Reliability of physical examination of the upper extremity among keyboard operators

Am J Ind Med. 2000 Apr;37(4):423-30. doi: 10.1002/(sici)1097-0274(200004)37:4<423::aid-ajim12>;2-w.


Background: Physical examination is a traditional outcome measure in epidemiological research. Its value as a reliable measure depends, in part, on the prevalence of positive findings. The purpose of this paper is to determine the empirical reliability of physical examination and anthropometry in a field study of upper extremity disorders among keyboard operators.

Methods: Two experienced examiners independently performed common provocative tests and procedures in physical examinations of the neck and upper extremity among 160 keyboard operators. Two additional examiners conducted anthropometric surveys among 137 workers. Inter-examiner reliability was assessed with observed agreement, kappa statistics, and intra-class correlations (ICC).

Results: Observed agreement was between 96% and 100% for neck and upper extremity signs, muscle stretch reflexes, and muscle strength, however, with the exception of provocative tests, reliability statistics were unstable. Among the provocative tests, Phalen and Tinel tests had modest agreement after adjusting for chance (kappa range: 0.20-0.43). The carpal compression test had the best reliability (kappa=0.60 and kappa=0.67, left and right side, respectively). The ICCs for anthropometry ranged from 0.36-0.91.

Conclusions: Results from the study showed that statistically, except for the carpal compression test, physical examination contributed minimal reliable information. This was attributed mainly to the low prevalence of positive findings, and generally mild nature of upper extremity disorders in this population. The results are the best estimate of what would be found in a field study with experienced examiners. While it may reduce bias, separating physical examination from medical history may contribute to the poor reliability of findings. With a shift toward reliable measures, resources can be allocated to more effective tools, like questionnaires, in epidemiological research of upper extremity disorders among keyboard operators.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anthropometry
  • Arm Injuries / diagnosis*
  • Bias
  • Carpal Tunnel Syndrome / diagnosis
  • Computer Systems
  • Cumulative Trauma Disorders / diagnosis*
  • Epidemiologic Research Design
  • Female
  • Humans
  • Male
  • Medical History Taking
  • Middle Aged
  • Muscle Contraction / physiology
  • Neck Injuries / diagnosis
  • Observer Variation
  • Occupational Diseases / diagnosis*
  • Outcome Assessment, Health Care
  • Physical Examination* / statistics & numerical data
  • Prevalence
  • Reflex, Stretch / physiology
  • Reproducibility of Results
  • Surveys and Questionnaires