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肩峰撞击综合征特殊检查的可靠性和诊断的准确性
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下面我翻译一篇比较好的文章，这篇文章来自弗吉尼亚联邦大学医学院物理治疗科，这篇文章告诉大家怎样才能确诊肩峰撞击综合征，怎样排除SAIS。
标题：Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement.
标题：肩峰撞击综合征5种特殊检查及其联合检查的可靠性和诊断的准确性Michener LA, Walsworth MK, Doukas WC, Murphy KP.
Department of Physical Therapy, Virginia Commonwealth University, Medical College of Virginia, PO Box 980224, Richmond, VA 23298, USA. lamichen@vcu.edu
Abstract
摘要
OBJECTIVE: To investigate the reliability and diagnostic accuracy of individual tests and combination of tests for subacromial impingement syndrome (SAIS).
目的：评估肩峰撞击综合征每个特殊试验及其联合试验的信度和诊断的准确性DESIGN: A prospective, blinded study design.
方案：预期，双盲试验
PARTICIPANTS: Patients with shoulder pain (n=55, mean age=40.6y).
受试者：肩痛患者（n=50，平均年龄=40.6岁）
INTERVENTIONS: Patients were evaluated with 5 physical examination tests for SAIS: Neer, Hawkins-Kennedy, painful arc, empty can (Jobe), and external rotation resistance tests. Surgical diagnosis was the reference standard.
介入方法：患者依次被做检查5种肩峰撞击综合征特殊试验：Neer 试验, Hawkins-Kennedy 试验, 疼痛弧试验,空罐头试验(Jobe), 和外旋抵抗试验。
MAIN OUTCOME MEASURES: Diagnostic accuracy calculated with a receiver operating characteristic (ROC) curve and sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood ratio (-LR).
A forward stepwise binary logistic regression analysis was used to determine the best test combination for SAIS. An ROC curve analysis was also used to determine the cut point of the number of tests discriminating between the presence and absence of SAIS. Kappa coefficients and percent agreement assessed interrater reliability.
主要测试方法：诊断的准确性由ROC曲线测量、以及敏感性、特殊性、阳性率和阴性率。多因素二元logistic回归分析用来确定肩峰撞击综合征最佳的特殊试验。ROC曲线分析用来确定肩峰撞击综合征的真阳性率和假阳性率，Kappa系数作为一致性检验。
标题：Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement.
标题：肩峰撞击综合征5种特殊检查及其联合检查的可靠性和诊断的准确性Michener LA, Walsworth MK, Doukas WC, Murphy KP.
Department of Physical Therapy, Virginia Commonwealth University, Medical College of Virginia, PO Box 980224, Richmond, VA 23298, USA. lamichen@vcu.edu
Abstract
摘要
OBJECTIVE: To investigate the reliability and diagnostic accuracy of individual tests and combination of tests for subacromial impingement syndrome (SAIS).
目的：评估肩峰撞击综合征每个特殊试验及其联合试验的信度和诊断的准确性DESIGN: A prospective, blinded study design.
方案：预期，双盲试验
PARTICIPANTS: Patients with shoulder pain (n=55, mean age=40.6y).
受试者：肩痛患者（n=50，平均年龄=40.6岁）
INTERVENTIONS: Patients were evaluated with 5 physical examination tests for SAIS: Neer, Hawkins-Kennedy, painful arc, empty can (Jobe), and external rotation resistance tests. Surgical diagnosis was the reference standard.
介入方法：患者依次被做检查5种肩峰撞击综合征特殊试验：Neer 试验, Hawkins-Kennedy 试验, 疼痛弧试验,空罐头试验(Jobe), 和外旋抵抗试验。
MAIN OUTCOME MEASURES: Diagnostic accuracy calculated with a receiver operating characteristic (ROC) curve and sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood ratio (-LR).
A forward stepwise binary logistic regression analysis was used to determine the best test combination for SAIS. An ROC curve analysis was also used to determine the cut point of the number of tests discriminating between the presence and absence of SAIS. Kappa coefficients and percent agreement assessed interrater reliability.
主要测试方法：诊断的准确性由ROC曲线测量、以及敏感性、特殊性、阳性率和阴性率。多因素二元logistic回归分析用来确定肩峰撞击综合征最佳的特殊试验。ROC曲线分析用来确定肩峰撞击综合征的真阳性率和假阳性率，Kappa系数作为一致性检验。
RESULTS: The ROC analyses revealed a significant area under the curve (AUC) (AUC=.67-.72, P<.05) for all tests, except for the Hawkins-Kennedy. The tests with a +LR greater than or equal to 2.0 were the painful arc (+LR=2.25; 95% CI, 1.33-3.81), empty can (+LR=3.90; 95% CI, 1.5-10.12), and the external rotation resistance tests (+LR=4.39; 95% CI, 1.74-11.07). Tests with -LR less than or equal to 0.50 were the painful arc (-LR=.38; 95% CI, .16-.90), external rotation resistance (-LR=.50; 95% CI, .28-.89), and Neer tests (-LR=.35; 95% CI, .12-.97). The regression analysis had no specific test combinations for confirming or ruling out SAIS. The ROC analysis was significant (AUC=.79, P=.001), with a cut point of 3 positive tests out of 5 tests. Reliability was moderate to substantial agreement (kappa=.45-.67) for the painful arc, empty can, and external rotation resistance tests and fair strength of agreement (kappa=.39-.40) for the Neer and Hawkins-Kennedy tests.
