title: Interrater reliability of clinical examination measures for identification of lumbar segmental instability.
abstract: OBJECTIVE
  To determine the interrater reliability of common clinical examination procedures proposed to identify patients with lumbar segmental instability.
  
  
  METHODS
  Single group repeated-measures interrater reliability study.
  
  
  METHODS
  Outpatient physical therapy (PT) clinic and university PT department.
  
  
  METHODS
  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.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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 (kappa=.87) showed greater reliability than the posterior shear test (kappa=.22). The Beighton Ligamentous Laxity Scale (LLS) for generalized ligamentous laxity showed high reliability (intraclass correlation coefficient=.79). Judgments of pain provocation (kappa range,.25-.55) were generally more reliable than judgments of segmental mobility (kappa 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.
authors.affiliation: Clinical Research Branch, National Institute on Aging, Harbor Hospital, 5th Floor, 3001 S. Hanover Street, Baltimore, MD 21225, USA. hicksgr@grc.nia.nih.gov
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Hicks
authors.forename: Julie M
authors.initials: JM
authors.lastname: Fritz
authors.forename: Anthony
authors.initials: A
authors.lastname: Delitto
authors.forename: John
authors.initials: J
authors.lastname: Mishock
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis* / Q000503:physiopathology; D007593:Joint Instability / Q000175:diagnosis* / Q000503:physiopathology; D017116:Low Back Pain / Q000209:etiology / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000503:physiopathology*; D008297:Male; D015588:Observer Variation; D010808:Physical Examination / Q000592:standards*; D016059:Range of Motion, Articular / Q000502:physiology; D015203:Reproducibility of Results; D014481:United States