Abstract：
BACKGROUND: The purpose of this study was to reach consensus on the most appropriate terminology and issues related to clinical reasoning, examination, and treatment of the kinetic chain (KC) in people with shoulder pain among an international panel of experts.
METHODS: A 3-round Delphi study that involved an international panel of experts with extensive clinical, teaching, and research experience in the study topic was conducted. A search equation of terms related to the KC in Web of Science and a manual search were used to find the experts. Participants were asked to rate items across 5 different domains (terminology, clinical reasoning, subjective examination, physical examination, and treatment) using a 5-point Likert-type scale. An Aiken coefficient of validity (V) ≥0.7 was considered indicative of group consensus.
RESULTS: The participation rate was 30.2% (n = 16), whereas the retention rate was high throughout the 3 rounds (100%, 93.8%, and 100%). A total of 15 experts from different fields and countries completed the study. After the 3 rounds, consensus was reached on 102 items: 3 items were included in the \"terminology\" domain; 17 items, in the \"rationale and clinical reasoning\" domain; 11 items, in the \"subjective examination\" domain; 44 items, in the \"physical examination\" domain; and 27 items, in the \"treatment\" domain. Terminology was the domain with the highest level of agreement, with 2 items achieving an Aiken V of 0.93, whereas the domains of physical examination and treatment of the KC were the 2 areas with less consensus. Together with the terminology items, 1 item from the treatment domain and 2 items from the rationale and clinical reasoning domain reached the highest level of agreement (V = 0.93 and V = 0.92, respectively).
CONCLUSIONS: This study defined a list of 102 items across 5 different domains (terminology, rationale and clinical reasoning, subjective examination, physical examination, and treatment) regarding the KC in people with shoulder pain. The term \"KC\" was preferred and a agreement on a definition of this concept was reached. Dysfunction of a segment in the chain (ie, weak link) was agreed to result in altered performance or injury to distal segments. Experts considered it important to assess and treat the KC in particular in throwing or overhead athletes and agreed that no one-size-fits-all approach exists when implementing shoulder KC exercises within the rehabilitation process. Further research is now required to determine the validity of the identified items.
METHODS: A 3-round Delphi study that involved an international panel of experts with extensive clinical, teaching, and research experience in the study topic was conducted. A search equation of terms related to the KC in Web of Science and a manual search were used to find the experts. Participants were asked to rate items across 5 different domains (terminology, clinical reasoning, subjective examination, physical examination, and treatment) using a 5-point Likert-type scale. An Aiken coefficient of validity (V) ≥0.7 was considered indicative of group consensus.
RESULTS: The participation rate was 30.2% (n = 16), whereas the retention rate was high throughout the 3 rounds (100%, 93.8%, and 100%). A total of 15 experts from different fields and countries completed the study. After the 3 rounds, consensus was reached on 102 items: 3 items were included in the \"terminology\" domain; 17 items, in the \"rationale and clinical reasoning\" domain; 11 items, in the \"subjective examination\" domain; 44 items, in the \"physical examination\" domain; and 27 items, in the \"treatment\" domain. Terminology was the domain with the highest level of agreement, with 2 items achieving an Aiken V of 0.93, whereas the domains of physical examination and treatment of the KC were the 2 areas with less consensus. Together with the terminology items, 1 item from the treatment domain and 2 items from the rationale and clinical reasoning domain reached the highest level of agreement (V = 0.93 and V = 0.92, respectively).
CONCLUSIONS: This study defined a list of 102 items across 5 different domains (terminology, rationale and clinical reasoning, subjective examination, physical examination, and treatment) regarding the KC in people with shoulder pain. The term \"KC\" was preferred and a agreement on a definition of this concept was reached. Dysfunction of a segment in the chain (ie, weak link) was agreed to result in altered performance or injury to distal segments. Experts considered it important to assess and treat the KC in particular in throwing or overhead athletes and agreed that no one-size-fits-all approach exists when implementing shoulder KC exercises within the rehabilitation process. Further research is now required to determine the validity of the identified items.
摘要：
背景：这项研究的目的是就与临床推理有关的最合适的术语和问题达成共识，考试,以及国际专家小组中肩部疼痛患者的动力学链（KC）治疗。
方法：一项三轮Delphi研究，涉及一个国际专家小组，具有广泛的临床，教学,并在研究主题中进行了研究经验。使用与WebofScience中的KC相关的术语搜索方程和手动搜索来查找专家。参与者被要求对5个不同领域的项目进行评级(术语，临床推理，主观检查,体检,和治疗）使用5点Likert型量表。艾肯效度系数(V)≥0.7被认为是群体共识的指示。
结果：参与率为30.2%（n=16），而在整个三轮中，保留率很高(100%，93.8%,和100%)。共有来自不同领域和国家的15名专家完成了这项研究。三轮过后,就102项达成共识:3项被列入“术语”领域；17项，在“基本原理和临床推理”领域；11项，在“主观考试”领域；44项，在“体检”领域；和27个项目，在“治疗”域中。术语是达成最高协议的领域，2个项目的AikenV为0.93，而KC的体检和治疗领域是2个共识较少的领域。连同术语项目，来自治疗领域的1个项目和来自基本原理和临床推理领域的2个项目达到了最高的一致性水平（分别为V=0.93和V=0.92）。
结论：本研究定义了5个不同领域的102个项目的列表（术语，基本原理和临床推理，主观检查,体检,和治疗）关于肩痛患者的KC。“KC”一词是首选，并就这一概念的定义达成了协议。链中一段的功能障碍(即，薄弱环节）同意导致远端段的性能改变或损伤。专家认为，评估和治疗KC非常重要，特别是在投掷或头顶运动员中，并同意在康复过程中实施肩部KC练习时，不存在一刀切的方法。现在需要进一步研究以确定已识别项目的有效性。
方法：一项三轮Delphi研究，涉及一个国际专家小组，具有广泛的临床，教学,并在研究主题中进行了研究经验。使用与WebofScience中的KC相关的术语搜索方程和手动搜索来查找专家。参与者被要求对5个不同领域的项目进行评级(术语，临床推理，主观检查,体检,和治疗）使用5点Likert型量表。艾肯效度系数(V)≥0.7被认为是群体共识的指示。
结果：参与率为30.2%（n=16），而在整个三轮中，保留率很高(100%，93.8%,和100%)。共有来自不同领域和国家的15名专家完成了这项研究。三轮过后,就102项达成共识:3项被列入“术语”领域；17项，在“基本原理和临床推理”领域；11项，在“主观考试”领域；44项，在“体检”领域；和27个项目，在“治疗”域中。术语是达成最高协议的领域，2个项目的AikenV为0.93，而KC的体检和治疗领域是2个共识较少的领域。连同术语项目，来自治疗领域的1个项目和来自基本原理和临床推理领域的2个项目达到了最高的一致性水平（分别为V=0.93和V=0.92）。
结论：本研究定义了5个不同领域的102个项目的列表（术语，基本原理和临床推理，主观检查,体检,和治疗）关于肩痛患者的KC。“KC”一词是首选，并就这一概念的定义达成了协议。链中一段的功能障碍(即，薄弱环节）同意导致远端段的性能改变或损伤。专家认为，评估和治疗KC非常重要，特别是在投掷或头顶运动员中，并同意在康复过程中实施肩部KC练习时，不存在一刀切的方法。现在需要进一步研究以确定已识别项目的有效性。
