Biomaterial Database

Interrater reliability of auscultation of breath sounds among physical therapists. 1995

D Brooks, and J Thomas

Department of Physical Therapy, University of Toronto, Ontario, Canada.

OBJECTIVE Although auscultation is routinely used in the assessment of respiratory status, the ability of the rater to accurately and consistently identify lung sounds has been questioned. The literature on this issue is sparse and has focused on reliability of auscultation of tape-recorded rather than in vivo lung sounds. The purposes of this study were to determine the interrater reliability of physical therapists in the direct auscultation of lung sounds based on their clinical experience in chest physical therapy and to determine whether the adoption of standardized nomenclature and education on proper technique and interpretation affects reliability. METHODS A group of 57 registered physical therapists were stratified by clinical experience into four groups. Sixteen therapists (ie, 4 in each stratum) were randomly chosen using a random number table. The following criteria were developed to delineate clinical experience. Group 1 subjects were senior chest physical therapists with at least 5 years of experience in this area of practice. Group 2 subjects were experienced therapists who had a minimum of 2 years of experience in chest physical therapy and were currently practicing in this area. Group 3 subjects were experienced physical therapists in other areas who were also practicing in chest physical therapy on occasional weekend service. Group 4 subjects were new graduates. Ten patients were evaluated by each group of 4 physical therapists using a teaching stethoscope with one diaphragm/bell and four pairs of earpieces. The education session consisted of discussion of the adoption of standardized nomenclature and education on proper technique and interpretation of auscultation. Interrater reliability was assessed before and after the education session using kappa (kappa) values. Comparisons were made between kappa values before and after the education session to determine the effect of education and between groups to determine the effect of clinical experience. RESULTS The kappa values before the education session were low, indicating poor reliability in detecting specific abnormal sounds (kappa = -.02-.59). Group 1 (seniors in respiratory therapy) and group 4 (new graduates) demonstrated the greatest reliability levels. The lowest kappa values were observed for detecting and categorizing the quality of breath sounds (normal, absent, bronchial, or decreased) (kappa = -.02-.25). Following the education session, there was a general improvement in reliability (kappa = -.30-.77), especially for group 3 (specialists in other areas). The most improvement was noted for the detection of the quality of breath sounds (kappa = .08-.50). CONCLUSIONS Reliability of auscultation was poor to fair, in general, before the education session. There was a definite improvement in reliability after the education session. There was no clear effect of clinical experience on reliability, and the agreement among observers appeared to depend on the abnormal lung sound present. Limitations of this study and recommendations for future research are discussed. [Brooks D, Thomas J. Interrater reliability of auscultation of breath sounds among physical therapists.

UI	MeSH Term	Description	Entries
D009626	Terminology as Topic	Works about the terms, expressions, designations, or symbols used in a particular science, discipline, or specialized subject area.	Etymology,Nomenclature as Topic,Etymologies
D012135	Respiratory Sounds	Noises, normal and abnormal, heard on auscultation over any part of the RESPIRATORY TRACT.	Breathing Sounds,Crackles,Lung Sounds,Pleural Rub,Rales,Rhonchi,Stridor,Wheezing,Breathing Sound,Crackle,Lung Sound,Pleural Rubs,Rale,Respiratory Sound,Rhonchus,Rub, Pleural,Sound, Breathing,Sound, Lung,Sound, Respiratory,Sounds, Breathing,Sounds, Lung,Stridors,Wheezings
D012138	Respiratory Therapy	Care of patients with deficiencies and abnormalities associated with the cardiopulmonary system. It includes the therapeutic use of medical gases and their administrative apparatus, environmental control systems, humidification, aerosols, ventilatory support, bronchopulmonary drainage and exercise, respiratory rehabilitation, assistance with cardiopulmonary resuscitation, and maintenance of natural, artificial, and mechanical airways.	Inhalation Therapy,Therapy, Inhalation,Therapy, Respiratory,Inhalation Therapies,Respiratory Therapies,Therapies, Inhalation,Therapies, Respiratory
D002983	Clinical Competence	The capability to perform acceptably those duties directly related to patient care.	Clinical Skills,Competence, Clinical,Clinical Competency,Clinical Skill,Competency, Clinical,Skill, Clinical,Skills, Clinical,Clinical Competencies,Competencies, Clinical
D004496	Education, Continuing	Educational programs designed to inform individuals of recent advances in their particular field of interest. They do not lead to any formal advanced standing.	Continuous Learning,Life-Long Learning,Lifelong Learning,Continuing Education,Learning, Continuous,Learning, Life-Long,Learning, Lifelong,Learnings, Life-Long,Life Long Learning,Life-Long Learnings
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001314	Auscultation	Act of listening for sounds within the body.	Auscultations
D015203	Reproducibility of Results	The statistical reproducibility of measurements (often in a clinical context), including the testing of instrumentation or techniques to obtain reproducible results. The concept includes reproducibility of physiological measurements, which may be used to develop rules to assess probability or prognosis, or response to a stimulus; reproducibility of occurrence of a condition; and reproducibility of experimental results.	Reliability and Validity,Reliability of Result,Reproducibility Of Result,Reproducibility of Finding,Validity of Result,Validity of Results,Face Validity,Reliability (Epidemiology),Reliability of Results,Reproducibility of Findings,Test-Retest Reliability,Validity (Epidemiology),Finding Reproducibilities,Finding Reproducibility,Of Result, Reproducibility,Of Results, Reproducibility,Reliabilities, Test-Retest,Reliability, Test-Retest,Result Reliabilities,Result Reliability,Result Validities,Result Validity,Result, Reproducibility Of,Results, Reproducibility Of,Test Retest Reliability,Validity and Reliability,Validity, Face
D015397	Program Evaluation	Studies designed to assess the efficacy of programs. They may include the evaluation of cost-effectiveness, the extent to which objectives are met, or impact.	Evaluation, Program,Family Planning Program Evaluation,Program Appropriateness,Program Effectiveness,Program Sustainability,Appropriateness, Program,Effectiveness, Program,Evaluations, Program,Program Evaluations,Program Sustainabilities,Sustainabilities, Program,Sustainability, Program
D015588	Observer Variation	The failure by the observer to measure or identify a phenomenon accurately, which results in an error. Sources for this may be due to the observer's missing an abnormality, or to faulty technique resulting in incorrect test measurement, or to misinterpretation of the data. Two varieties are inter-observer variation (the amount observers vary from one another when reporting on the same material) and intra-observer variation (the amount one observer varies between observations when reporting more than once on the same material).	Bias, Observer,Interobserver Variation,Intraobserver Variation,Observer Bias,Inter-Observer Variability,Inter-Observer Variation,Interobserver Variability,Intra-Observer Variability,Intra-Observer Variation,Intraobserver Variability,Inter Observer Variability,Inter Observer Variation,Inter-Observer Variabilities,Inter-Observer Variations,Interobserver Variabilities,Interobserver Variations,Intra Observer Variability,Intra Observer Variation,Intra-Observer Variabilities,Intra-Observer Variations,Intraobserver Variabilities,Intraobserver Variations,Observer Variations,Variabilities, Inter-Observer,Variabilities, Interobserver,Variabilities, Intra-Observer,Variabilities, Intraobserver,Variability, Inter-Observer,Variability, Interobserver,Variability, Intra-Observer,Variability, Intraobserver,Variation, Inter-Observer,Variation, Interobserver,Variation, Intra-Observer,Variation, Intraobserver,Variation, Observer,Variations, Inter-Observer,Variations, Interobserver,Variations, Intra-Observer,Variations, Intraobserver,Variations, Observer