Evidence map›Paper›PMID 29431171›Full record

ArticleNeurology. Clinical practice2017

The upgoing thumb sign: An interobserver/intraobserver reliability study.

Shahram Abootalebi, Mahmoud Reza Azarpazhooh, Luciano Sposato, Vladimir Hachinski

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In one paragraph

Article in Neurology. Clinical practice, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
0.3field-weighted citation impact, top 36% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed, 2 citations in OpenAlex.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 2 institutions in 1 country.

Shahram AbootalebiDepartment 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.
Mahmoud Reza AzarpazhoohDepartment 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.
Luciano SposatoDepartment 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.
Vladimir HachinskiDepartment 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.
Dalhousie University · CADr. Everett Chalmers Regional Hospital · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe 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.

methodsThe 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.

resultsThe 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).

conclusionsThe 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.

Identifiers

PMID29431171
PMCPMC5800718
OpenAlexW2749306785

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.