Inter-examiner reliability of the Doha agreement meeting classification system of groin pain in male athletesKEYWORDS

The Doha agreement classification is used to classify groin pain in athletes. We evaluated the inter-examiner reliability of this classification system. We prospectively recruited 48 male athletes (66 symptomatic sides) with groin pain between 10-2017 and 03-2020 at a sports medicine hospital in Qatar. Two examiners (23 and 10 years of clinical experience) performed history taking, and a standardized clinical examination blinded to each other's findings. Examiners classified groin pain using the Doha agreement terminology (adductor-, inguinal-, iliopsoas-, pubic-, hip-related groin pain, or other causes of groin pain). Multiple entities were ranked in order of perceived clinical importance. Each side was classified separately for bilateral groin pain. Inter-examiner reliability was calculated using Cohen's Kappa statistic (kappa). Inter-examiner reliability was slight to moderate for adductor- (kappa = 0.40), inguinal- (kappa = 0.44), iliopsoas- (kappa = 0.57), and pubic-related groin pain (kappa = 0.12), substantial for hip-related groin pain (kappa = 0.62), and slight for "other causes of groin pain" (kappa = 0.13). Ranking entities in order of perceived clinical importance improved inter-examiner reliability for adductor-, inguinal-, and iliopsoas-related groin pain (kappa = 0.52-0.65), but not for pubic (kappa = 0.12), hip (kappa = 0.51), and "other causes of groin pain" (kappa = 0.03). For participants with unilateral groin pain classified with a single entity (n = 7), there was 100% agreement between the two examiners. Inter-examiner reliability of the Doha agreement meeting classification system varied from slight to substantial, depending on the clinical entity. Agreement between examiners was perfect when athletes were classified with a single clinical entity of groin pain, but lower when athletes were classified with multiple clinical entities.