Interrater reliability of clinical examination measures for identification of lumbar segmental instability.
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.
Hicks
Gregory E
GE
Clinical Research Branch, National Institute on Aging, Harbor Hospital, 5th Floor, 3001 S. Hanover Street, Baltimore, MD 21225, USA. hicksgr@grc.nia.nih.gov
Fritz
Julie M
JM
Delitto
Anthony
A
Mishock
John
J
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