Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system

Schmid, Anninna B., Brunner, Florian, Luomajoki, Hannu, Held, Ulrike, Bachmann, Lucas M., Kunzer, Sabine and Coppieters, Michel W. (2009) Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system. BMC Musculoskeletal Disorders, 10 11: 1-9. doi:10.1186/1471-2474-10-11

Author Schmid, Anninna B.
Brunner, Florian
Luomajoki, Hannu
Held, Ulrike
Bachmann, Lucas M.
Kunzer, Sabine
Coppieters, Michel W.
Title Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system
Journal name BMC Musculoskeletal Disorders   Check publisher's open access policy
ISSN 1471-2474
Publication date 2009-01
Year available 2009
Sub-type Article (original research)
DOI 10.1186/1471-2474-10-11
Open Access Status DOI
Volume 10
Issue 11
Start page 1
End page 9
Total pages 9
Editor Norton, M.
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2010
Language eng
Subject C1
920201 Allied Health Therapies (excl. Mental Health Services)
110317 Physiotherapy
Formatted abstract
Background: Clinical tests to assess peripheral nerve disorders can be classified into two categories: tests for afferent/efferent nerve function such as nerve conduction (bedside neurological examination) and tests for increased mechanosensitivity (e.g. upper limb neurodynamic tests (ULNTs) and nerve palpation). Reliability reports of nerve palpation and the interpretation of neurodynamic tests are scarce. This study therefore investigated the intertester reliability of nerve palpation and ULNTs. ULNTs were interpreted based on symptom reproduction and structural differentiation. To put the reliability of these tests in perspective, a comparison with the reliability of clinical tests for nerve function was made.

Methods: Two experienced clinicians examined 31 patients with unilateral arm and/or neck pain. The examination included clinical tests for nerve function (sensory testing, reflexes and manual muscle testing (MMT)) and mechanosensitivity (ULNTs and palpation of the median, radial and ulnar nerve). Kappa statistics were calculated to evaluate intertester reliability. A meta-analysis determined an overall kappa for the domains with multiple kappa values (MMT, ULNT, palpation). We then compared the difference in reliability between the tests of mechanosensitivity and nerve function using a one-sample t-test.

Results: We observed moderate to substantial reliability for the tests for afferent/efferent nerve function (sensory testing: kappa = 0.53; MMT: kappa = 0.68; no kappa was calculated for reflexes due to a lack of variation). Tests to investigate mechanosensitivity demonstrated moderate reliability (ULNT: kappa = 0.45; palpation: kappa = 0.59). When compared statistically, there was no difference in reliability for tests for nerve function and mechanosensitivity (p = 0.06).

Conclusion:  This study demonstrates that clinical tests which evaluate increased nerve mechanosensitivity and afferent/efferent nerve function have comparable moderate to substantial reliability. To further investigate the clinometric properties of these tests, more studies are needed to evaluate their validity.  
Keyword Small fiber neuropathy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2010 Higher Education Research Data Collection
ERA 2012 Admin Only
School of Health and Rehabilitation Sciences Publications
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Citation counts: TR Web of Science Citation Count  Cited 18 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 30 times in Scopus Article | Citations
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Created: Thu, 03 Sep 2009, 08:32:27 EST by Mr Andrew Martlew on behalf of School of Health & Rehabilitation Sciences