University of Hertfordshire

From the same journal

By the same authors

Inter-rater reliability of the Shoulder Symptom Modification Procedure in people with shoulder pain

Research output: Contribution to journalArticlepeer-review


View graph of relations
Original languageEnglish
Pages (from-to)1-12
Number of pages12
JournalBMJ Open Sport & Exercise Medicine
Publication statusPublished - 11 Nov 2016


Background: Musculoskeletal conditions involving the
shoulder are common and, because of the importance
of the upper limb and hand in daily function,
symptoms in this region are commonly associated with
functional impairment in athletic and non-athletic
populations. Deriving a definitive diagnosis as to the
cause of shoulder symptoms is fraught with difficulty.
Limitations have been recognised for imaging and for
orthopaedic special tests. 1 solution is to partially base
management on the response to tests aimed at
reducing the severity of the patient’s perception of
symptoms. 1 (of many) such tests is the Shoulder
Symptom Modification Procedure (SSMP). The
reliability of this procedure is unknown.
Methods: 37 clinician participants independently
watched the videos of 11 patient participants
undergoing the SSMP and recorded each patient’s
response as improved (partially or completely), no
change or worse. Inter-rater reliability was assessed by
Krippendorff’s α, which ranges from 0 to 1.
Results: Krippendorff’s α was found to range from
0.762 to 1.000, indicating moderate to substantial
reliability. In addition, short (3-hour) and longer
(1-day) durations of training were associated with
similar levels of reliability across the techniques.
Conclusions: Deriving a definitive structural diagnosis
for a person presenting with a musculoskeletal
condition involving the shoulder is difficult. The
findings of the present study suggest that the SSMP
demonstrates a high level of reliability. More research
is needed to better understand the relevance of such


© BMJ Publishing Group Limited. 2016. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BYNC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See:

ID: 10670954