A study of the noninstrumented physical examination of the knee found high observer variability

J Clin Epidemiol. 2006 May;59(5):512-20. doi: 10.1016/j.jclinepi.2005.11.004. Epub 2006 Mar 14.


Objective: This study estimated the inter- and intraobserver reliability of a set of noninstrumented physical examination measures for knee pain in older adults.

Study design and setting: Forty-five patients from primary care, and 13 patients from secondary care, were each examined by two out of a team of three physical therapists, and were reexamined by one of these observers 1 month later. The examination items were standardized and included dichotomous, ordinal and continuous variables considered relevant to a primary care context.

Results: For individual dichotomous items, median interobserver and intraobserver agreement (kappa) was 0.22 (interquartile range IQR=0.12-0.35) and 0.41 (IQR=0.28-0.56) respectively. For ordinally rated variables, weighted kappa ranged from -0.08 to 0.43 for interobserver agreement, and from 0.00 to 0.79 for intraobserver agreement. The median intraclass correlation coefficient for continuous examination variables was 0.80 (range 0.68-0.89) for interobserver agreement, and 0.84 (range 0.67-0.95) for intraobserver agreement.

Conclusion: For trained but nonexpert examiners, agreement was generally poor for dichotomous and ordinal examination items; however, kappa-values are liable to be depressed by the low prevalence of clinical signs in this sample. Agreement on continuous variables was notably better.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Foot Deformities / complications
  • Foot Deformities / pathology
  • Foot Deformities / physiopathology
  • Humans
  • Knee / pathology
  • Knee / physiopathology*
  • Knee Joint / abnormalities
  • Knee Joint / pathology
  • Knee Joint / physiopathology
  • Male
  • Middle Aged
  • Observer Variation
  • Osteoarthritis, Knee / complications
  • Osteoarthritis, Knee / pathology
  • Osteoarthritis, Knee / physiopathology
  • Pain
  • Pain Measurement / methods*
  • Palpation
  • Physical Examination / methods*
  • Physical Therapy Modalities
  • Reproducibility of Results
  • Retrospective Studies