结果：ROC曲线说明了除了Hawkins-Kennedy试验外，所有试验的曲线下面积有显著意义(AUC=.67-.72, P<.05)。阳性率大于等于2.0的试验是疼痛弧试验(+LR=2.25; 95% CI, 1.33-3.81)，空罐头试验(+LR=3.90; 95% CI, 1.5-10.12)和外旋抵抗试验(+LR=4.39; 95% CI, 1.74-11.07)。阴性率小于等于0.50的试验是疼痛弧试验(-LR=.38; 95% CI, .16-.90), 外旋抵抗试验(-LR=.50; 95% CI, .28-.89), 和Neer 试验(-LR=.35; 95% CI, .12-.97)。回归分析显示没有特殊试验组合确定或排除SAIS。ROC曲线分析3/5试验阳性具有显著意义(AUC=.79, P=.001)，疼痛弧试验、空罐头试验和外旋抵抗试验具有良好相关性(kappa=.45-.67)，Neer试验和 Hawkins-Kennedy 试验具有中等的相关性(kappa=.39-.40)。
CONCLUSIONS: The single tests of painful arc, external rotation resistance, and Neer are useful screening tests to rule out SAIS. The single tests of painful arc, external rotation resistance, and empty can are helpful to confirm SAIS. The reliability of all tests was acceptable for clinical use. Based on reliability and diagnostic accuracy, the single tests of the painful arc, external rotation resistance, and empty can have the best overall clinical utility. The cut point of 3 or more positive of 5 tests can confirm the diagnosis of SAIS, while less than 3 positive of 5 rules out SAIS.
结论：疼痛弧试验、外旋抵抗试验和Neer试验对筛选排除SAIS较有用。疼痛弧试验、外旋抵抗试验和空罐头试验对确诊SAIS较有用。这五种试验的信度在临床上都可以被接受。基于信度与诊断的准确性，疼痛弧试验、外旋抵抗试验和空罐头试验临床的使用价值最大。这5种试验中的3种试验阳性便可以确诊SAIS，然而5个试验中少于3种试验阳性便可以排除SAIS。
结果：ROC曲线说明了除了Hawkins-Kennedy试验外，所有试验的曲线下面积有显著意义(AUC=.67-.72, P<.05)。阳性率大于等于2.0的试验是疼痛弧试验(+LR=2.25; 95% CI, 1.33-3.81)，空罐头试验(+LR=3.90; 95% CI, 1.5-10.12)和外旋抵抗试验(+LR=4.39; 95% CI, 1.74-11.07)。阴性率小于等于0.50的试验是疼痛弧试验(-LR=.38; 95% CI, .16-.90), 外旋抵抗试验(-LR=.50; 95% CI, .28-.89), 和Neer 试验(-LR=.35; 95% CI, .12-.97)。回归分析显示没有特殊试验组合确定或排除SAIS。ROC曲线分析3/5试验阳性具有显著意义(AUC=.79, P=.001)，疼痛弧试验、空罐头试验和外旋抵抗试验具有良好相关性(kappa=.45-.67)，Neer试验和 Hawkins-Kennedy 试验具有中等的相关性(kappa=.39-.40)。
CONCLUSIONS: The single tests of painful arc, external rotation resistance, and Neer are useful screening tests to rule out SAIS. The single tests of painful arc, external rotation resistance, and empty can are helpful to confirm SAIS. The reliability of all tests was acceptable for clinical use. Based on reliability and diagnostic accuracy, the single tests of the painful arc, external rotation resistance, and empty can have the best overall clinical utility. The cut point of 3 or more positive of 5 tests can confirm the diagnosis of SAIS, while less than 3 positive of 5 rules out SAIS.
结论：疼痛弧试验、外旋抵抗试验和Neer试验对筛选排除SAIS较有用。疼痛弧试验、外旋抵抗试验和空罐头试验对确诊SAIS较有用。这五种试验的信度在临床上都可以被接受。基于信度与诊断的准确性，疼痛弧试验、外旋抵抗试验和空罐头试验临床的使用价值最大。这5种试验中的3种试验阳性便可以确诊SAIS，然而5个试验中少于3种试验阳性便可以排除SAIS。
表1五种肩峰撞击征特殊试验的可靠性系数Kappa值
表2. 肩峰撞击征试验诊断的准确性
表3.联合试验诊断的准确性
表4. 每个特殊试验及联合试验队肩峰撞击征确诊的概率和排除的概率
文章PubMed链接：http://www.ncbi.nlm.nih.gov/pubmed/19887215
https://blog.sciencenet.cn/blog-506928-398069.html
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