Shahram Abootalebi1, Mahmoud Reza Azarpazhooh1, Luciano Sposato1, Vladimir Hachinski1. 1. Department of Clinical Neurological Sciences, University Hospital (SA, MRA, LS, VH), Stroke, Dementia and Heart Disease Laboratory, Department of Anatomy and Cell Biology (LS) and Department of Epidemiology and Biostatics (MRA, VH), the University of Western Ontario, London; Dr. Everett Chalmers Regional Hospital (SA), Fredericton Medical Clinic, Dalhousie University, New Brunswick, Canada; and Department of Neurology (MRA), Ghaem Hospital, Mashhad University of Medical Sciences, Iran.
Abstract
BACKGROUND: The upgoing thumb sign as a subtle clinical finding of upper motor neuron involvement has been frequently reported in patients with TIAs and minor strokes. This study was designed to show the method of examination and interpretation and the interobserver/intraobserver reliability. METHODS: The thumb sign was elicited in TIA/minor strokes or stroke mimics. After obtaining the participant's permission, the examinations were recorded. Two independent neurologists reviewed all patients for the possibility of an upgoing thumb sign. After 1 hour education about the definition of an upgoing thumb sign to a group of stroke fellows, nurse practitioners, and a research secretary, the videos were reviewed and the participants rated the thumb sign independently. The intraobserver reliability was assessed after 3 months by rating the same videos. RESULTS: The interobserver reliability among 9 raters showed an overall agreement of 0.83 and fixed-marginal kappa of 0.66. The same videos were reviewed by the observers after 3 months with a similar level of agreement (percent of overall agreement 0.84, fixed-marginal kappa 0.66) and a substantial to almost perfect level of intraobserver concordance (mean 0.86; SD 0.08; median 0.90; interquartile range 25-75, 0.8, 0.95). CONCLUSIONS: The upgoing thumb sign is a subtle upper limb neurologic finding, with a high level of interobserver and intraobserver reliability. The test is easy to perform and can be interpreted accurately.
BACKGROUND: The upgoing thumb sign as a subtle clinical finding of upper motor neuron involvement has been frequently reported in patients with TIAs and minor strokes. This study was designed to show the method of examination and interpretation and the interobserver/intraobserver reliability. METHODS: The thumb sign was elicited in TIA/minor strokes or stroke mimics. After obtaining the participant's permission, the examinations were recorded. Two independent neurologists reviewed all patients for the possibility of an upgoing thumb sign. After 1 hour education about the definition of an upgoing thumb sign to a group of stroke fellows, nurse practitioners, and a research secretary, the videos were reviewed and the participants rated the thumb sign independently. The intraobserver reliability was assessed after 3 months by rating the same videos. RESULTS: The interobserver reliability among 9 raters showed an overall agreement of 0.83 and fixed-marginal kappa of 0.66. The same videos were reviewed by the observers after 3 months with a similar level of agreement (percent of overall agreement 0.84, fixed-marginal kappa 0.66) and a substantial to almost perfect level of intraobserver concordance (mean 0.86; SD 0.08; median 0.90; interquartile range 25-75, 0.8, 0.95). CONCLUSIONS: The upgoing thumb sign is a subtle upper limb neurologic finding, with a high level of interobserver and intraobserver reliability. The test is easy to perform and can be interpreted accurately.
Authors: N E Anderson; D F Mason; J N Fink; P S Bergin; A J Charleston; G D Gamble Journal: J Neurol Neurosurg Psychiatry Date: 2005-04 Impact factor: 10.154
Authors: Sandra Patricia Isaza Jaramillo; Carlos Santiago Uribe Uribe; Francisco A García Jimenez; William Cornejo-Ochoa; Juan Felipe Alvarez Restrepo; Gustavo C Román Journal: J Neurol Sci Date: 2014-05-21 Impact factor: 3.181