Critically re-evaluating a common technique: Accuracy, reliability, and confirmation bias of EMG

Pushpa Narayanaswami, Thomas Geisbush, Lyell Jones, Michael Weiss, Tahseen Mozaffar, Gary Gronseth, Seward B. Rutkove

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objectives: (1) To assess the diagnostic accuracy of EMG in radiculopathy. (2) To evaluate the intrarater reliability and interrater reliability of EMG in radiculopathy. (3) To assess the presence of confirmation bias in EMG. Methods: Three experienced academic electromyographers interpreted 3 compact discs with 20 EMG videos (10 normal, 10 radiculopathy) in a blinded, standardized fashion without information regarding the nature of the study. The EMGs were interpreted 3 times (discs A, B, C) 1 month apart. Clinical information was provided only with disc C. Intrarater reliability was calculated by comparing interpretations in discs A and B, interrater reliability by comparing interpretation between reviewers. Confirmation bias was estimated by the difference in correct interpretations when clinical information was provided. Results: Sensitivity was similar to previous reports (77%, confidence interval [CI] 63%-90%); specificity was 71%, CI 56%-85%. Intrarater reliability was good (k 0.61, 95%CI 0.41-0.81); interrater reliability was lower (k 0.53, CI 0.35-0.71). There was no substantial confirmation bias when clinical information was provided (absolute difference in correct responses 2.2%, CI 213.3% to 17.7%); the study lacked precision to exclude moderate confirmation bias. Conclusions: This study supports that (1) serial EMG studies should be performed by the same electromyographer since intrarater reliability is better than interrater reliability; (2) knowledge of clinical information does not bias EMG interpretation substantially; (3) EMG has moderate diagnostic accuracy for radiculopathy with modest specificity and electromyographers should exercise caution interpreting mild abnormalities.

Original languageEnglish (US)
Pages (from-to)218-223
Number of pages6
JournalNeurology
Volume86
Issue number3
DOIs
StatePublished - Jan 19 2016

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Radiculopathy
Confidence Intervals

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Narayanaswami, P., Geisbush, T., Jones, L., Weiss, M., Mozaffar, T., Gronseth, G., & Rutkove, S. B. (2016). Critically re-evaluating a common technique: Accuracy, reliability, and confirmation bias of EMG. Neurology, 86(3), 218-223. https://doi.org/10.1212/WNL.0000000000002292

Critically re-evaluating a common technique : Accuracy, reliability, and confirmation bias of EMG. / Narayanaswami, Pushpa; Geisbush, Thomas; Jones, Lyell; Weiss, Michael; Mozaffar, Tahseen; Gronseth, Gary; Rutkove, Seward B.

In: Neurology, Vol. 86, No. 3, 19.01.2016, p. 218-223.

Research output: Contribution to journalArticle

Narayanaswami, P, Geisbush, T, Jones, L, Weiss, M, Mozaffar, T, Gronseth, G & Rutkove, SB 2016, 'Critically re-evaluating a common technique: Accuracy, reliability, and confirmation bias of EMG', Neurology, vol. 86, no. 3, pp. 218-223. https://doi.org/10.1212/WNL.0000000000002292
Narayanaswami, Pushpa ; Geisbush, Thomas ; Jones, Lyell ; Weiss, Michael ; Mozaffar, Tahseen ; Gronseth, Gary ; Rutkove, Seward B. / Critically re-evaluating a common technique : Accuracy, reliability, and confirmation bias of EMG. In: Neurology. 2016 ; Vol. 86, No. 3. pp. 218-223.
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abstract = "Objectives: (1) To assess the diagnostic accuracy of EMG in radiculopathy. (2) To evaluate the intrarater reliability and interrater reliability of EMG in radiculopathy. (3) To assess the presence of confirmation bias in EMG. Methods: Three experienced academic electromyographers interpreted 3 compact discs with 20 EMG videos (10 normal, 10 radiculopathy) in a blinded, standardized fashion without information regarding the nature of the study. The EMGs were interpreted 3 times (discs A, B, C) 1 month apart. Clinical information was provided only with disc C. Intrarater reliability was calculated by comparing interpretations in discs A and B, interrater reliability by comparing interpretation between reviewers. Confirmation bias was estimated by the difference in correct interpretations when clinical information was provided. Results: Sensitivity was similar to previous reports (77{\%}, confidence interval [CI] 63{\%}-90{\%}); specificity was 71{\%}, CI 56{\%}-85{\%}. Intrarater reliability was good (k 0.61, 95{\%}CI 0.41-0.81); interrater reliability was lower (k 0.53, CI 0.35-0.71). There was no substantial confirmation bias when clinical information was provided (absolute difference in correct responses 2.2{\%}, CI 213.3{\%} to 17.7{\%}); the study lacked precision to exclude moderate confirmation bias. Conclusions: This study supports that (1) serial EMG studies should be performed by the same electromyographer since intrarater reliability is better than interrater reliability; (2) knowledge of clinical information does not bias EMG interpretation substantially; (3) EMG has moderate diagnostic accuracy for radiculopathy with modest specificity and electromyographers should exercise caution interpreting mild abnormalities.",
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AU - Jones, Lyell

