Table 3. Repeatability of symptoms and physical signs used in the assessment of upper limb disorders.

Ref(s)	Setting/protocol	Items	Agreement
Symptoms			Observed (%)	κ/weightedκ
[23]	44 cashier workers; self- completed Nordic-style questionnaire; test-retest at 1 week interval	Trouble (aches, pain, discomfort, numbness):
		In past 7 days	74 - 100
		In past 12 months
		In past 12 months  interfering with normal  activity
[25]	148 industrial workers; self-completed Nordic-style questionnaire; test-retest at 1 week interval	At least 3 episodes or 1 lasting >7 days in past 12 months:
		Any episode	89 - 93	0.76 - 0.82
		Current episode	86 - 88	0.46 - 0.61
		Sought treatment	89 - 92	0.62 - 0.72
		Frequency of episodes	91 - 93	0.73 - 0.74
		Doctor diagnosed:
		Carpal tunnel syndrome	98	0.92
		Ulnar neuropathy	99	0.85
		Tendinitis	88	0.64
		Thoracic outlet syndrome	99	0.60
		Rotator cuff injury	98	0.56
[38]	27 clerical workers and 82 women in the electronics industry; self-completed Nordic questionnaire, test- retest at 3 week interval	Trouble (aches, pain, discomfort, numbness):
		In past 7 days	70 - 100%	-
		In past 12 months
		In past 12 months  interfering with normal  activity
[59]	105 rheumatology outpatients; self-completed Nordic-style questionnaire; test-retest at 1 week interval	Pain in past 7 days	83 - 86	0.66 - 0.71
		Pain in past 12 months	89 - 91	0.73 - 0.82
		Pain in past 12 months interfering with work or leisure	80 - 89	0.59 - 0.75
		Numbness/tingling in past 7 days	82 - 87	0.63 - 0.73
		Numbness/tingling in past 12 months	86 - 87	0.70 - 0.75
Physical signs			Measure of agreement	Estimate
Elbow
[60]	88 rheumatological outpatients examined independently by two pre- trained observers	Tenderness over lateral epicondyle	κ	0.75
		Pain on resisted wrist flexion/extension	κ	0.75 - 0.79
[81]	97 working age adults with neck or upper limb pain, identified from the general community; examined independently by two pre- trained observers	Tenderness over lateral epicondyle	κ	0.64
		Pain on resisted wrist flexion/extension	κ	0.52 - 0.56
Neck
[5]	21 healthy volunteers: 6 neck movements measured by 3 physical therapists using a goniometer; intra- and inter-rater comparisons		Inter-rater reliability coefficient	0.26 - 0.84 (10/18≥0.6)
			Intra-rater reliability coefficient	0.31 - 0.86 (10/18≥0.6)
[60]	88 rheumatological outpatients examined independently by two pre- trained observers	Range of active movement (various)	Between- observer mean differences	−4.9 to 6.2° (≥88% of pairs within 20°)*
[79]	52 neurosurgical outpatients referred for cervical myelopathy; examined independently by two pre-trained observers	Tenderness at various pre-specified neck- shoulder sites	κ	0.43 - 0.67
		Muscle atrophy (deltoid, triceps, hypothenar eminence)	κ	0.32 - 0.81
		Muscle strength (deltoid, triceps, biceps, dorsal interossei)	κ	0.40 - 0.64
		Limitation of neck movements (various)	κ	0.40 - 0.56
[86]	60 patients with orthopaedic disorders of the neck; 6 active neck movements measured by goniometry, visual inspection and custom- designed device by 11 physical therapists; intra- and inter-rater comparisons	Intra-rater:
		Goniometer	ICC	0.78 - 0.90
		Custom device	ICC	0.84 - 0.95
		Intra-rater:	ICC
		Goniometer	ICC	0.54 - 0.79
		Custom device	ICC	0.73 - 0.92
		Visual inspection	ICC	0.42 - 0.70
Shoulder
[8]	Once weekly replicate measurements of shoulder movement over 4 weeks by 4 testers with varying experience of goniometry; intra- and inter-rater comparison		Inter-rater reliability	0.97
			Inter-tester reliability	0.96
[9]	8 patients with rheumatoid arthritis; shoulder movements assessed in terms of functional achievements (categorical descriptors)		Inter-rater/intra-rater:≠
		Hand raising	% agreement	81/85
		Hand behind back		65/75
		Hand to neck		54/87
		Hand to opposite shoulder		81/85
[19]	6 patients with shoulder problems from primary care, observed in random order by 6 physicians; inter-rater comparison of joint movements (observed, recorded by diagram and measured by protractor)	Passive arm abduction:
		To start of pain	ICC	0.84
		To maximum elevation	ICC	0.95
		Passive external  rotation	ICC	0.43
[28]	54 patients with shoulder pain; 6 movements measured by 6 physiotherapists using a pleurimeter; intra- and inter-rater comparisons		Intra-rater ICC	0.38 - 0.85 (4/8 >0.8)
			Inter-rater ICC	0.45 - 0.90) (6/8 ≥0.66)
[60]	88 rheumatological outpatients examined independently by two pre- trained observers	Tenderness	κ	0.80
		Pain on various resisted movements	κ	0.54 - 0.93
		Painful arc	κ	0.93
		Range of active movement	Between- observer mean differences	−1.4 to 11.9° (≥70% of pairs within 20°)*
		Range of passive movement	Between- observer mean differences	−1.4 to 11.0° (≥71% of pairs within 20°)*
[70]	50 patients referred to a physical therapy department; 7 shoulder movements measured by random pairs of 16 therapists using 2 sizes of goniometer; intra- and inter-rater comparisons		Intra-rater ICC	0.87 - 0.99
			Inter-rater ICC	0.32 - 0.90 (6/14 ≥0.8)
[34]	6 patients with shoulder pain and stiffness; 8 movements measured by 6 rheumatologists in random order, Latin square design	Total shoulder flexion	Inter-rater ICC	0.72
		Total shoulder abduction	Inter-rater ICC	0.49
		Glenohumeral abduction	Inter-rater ICC	0.51
		External rotation in neutral	Inter-rater ICC	0.29
		Hand behind back	Inter-rater ICC	0.80
[81]	97 working age adults with neck or upper limb pain, identified from the general community; examined independently by two pre- trained observers	Tenderness	κ	0.94
		Pain on various resisted movements	κ	0.29 - 0.66
		Painful arc	κ	0.47
[57]	136 rheumatology patients assessed in random order by a specialist, trainee and research nurse	Tenderness	κ	0.32‡
		Painful arc (start of pain)	κ	0.48‡
		Painful arc (end of pain)	κ	0.64‡
		External rotation <45°	κ	0.68‡
Wrist
[60]	88 rheumatological outpatients examined independently by two pre- trained observers	Radial wrist tenderness	κ	0.66
		+ve Finkelstein’s test	κ	0.79
[71]	160 keyboard operators examined independently by two experienced observers	+ve Finkelstein’s test	κ	0.15 - 0.49
[43, 60,71,81]	Various	Phalen’s test	Intra-rater κ	0.53
			Inter-rater κ	0.41 - 1.0
		Tinel’s test	Intra-rater κ	0.80
			Inter-rater κ	0.20 - 0.79
[81]	97 working age adults with neck or upper limb pain, identified from the general community; examined independently by two pre- trained observers	Radial wrist tenderness	κ	0.16
		+ve Finkelstein’s test	κ	0.35

^*Mean difference.

^≠Agreement within one category.

^‡Specialist vs. doctor in postgraduate specialist training