Table 2

Interexaminer reliability of abdominal pain provocation tests including palpation and resistance (n=61)

Kappa (95% CI)Kappa interpretationOverall agreementPositive agreementNegative agreementBias indexPrevalence (PI)Mean prevalence of positive tests in IRGP*
Abdominal palpation pain
Pubic tubercle0.41 (0.18 to 0.64)Moderate71%68%73%0.1046% (−0.08)66%
Inguinal ligament0.39 (0.16 to 0.62)Fair69%62%74%0.2540% (−0.20)58%
External ring
(medial border)
0.49 (0.26 to 0.72)Moderate75%68%80%0.1139% (−0.23)59%
External ring*0.35 (0.10 to 0.61)Fair70%59%76%0.0337% (−0.27)55%
Conjoint tendon*0.42 (0.18 to 0.65)Moderate70%62%75%0.2639% (−0.21)54%
Posterior wall
(during Valsalva)*
0.40 (0.17 to 0.64)Fair70%73%67%0.1355% (0.10)79%
Any inguinal palpation pain without invagination†0.61 (0.41 to 0.81)Substantial80%81%80%0.0751% (0.02)77%
Any inguinal palpation pain during invagination‡ *0.54 (0.31 to 0.76)Moderate78%83%70%0.1264% (0.28)94%
Any inguinal palpation pain without or during invagination*0.65 (0.44 to 0.87)Substantial85%89%76%0.0869% (0.38)100%
Rectus abdominis insertion0.17 (-0.16 to 0.50)Slight71%36%81%0.0723% (−0.54)
Rectus abdominis muscle/tendon0.66 (0.37 to 0.95)Substantial92%71%95%0.0214% (0.72)
Abdominal resistance pain
Straight sit-up 0°0.63 (0.39 to 0.87)Substantial87%71%92%0.0323% (−0.54)30%
Cross test 0°—shoulder affected side0.67 (0.44 to 0.91)Substantial89%74%93%0.0822% (−0.56)27%
Cross test 0°—shoulder contralateral side§0.61 (0.40 to 0.82)Substantial82%76%86%−0.0237% (−0.26)49%
Straight sit-up 45°0.72 (0.52 to 0.92)Substantial89%80%92%0.0229% (−0.43)38%
Oblique sit-up 45°—shoulder affected side0.35 (-0.03 to 0.73)Fair84%44%90%−0.0315% (−0.70)21%
Oblique sit-up 45°—shoulder contralateral side§0.56 (0.32 to 0.80)Moderate82%69%87%−0.0829% (−0.43)39%
Pain during any abdominal resistance test0.54 (0.32 to 0.75)Moderate77%74%79%0.0344% (−0.11)58%
  • *1 participant with unilateral groin pain refused a second inguinal invagination and was therefore excluded from this specific analyses. The conjoint tendon (three sides) and posterior wall (one side) were not assessable during scrotal invagination by at least one of the examiners.

  • †If any of the above three tests (pubic tubercle, inguinal ligament, external ring (medial border)) were scored positive.

  • ‡If any of the above three test (external ring, conjoint tendon during invagination, posterior wall) were scored positive.

  • §Pain reported on the contralateral side (eg, patient reported recognisable injury pain in the left inguinal canal region during an oblique sit-up with resistance on the right shoulder).

  • IRGP, inguinal-related groin pain according to the defined clinical entity; PI, prevalence index.