Original article

Scand J Work Environ Health 2007;33(2):131-140    pdf


A pattern recognition approach to the development of a classification system for upper-limb musculoskeletal disorders of workers

by Beaton DE, Bombardier C, Cole DC, Hogg-Johnson S, Van Eerd D; Clinical Expert Group

Objectives Workers’ musculoskeletal disorders are often pain-based and elude specific diagnoses; yet diagnosis or classification is the cornerstone to researching and managing these disorders. Clinicians are skilled in pattern recognition and use it in their daily practice. The purpose of this study was to use the clinical reasoning of experienced clinicians to recognize patterns of signs and symptoms and thus create a classification system.

Methods Two hundred and forty-two workers consented to a standardized physical assessment and to completing a questionnaire. Each physical assessment finding was dichotomized (normal versus abnormal), and the results were graphically displayed on body diagrams. At two different workshops, groups of experienced researchers or clinicians were led through an exercise of pattern recognition (clustering and naming of clusters) to arrive at a classification system. Interobserver reliability was assessed (8 observers, 40 workers), and the classification system was revised to improve reliability.

Results The initial classification system had good face validity but low interobserver reliability (kappa

This article refers to the following text of the Journal: 2001;27 suppl 1:1-102