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Reliability of Physical Examination Items Used for Classification of Patients With Low Back Pain

L Van Dillen, PhD, PT, is Instructor, Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, St Louis, MO 63110 (USA) (vandille@medicine.wustl.edu).
SA Sahrmann, PhD, PT, FAPTA, is Professor and Associate Director for Doctoral Studies, Program in Physical Therapy, Washington University School of Medicine.
BJ Norton, PhD, PT, is Assistant Professor and Associate Director of Post-Professional Studies, Program in Physical Therapy, Washington University School of Medicine.
CA Caldwell, PT, CHT, is Instructor, Program in Physical Therapy, Washington University School of Medicine.
DA Fleming, PT, is Lead Physical Therapist, BJC Health System, St Louis, Mo.
MK McDonnell, PT, OCS, is Instructor, Program in Physical Therapy, Washington University School of Medicine.
NB Woolsey, OT, PT, is Instructor, Program in Physical Therapy, Washington University School of Medicine.

Background and Purpose. The purpose of this study was to examine the interrater reliability of measurements obtained by examiners administering tests proposed to be important for classifying low back pain (LBP) problems. Subjects. Ninety-five subjects with LBP (41 men, 54 women) and 43 subjects without LBP (17 men, 26 women) were examined by 5 therapists trained in the techniques used. Methods. A manual was developed by the first author that described the clinical examination procedures. The therapists were trained by the first author in the test procedures and definitions. The training included instruction through videotapes, practice, and a written examination. Each examination was conducted by a pair of therapists. Within a pair, a therapist was the primary examiner for half of the subjects and an observer was the primary examiner for half of the subjects. Examination findings were recorded independently, without discussion. Results. Percentage of agreement and generalized kappa coefficients were used to analyze the data. Kappa values were .75 for all 28 items related to the symptoms elicited and .40 for 72% of the 25 items related to alignment and movement. Conclusion and Discussion. The results suggest that experienced therapists who had trained together were able to agree on the results of examinations and obtain an acceptable level of reliability. Future work should focus on testing of reliability when more than one therapist performs the examination and when therapists not trained by the test developer to administer the examination perform the tests.

Key Words: Classification • Low back pain • Reliability • Spinal disorders

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