Inter and intra-rated reliability of sport and exercise medicine consultants when using the modified ohberg score to assess neovascular changes in symptomatic achilles and patellar tendinopathy
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Objective. A number of treatment modalities in the management of lower limb Tendinopathies target pathological para- or intra-tendinous neovascularisation in order to address the pain stimulus. Therefore, the ability to reliably locate and assess the degree of neovascularity in order for treatment modalities such as injection therapies to be delivered is important in clinical practice. The Modified Ohberg Score is frequently utilised to determine degree of neovascularity, but its reliability has not been established amongst Sports and Exercise Medicine Consultants. This study aims to determine inter and intra-rater reliability of an SEM Consultant cohort when assessing tendon neovascularity using the 5-point Modified Ohberg Score. Method. Eleven patient participants (7 male and 4 female) provided sixteen symptomatic Achilles and Patellar Tendons. These were each ultrasound scanned sequentially by five of the seven Sports and Exercise Consultants recruited to the study. On completion of scanning, Consultants rated the neovascular changes seen using the 5 point Modified Ohberg Score. Copies of scans were electronically retained for later re-scoring. Raw data sets for both Inter and Intra-Rater components of the study were analysed using Intra-class Correlation Coefficient and Kappa Agreement. Results. Neovascular changes were reported in 69% of the 80 scans undertaken. The Intraclass Correlation Coefficient (ICC) for inter-rater reliability was 0.90. The ICC for intra-rater reliability was 0.97. Conclusions. Neovascular changes were present in the majority of symptomatic tendons. Excellent inter and intra rater reliability was seen between the SEM Consultant cohort. The findings support the current use of US examination and specifically Doppler US to assess neovascularity within routine SEM examination procedures. Furthermore, future intervention research using a similarly experienced SEM Consultant cohort can be undertaken with assurance that assessment of neovascularity will be reliable.
- Masters Degrees (Sport) 
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