Interrater reliability of clinical examination measures for identification of lumbar segmental instability

doi:10.1016/S0003-9993(03)00365-4

Archives of Physical Medicine and Rehabilitation

Volume 84, Issue 12, December 2003, Pages 1858-1864

https://doi.org/10.1016/S0003-9993(03)00365-4 Get rights and content

Abstract

Hicks GE, Fritz JM, Delitto A, Mishock J. Interrater reliability of clinical examination measures for identification of lumbar segmental instability. Arch Phys Med Rehabil 2003;84:1858–64.

Objective

To determine the interrater reliability of common clinical examination procedures proposed to identify patients with lumbar segmental instability.

Design

Single group repeated-measures interrater reliability study.

Setting

Outpatient physical therapy (PT) clinic and university PT department.

Participants

A consecutive sample of 63 subjects (38 women, 25 men; 81% with previous episodes of low back pain [LBP]) with current LBP was examined by 3 pairs of raters.

Interventions

Not applicable.

Main outcome measures

Repeat measurements of clinical signs and tests proposed to identify lumbar segmental instability.

Results

Kappa values for the trunk range of motion (ROM) findings varied (range, .00–.69). The prone instability test (κ=.87) showed greater reliability than the posterior shear test (κ=.22). The Beighton Ligamentous Laxity Scale (LLS) for generalized ligamentous laxity showed high reliability (intraclass correlation coefficient=.79). Judgments of pain provocation (κ range, .25–.55) were generally more reliable than judgments of segmental mobility (κ range, −.02 to .26) during passive intervertebral motion testing.

Conclusions

The results agree with previous studies suggesting that segmental mobility testing is not reliable. The prone instability test, generalized LLS, and aberrant motion with trunk ROM demonstrated higher levels of reliability.

Section snippets

Participants

Subjects with current complaints of LBP without radiation of symptoms below the knee were recruited for this study. Patients were excluded if their LBP could be attributed to current pregnancy, acute fracture, tumor, or infection. Previous lumbar surgical fusion was also an exclusion criterion. To assess the generalizability of the results, subjects were recruited from 2 different sources, and 3 pairs of raters were used. Subjects were recruited either as consecutive participants in research

Results

The reliability coefficients with corresponding 95% CIs and percentage agreements for the observations of trunk ROM, the special tests, and generalized LLS for the entire sample are in table 3. The κ values for the observations of trunk ROM ranged from .00 to .69. During the study, we noted that making distinctions among the different categories was sometimes difficult and that prevalence was often low; therefore, we decided to collapse all 5 observational elements into a single category. The

Discussion

Although we examined the reliability of several aspects of the clinical examination that have been proposed as useful in the identification of patients with LSI, we did not examine the validity of these findings, and, therefore, no conclusions can be drawn about the diagnostic accuracy of these tests. Although no globally acknowledged standards for interpretation of reliability coefficients exists, Landis and Koch24 suggested the following interpretation for the Cohen κ statistic: less than 0.0

Conclusion

Observation of movement patterns during trunk AROM can be reliable, particularly when the separate components are collapsed into 1 category. The Beighton LLS, as a measure of generalized ligamentous laxity, proved highly reliable, as did the prone instability test. Similar to other studies, we found poor reliability for judgments of passive segmental mobility and better reliability for judgments of pain provocation. The error related to judgments of pain provocation may be related to naming the

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View all citing articles on Scopus

^☆: Supported in part by the Foundation for Physical Therapy (grant no. P5397).

¹: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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ArticleInterrater reliability of clinical examination measures for identification of lumbar segmental instability1☆,

Abstract

Objective

Design

Setting

Participants

Interventions

Main outcome measures

Results

Conclusions

Section snippets

Participants

Results

Discussion

Conclusion

Arch Phys Med Rehabil

The need for a new medical modela challenge for biomedicine

Science

A treatment based classification approach to low back syndromeidentifying and staging patients for conservative treatment

Phys Ther

The lumbar spinemechanical diagnosis and therapy

A report from the second international forum for primary care research on low back painreexamining priorities

Spine

The nature of instability

Spine

Clinical perspectives

The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement

J Spinal Disord

The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis

J Spinal Disord

Diagnosing instability

Clin Orthop

Instability of the lumbar spine

Clin Orthop

Low back pain and spinal instability

Radiographic diagnosis of degenerative lumbar spinal instability

Spine

A biomechanical analysis of the clinical stability of the lumbar and lumbosacral spine

Spine

Roentgenographic evaluation of the lumbar spine flexion-extension in asymptomatic individuals

Spine

On the understanding of clinical instability

Spine

Segmental instabilityoverview and classification

Physical signs of instability

Spine

Article
Interrater reliability of clinical examination measures for identification of lumbar segmental instability¹☆,