Reliability of pain and stiffness assessments in clinical manual lumbar spine examination.
OBJECTIVE
The purpose of this study was to determine the intertherapist reliability of judgments of stiffness and pain at L-1 to L-5 made using posteroanterior (PA) central pressure testing.


METHODS
Three pairs of manipulative physical therapists with a minimum of 5 years of experience were asked to rate pain and stiffness in a total of 90 patients with low back pain.


METHODS
Each pair of therapists assessed 30 patients within their own clinic, using their preferred technique to perform an examination using the PA central pressure test at the five lumbar levels. Each pair of therapists recorded their ratings of pain and stiffness. Reliability of judgments was evaluated by intraclass correlation coefficients (ICC) and percentage of exact agreement scores.


RESULTS
The ICC values for pain judgments for the group as a whole ranged from .67 to .72, with agreement scores ranging from 31% to 43%. The ICC values for stiffness judgments ranged from .03 to .37, with agreement scores ranging from 21% to 29%.


CONCLUSIONS
Judgments of stiffness made by experienced manipulative physical therapists examining patients in their own clinics were found to have poor reliability, whereas pain judgments had good reliability. Further investigation of this test is required in order to develop a more reliable method of assessing PA stiffness.
Maher
C
C
School of Physiotherapy, Faculty of Health Sciences, University of Sydney, New South Wales, Australia.
Adams
R
R
D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000592:standards; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010173:Palpation / Q000592:standards*; D026741:Physical Therapy Modalities / Q000592:standards*