AU - Weiss, Michael

AU - Mozaffar, Tahseen

AU - Gronseth, Gary

AU - Rutkove, Seward B.

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N2 - Objectives: (1) To assess the diagnostic accuracy of EMG in radiculopathy. (2) To evaluate the intrarater reliability and interrater reliability of EMG in radiculopathy. (3) To assess the presence of confirmation bias in EMG. Methods: Three experienced academic electromyographers interpreted 3 compact discs with 20 EMG videos (10 normal, 10 radiculopathy) in a blinded, standardized fashion without information regarding the nature of the study. The EMGs were interpreted 3 times (discs A, B, C) 1 month apart. Clinical information was provided only with disc C. Intrarater reliability was calculated by comparing interpretations in discs A and B, interrater reliability by comparing interpretation between reviewers. Confirmation bias was estimated by the difference in correct interpretations when clinical information was provided. Results: Sensitivity was similar to previous reports (77%, confidence interval [CI] 63%-90%); specificity was 71%, CI 56%-85%. Intrarater reliability was good (k 0.61, 95%CI 0.41-0.81); interrater reliability was lower (k 0.53, CI 0.35-0.71). There was no substantial confirmation bias when clinical information was provided (absolute difference in correct responses 2.2%, CI 213.3% to 17.7%); the study lacked precision to exclude moderate confirmation bias. Conclusions: This study supports that (1) serial EMG studies should be performed by the same electromyographer since intrarater reliability is better than interrater reliability; (2) knowledge of clinical information does not bias EMG interpretation substantially; (3) EMG has moderate diagnostic accuracy for radiculopathy with modest specificity and electromyographers should exercise caution interpreting mild abnormalities.

AB - Objectives: (1) To assess the diagnostic accuracy of EMG in radiculopathy. (2) To evaluate the intrarater reliability and interrater reliability of EMG in radiculopathy. (3) To assess the presence of confirmation bias in EMG. Methods: Three experienced academic electromyographers interpreted 3 compact discs with 20 EMG videos (10 normal, 10 radiculopathy) in a blinded, standardized fashion without information regarding the nature of the study. The EMGs were interpreted 3 times (discs A, B, C) 1 month apart. Clinical information was provided only with disc C. Intrarater reliability was calculated by comparing interpretations in discs A and B, interrater reliability by comparing interpretation between reviewers. Confirmation bias was estimated by the difference in correct interpretations when clinical information was provided. Results: Sensitivity was similar to previous reports (77%, confidence interval [CI] 63%-90%); specificity was 71%, CI 56%-85%. Intrarater reliability was good (k 0.61, 95%CI 0.41-0.81); interrater reliability was lower (k 0.53, CI 0.35-0.71). There was no substantial confirmation bias when clinical information was provided (absolute difference in correct responses 2.2%, CI 213.3% to 17.7%); the study lacked precision to exclude moderate confirmation bias. Conclusions: This study supports that (1) serial EMG studies should be performed by the same electromyographer since intrarater reliability is better than interrater reliability; (2) knowledge of clinical information does not bias EMG interpretation substantially; (3) EMG has moderate diagnostic accuracy for radiculopathy with modest specificity and electromyographers should exercise caution interpreting mild abnormalities.

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