title: McKenzie lumbar classification: inter-rater agreement by physical therapists with different levels of formal McKenzie postgraduate training.
abstract: METHODS
  Inter-rater chance-corrected agreement study.
  
  
  OBJECTIVE
  The aim was to examine the association between therapists' level of formal precredential McKenzie postgraduate training and agreement on the following McKenzie classification variables for patients with low back pain: main McKenzie syndromes, presence of lateral shift, derangement reducibility, directional preference, and centralization.
  
  
  BACKGROUND
  Minimal level of McKenzie postgraduate training needed to achieve acceptable agreement of McKenzie classification system is unknown.
  
  
  METHODS
  Raters (N = 47) completed multiple sets of 2 independent successive examinations at 3 different stages of McKenzie postgraduate training (levels parts A and B, part C, and part D). Agreement was assessed with κ coefficients and associated 95% confidence intervals. A minimum κ threshold of 0.60 was used as a predetermined criterion for level of agreement acceptable for clinical use.
  
  
  RESULTS
  Raters examined 1662 patients (mean age = 51 ± 15; range, 18-91; females, 57%). Data distributions were not even and were highly skewed for all classification variables. No training level studied had acceptable agreement for any McKenzie classification variable. Agreements for all levels of McKenzie postgraduate training were higher than expected by chance for most of the classification variables except parts A and B training level for judging lateral shift and centralization and part D training level for judging reducibility. Agreement between training levels parts A and B, part C, and part D were similar with overlapping 95% confidence intervals.
  
  
  CONCLUSIONS
  Results indicate that level of inter-rater chance-corrected agreement of McKenzie classification system was not acceptable for therapists at any level of formal McKenzie postgraduate training. This finding raises concerns about the clinical utility of the McKenzie classification system at these training levels. Additional studies are needed to assess agreement levels for therapists who receive additional training or experience at the McKenzie credentialed or diploma levels.
  
  
  METHODS
  2.
authors.affiliation: *CentraState Medical Center, Freehold, NJ †Physical Therapy Service, Maccabi Healthcare Services, Tel Aviv, Israel ‡Focus On Therapeutic Outcomes, Inc., White Stone, VA §School of Rehabilitation Science, Institute of Applied Sciences and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada ¶Physical Therapy Service, Maccabi Healthcare Services, Tel Aviv, Israel ‖Team Care Physical Therapy, Oxford, NC **Physical Therapy Department, St David's Hospital Austin, TX; and ††Providence VA Medical Center, Providence, RI, and Department of Health Services, Policy and Practice, Brown University, Providence, RI.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Werneke
authors.forename: Daniel
authors.initials: D
authors.lastname: Deutscher
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Hart
authors.forename: Paul
authors.initials: P
authors.lastname: Stratford
authors.forename: Joel
authors.initials: J
authors.lastname: Ladin
authors.forename: Jon
authors.initials: J
authors.lastname: Weinberg
authors.forename: Scott
authors.initials: S
authors.lastname: Herbowy
authors.forename: Linda
authors.initials: L
authors.lastname: Resnik
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D008875:Middle Aged; D059825:Physical Therapists / Q000193:education* / Q000592:standards; D026741:Physical Therapy Modalities / Q000193:education / Q000592:standards; D026761:Physical Therapy Specialty / Q000193:education* / Q000592:standards; D011446:Prospective Studies; D013122:Spinal Diseases / Q000145:classification* / Q000175:diagnosis / Q000628:therapy