title: The evaluation of lumbar multifidus muscle function via palpation: reliability and validity of a new clinical test.
abstract: BACKGROUND
  The lumbar multifidus muscle provides an important contribution to lumbar spine stability, and the restoration of lumbar multifidus function is a frequent goal of rehabilitation. Currently, there are no reliable and valid physical examination procedures available to assess lumbar multifidus function among patients with low back pain.
  
  
  OBJECTIVE
  To examine the inter-rater reliability and concurrent validity of the multifidus lift test (MLT) to identify lumbar multifidus dysfunction among patients with low back pain.
  
  
  METHODS
  A cross-sectional analysis of reliability and concurrent validity performed in a university outpatient research facility.
  
  
  METHODS
  Thirty-two persons aged 18 to 60 years with current low back pain and a minimum modified Oswestry disability score of 20%. Study participants were excluded if they reported a history of lumbar spine surgery, lumbar radiculopathy, medical red flags, osteoporosis, or had recently been treated with spinal manipulation or trunk stabilization exercises.
  
  
  METHODS
  Concurrent measures of lumbar multifidus muscle function at the L4-L5 and L5-S1 levels were obtained with the MLT (index test) and real-time ultrasound imaging (reference standard).
  
  
  METHODS
  The inter-rater reliability of the MLT was examined by measuring the level of agreement between two blinded examiners. Concurrent validity of the MLT was investigated by comparing clinicians' judgments with real-time ultrasound imaging measures of lumbar multifidus function.
  
  
  RESULTS
  Inter-rater reliability of the MLT was substantial to excellent (κ=0.75 to 0.81, p≤.01) and free from errors of bias and prevalence. When performed at L4-L5 or L5-S1, the MLT demonstrated evidence of concurrent validity through its relationship with the reference standard results at L4-L5 (rbis=0.59-0.73, p≤.01). The MLT generally failed to demonstrate a relationship with the reference standard results from the L5-S1 level.
  
  
  CONCLUSIONS
  Our results provide preliminary evidence supporting the reliability and validity of the MLT to assess lumbar multifidus function at the L4-L5 spinal level. Additional research examining the measurement properties and utility of this test should be undertaken before confident implementation with patients.
authors: School of Psychology and Exercise Science, Murdoch University, 90 South St, Perth, Western Australia, Australia. Electronic address: J.Hebert@Murdoch.edu.au.
authors: Jeffrey J
authors: JJ
authors: Hebert
authors: School of Psychology and Exercise Science, Murdoch University, 90 South St, Perth, Western Australia, Australia; US Army-Baylor University Doctoral Program in Physical Therapy, 3599 Scott Rd, San Antonio, TX, USA.
authors: Shane L
authors: SL
authors: Koppenhaver
authors: US Army-Baylor University Doctoral Program in Physical Therapy, 3599 Scott Rd, San Antonio, TX, USA; Telemedicine and Advanced Technology Research Center, US Army Medical Research and Material Command, Bldg. 1054 Patchel St, Fort Detrick, MD 21702, USA.
authors: Deydre S
authors: DS
authors: Teyhen
authors: School of Health Professions, Murdoch University, 90 South St, Perth, Western Australia, Australia.
authors: Bruce F
authors: BF
authors: Walker
authors: Department of Physical Therapy, University of Utah and Intermountain Healthcare, 250 S. 1850 E, Salt Lake City, UT, USA.
authors: Julie M
authors: JM
authors: Fritz
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000503:physiopathology; D008161:Lumbosacral Region / Q000503:physiopathology*; D008297:Male; D010173:Palpation; D064170:Paraspinal Muscles / Q000503:physiopathology*; D015203:Reproducibility of Results; D055815:Young Adult
keywords: Diagnosis; Low back pain; Reliability; Skeletal muscle; Spine; Validity