Soft-tissue disorders of the shoulder. A study of inter-observer agreement between general practitioners and physiotherapists and an overview of physiotherapeutic treatment

Objective: To study the inter-observer agreement between general practitioners (GPs) and physiotherapists in diagnosing soft-tissue shoulder disorders. In addition, to describe the physiotherapy for shoulder disorders in primary care. Methods: 18 GPs recruited 349 consecutive patients with a new episode of shoulder pain for a follow-up study. Cohen's kappa for diagnostic agreement between GPs and physiotherapists was calculated for a subset of 120 patients who were referred for physiotherapy. The physiotherapists recorded the nature of the physiotherapeutic treatment on standardised forms. Results: The overall kappa for the classification of shoulder disorders was 0.31 (95% confidence limits:0.19, 0.42). Agreement was somewhat better in cases of capsular syndrome (0.48, 95%) confidence limits: 0.30, 0.66), but worse in cases of acute bursitis (-0.03, 95% confidence limits: -0.21, 0.15). Agreement also appeared to be better in patients with a long symptom duration. The physiotherapists most frequently used deep friction massage, exercise therapy and passive mobilisations to treat shoulder pain. Nearly all cases of tendinitis were treated with deep friction massage (97%), whereas the majority of patients with a capsular syndrome were treated with exercise therapy (67%) and passive mobilisation (72%). Conclusions: Inter-observer agreement between GPs and physiotherapists was rather low, considering the fact that diagnosis of shoulder pain often has implications for the selection of therapy. Future research should focus on the question of whether infer-observer agreement can be improved and whether different diagnostic categories do, indeed, require different therapeutic strategies.