How do we assess the position of the scapula and do we assess it the same way? : An inter-rater reliability study

Abstract: Background An altered position of the scapula on the thoracic spine has been shown as a part of both shoulder and neck pain and therefore it is suggested that the position is thoroughly assessed as a part of the evaluation and the following treatment. However, while there is research that shows reliability using instruments for determining the scapulas position, it is lacking regarding assessment through visual inspection and palpation.  Method 11 participants (3 men and 8 women) with a mean age of 43 years were recruited. The position of the scapula was clinically assessed by two physiotherapists using visual inspection and palpation. The purpose of the assessment was to determine whether the scapula was considered neutral, rotated, tilted or ab-adducted. The result was presented in Cohen´s kappa calculated in SPSS. Result The intra-rater reliability is generally slight and only ab-adduction was considered moderate reliable (0.41). The two positions where the position is determined by degrees (the medially- and laterally rotation and tilt) were the hardest to assess and had the lowest kappa value.  Conclusion The result shows a slight to moderate inter-rater reliability in four positions and two positions were poor. Meaning that this method is not considered inter-rater reliable to determine the position of the scapula. Key words Cohen´s kappa, inter-rater reliability, landmarks, scapula, position