PT  - JOURNAL ARTICLE
AU  - James Watson
AU  - Robert M Barker-Davies
AU  - Alexander N Bennett
AU  - Daniel T P Fong
AU  - Patrick C Wheeler
AU  - Mark Lewis
AU  - Craig Ranson
TI  - Sport and exercise medicine consultants are reliable in assessing tendon neovascularity using ultrasound Doppler
AID  - 10.1136/bmjsem-2017-000298
DP  - 2018 Feb 01
TA  - BMJ Open Sport & Exercise Medicine
PG  - e000298
VI  - 4
IP  - 1
4099  - http://bmjopensem.bmj.com/content/4/1/e000298.short
4100  - http://bmjopensem.bmj.com/content/4/1/e000298.full
SO  - BMJ OPEN SP EX MED2018 Feb 01; 4
AB  - Objective Several lower limb tendinopathy treatment modalities involve identification of pathological paratendinous or intratendinous neovascularisation to target proposed co-location of painful neoneuralisation. The ability to reliably locate and assess the degree of neovascularity is therefore clinically important. The Modified Ohberg Score (MOS) is frequently used to determine degree of neovascularity, but reliability has yet to be established among Sport and Exercise Medicine (SEM) consultants. This study aims to determine inter-rater and intra-rater reliability of an SEM consultant cohort when assessing neovascularity using the 5-point MOS.Method Eleven participants (7 male and 4 female) provided 16 symptomatic Achilles and patella tendons. These were sequentially examined using power Doppler (PD) enabled ultrasound (US) imaging by 6 SEM consultants who rated neovascular changes seen using the MOS. Representative digital scan images were saved for rescoring 3 weeks later. Inter-rater and intra-rater reliability of the MOS was examined using intraclass correlation coefficient (ICC) and Kappa Agreement scores.Results Neovascular changes were reported in 65.6% of 96 scans undertaken. ICC for inter-rater reliability was 0.86 and Fleiss Kappa 0.52. ICC for intra-rater reliability was 0.95 and Weighted Kappa 0.91.Conclusions Neovascular changes were present in two-thirds of symptomatic tendons. Excellent SEM consultant inter-rater and intra-rater reliability was demonstrated. These findings support the use of PD-enabled US to assess neovascularity by appropriately experienced SEM consultants. Furthermore, future interventional research using a similarly experienced SEM consultant cohort can be undertaken with assurance that assessment of neovascularity will be reliable.