Agreement of Opinion Between an Orthopedic Surgeon and a Physical Therapist About the Management and Advice of Intraarticular Corticosteroid Injections for Patients with Shoulder Pain.

Abstract

Background: Physical therapist attends the patients with shoulder pain. An agreed understanding of the orthopedics and physical therapist will help them to improve the quality of patient care and will be cost effective. Objectives: To reveal the index of agreement of opinion between orthopedic surgeons and Physical Therapist about diagnosis, investigations, management and administration of corticosteroid injections in orthopedic shoulder referrals. Methodology: It was an Inter-Rater agreement study. The study was conducted at Sialkot College of Physical therapy, Amin Welfare and Teaching Hospital Sialkot from November 2016 to February 2017. Non-probability purposive sampling technique was used. Total 50 patients were assessed by a Physical Therapist and an orthopedic surgeon, having painful shoulder since 1 month, diabetes mellitus, and agreed to participate in this study. Patients with history of trauma, RA or having any previous surgery were excluded. The choices of both the specialist regarding investigations, diagnosis management and intra articular corticosteroid injection regimes were compared using inter rater reliability statistical methods using SPSS. Results: The agreement between the Physical therapist and the orthopedic surgeon was nearly perfect for surgical and non-surgical treatment options (Cohen’s kappa for agreement 0.885, for investigations desired (x-ray) 1.000), 0.879 which gives almost perfect agreement for investigations (musculoskeletal ultrasound) and 0.372 which gives fair agreement for Intra-Articular Injection as first choice for orthopedic surgeon. With the orthopedic surgeon were more inclined towards selection of corticosteroids as first choice of treatment and physical therapist were more confident to start with physical treatment first. Conclusion: In this study a similarity was found in the decisions of physical therapist and the orthopedic surgeon for the management of shoulder pain, investigations to be advised (i.e. radiographs, RBS, musculoskeletal ultrasound) but the physical therapist were more inclined towards physical therapy treatment rather than intra articular injection as compared to the orthopedic surgeon at initial consultations. Keywords: Corticosteroid Injection Inter Rater Agreement, Orthopedics, Physical Therapy, Shoulder Pain.