Reliability of physical examination items used for classification of patients with low back pain.
OBJECTIVE
The purpose of this study was to examine the interrater reliability of measurements obtained by examiners administering tests proposed to be important for classifying low back pain (LBP) problems.


METHODS
Ninety-five subjects with LBP (41 men, 54 women) and 43 subjects without LBP (17 men, 26 women) were examined by 5 therapists trained in the techniques used.


METHODS
A manual was developed by the first author that described the clinical examination procedures. The therapists were trained by the first author in the test procedures and definitions. The training included instruction through videotapes, practice and a written examination. Each examination was conducted by a pair of therapists. Within a pair, a therapist was the primary examiner for half of the subjects and an observer was the primary examiner for half of the subjects. Examination findings were recorded independently, without discussion.


RESULTS
Percentage of agreement and generalized kappa coefficients were used to analyzed the data. Kappa values were > or = .75 for all 28 items related to the symptoms elicited and > or = .40 for 72% of the 25 items related to alignment and movement.


CONCLUSIONS
The results suggest that experienced therapist who had trained together were able to agree on the results of examinations and obtain an acceptable level of reliability. Future work should focus on testing of reliability when more than one therapist performs the examination and when therapist not trained by the test developer to administer the examination perform the tests. [Van Dillen LR, Sahrmann SA, Norton BJ, et al. Reliability of physical examination items used for classification of patients with low back pain.
Van Dillen
L R
LR
Program in Physical Therapy, Washington University School of Medicie, St Louis, MO, USA. vandille@medicine.wustl.edu
Sahrmann
S A
SA
Norton
B J
BJ
Caldwell
C A
CA
Fleming
D A
DA
McDonnell
M K
MK
Woolsey
N B
NB
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000145:classification*; D008297:Male; D008875:Middle Aged; D008923:Missouri; D015588:Observer Variation; D010808:Physical Examination / Q000379:methods*; D026741:Physical Therapy Modalities; D015203:Reproducibility of Results; D012720:Severity of Illness Index