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Reliability of a measure of post-stroke shoulder pain in patients with and without aphasia and/or unilateral spatial neglect

Christine Frames

The Stroke Association's Therapy Research Unit, Salford, UK

Eric B Faragher

Medical Statistics Unit, Salford, UK

Anne Hesketh

Centre for Human Communication and Deafness, Salford, UK

Elizabeth Hill

The Stroke Association's Therapy Research Unit, The University of Manchester, Salford, UK

Paul Watson

Chris J Main

Department of Behavioural Medicine, Salford Royal Hospitals NHS Trust, Salford, UK

Objective: To determine the inter/intra-rater reliability of expert physiotherapists (PTs) measuring post-stroke shoulder pain with 100 mm vertical visual analogue scales (VAS; intensity, frequency and affective response) and a categorical site-of-pain scale.

Design: Three PTs independently rated subjects (normal clinical procedure but with a standardized starting position) on three days, at the same time of day, during one week in a randomized order determined by a nested latin square. Reliability for VAS scores was determined with the intraclass correlation coefficient (ICC) and for site-of-pain with the kappa statistic (. Acceptable reliability was set at 0.75. The limits of agreement were also calculated.

Setting: Community.

Subjects: Thirty-three patients, mean time post stroke 42 months (range 7–360).

Results: Mean inter-rater reliability was 0.79 for intensity, 0.75 for frequency and 0.62 for affective response (ICC). The limits of agreement were wide and rater bias was significant for 6/27 ratings. Mean intra-rater reliability was 0.70 for intensity, 0.77 for frequency and 0.69 for affective response (ICC). For site-of-pain inter-rater reliability ranged from 0.156 (to 0.385 (and intrarater reliability ranged from 0.300 (to 0.559 (.

Conclusions: Although inter-rater reliability was acceptable for intensity and frequency there was a consistently large systematic bias between pairs of raters. Agreement might be improved if a standardized assessment procedure was used and/or if training in pain behaviour interpretation was provided.

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