliability.
The concept of tissue *irritability* is meant to reflect the tissue*s ability
to handle physical stress and theoretically relates to its physical status
and the degree of inflammatory activity present. Three phases of irritability
have recently been developed by consensus, however they have not been assessed
on inter-rater reliability.

The aim is to determine the inter-rater reliability of 1. the classification
algorithm as published the Dutch College of General Practitioners, 2 the
inter-rater reliability of individual shouldertests used in the classification
algorithm of prof. Cools and 3, of the three phases of irritability.

This is an inter-rater reliability study. Patients with aspecific and mild
specific shouldercomplaints will be informed about the study. If a person
fulfils the initial requirements for eligibility, the person receives written
information. After 2 or more days the physical therapist will ask the person if
he wants to participate in the study. If the patient agrees with participation,
the patient will be assessed by two physical therapists. The first physical
therapist will evaluate patient's eligibility, will obtain a written informed
consent, will collect baseline questionnaires and will conduct a clinical
examination according to a standardized protocol. Immediately following this
examination, the person will be examined independently by another physical
therapist according to the same standardized protocol. Which of the physical
therapist conduct the first and second examination will depend on availability
and will not be randomized. The persons will be told not to discuss findings of
the first examination with the second rater. The duration of each assessment
will be approximately 30 minutes. Before each assessment, a score for current
shoulder complaint will be collected to check stability of person's pain
between assessments. Unstable persons will be defined as those having 2 of more
points change on an 11-point numerical rating scale (NRS, 0-10) for current
shoulder complaints.
The general practitioner of the person will be informed about person's
participation in the study.
The assessment forms of the two physical therapists will be handed over to an
independent colleague.

Some of the physical tests can provoke pain (painprovocative tests). It might
be that the some of the participating persons will experience more pain for a
short period of time (maximum one day).