title: Inter-examiner reliability of a proposed decision-making treatment based classification system for low back pain patients.
abstract: Evolving evidence has shown increased clinical outcomes, when low back pain (LBP) patients are classified and receive matched physical treatment. The present study aimed to examine the inter-examiner reliability of a proposed new decision-making classification system for non-specific LBP patients, using a mixed simultaneous and independent examiner design. With minimal familiarization, two pairs of experienced physiotherapists trained in Orthopedic Manual Therapy (OMT) at two different out-patient clinics in primary care, examined and classified 64 consenting consecutive patients. Further, inter-examiner reliability on five examination items was examined. The agreement between examiners was expressed by percentage of agreement (%) and by the un-weighted (κ) or weighted (κ(w)) kappa coefficient. The overall % agreement, categorizing patients into one of four classifications was 80% and κ = 0.72. For each classification, pain modulation, stabilization exercise, mobilization and training, agreement was 90%, 83%, 58% and 89% (κ = 0.77, 0.67, 0.11 and 0.75), respectively. Agreement on five individual examination items was; irritability 82% (κ(w) = 0.41), specific movement pattern 68% (κ = 0.38), specific segmental signs 67% (κ = 0.28), uni- or bilateral signs 62% (κ = 0.42), and neurological signs and symptoms 92% (κ = 0.84). This study demonstrated that this new classification system had substantial inter-examiner reliability when used by clinically experienced OMT-trained physiotherapists. Agreement within classification was substantial, except for mobilization which was poor. Inter-examiner reliability for the individual examination items varied from fair to almost perfect. Further studies are needed to investigate utility and validity of this new classification system.
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy 23 100, Karolinska Institutet, SE 141 83 Huddinge, Sweden. birgitta.widerstrom@ki.se
authors.forename: Birgitta
authors.initials: B
authors.lastname: Widerström
authors.forename: Niclas
authors.initials: N
authors.lastname: Olofsson
authors.forename: Inga
authors.initials: I
authors.lastname: Arvidsson
authors.forename: Karin
authors.initials: K
authors.lastname: Harms-Ringdahl
authors.forename: Ulla Evers
authors.initials: UE
authors.lastname: Larsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003657:Decision Making; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000145:classification* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires