title: Reliability of chiropractic methods commonly used to detect manipulable lesions in patients with chronic low-back pain.
abstract: OBJECTIVE
  To assess the intraexaminer and interexaminer reliability of a multidimensional spinal diagnostic method commonly used by chiropractors.
  
  
  METHODS
  An intraexaminer and interexaminer Latin square, repeated measures reliability study. The techniques of diagnosis under investigation included visual postural analysis, pain description by the patient, plain static erect x-ray film of the lumbar spine, leg length discrepancy, neurologic tests, motion palpation, static palpation, and orthopedic tests.
  
  
  METHODS
  Three experienced chiropractors examined 19 patients, and 2 experienced chiropractors examined 10 and 9 patients, respectively, who were suffering from chronic mechanical low-back pain.
  
  
  RESULTS
  Intraexaminer reliability of the decision to manipulate a certain spinal segmental level was moderate (kappa = 0.47). The interexaminer agreement pooled across all spinal joints indicated fair agreement (kappa = 0.27). Interexaminer reliability for individual examiner pairs for the L4/L5 segmental level was slight (kappa = 0.09). At the L5/S1 level, the interexaminer reliability was fair (kappa = 0.25). For the sacroiliac joints, interexaminer reliability was slight (kappa = 0.04 and 0.14).
  
  
  CONCLUSIONS
  This study of commonly used chiropractic diagnostic methods in patients with chronic mechanical low-back pain to detect manipulable lesions in the lower thoracic spine, lumbar spine, and the sacroiliac joints has revealed that the measures are not reproducible. The implementation of these examination techniques alone should not be seen by practitioners to provide reliable information concerning where to direct a manipulative procedure in patients with chronic mechanical low-back pain.
authors.affiliation: simsime@ozemail.com.au
authors.forename: S D
authors.initials: SD
authors.lastname: French
authors.forename: S
authors.initials: S
authors.lastname: Green
authors.forename: A
authors.initials: A
authors.lastname: Forbes
mesh_terms: D000328:Adult; D000368:Aged; D002684:Chiropractic / Q000379:methods*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007870:Leg Length Inequality / Q000150:complications / Q000175:diagnosis; D017116:Low Back Pain / Q000209:etiology* / Q000534:rehabilitation*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods; D015588:Observer Variation; D010173:Palpation / Q000379:methods; D010808:Physical Examination / Q000379:methods; D011859:Radiography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013122:Spinal Diseases / Q000150:complications / Q000175:diagnosis* / Q000534:rehabilitation