• V M Pomeroy, C Frames, E B Faragher, A Hesketh, E Hill, P Watson, and C J Main.
• The Stroke Association's Therapy Research Unit, The University of Manchester, Salford Royal Hospitals NHS Trust, UK. vpomeroy@fs1.ho.man.ac.uk
• Clin Rehabil. 2000 Dec 1;14(6):584-91.

ObjectiveTo determine the inter/intra-rater reliability of expert physiotherapists (PTs) measuring post-stroke shoulder pain with 100 mm vertical visual analogue scales (VAS; intensity, frequency and affective response) and a categorical site-of-pain scale.DesignThree PTs independently rated subjects (normal clinical procedure but with a standardized starting position) on three days, at the same time of day, during one week in a randomized order determined by a nested latin square. Reliability for VAS scores was determined with the intraclass correlation coefficient (ICC) and for site-of-pain with the kappa statistic (kappa). Acceptable reliability was set at 0.75. The limits of agreement were also calculated.SettingCommunity.SubjectsThirty-three patients, mean time post stroke 42 months (range 7-360).ResultsMean inter-rater reliability was 0.79 for intensity, 0.75 for frequency and 0.62 for affective response (ICC). The limits of agreement were wide and rater bias was significant for 6/27 ratings. Mean intra-rater reliability was 0.70 for intensity, 0.77 for frequency and 0.69 for affective response (ICC). For site-of-pain inter-rater reliability ranged from 0.156 (kappa) to 0.385 (kappa) and intrarater reliability ranged from 0.300 (kappa) to 0.559 (kappa).ConclusionsAlthough inter-rater reliability was acceptable for intensity and frequency there was a consistently large systematic bias between pairs of raters. Agreement might be improved if a standardized assessment procedure was used and/or if training in pain behaviour interpretation was provided.

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