Intra- and inter-rater reliability of anterior and posterior drawer tests for the assessment of people with shoulder instability.
Rocio Aldon-Villegas, Gema Chamorro-Moriana, Patricio Lopez-Tarrida and 1 others
PMID 40340595WHAT IT FOUND
Two physiotherapists grading shoulder laxity agreed well with each other and almost perfectly with themselves.
The anterior drawer test was more reliable than the posterior one. Using a simplified pass/fail grading system improved agreement further. These manual tests are consistent tools for assessing instability.
Key findings
01Intra-rater reliability for both drawer tests was excellent when the same examiner repeated the assessment after 7-14 days.
02Inter-rater agreement between two different examiners was good, with the anterior drawer test showing higher reliability than the posterior drawer test.
03Collapsing the grading scale into just negative or positive findings improved inter-rater reliability for both tests.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only one examiner repeated the tests, so we do not know if the second examiner would have been as consistent over time. The participants were recruited via convenience sampling, which may not represent all patients with shoulder instability. The study did not compare these manual tests against imaging or surgical findings, so it confirms the tests are consistent, not necessarily that they are accurate.
Declared interests
The authors declared no conflicts of interest and received no financial support.
The easy way to misread this
Do not assume these tests are accurate for diagnosing instability. This study only proves that two therapists get the same result when they perform the test; it does not prove that the result correctly identifies true pathology compared to a gold standard like MRI.