Neurological Examination of the Upper Limb: A Study of Construct Validity
Jørgen R Jepsen*, 1, Lise H Laursen1, Svend Kreiner2, Anders I Larsen3
1 Department of Occupational Medicine, Sydvestjysk Sygehus Esbjerg, Østergade 81-83, DK-6700 Esbjerg, Denmark
2 Department of Biostatistics, University of Copenhagen, DK-2200 Copenhagen, Denmark
3 Occupational Health Services, Novozymes, DK-2880 Bagsværd, Denmark
We have previously demonstrated that neurological individual findings and patterns can be reliably assessed in the examination of the upper limb and also that they are related to pain, weakness, and/or numbness/tingling. This study aimed to study further aspects of the construct validity of the neurological examination.
Blinded to patient-characteristics, two examiners assessed the function of 16 muscles, the sensibility in 7 territories, and the nerve-mechanosensitivity at 20 locations in 82 upper limbs. Based on anatomical patterns and pre-designed algorithms, one or both examiners rated neuropathy as “possible” or “definite” in 40 limbs and also determined the location( s). We developed and tested hypotheses on anatomically and regionally related locations of nerve afflictions (a selective vulnerability of neurons, double and multiple crush, and a tendency to regional spread) and examined the stability of the internal structure of the constructs in different situations. The interrelations of findings were analyzed by hypothesis testing and factor analyses, and the homogeneity of location profiles was analyzed by a conditional likelihood test.
Out of 30 limbs with related locations of neuropathy, the findings of each examiner correlated positively (gamma > 0.35) in 22/25, respectively. The patterns of the interrelations identified by the two examiners were similar, with no evidence of any heterogeneity of location profiles for either examiner.
This study supports the validity of the physical examination. However, feasibility of its application requires the demonstration of further aspects of construct validity and a favorable influence on patient-management and/or prevention.
open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
* Address correspondence to this author at the Department of Occupational Medicine, Sydvestjysk Sygehus, Østergade 81-83, DK-6700 Esbjerg, Denmark; Tel: +45 79182285; E-mail: Joergen.Riis.Jepsen@svs.regionsyddanmark.dk